Medicare Benefits Schedule - Item 92026

Contribution by a general practitioner by video, to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 235 to 240 or 735 to 758 of the general medical services table apply)

NOTE: It is a legislative requirement that this service must be performed by the patient’s usual medical practitioner (please see Note AN.1.1 for the definition of ‘patient’s usual medical practitioner’ as some exemptions do apply)

Fee: $82.10 Benefit: 100% = $82.10

(See para AN.15.3, AN.15.7 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $246.30

• Previous - Item 92011
• Next - Item 92027

Publication date: 1 July 2025

Summary

This note provides an overview of MBS items to support the management of patients with chronic conditions in general practice by general practitioners (see GN.4.13) and prescribed medical practitioners (see AN.7.1). For detailed information on the individual items, including item requirements and patient eligibility, see item-specific notes listed below. 

MBS and management of patients with chronic conditions

There are a range of MBS items for clinically relevant services provided in general practice for patients with chronic conditions. These include: 

• time-tiered attendance items (see AN.0.9), which can be used when a more specific MBS item does not apply

• health assessment items for early detection and prevention of chronic conditions in specific patient cohorts (see AN.0.36, AN.0.43, AN.14.2 and AN.14.3)
  
  
• items to support general practitioners and prescribed medical practitioners to develop and review plans the care of patients with a chronic condition and, where relevant, refer patients to MBS-supported allied health services (see AN.0.47 for chronic condition management plans and AN.15.7 and AN.15.8 for multidisciplinary care plans)
  
  
• medication management reviews to support quality use of medicines and minimise the risk of medication misadventure (see AN.0.52 and AN.7.18)
  
  
• case conferencing items to support multidisciplinary team care (see AN.0.49).

Patients with a mental health condition or eating disorder may be eligible for treatment through the Better Access mental health items (see AN.0.56) or eating disorder items (see AN.36.2).

It is important to note that:

• some of these items have specific eligibility criteria that are detailed in the item-specific explanatory notes, and
  
  
• all MBS services must be clinically relevant, meaning they are generally accepted in the medical profession as necessary for the appropriate treatment of the patient

General practitioners and prescribed medical practitioners in primary care can also refer patients to specialists where appropriate as part of the management of their chronic condition.

GP chronic condition management plans and multidisciplinary care plans 

GP chronic condition management plans and multidisciplinary care plan items allow GPs/prescribed medical practitioners to develop and periodically review structured plans for patients with a chronic condition. 

Patient Eligibility 

These items are available to patients that have at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal. There is no list of eligible conditions. It is up to the GP or prescribed medical practitioner’s clinical judgment to determine whether an individual patient with a chronic condition would benefit from a structured plan for the management of their condition. 

In considering the need for a structured plan, GPs and prescribed medical practitioners need to ensure the service is clinically relevant, which is a requirement of the Health Insurance Act 1973. The Act defines a clinically relevant services as “a service rendered by a medical or dental practitioner or an optometrist that is generally accepted in the medical, dental or optometric profession (as the case may be) as being necessary for the appropriate treatment of the patient to whom it is rendered.”

GP chronic condition management plans

A GP chronic condition management plan is a plan that is developed collaboratively between the general practitioner/prescribed medical practitioner and the patient for the management of the patient’s chronic condition(s). Patients registered with a practice through MyMedicare must access these services through the practice at which they are registered. Patients that are not registered can access these services from their usual medical practitioner See AN.0.47 for detailed information on GP chronic condition management plans. 

Multidisciplinary care plans

Multidisciplinary care plans allow for the general practitioner/prescribed medical practitioner to contribute to a plan which may be coordinated by another person. MBS items 232, 731, 92027 and 92058 are available for patients living in a residential aged care facility; MBS items 231, 729, 92026 and 92057 are available for patients not in residential aged care.

Patients living in residential aged care who have a multidisciplinary care plan have the same access to allied health and other services as patients with a GP chronic condition management plan.

See AN.15.7 and AN.15.8 for detailed information.

Services available under GP chronic condition management plans and multidisciplinary care plans

A range of MBS-supported multidisciplinary services may be available to patients with a GP chronic condition management plan or a multidisciplinary care plan, where those services are consistent with the plan.

Patients who had a GP management plan and/or team care arrangement prior to 1 July 2025 can continue to access the services outlined below until 30 June 2027 under those plans. For more information about the transition arrangements for GP chronic condition management plans see AN.15.5.

