Medicare Benefits Schedule - Item 92060

Video attendance by a prescribed medical practitioner to prepare a GP chronic condition management plan for a patient

Fee: $125.30 Benefit: 100% = $125.30

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $375.90

• Previous - Item 92058
• Next - Item 92061

Publication date: 1 November 2025

SUMMARY

This note sets out the requirements for developing and reviewing GP chronic condition management plans. GP chronic condition management plans are used by GPs (see GN.4.13) and prescribed medical practitioners (see AN.7.1) to plan the management of patients with one or more chronic conditions.

GP chronic condition management plan items replaced GP Management Plans and Team Care Arrangements on 1 July 2025. For information on the transition arrangements for patients with an existing GP Management Plan and/or Team Care Arrangement see AN.15.5.

GP chronic condition management plans are not available to people in residential aged care. Residents of a residential aged care facility may be eligible for a multidisciplinary care plan (see AN.15.8).

USE OF THE ITEMS

GP chronic condition management plans are intended for patients that would benefit from a structured approach to managing their chronic condition(s). The MBS items allow GPs and prescribed medical practitioners to work with their patients to set the goals for the patient’s treatment/management of their condition, roles and responsibilities, and a structured plan for their care.

Items 392, 965, 92029 and 92060 are for the preparation of a GP chronic condition management plan. The Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations) defines preparing a GP chronic condition management plan as the process whereby the GP or prescribed medical practitioner:

"(a) prepares a written plan for the patient that describes

(i) the patient’s chronic condition and associated health care needs; and

(ii) health and lifestyle goals developed by the patient and medical practitioner using a shared decision making approach; and

(iii) actions to be taken by the patient; and

(iv) treatment and services the patient is likely to need; and

(v) if the patient would benefit from multidisciplinary care to manage the chronic condition, the treatments or services to which the practitioner will refer the patient (including the purposes of those treatments or services); and

(vi) arrangements to review the plan (including the proposed timeframe for review); and

(b) if the patient is to be referred to a member or members of a multidisciplinary team for management of the patient’s chronic condition:

(i) obtains the patient’s consent to sharing relevant information (including relevant parts of the plan) with the members of the multidisciplinary team; and

(ii) if the patient so consents—provides relevant parts of the plan to the members of the multidisciplinary team; and

(c) records the patient’s consent and agreement to the preparation of the plan; and

(d) offers a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(e) adds a copy of the plan to the patient’s medical records.”

Items 393, 967, 92030 and 92061 are for reviewing a patient’s GP chronic condition management plan. The Regulations define reviewing a plan as the process by which a GP or prescribed medical practitioner:

"(a) discusses and documents:

(i) the patient’s progress in relation to the goals mentioned in paragraph (a) of the definition of preparing a GP chronic condition management plan; and

(ii) whether any updates should be made to the GP chronic condition management plan; taking into account:

(iii) whether the goals remain appropriate and the degree of progress towards meeting the goals; and

(iv) information provided by members of the multidisciplinary team (if any) referred to in paragraph (b) of the definition of preparing a GP chronic condition management plan in relation to the members’ treatment of the patient and the extent to which the services provided by the members are supporting the patient to meet the patient’s goals; and

(b) updates the arrangements to review the plan (including the proposed timeframe for review); and

(c) makes any other updates to the plan required as a result of the discussions referred to in paragraph (a); and

(d) if the patient is to be referred to a member or members of a multidisciplinary team for management of the patient’s chronic condition

(i) obtains the patient’s consent to sharing relevant information (including relevant parts of the plan) with the members of the multidisciplinary team; and

(ii) if the patient so consents—provides relevant updated parts of the plan to the members of the multidisciplinary team; and

(e) records the patient’s consent and agreement to the updates; and

(f) offers a copy of the updated plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(g) adds a copy of the updated plan to the patient’s medical records."

Who are considered members of a multidisciplinary care team?

The Regulations define a member of the multidisciplinary team as a person who:

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

(b) provides a different kind of treatment or service to the patient than each other member of the multidisciplinary team; and

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

This can include both health care professionals who provide MBS-supported services, such as medical specialists, allied health providers or Aboriginal and Torres Strait Islander primary health care professionals, as well as providers who do not provide services through the MBS, such as disability support workers.

When should a GP chronic condition management plan be considered?

Patients are eligible for a GP chronic condition management 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.

