Medicare Benefits Schedule - Item 81100

Diabetes education health service provided to a patient by an eligible diabetes educator for assessing the patient’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the patient for the group services if:

(a) the patient has type 2 diabetes; and

(b) the patient is 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 prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

(c) the patient is referred to an eligible diabetes educator by the medical practitioner; and

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

(e) the service is of at least 45 minutes duration; and

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

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth Attendance Determination)

Fee: $93.25 Benefit: 85% = $79.30

(See para AN.15.3, AN.15.5, AN.15.6, MN.9.1, MN.9.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $279.75

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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

On 1 July 2025, GP Management Plans (MBS items 229, 721, 92024 and 92055) and Team Care Arrangements (MBS items 230, 723, 92025 and 92056) were replaced with the new GP chronic condition management plan framework (MBS items 392, 965, 92029 and 92060). MBS items for reviewing a GP Management Plan or Team Care Arrangement (MBS items 233, 732, 92028 and 92059) also ceased. This note sets out the transition arrangements for patients that have a GP Management Plan and/or Team Care Arrangement that was put in place prior to 1 July 2025.

These transition arrangements are intended to allow for a smooth transition to the new framework, minimising the risk of service disruption for new and existing patients.

Patients with a multidisciplinary care plan (see AN.15.7 and AN.15.8) are only affected by the changes to referral requirements.

TRANSITION ARRANGEMENTS – PLANS

Patients with an existing GP Management Plan and/or Team Care Arrangements (ie the plans were put in place prior to 1 July 2025) can continue to access services under those plans for two years.

Patients that had a GP Management Plan and/or Team Care Arrangement in place prior to 1 July 2025 can continue to access allied health and other services that are consistent with those plans until 1 July 2027. From 1 July 2027 a GP chronic condition plan or multidisciplinary care plan will be required for ongoing access to services. 

The items for reviewing GP Management Plans and Team Care Arrangements (MBS items 233, 732, 92028 and 92059) are also ceasing. GP Management Plans and Team Care Arrangements should not be reviewed under the new GP chronic condition management review items (393, 967, 92030 and 92061). If a patient requires a review of their GP Manage Plan or Team Care Arrangement, it is an appropriate time to transition them to the new GP chronic disease management plan.

The services that can continue to be accessed by eligible patients with a GP Management Plan and/or Team Care Arrangement until 1 July 2027 are:

• MBS item 10997 (see MN.12.4) – patients with a GP Management Plan and/or Team Care Arrangement
  
  
• Group M3 individual allied health services for chronic condition management (see MN.3.1)– patients with a GP Management Plan and Team Care Arrangement
  
  
• Group M9 allied health group services (see MN.9.1 and MN.9.2) – patients with a GP Management Plan and type 2 diabetes
  
  
• Group M11 allied health services for Aboriginal and Torres Strait Islander people (see MN.11.1) – when accessed through a GP Management Plan and Team Care Arrangement
  
  
• Telehealth equivalent items (as applicable) for the above categories

My patient has a GP Management Plan and Team Care Arrangement. When do I need to move them to a GP chronic condition management plan (GPCCMP)?

They will need to have a GP chronic condition management plan in place by 1 July 2027 if they need to continue to access the services listed above on or after that date. 

The number of allied health services (5 individual services) available is counted from 1 January each year. Will my patient need a GP chronic condition management plan before they can access allied health services in the new year?

No. If the allied health services required are still consistent with the patient’s team care arrangement they do not need to transition to a GP chronic condition management plan to continue to access allied health services in the new year.

Patients will need to have transitioned to a GPCCMP to continue to access allied health services after 1 July 2027.

My patient’s condition has changed and as a result their team care arrangement needs to be reviewed to change the types of allied health services they receive. Item 732 has been removed. What should I do?

This is an appropriate time to put in place a new GP chronic condition management plan for the patient. 

Can I review my patient’s GP Management Plan and Team Care Arrangement using the new items to review a GP chronic condition management plan?

No. The new items are for reviewing a GP chronic condition management plan only. Instead of reviewing the old plans a new GP chronic condition management plan should be prepared. 