Services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner

Patients with a GP chronic condition management plan or a multidisciplinary care plan can access up to 5 services per calendar year provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner to support management of their chronic condition (MBS items 93201, 93203 and 10997). The services provided must be consistent with the patient’s plan. See MN.12.4 for detailed information about the use of these items.

For follow up services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for a person of Aboriginal or Torres Strait Islander descent who has received a health assessment see MN.12.3.

Individual allied health services

Patients with a GP chronic condition management plan or care recipient of an aged care facility that have a multidisciplinary care plan can access up to 5 (10 for a person of Aboriginal or Torres Strait Islander descent) individual MBS supported allied health services per calendar year. The allied services provided must be consistent with the patient’s plan and a referral is required.

For more information on the types of allied health services available see AN.15.4.

For detailed information about the allied health items see MN.3.1.

For information on referral requirements for allied health see AN.15.6.

Group allied health service for patients with type 2 diabetes

Patients with type 2 diabetes who have a GP chronic condition management plan, or are a care recipient of an aged care facility and have a multidisciplinary care plan, can be assessed for their suitability for group diabetes education, exercise physiology or dietetics services. Patients are eligible for one assessment per calendar year and, if they are found suitable, up to 8 group services per calendar year.

For detailed information on suitability assessments and group allied health services see MN.9.1 and MN.9.2.

Related Items: 231 232 245 249 392 393 729 731 900 903 965 967 10950 10951 10952 10953 10954 10955 10956 10957 10958 10959 10960 10962 10964 10966 10968 10970 10997 81100 81105 81110 81115 81120 81125 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 92026 92027 92029 92030 92057 92058 92060 92061 93201 93203

Publication date: 1 July 2025

SUMMARY

Multidisciplinary care plans are part of the MBS framework for managing patients with chronic conditions (see AN.15.3 for an overview of MBS items that support the management of chronic conditions).

The multidisciplinary care plan items covered in this note are for patients who are not care recipients in a residential aged care facility. The items can be used to contribute to the preparation or review a multidisciplinary care plan prepared by another provider. For multidisciplinary care plans for patients who are care recipients in a residential aged care facility see AN.15.8.

Multidisciplinary care plans allow GPs (see GN.4.13) and prescribed medical practitioners (see AN.7.1) to contribute to or review the patient’s plan that is developed by other providers.

Patients with a multidisciplinary care plan and living in the community are not eligible for MBS-supported allied health and other services.

USE OF THE ITEMS

Multidisciplinary care plans are intended to support multidisciplinary care for patients with a chronic condition.

The Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations) define a multidisciplinary care plan as a written plan that:

“(a) is prepared for the patient by:

(i) a general practitioner (for items 729 [and 92026]) or a prescribed medical practitioner (for items 231 [and 92057], in consultation with 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and one of whom may be another medical practitioner; or

 (ii) a collaborating provider (other than a general practitioner or a prescribed medical practitioner, as the case may be), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and

(b) describes, at least, treatment and services to be provided to the patient by the collaborating providers.”

For the purpose of the multidisciplinary care plans, the Regulations specify that a collaborating provider is “a person, including a medical practitioner, who:

(a) provides treatment or a service to a patient; and

(b) is not an unpaid carer of the patient.”

Multidisciplinary care plan items 231, 729, 92026 and 92057 allow the GP or prescribed medical practitioner to contribute to the plan, or a review a plan prepared by another provider.

The Regulations state that contributing to a multidisciplinary care plan includes the following:

(a) preparing part of a multidisciplinary care plan and adding a copy of that part of the plan to the patient’s medical records;

(b) preparing amendments to part of a multidisciplinary care plan and adding a copy of the amendments to the patient’s medical records;

(c) giving advice to a person who prepares part of a multidisciplinary care plan and recording in writing, on the patient’s medical records, any advice provided to the person;

(d) giving advice to a person who reviews part of a multidisciplinary care plan and recording in writing, on the patient’s medical records, any advice provided to the person.”

What is a chronic condition?

For the purpose of multidisciplinary care plans, the Regulations define a chronic condition to be a medical condition that has been (or is likely to be) present for at least 6 months, or is terminal.

There is no list of eligible conditions. It is up to the GP or prescribed medical practitioner’s clinical judgment to determine whether an individual patient with a chronic condition requires multidisciplinary care to manage the condition.

The items are for contributing to a plan or review. Who prepares the multidisciplinary care plan?

The multidisciplinary care plan is prepared by another provider (i.e. not the GP or prescribed medical practitioner using MBS items 231, 729, 92026 or 92057).

Is there a maximum number of collaborating providers for a multidisciplinary care plan?

