Medicare Benefits Schedule - Item 93000

Video attendance by an eligible allied health practitioner or Aboriginal and Torres Strait Islander primary health care professional if:

(a) the patient has a chronic condition and complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan and Team Care Arrangements prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

(b) the service is recommended in the patient’s plan or arrangements as part of the management of the patient’s chronic condition and complex care needs; and

(c) the person is referred to the eligible health practitioner by the medical practitioner; and

(d) the service is provided to the person individually; and

(e) the service is of at least 20 minutes duration; and

(f) after the service, the eligible health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):

(i) if the service is the only service under the referral—in relation to that service; or

(ii) if the service is the first or last service under the referral—in relation to that service; or

(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;

to a maximum of 5 services (including any services to which this item, item 93013 or any item in Subgroup 1 of Group M3 of the Allied Health and other Primary Health Care Services Determination applies) in a calendar year

Fee: $72.65 Benefit: 85% = $61.80

(See para MN.3.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $217.95

• Previous - Item 92768
• Next - Item 93013

Publication date: 1 November 2025

SUMMARY

This note sets out the requirements for the individual health services for patients with a chronic condition. These services are part of the MBS framework for patient with a chronic condition (see AN.15.3).

Individual health services are available to patients with a GP chronic condition management plan (see AN.15.4) or residents of a residential aged care facility that have a multidisciplinary care plan (see AN.15.8). Until 1 July 2027 these services are also available to patients that have both a GP management plan and team care arrangement (see AN.15.5).

These health services must be consistent with the patient’s plan and a GP or prescribed medical practitioner must refer the patient for the service (see AN.15.6).

Patients can access up to 5 MBS-supported individual health services each calendar year (January to December).

On 1 July 2025 GP management plans and team care arrangements were replaced with new GP chronic condition management plan (see AN.15.3) items. These new items provide a streamlined and simplified approach to multidisciplinary care for patients with a chronic condition. Transition arrangements are in place for existing patients with a GP management plan and team care arrangement (see AN.15.5). New requirements for referrals to health services written on or after 1 July 2025 also came into effect (see AN.15.6).

References in this note to the term “Management Plan” refer to any of a GP chronic condition management plan, GP management plan and team care arrangement, or a multidisciplinary care plan for a resident of a residential aged care facility.

USE OF THE ITEMS

The requirements of the items for individual health services are set out in the Health Insurance (Section 3C General Medical Services - Allied Health and Other Primary Health Care Services) Determination 2024 (the Determination) and the Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 (Telehealth Determination).

Is there a minimum length for the service?

Yes, the service must last at least 20 minutes.

The service I provide must be consistent with the Management Plan. How do I know what is in the Management Plan?

Subject to the patient’s consent, you will be given the relevant parts of the Management Plan. In addition, you will receive a referral from the treating medical practitioner (see AN.15.6).

How long does a referral last?

For referrals written on or after 1 July 2025, referrals will be valid for the length of time specified in the referral, or if no timeframe is specified, 18 months from the date of the first service provided; under the referral. The referral may also specify the number of services to be provided, however, this is not required.

For referrals written prior to 1 July 2025 the referral must specify the number of services. The referral remains valid until all services are provided.

For further information on referrals see (AN.15.6).

Should the referral be for a named specific health professional?

No. The patient can take the referral to any eligible health professional of the same profession/type specified in the referral of their choosing. For example, a referral to physiotherapy services can be taken to any physiotherapist, but it cannot be used to access chiropractic services.

For further information on referrals see (AN.15.6).

How many individual health services can be claimed for a patient?

Patients can access up to 5 MBS-supported individual health services per calendar year (January to December). The 5 services can be made up of one type of service (e.g. 5 physiotherapy services) or a combination of different types of services (e.g. 1 dietetic and 4 podiatry services).

Aboriginal and Torres Strait Islander patients can claim additional health services under MBS Group M11 (see MN.11.1).

My patient’s Management Plan identifies more than 5 individual health services. Which ones should be billed to the MBS?

The MBS benefit is the patient’s benefit. Ultimately it is up to the patient to decide how they use their MBS benefits. Some patients can access additional services using private health insurance extras cover, non-MBS services (e.g. through state or PHN programs), or self-funding.

Providers should obtain informed financial consent from patients for the service. Therefore, it is important that you clarify with the patient whether they would like to use their MBS-benefit for the service.