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 GP chronic condition management plan.

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 service 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.”

Patients with a GP chronic condition management plan may be eligible for a range of MBS-supported allied health and Aboriginal and Torres Strait Islander health and wellbeing services (see AN.15.4) and services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner (see MN.12.4).

Does my patient need to be diagnosed with a specific disease or pathological entity to access GP chronic condition management plans?

No. Patients are eligible for a GP chronic condition management 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.

For example, if your patient has had chronic pain for more than 6 months, and the specific underlying cause of the pain has not been diagnosed, it may be appropriate to put in place a GP chronic condition management plan to set out management goals and agreed patient actions. It may also be appropriate to consider referring them to allied health services such as exercise physiology services or psychological services to support the management of their condition.

What are the collaboration requirements? Do the members of the multidisciplinary care team need to agree before I can bill the item?

No. The plan should set out the multidisciplinary services that the patient will be referred to. There is no requirement for a provider to agree to accept the referral prior to the plan/review being finalised. For detailed information on referrals to allied health and Aboriginal and Torres Strait Islander health and wellbeing services see AN.15.6.

How frequently can GP chronic condition management plans be provided?

The Regulations provide for a plan to be:

• prepared no more than once every 12 months, and that any new plan must be at least 3 months after the last review
  
  
• reviewed no more than once every 3 months

unless exceptional circumstances apply (see below).

My patient has a GP chronic condition management plan for their asthma, which was reviewed 1 month ago. They have just been diagnosed with type 1 diabetes. Can I review their plan (or develop a new plan) and refer them to a diabetes educator and other appropriate services as a priority?

Yes, the Regulations provide for GP chronic condition management plan 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 particulars of the exceptional circumstances should be documented in the patient’s record to substantiate the claim.

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.

My patient has had their plan for 12 months. Should I review the plan or prepare a new one?

This is a matter for clinical judgement. However, for most patients, unless there is a major change in their clinical condition (or other circumstances) that warrants a completely new plan it is likely that periodic reviews are appropriate. The review items allow the plan to be adjusted as required. While a new plan can be prepared every 12 months, this is not required.

Can anyone assist with preparing or reviewing the plan?

Yes, the Regulations allow for a practice nurse, Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker to assist with the preparation or review of the plan as appropriate. However, the GP chronic condition management plan is a plan between the GP/prescribed medical practitioner and their patient. It is a requirement that the GP/prescribed medical practitioner sees the patient as part of the service, and they are responsible for the service.

The items for preparing and reviewing a GP chronic condition management plan are complete medical services. Item 10997 (and its telehealth equivalents) cannot be used when a practice nurse or Aboriginal and Torres Strait Islander health practitioner assists with the preparation or review of a GP chronic condition management plan.

A practice nurse assisted with reviewing my patient’s plan. Can I claim item 10997 (or its telehealth equivalents)?

No, item 10997 cannot be co-claimed when a practice nurse assists with preparing or reviewing a GP chronic condition management plan. The items for preparing and reviewing a GP chronic condition management plan are complete medical services.

See MN.12.4 for further information on item 10997, including circumstances where co-claiming of 10997 and preparation or a review of a GP chronic condition management plan may be appropriate.

Is there a minimum amount of time I need to spend with the patient?

No. However, all MBS requirements must be met including that the GP or prescribed medical practitioner must attend the patient, have a discussion with them about the plan, and be satisfied that the patient understands and agrees with the plan (including actions they are to take), even if a practice nurse, Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker has assisted in preparing or reviewing the plan.

There will be several factors that determine how long this will take, including the complexity of their condition(s) whether this is the patient’s first plan, whether their condition is stable or has changed significantly, and whether their treatment goals remain the same.

Do GP chronic condition management plans expire?

No, GP chronic condition management plans do not expire. However, to promote continuous care for patients with a chronic condition, patients must have had their plan prepared or reviewed within the last 18 months to continue to access allied health and Aboriginal and Torres Strait Islander health and wellbeing services, and other services.

How many allied health and Aboriginal and Torres Strait Islander health and wellbeing services can patients access?

Patients with a GP chronic condition management plan may be eligible for the following MBS‑supported services per calendar year:

• up to 5 individual health services (10 for patients of Aboriginal or Torres Strait Islander descent). Individual health services include allied health and Aboriginal and Torres Strait Islander health and wellbeing services (see AN.15.4)
  
  
• up to 5 services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner (see MN.12.4)
  
  
• if the patient has type 2 diabetes, one assessment of their suitability for group allied health services and, if they are suitable, up to 8 group allied health sessions (see MN.9.1 and MN.9.2).