What happens if my patient doesn’t have a GP chronic condition management plan in place on 1 July 2027?

Your patient won’t be able to access MBS-supported allied health services (or item 10997 services) from 1 July 2027 until a GP chronic condition management plan is in place.

I am an allied health professional. I agreed to be part of my patient’s team care arrangement before 1 July 2025. Can I continue to provide services consistent with the team care arrangement? 

Yes. The patient can continue to access services that are consistent with their Team Care Arrangement until 1 July 2027. From 1 July 2027 they will need to have a GP chronic condition management plan to continue to access services. In all cases a valid referral is also required.

I am a diabetes educator. I assessed my patient as suitable for group diabetes education services for patients with type 2 diabetes before 1 July 2025 but they hadn’t attended any group sessions by that date. Are they still eligible to access the group services under their GP Management Plan?

Yes, if the service is consistent with their GP Management Plan patients can continue to access service under that plan until 1 July 2027. 

TRANSITION ARRANGEMENTS – REFERRALS

From 1 July 2025 all new referrals for allied health services for patients with a chronic condition should be in line with the new referral requirements (see AN.15.6). Referrals that were issued prior to this date can continue to be used until they expire.

I gave my patient a referral for physiotherapy under their GP Management Plan and Team Care Arrangement in February 2025. They still have two services remaining on that referral. Do I need to write another referral so they can continue to access the services?

No. Referrals issued before 1 July 2025 continue to be valid until all services covered by the referral have been provided.

My patient hasn’t transitioned to the new GP chronic condition management plan yet, but they need a new referral for their mental health service. Should I use the old form or issue a referral letter?

The new referral should be a letter. All referrals issued from 1 July 2025 should meet the new requirements (see AN.15.6), regardless of which plan type they are made under.

I am a speech therapist. I have a new patient and their referral was issued on the old form prior to 1 July 2025. Can I accept it?

Yes. Referrals issued prior to 1 July 2025 remain valid until all services covered by the referral have been delivered.

I am a podiatrist. My patient in a residential aged care facility has a multidisciplinary care plan that includes podiatry. What form should their new referral take?

If the referral is issued on or after 1 July 2025 the referral should be a letter and should meet the new referral requirements (see AN.15.6).

I am an occupational therapist. My patient’s referral provided for 3 occupational therapy sessions in 2025. They had used two services before 1 July 2025. Is a new referral required before I can provide the third service?

No. Referrals issued before 1 July 2025 continue to be valid until all services covered by the referral have been provided.

RECORD KEEPING AND REPORTING REQUIREMENTS

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(s) can be found on the Federal Register of Legislation at www.legislation.gov.au.  

Related Items: 392 393 965 967 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 92029 92030 92060 92061

Publication date: 1 July 2025

SUMMARY

This note sets out the requirements for referring patients to MBS-supported allied health services. These requirements apply to referrals written on or after 1 July 2025.

APPLICATION OF REFERRAL REQUIREMENTS

The requirements outlined in this note apply to referrals written on or after 1 July 2025 for the following groups of allied health services and, where applicable, their telehealth (video and phone) equivalents:

• M3 (subgroup 1) – individual allied health services for patients with a chronic condition (referred under the chronic conditions management arrangements (see MN.3.1)

• M8 – pregnancy support counselling allied health services (see MN.8.1)

• M9 – allied health group services for patients with type 2 diabetes (referred under the chronic conditions management arrangements (see MN.9.1 and MN.9.2)

• M10 (subgroup 1) – complex neurodevelopmental disorders and eligible disabilities allied health services (see MN.10.1)

• M11 – allied health services for Aboriginal and Torres Strait Islander people (referred under the chronic conditions management arrangements or following an Aboriginal and Torres Strait Islander health assessments (see MN.11.1))

As of 1 July 2025, these requirements do not apply to other MBS-supported allied health services, including Better Access psychological therapy services, focussed psychological strategies (allied mental health) services, eating disorder allied health services, or diagnostic audiology services.