Can the patient claim for a service under Medicare and private health insurance?

No. Patients cannot claim MBS benefits and payments under their private health insurance fund for the same service.

How do I know how many individual health services a patient has already used this year?

You can check a patient’s eligibility for a service through the MBS Items Online Checker Check MBS Item numbers - Health professionals - Services Australia and view their care plan history through HPOS Patient details in HPOS - Health professionals - Services Australia. Patients can also check their care plan service history through their Medicare Online Account.

My patient has elected not to claim MBS benefits for the service. Do I still need to meet all of the requirements of the MBS item?

No. However, it is still good practice to provide regular updates to the patient’s GP about their progress.

Am I required to provide information back to the referring medical practitioner?

Yes. The Determination requires that the health professional provide a written report to the referring medical practitioner:

"i. if the service is the only service under the referral—in relation to that service; or

ii. if the service is the first or last service under the referral—in relation to that service; or

iii. if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters.”

What should I include in a report back to the referring medical practitioner?

Generally, written reports should include:

• any investigations, tests, and/or assessments carried out on the patient;
  
  
• any treatment provided; and
  
  
• advice regarding future management of the patient's condition or problem.

ELIGIBLE PATIENTS

Patients are eligible for an individual health service if:

• they have a:
  
  
  • GP chronic condition management plan that has been put in place or reviewed in the last 18 months, or
    
    
  • Until 1 November 2026, a GP management plan and team care arrangement that were in place before 1 November 2024, or
    
    
  • Are a resident of a residential aged care facility and have a multidisciplinary care plan
    
    
• the service provided is consistent with the Management Plan, and
  
  
• they have a referral from their GP or prescribed medical practitioner for the service.

ELIGIBLE PRACTITIONERS

Health professionals are eligible to provide these services if they meet the qualification and credentialling requirements set out in the Determination (see AN.15.4). To provide MBS services eligible health professionals must have a Medicare Provider Number.

There are MBS item numbers for each health service for face-to-face services. However, all service types are provided using the same items for video (93000), or phone (93013) services. The treating health professional must satisfy themselves that a service is appropriate to be delivered by video or telephone. The limit of 5 services per year for the patient applies across all modes of service.

Service	Eligible health professionals (must meet any relevant credentialling requirements)	MBS item number (face to face service)
Aboriginal and Torres Strait Islander health and wellbeing service	Aboriginal and Torres Strait Islander health worker Aboriginal and Torres Strait Islander health practitioner	10950
Audiology health service	Audiologist	10952
Chiropractic health service	Chiropractor	10964
Diabetes education health service	Credentialled diabetes educator	10951
Dietetics health service	Accredited practising dietitian	10954
Exercise physiology health service	Accredited exercise physiologist	10953
Mental health service	Aboriginal and Torres Strait Islander health worker Aboriginal and Torres Strait Islander health practitioner Credentialled mental health nurse Occupational therapist Psychologist (general registration) Social worker	10956
Occupational therapy health service	Occupational therapist	10958
Osteopathy health service	Osteopath	10966
Physiotherapy health service	Physiotherapist	10960
Podiatry health service	Podiatrist	10962
Psychology health service	Psychologist (general registration)	10968
Speech pathology health service	Certified practising speech pathologist	10970

RECORD KEEPING AND REPORTING REQUIREMENTS

The Determination requires that the health professional provide a written report to the referring medical practitioner:

"i. if the service is the only service under the referral—in relation to that service; or

ii. if the service is the first or last service under the referral—in relation to that service; or

iii. if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters.”

It is a requirement that, where an item specifies the creation of a document (however described), the document must be retained for a period of 2 years. This includes records made by the health provider for reporting back to the referring medical practitioner.

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.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item can be found on the Federal Register of Legislation at www.legislation.gov.au. Individual allied health and Aboriginal and Torres Strait Islander health and wellbeing items are set out in two regulatory instruments:

• Health Insurance (Section 3C General Medical Services – Allied Health and Other Primary Health Care Services) Determination 2024 – items 10950, 10952, 10964, 10951, 10954, 10953, 10956, 10958, 10966, 10960, 10962, 10968 and 10970
  
  
• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 - items 93000 and 93013

Related Items: 10950 10951 10952 10953 10954 10956 10958 10960 10962 10964 10966 10968 10970 93000 93013