Do patients need a referral for allied health and Aboriginal and Torres Strait Islander health and wellbeing services?

Yes, a referral is required for MBS benefits to be payable. For detailed information on referrals to individual and group health services see AN.15.6.

It is November and I would like to put a GP chronic condition management plan in place for my patient. Will it need to be reviewed before they can access their allocation of services next year?

No, patient’s eligibility is reset on 1 January every year automatically. You are not required to review their plan to enable services or otherwise reset the count provided patients continue to meet the eligibility requirements for the service.

To be eligible for services the patient must have had their plan prepared or reviewed within the previous 18 months.

It is December. If I issue new referrals for allied health and Aboriginal and Torres Strait Islander health and wellbeing services to my patient now, will they have to be reissued next year before they can access services?

No. Allied health and Aboriginal and Torres Strait Islander health and wellbeing referrals remain valid until all services under the referral have been provided, or they expire (see AN.15.6).

The MBS only provides for 5 individual health services per year or up to 10 for patients of Aboriginal or Torres Strait Islander descent. My patient would benefit from more allied health or Aboriginal and Torres Strait Islander health and wellbeing services. How do I determine what services I should refer them to?

This is a matter that should be discussed as part of the development of the plan. While the number of MBS-supported allied health and Aboriginal and Torres Strait Islander health and wellbeing services is limited at 5 per calendar year, 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.

For patients who don’t have access to non-MBS services, services should be prioritised, in discussion with the patient. Factors to consider when prioritising services include clinical need and the patient’s management goals for their condition.

My patient is willing and able to fund additional allied health and Aboriginal and Torres Strait Islander health and wellbeing services this year. Which services will the MBS support?

MBS benefits are patient benefits. Ultimately it is up to the patient to decide how they use their MBS benefits, noting that the number of services available under the MBS is limited. When considering which services they should use their MBS benefits for patients may wish to consider factors such as the total cost of the service (and therefore any likely out of pocket costs) and the availability of any other support (e.g. private health insurance cover).

My patient only used 3 allied health services this year. Do the unused services carry over into next year?

No, unused services do not rollover. Patients are eligible for up to 5 services per calendar year regardless of any prior claiming patterns.

My patient needs physiotherapy services but I am not sure how many services they need. Can I still refer them?

Yes. You are not required to specify the number of services in the referral.

My patient has a GP chronic condition management plan. I know that allied health services are to be provided consistent with the plan. Is it ever appropriate to refer my patient to an allied health service under their plan for an acute condition?

It may be appropriate if the acute condition is likely to exacerbate the patient’s chronic condition or the chronic condition led to the acute condition. For example:

• Mrs Jones has chronic obstructive pulmonary disease and diabetes. She has a GP chronic condition management plan which includes goals relating to maximising exercise tolerance and keeping her feet healthy. She has existing allied health referrals to an exercise physiologist and podiatrist. However, she contracts acute pneumonia and in conjunction with her GP it is determined she would benefit from chest physiotherapy to assist with her recovery. A referral is provided to a physiotherapist consistent with her goal to maximise exercise tolerance.
  
  
• Jim, 42, has type 2 diabetes. It’s generally been well controlled, and he has a GP chronic condition management plan. His goals include maintaining a tight HbA1c as he is relatively young, and to assist with this he has been referred to an exercise physiologist and a diabetes educator. However, whilst exercising he has an accident, and a nail ends up embedded in the plantar surface of his foot. The GP removes it under local anaesthetic but is concerned that the wound may be slow to heal due to previous wound healing issues. Therefore, the following day Jim's GP chronic condition management plan is reviewed and goals updated to incorporate maintenance of foot health and prevention of ulceration. He is also referred to a podiatrist for assistance with wound care, pressure off-loading at the wound site and appropriate footwear for optimal healing.

Can I include social prescribing in my patient’s GP chronic condition management plan?

The GP chronic condition management plan is intended to set out the agreed actions and services that would be beneficial to the patient in managing their chronic condition. There is nothing that precludes the inclusion of activities or services that are not covered by MBS funding arrangements, such as social prescribing. However, it is important that patients are aware when services that are not supported by the MBS are included in their plan.