REFERRAL REQUIREMENTS

The requirements for referrals to allied health professionals are set out in the Health Insurance (Section 3C – Allied Health Services) Determination 2024 (Allied Health Determination) and mirror those for referrals to medical specialists and other MBS-supported services. The Allied Health Determination requires the following “prescribed particulars” to be included in the referral:

• The name of the referring practitioner
  
  
• The address of the practice, or the practitioner’s provider number at that practice, of the referring practitioner
  
  
• The date on which the referring practitioner made the referral

The Allied Health Determination also requires that referrals:

• Be in writing

• Signed by the referring practitioner (noting this can be an electronic signature)

• Dated, and

• Explain the reasons for referring the patient, including any information about the patient’s condition that the referring practitioner considers necessary to give the allied health professional.

How long is a referral valid?

Referrals for allied health services for patients with chronic conditions (M3, M10 and M11) are valid for:

• The period of time stated in the referral, or
  
  
• If no timeframe is stated, 18 months.

These timeframes are measured from the date the first service is provided under the referral, not the date of the referral.

Does the referral need to specify the number of services to be provided?

No. From 1 July 2025 referrals do not need to specify the number of services to be provided. However, nothing prevents the referring medical practitioner from specifying the number of services to be provided under the referral if they choose to do so.

This recognises that some patients accessing allied health services may wish to access a higher number of services than are supported by the MBS. As the MBS benefits are the patient’s benefit, ultimately it is up to them to determine which services they would like to use their MBS benefit for.

For information on which allied health professionals are eligible to provide MBS services see AN.15.4.

Does the referral need to include the allied health professional’s name?

No. The patient can take the referral to any eligible allied 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.

I am an allied health professional. Can I accept a referral with another allied health professional’s name on it?

Yes. The patient can choose to take their referral to any eligible allied health professional of the same profession/type specified in the referral.

I am an allied health professional. Am I required to accept a referral?

No. Acceptance of a referral is at the discretion of the individual practitioner, subject to anti-discrimination legislation. However, if the referral is not accepted after being presented to the practice it is important to inform the referring practitioner that the request cannot be accommodated.

I am an occupational therapist and I will be away when my patient is due for their next appointment. Can another practitioner in my practice provide the service or does the patient have to delay their appointment until I return?

Yes, your patient can see another practitioner in the practice under the same referral, provided the other practitioner is an eligible allied health professional of the same profession/type specified in the referral. In this circumstance the allied health professional that provides the service would need to report to the referring medical practitioner, if required.

The referral has to be signed and in writing. Does this mean it needs to be in hard copy?

No. The Electronic Transactions Act 1999 allows for documents required under Commonwealth Law, such as referrals under the Allied Health Determination, to be signed and transmitted electronically.

Are there any differences in the requirements for referrals to allied health providers and medical specialists?

Yes, there are some differences in the requirements:

• For allied health services for patients with a chronic condition (M3, M10 and M11), the default length of an allied health referral is 18 months from the date of the first service provided under the referral. This aligns with the requirement for patients with a GP chronic condition management plan to have had their plan put in place or reviewed within the last 18 months to continue to access services (see AN.0.47). For specialist services the default referral length is 12 months from the date of the first service provided under the referral
  
  
• Referrals to allied health professionals cannot be indefinite referrals. This is in recognition of the requirement of many allied health items to provide a report back to the referring medical practitioner after the last service on the referral
  
  
• There is no emergency exception to the requirement for a written referral to exist before Allied health services are rendered unlike for specialist or consultant physical referred attendances.

What happens if the referral gets lost or destroyed?

A service can be provided on the basis of a lost, stolen or destroyed referral. However, this is not expected to be a common occurrence. In these circumstances the phrase ‘lost referral’ replaces the prescribed particulars.

Where the intended allied health provider is known, referring practitioners are encouraged to send referrals electronically whenever possible to minimise the risk of lost referrals.

RECORD KEEPING AND REPORTING REQUIREMENTS

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. Referral requirements for allied health services are set out in the Health Insurance (Section 3C – Allied Health Services) Determination 2024.