No, there is no maximum number of collaborating providers. However, a multidisciplinary care plan requires a minimum of three collaborating providers (including the GP or prescribed medical practitioner) supplying different types of services to the patient.

At least one of the collaborating providers must be a medical practitioner. A maximum of two medical practitioners can be counted in the minimum requirement of three collaborating providers. This means that if there are more than two medical practitioners collaborating on the plan (e.g. a GP, an orthopaedic surgeon and a neurologist) there must also be at least one collaborating provider that is not a medical practitioner.

Do all collaborating providers have to be health care professionals?

No. Any person providing a treatment or service to the patient is a collaborating provider unless they are an unpaid carer of the patient. However, MBS benefits are only available for the GP or prescribed medical practitioner’s contribution to the multidisciplinary care plan.

Do all collaborating providers have to provide services under the MBS?

No. At least one of the collaborating providers must be the GP or prescribed medical practitioner that bills the multidisciplinary care item. That a GP or prescribed medical practitioner has contributed to or reviewed a multidisciplinary care plan under these items does not give access to a patient who is not a care recipient of a residential aged care facility access to MBS subsidised allied health services. Other collaborating providers may provide MBS services (e.g. a specialist), but could also include providers that do not provide services under the MBS e.g. a social worker.

Do all collaborating providers have to meet the MBS item requirements?

The GP or prescribed medical practitioner who bills the multidisciplinary care plan item must meet the requirements of the item.

Other collaborating providers are not able to bill these MBS items and are therefore not required to comply with the item requirements.

How often can the patient have a multidisciplinary care plan?

Multidisciplinary care plan items 231, 729, 92026 and 92057 can be provided once in a 3 month period. However, it cannot be provided if the patient has:

• In the preceding 3 months had a multidisciplinary care plan for a resident of an aged care facility (see AN.15.8) or a review of their GP chronic condition management plan, or
  
  
• In the preceding 12 months had a service:
  
  
  • by the general practitioner who performs the service to which item 729 would, but for this item, apply; and
    
    
  • for which a payment has been made for a GP chronic condition management plan.

My patient’s clinical condition has changed unexpectedly and their plan should be updated. Can an update ever be done sooner than 3 months? 

Yes, the Regulations provide for multidisciplinary care services to be provided to a patient sooner if exceptional circumstances apply. The Regulations define exceptional circumstances as “there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient”. The reasons for exceptional circumstances should be documented in the patient’s notes. 

Services Australia needs to be advised that exceptional circumstances apply to pay a benefit sooner than is generally allowable. To facilitate this the patient's invoice, Medicare voucher or the digital claim should indicate that exceptional circumstances apply, no further explanation is required to support payment. 

Can patients with a multidisciplinary care plan access allied health services?

Patients with a multidisciplinary care plan who are not care recipients in a residential aged care facility are not eligible to access MBS supported allied health services. This will apply to all patients at the time a GP or prescribed medical practitioner provides the services described in this note.

ELIGIBLE PATIENTS

Patients are eligible for a multidisciplinary care plan if they:

• have at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal, and
  
  
• the patient must not be a care recipient in a residential aged care facility, and
  
  
• requires ongoing care from at least three collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner. One of the collaborating providers must also be a provider other than a medical practitioner.

To be eligible for a multidisciplinary care plan provided by telehealth (video) the patient must have an established clinical relationship with the medical practitioner providing the service (see AN.1.1).

ELIGIBLE PRACTITIONERS

Multidisciplinary care plan items are available for different practitioner types:

• general practitioner items can be claimed by GPs only (see GN.4.13).
  
  
• prescribed medical practitioner items can be claimed by prescribed medical practitioners only (see AN.7.1).

	GP item number	Prescribed medical practitioner item number
Face to Face	729	231
Video	92026	92057

Noting that, under certain circumstances a multidisciplinary care plan can be provided to a patient in a hospital, the Regulations state that multidisciplinary care items can only be used by medical practitioners that:

• are not employed by the proprietor of a hospital that is not a private hospital, or
• is employed by the proprietor of a hospital that is not a private hospital and provides the service otherwise that in the course of employment by that proprietor.

RECORD KEEPING AND REPORTING REQUIREMENTS

As outlined above, the Regulations require that contributions to a patient’s multidisciplinary care plan, including any advice, be added to the patient’s medical records.

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. Multidisciplinary care plan items are set out in two regulatory instruments:

• Health Insurance (General Medical Services Table) Regulations 2021 – 231, 729
  
  
• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 - 92026, 92057

Related Items: 231 729 92026 92057