Can I use a GP chronic condition management plan to support a patient with managing obesity?

It may be appropriate if obesity requires management alongside the patient’s chronic condition. For example:

• A patient, during attendance with their GP, is assessed as needing a GP chronic condition management plan to manage all their risk factors that contributed to their recent heart attack. The GP and the patient have agreed to establishing a GP chronic condition management plan and it is being completed in this appointment.

As part of the GP chronic condition management plan, the GP identifies that the patient’s hypertension and obesity puts them at a higher risk of another cardiovascular event. The GP and patient recognise weight reduction would assist in reducing the cardiovascular risk. The GP and patient agree that addressing these risk factors should be included in their plan.

The patient gives consent for a referral to a psychologist to address their underlying relationship with food, an exercise physiologist to assist with increased physical activity and a dietician to support nutritional changes. The patient identifies that a family member already attends ParkRun and commits to attending with them. This is documented in the plan.

• A patient, during previous attendances with their GP, is assessed as having multiple cardiovascular risk factors including hypertension, and pre-clinical obesity. They are a current smoker with daily alcohol use. They have a family history of diabetes but are not diabetic themselves.

The GP and the patient both recognise that things need to change to prevent developing diabetes, a heart attack or stroke. There is a recognised evidence-based role for a multi-disciplinary care team in this situation. The GP and patient have agreed to establishing a GP chronic condition management plan to enable multi-disciplinary support and the plan is being completed in this appointment.

The patient gives consent for a referral to an exercise physiologist to assist with increased physical activity and a dietician to support nutritional changes. The patient identifies the Quitline is available to support their smoking cessation attempt alongside nicotine replacement therapy. They also commit to attending the local heart health walking group. This is documented in the plan.

During the consultation it becomes clear that anxiety has prevented the patient engaging with services in the past. It also becomes clear that alcohol use is a form of self-managing the anxiety. The patient requests referral to the local mental health services to address their anxiety and for support with broader lifestyle changes including a reduction in alcohol. As the patient has a clear indication for at least moderate intensity mental health support requirements, a GP mental health treatment plan is also completed to support this referral.

Do I need to upload the plan to My Health Record?

GPs and prescribed medical practitioners are strongly encouraged to upload GP chronic condition management plans to the patient’s My Health Record. However, as upload is not a requirement of the item it is not essential that the plan be uploaded prior to submitting an MBS claim.

ELIGIBLE PATIENTS

To be eligible for a GP chronic condition management plan patients must:

• have at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal, and

• either:
  
  
  • Be living in the community (i.e. they are not a care recipient in a residential aged care facility), or
    
    
  • For face-to-face items only, be an in-patient of a private hospital. Patients that are public in-patients of a hospital are not eligible for these services.

Patients registered under MyMedicare must access GP chronic condition management services through the practice where they are registered. Patients that are not registered through MyMedicare can access the services through their usual medical practitioner. The Regulations define "usual medical practitioner” as:

“a general practitioner or prescribed medical practitioner:

(a) who has provided the majority of services to the person in the past 12 months; or

(b) who is likely to provide the majority of services to the person in the following 12 months; or

(c) located at a medical practice that:

(i) has provided the majority of services to the person in the past 12 months; or

(ii) is likely to provide the majority of services to the person in the next 12 months.”

Telehealth items – 92029, 92030, 92060, 92061

These items are not subject to the established clinical relationship rule (see AN.1.1) that applies to most general practice telehealth items. Instead, these items are subject to the same MyMedicare and usual medical practitioner requirements of the GP chronic condition management plan face to face items.

Consistent with the general rules applying to telehealth services, items 92029, 92030, 92060, 92061 cannot be used when the patient is an admitted patient of a hospital.

ELIGIBLE PRACTITIONERS

GP chronic condition management plan items are available for different medical 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)

Name of Item	GP item number	Prescribed medical practitioner item number
Prepare a GP chronic condition management plan – face to face	965	392
Prepare a GP chronic condition management plan - telehealth	92029	92060
Review a GP chronic condition management plan – face to face	967	393
Review a GP chronic condition management plan – telehealth	92030	92061

Noting that, under certain circumstances GP chronic condition management plan services can be provided to a patient in a hospital, the Regulations state that the 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.