Related Items: 232 392 393 731 965 967 10950 10951 10952 10953 10954 10955 10956 10957 10958 10959 10960 10962 10964 10966 10968 10970 81000 81005 81010 81100 81105 81110 81115 81120 81125 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 82000 82005 82010 82015 82020 82025 82030 82035 92027 92029 92030 92058 92060 92061

Publication date: 1 July 2025

SUMMARY

This note sets out the requirements for assessing a patient with type 2 diabetes suitability for group diabetes education, dietetics or exercise physiology allied health services to support their diabetes management. These services are part of the MBS framework for patients with a chronic condition (see AN.15.3).

Assessments of suitability for group allied health services are available to patients with type 2 diabetes with a GP chronic condition management plan (see AN.15.3) 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 a GP management plan (see AN.15.3).

The service must be consistent with the patient’s plan and a medical practitioner must refer the patient for the service (see AN.15.6).

Patients can access 1 group allied health assessment service each calendar year.

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

USE OF THE ITEMS

These services are to assess a patient’s suitability for group diabetes education, dietetics and/or exercise physiology services to support the management of their type 2 diabetes. The assessment includes:

• Taking a comprehensive patient history
• Identifying an appropriate group services program based on the patient's needs, and
  
  
• Preparing the person for group services. 

The requirements of the items for assessments of a patient’s suitability for group allied health services are set out in the Health Insurance (Section 3C General Medical Services - Allied Health Services) Determination 2024 (Allied Health 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 assessment?

Yes, the Allied Health and Telehealth Determinations specify that the assessment must last at least 45 minutes.

This is an assessment for group services. Is it provided to a group or the individual?

The assessment must be provided to an individual. While it is an assessment of the patient’s suitability for group services the assessment must not be provided in a group setting.

I am a diabetes educator. If I find the patient suitable, can they only access group diabetes education services?

No. You are assessing their suitability for group services relating to the management of type 2 diabetes. If they are assessed as suitable, they will be able to access any combination of diabetes education, dietetics and exercise physiology group services.

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

Yes. You must provide a written report back to the referring GP or prescribed medical practitioner.

How many group allied health assessment services can be claimed for a patient?

Patients can access one suitability assessment for group allied health services per calendar year.

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.

For referrals written where the assessment was undertaken prior to 1 July 2025 the referral with the completed assessment 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 specific allied health professional?

No. The patient can take the referral to any eligible allied health professional of the same profession/type specified in the referral of their choosing. For example, a referral to credentialled diabetes educator for an assessment can be taken to any credentialled diabetes educator but it cannot be taken to an accredited exercise physiologist.

For further information on referrals see AN.15.6.

ELIGIBLE PATIENTS

To be eligible for this MBS service a patient must:

• Have type 2 diabetes
• Be being managed by a GP or prescribed medical practitioner under:
  
  • a GP chronic condition management plan that has been put in place of reviewed in the last 18 months, or
    
    
  • Until 1 July 2027, a GP management plan that was in place before 1 July 2025, or
    
    
  • Are a resident of a residential aged care facility and have a multidisciplinary care plan, and
    
    
• Be referred for the service by their GP or prescribed medical practitioner (see AN.15.6).

ELIGIBLE PRACTITIONERS

These services can be provided by credentialled diabetes educators, accredited practising Dieticians and accredited exercise physiologists. These allied health practitioners must have a Medicare Provider Number to provide these services. For further information on the qualification requirements for allied health professionals to provide MBS services see AN.15.4.

RECORD KEEPING AND REPORTING REQUIREMENTS

The Allied Health Determination requires that the allied health provider that performs the assessment provides a written report back to the referring medical practitioner.

It is a requirement that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for a period of 2 years. This includes records made by the allied 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(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. These items are set out in the following regulatory instruments:

• Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2014 – items 8110, 81110, 81190
• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 – items 93284, 93286

Related Items: 81100 81110 81120 93284 93286

Publication date: 1 July 2025

SUMMARY

This note sets out the requirements for group diabetes education, dietetics and exercise physiology allied health services for patients with type 2 diabetes to support the management of their condition. These services are part of the MBS framework for patients with a chronic condition (see AN.15.3).