CO-CLAIMING RESTRICTIONS

Planning and review items for GP chronic condition management plans cannot be co-claimed by the same practitioner on the same day for the same patient as general attendance items (note the date of service should be recorded as the date the attendance occurred):

• items 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 123, 124, 151 and 165
  
  
• items 179, 181, 185, 187, 189, 191, 203, 206, 301, 303, 733, 737, 741, 745, 761, 763, 766, 769, 2197 and 2198
  
  
• items 585, 588, 591, 594, 599 and 600
  
  
• items 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5071 and 5076
  
  
• items 5200, 5203, 5207, 5208, 5209, 5220, 5223, 5227, 5228 and 5261
  
  
• items 91790, 91792, 91794, 91800, 91801, 91802, 91803, 91804, 91805, 91806, 91807, 91808, 91890, 91891, 91892, 91893, 91900, 91903, 91906, 91910, 91913, 91916, 91920, 91923, 91926, 92210 and 92211.

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. GP chronic condition management plan items are set out in two regulatory instruments:

• Health Insurance (General Medical Services Table) Regulations 2021 – items 392, 393, 965, 967
  
  
• Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 – items 92029, 92030, 92060, 92061

Related Items: 392 393 965 967 92029 92030 92060 92061

Publication date: 1 November 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 for the care of patients with a chronic condition and, where relevant, refer patients to MBS-supported allied health and Aboriginal and Torres Strait Islander health and wellbeing services (see AN.0.47 for GP 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, Aboriginal and Torres Strait Islander health and wellbeing, 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 and Aboriginal and Torres Strait Islander health and wellbeing services

Patients with a GP chronic condition management plan or care recipients of an aged care facility who 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 and Aboriginal and Torres Strait Islander health and wellbeing services per calendar year. The services provided must be consistent with the patient’s plan and a referral is required.

For more information on the types of allied health and Aboriginal and Torres Strait Islander health and wellbeing services available see AN.15.4.

For detailed information about the allied health and Aboriginal and Torres Strait Islander health and wellbeing items see MN.3.1.

For information on referral requirements for allied health and other primary health care services 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 November 2025

SUMMARY

This note sets out the range of allied health and Aboriginal and Torres Strait Islander health and wellbeing services (health services), and the professionals who can provide those services, for patients with a GP chronic condition management plan (see AN.0.47) and residents of an aged care facility (home) who have a multidisciplinary care plan (see AN.15.7 and AN.15.8). 

Patients who had a GP management plan and a team care arrangement in place prior to 1 July 2025 can also access these services under those plans until 1 July 2027 (see AN.15.5 for further information on transition arrangements).

HEALTH SERVICES AVAILABLE

Individual allied health and Aboriginal and Torres Strait Islander health and wellbeing services

Patients with a GP chronic condition management plan or residents of an aged care facility with a multidisciplinary care plan can access up to 5 MBS-supported individual health services in a calendar year (10 for patients of Aboriginal or Torres Strait Islander descent). The requirements for MBS 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).

The Determination sets out the following services that can be provided to individual patients under the MBS chronic condition management framework:

 

Service Type	Eligible Providers
Aboriginal and Torres Strait Islander health and wellbeing service	Aboriginal and Torres Strait Islander health worker Aboriginal and Torres Strait Islander health practitioner
Audiology health service	Audiologist
Chiropractic health service	Chiropractor
Diabetes education health service	Credentialled diabetes educator
Dietetics health service	Accredited practising dietitian
Exercise physiology health service	Accredited exercise physiologist
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
Occupational therapy health service	Occupational therapist
Osteopathy health service	Osteopath
Physiotherapy health service	Physiotherapist
Podiatry health service	Podiatrist
Psychology health service	Psychologist (general registration)
Speech pathology health service	Certified practising speech pathologist

Group allied health services – patients with Type 2 diabetes 

Patients with type 2 diabetes that have a GP chronic condition management plan or are a resident of an aged care facility with a multidisciplinary care plan can have 1 assessment of their suitability for group allied health services per calendar year, and if suitable up to 8 allied health group sessions. The allied health services available are: 

Service Type	Eligible Providers
Diabetes education health service	Credentialled diabetes educator
Exercise physiology health service	Accredited exercise physiologist
Dietetics health service	Accredited practising Dietitian

Are all members of an allied health or Aboriginal and Torres Strait Islander primary health care profession eligible to provide services through the MBS?

This depends on the profession. Some professional groups require specific qualifications, accreditation or credentialing to provide services under the MBS.

How do I check an allied health or Aboriginal and Torres Strait Islander primary health care professional is eligible to provide MBS-supported services to my patient?

To provide services under the MBS individual health professionals must have a Medicare Provider Number. Allied health and Aboriginal and Torres Strait Islander primary health care providers listed on the registers identified below are eligible to provide MBS-supported services and may have Medicare Provider Numbers.

The following health professions can be found through the Ahpra register at Australian Health Practitioner Regulation Agency - Home (ahpra.gov.au). The register can be searched by health practitioner type, state/territory, suburb and postcode. All practitioners in the following professions that appear on the Ahpra register are eligible to provide MBS-supported services if they have a Medicare Provider Number:

• Aboriginal and Torres Strait Islander health practitioners
  
  
• Chiropractors 
  
  
• Occupational therapists 
  
  
• Osteopaths 
  
  
• Physiotherapists 
  
  
• Podiatrists
   
• Psychologists 

Other professions are registered through their member organisations, which have registers on their websites. It is important to note that some health professionals may choose not to appear on the public register. 

• Aboriginal and Torres Strait Islander health workers providing these services must have a Certificate III or above in Aboriginal and/or Torres Strait Islander Primary Health Care from the Health (HLT) training package
  
  
• Accredited Exercise physiologists are accredited by Exercise & Sports Science Australia. See Find an Accredited Exercise Professional
  
  
• Accredited Practising Dietitians are accredited by Dietitians Australia. See Find a Dietitian (dietitiansaustralia.org.au)
  
  
• Audiologists are either:
  
  
  • Full members of Audiology Australia and certified as an Audiology Australia Accredited Audiologist. See Find an Audiologist - Audiology Australia, or
     
  • Full/Ordinary members or a Fellow of the Australian College of Audiology, with Hearing Rehabilitation Specialist and Diagnostic Rehabilitation Specialist Competencies. See Member Directory – The Australian College of Audiology (acaud.com.au)
    
    
• Certified Practising Speech pathologists are certified by Speech Pathology Australia. See Find a Speech Pathologist (speechpathologyaustralia.org.au)
  
  
• Credentialled diabetes educators are registered with the Australian Diabetes Educators Association. See ADEA | Find a CDE - ADEA
   
• Credentialled mental health nurses are certified by the Australian College of Mental Health Nurses. See Find a Credentialed Mental Health Nurse (acmhn.org)
  
  
• Social workers are Members of the Australian Association of Social Workers (AASW) and accredited by AASW as meeting the criteria set out in the “AASW Accredited Mental Health Social Worker Application Criteria” (July 2022) or as an accredited social worker. See Find a Social Worker (aasw.asn.au). 

ELIGIBLE PATIENTS 

Patients with a GP chronic condition management plan and residents of an aged care facility with a multidisciplinary care plan can access up to 5 MBS-supported (10 for patients of Aboriginal and Torres Strait Islander descent) individual allied health services and Aboriginal and Torres Strait Islander health and wellbeing services per calendar year (see MN.3.1) for further details). 

Patients with type 2 diabetes and either a GP chronic condition management plan or a multidisciplinary care plan (for residents of an aged care facility) may also be eligible for group services (see MN.9.1 and MN.9.2 for further details).

Patients who had a GP management plan and/or team care arrangement in place prior to 1 July 2025 can continue to access individual and group services (as applicable) under those plans until 1 July 2027 under transition arrangements (see AN.15.5).

In all cases, the patient’s general practitioner or prescribed medical practitioner must refer the patient to the service and the service must be consistent with the patient’s GP chronic condition management plan or multidisciplinary care plan (or team care arrangement) (see AN.15.6).

RECORD KEEPING AND REPORTING REQUIREMENTS

The Determination requires the allied health professional or Aboriginal and Torres Strait Islander primary health care professional to provide a written report to the referring medical practitioner in relation to a service if that service is:

• the only service under the referral
  
  
• the first or last service under the referral, or
  
  
• any other service if the service involves matters that the referring medical practitioner would reasonably expect to be informed of.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation. Allied health and Aboriginal and Torres Strait Islander health and wellbeing items are set out in the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.

Related Items: 232 392 393 731 965 967 92027 92029 92030 92058 92060 92061

Publication date: 1 November 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 (i.e. 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 and Aboriginal and Torres Strait Islander health and wellbeing 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 and Aboriginal and Torres Strait Islander health and wellbeing 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?