Patients are eligible for group allied health services if they have type 2 diabetes and have been assessed as suitable for group therapy services by a credentialled diabetes educator, accredited practising dietitian or an accredited exercise physiologist (see MN.9.1). Assessments are available to patients with a GP chronic condition management plan (see AN.15.3) and residents of a residential aged care facility with a multidisciplinary care plan (see AN.15.8). Until 1 July 2027 they are also available to patients with a GP management plan that was put in place prior to 1 July 2025 (see AN.15.5).

Patients can access up to 8 group allied health services per calendar year.

On 1 July 2025 GP management plans and team care arrangements were replaced with new GP chronic condition management plan items (see AN.15.3). New requirements for referrals to allied health services written on or after 1 July 2025 also came into effect (see AN.15.6).

USE OF THE ITEMS

Group allied health services are available for diabetes education, dietetics and exercise physiology for the management of type 2 diabetes.

The requirements of the items for group allied health services are set out in the Health Insurance (Section 3C General Medical Services - Allied Health Services) Determination 2024 (Allied Health 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 assessment?

Yes, the Allied Health and Telehealth Determinations specify that the group session must last at least 60 minutes.

How many group allied health therapy services can be claimed for a patient?

Patients can access 8 group allied health  therapy services per calendar year. This is in addition to any individual allied health services the patient may be eligible for.

It is February. Does my patient need another assessment to continue group therapy services this year?

No. Once a patient has been assessed as suitable for group therapy services, they do not require another assessment to continue. However, in some circumstances their medical practitioner may request another assessment, for example, if there has been a significant change in their condition.

How many patients need to be in the group?

In order to use the MBS items there must be a minimum of two and maximum of 12 patients in attendance. The diabetes educator, dietician or exercise physiologist providing the service must keep an attendance record for the group.

My patient was assessed as suitable for group therapy by a diabetes educator. Can they only access group diabetes education services?

No. They have been assessed as suitable for group services relating to the management of type 2 diabetes. They can access any combination of diabetes education, dietetics and exercise physiology group services.

Can one session cover more than one of diabetes education, dietetics and exercise physiology?

A collaborative approach, where diabetes educators, exercise physiologists and dietitians work together to develop group service programs in their local area, is encouraged. However, for more than one MBS group service to be delivered on a day the requirements of both items must be met. 

For example, a credentialled diabetes educator delivers a 60-minute group diabetes education service to the patient and the patient then attends a 60-minute dietitians group therapy session for an accredited practising dietician later in the day. These two services cannot be delivered in the same 60-minute period.

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

Yes, if the service is the last group service in the program the diabetes educator, dietitian or exercise physiologist who delivered the service must prepare or contribute to a written report back to the referring medical practitioner to meet the requirements of the item.

ELIGIBLE PATIENTS

Patients are eligible for group therapy services if they have type 2 diabetes and have been assessed as suitable for group therapy services under items 81100, 81110, 81120 or 93284 (see MN.9.1).

Patients being managed by the GP or prescribed medical practitioner through a GP chronic condition management plan (see AN.15.3) need to have had their plan put in place or reviewed within the last 18 months to be eligible for services.

Patients with a multidisciplinary care plan must be a resident of an aged care facility to be eligible for these services.

Until 1 July 2027, patients who have a GP management plan that was put in place before 1 July 2025 can continue to access these services under that plan.

ELIGIBLE PRACTITIONERS

These services can be provided by credentialled diabetes educators, accredited practising dieticians and accredited exercise physiologists. These allied health practitioners must have a Medicare provider number to provide these services. For further information on the qualification requirements for allied health professionals to provide MBS services see (AN.15.4).

RECORD KEEPING AND REPORTING REQUIREMENTS

If the service is the last group service in the program the diabetes educator, dietitian or exercise physiologist who delivered the service must prepare or contribute to a written report back to the referring medical practitioner to meet the requirements of the item. 

It is a requirement that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for a period of 2 years. This includes the report/s back to the referring GP or prescribed medical practitioner that the allied health professional is required to write or contribute to under these items.

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. These items are set out in:

• Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 – items 81105, 81115, 81125
• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 – item 93285

Related Items: 81100 81110 81120 93284 93285 93286