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 and Aboriginal and Torres Strait Islander health and wellbeing 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 these services in the new year?

No. If the 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 these services in the new year.

Patients will need to have transitioned to a GP chronic condition management plan to continue to access allied health and Aboriginal and Torres Strait Islander health and wellbeing 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 and Aboriginal and Torres Strait Islander health and wellbeing 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 services under that plan until 1 July 2027. 

TRANSITION ARRANGEMENTS – REFERRALS

From 1 July 2025 all new referrals for allied health and Aboriginal and Torres Strait Islander health and wellbeing 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.

• Health Insurance (General Medical Services Table) Regulations 2021
• Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021
• Health Insurance (Section 3C – Allied Health and Other Primary Health Care Services) Determination 2024

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 November 2025

SUMMARY

This note sets out the requirements for referring patients to MBS-supported allied health and other primary health care services. 

For Subgroup 1 of Group M3, Group M8, Group M9, Subgroup 1 of Group M10 or Group M11 (and telehealth equivalents) these requirements apply to referrals written on or after 1 July 2025.

For Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18, these requirements apply to referrals written on or after 1 November 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 and Aboriginal and Torres Strait Islander health and wellbeing services and, where applicable, their telehealth (video and phone) equivalents:

• M3 (subgroup 1) – individual allied health and Aboriginal and Torres Strait Islander health and wellbeing 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 and Aboriginal and Torres Strait Islander health and wellbeing services for Aboriginal and Torres Strait Islander people (referred under the chronic conditions management arrangements or following an Aboriginal and Torres Strait Islander health assessment (see MN.11.1))

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

• M6 and M18 (subgroup 1 and 6) – Provision of psychological therapy services (see MN.6.2 and MN.7.5)

• M7 (subgroup 1) and M18 (subgroup 2, 3, 4, 7, 8, 9 – Provision of focussed psychological strategies (see MN.7.4 and MN.7.5)

As of 1 November 2025, these requirements do not apply to other MBS-supported allied health services, including eating disorder allied health services, or diagnostic audiology services.

REFERRAL REQUIREMENTS

The requirements for referrals are set out in the Health Insurance (Section 3C – Allied Health and Other Primary Health Care Services) Determination 2024 (the Determination) and mirror those for referrals to medical specialists and other MBS-supported services. The 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 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 health professional.

For psychological therapy services and focussed psychological strategies services under the Better Access initiative (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18), additional referral requirements are required for a patient to access mental health treatment services. Further information on referral requirements for Better Access treatment services can be found at MN.6.3.

How long is a referral valid?

Referrals for patients with chronic conditions (M3, M10 and M11 and telehealth equivalents) 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.

Referrals for a focussed psychological strategy service or psychological therapy service (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18) are valid until the end of the number of sessions in the course of treatment the referring practitioner recommends up to the maximum session limit for each course of treatment.

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

No for referrals for patients with the management of chronic conditions. 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 and Aboriginal and Torres Strait Islander health and wellbeing 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 and Aboriginal and Torres Strait Islander primary health care professionals are eligible to provide MBS services see AN.15.4.

Yes, for psychological therapy services and focussed psychological strategies services under the Better Access initiative (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18 services), the referral should include the number of services the patient is being referred to in the course of treatment. Further information on referral requirements for Better Access treatment services can be found at MN.6.3.

Does the referral need to include the name of the health professional who is to provide the referred service?

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.

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 Determination, to be signed and transmitted electronically.

Are there any differences in the requirements for referrals to allied health and Aboriginal and Torres Strait Islander primary health care professionals and medical specialists?

Yes, there are some differences in the requirements:

• For allied health and Aboriginal and Torres Strait Islander health and wellbeing services for patients with a chronic condition (M3, M10 and M11 and telehealth equivalents), the default length of a 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
  
  
• For psychological therapy services and focussed psychological strategies services under the Better Access initiative (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18 services), additional referral requirements are required for a patient to access mental health treatment services. Further information on referral requirements for Better Access treatment services can be found at MN.6.3.

• Referrals to allied health and Aboriginal and Torres Strait Islander primary health care professionals cannot be indefinite referrals. This is in recognition of the requirement of many allied health and Aboriginal and Torres Strait Islander health and wellbeing 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 and Aboriginal and Torres Strait Islander health and wellbeing services are rendered unlike for specialist or consultant physician 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 or Aboriginal and Torres Strait Islander primary health care 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 and Aboriginal and Torres Strait Islander health and wellbeing services are set out in the Health Insurance (Section 3C – Allied Health and other Primary Health Care 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

Eating Disorders Treatment and Management Plans Explanatory Notes (items 90250-90257, 92146-92153, 90260-90261, and 92162-92163)

This note provides information on Eating Disorders Treatment and Management Plan (EDTMP) items and should be read in conjunction with the Eating Disorders General Explanatory Notes

Eating Disorder Treatment and Management Plan (EDTMP) items overview

The EDTMP items define services for which Medicare benefits are payable where practitioners undertake the development of a treatment and management plan for patients with a diagnosis of anorexia nervosa, bulimia nervosa, binge-eating disorder and other specified feeding or eating disorder diagnoses who meet the eligibility criteria.

The EDTMP items trigger eligibility for items which provide delivery of eating disorders psychological treatment services (up to a total of 40 psychological services in a 12-month period) and dietetic services (up to a total of 20 in a 12-month period).

For any particular patient, an eating disorder treatment and management plan expires at the end of a 12-month period following provision of that service. Eating Disorders treatment services are not available to the patient if the EDTMP has expired.

Preparation of the EDTMP must include:

• discussing the patient’s medical and psychological health status with the patient and if appropriate their family/carer;
• identifying and discussing referral and treatment options with the patient and their family/carer where appropriate, including identification of appropriate support services;
• agreeing goals with the patient and their family/carer where appropriate - what should be achieved by the treatment - and any actions the patient will take;
• planning for the provision of appropriate patient and family/carer education;
• a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
• making arrangements for required referrals, treatment, appropriate support services, review and follow-up;
• documenting the results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date in the patient's plan;
• discussing and organising the appropriate reviews throughout the patient’s treatment; and
• discussing the need for the patient to be reviewed to access a higher intensity of eating disorder psychological treatment services in a 12-month period.
   

Preparing a Medical practitioner in general practice Eating Disorder Treatment & Management Plan (items 90250-90257 and 92146-92153)

Who can provide the service

Items in subgroup 1 of Group A36 can be rendered by a medical practitioner in general practice. This includes:

• Medical practitioners who can render a general practitioner service in Group A1 of the MBS (see note AN.0.9 for the types of medical practitioners). These medical practitioners can render a ‘general practitioner’ service for items in subgroup 1 of Group A36.
• Medical practitioners who are not general practitioners, specialists or consultant physicians. These medical practitioners can render a ‘medical practitioner’ service for items in subgroup 1 of Group A36.

What is Involved - Assess and Plan

It is expected that the practitioner developing the EDTMP has either performed or reviewed the assessments and examinations required to make a judgement that the patient meets the eligibility criteria for accessing these items.

Items 90250-90257 and their equivalent telehealth items (92146-92153) provide services for development of the eating disorder treatment and management plan. Where a comprehensive physical examination is performed, either on the same occasion or different occasion, the appropriate item could be claimed provided the time taken performing the assessment is not included in the time for producing the plan, or time producing the EDTMP is not included in the time for assessment.

It is emphasised that it is best practice for the practitioner to perform a comprehensive physical assessment to facilitate ongoing patient management and monitoring of medical and nutritional status.

Patient Assessment

An assessment of a patient with an eating disorders includes:

• taking relevant history (biological, psychological, social, including family/carer support);
• eating disorder diagnostic assessment;
• medical review including physical examination and relevant tests;
• conducting an assessment of mental state, including identification of comorbid psychiatric conditions;
• an assessment of eating disorder behaviours;
• an assessment of associated risk and any medical co-morbidity, including as assessment on how this impacts on the patients functioning and activities of daily living;
• an assessment of family and/or carer support; and
• administering an outcome measurement tool, except where it is considered clinically inappropriate.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.

It should be noted that the patient's EDTMP should be treated as a living document for updating as required. In particular, the plan can be updated at any time to incorporate relevant information, such as feedback or advice from other health professionals on the diagnosis or treatment of the patient.

Preparing a Consultant Psychiatrist Eating Disorder Treatment & Management Plan (90260-90261 and 92162-92163)

Who can provide the service

Items in subgroup 2 of Group 36 can be rendered by consultant psychiatrists (items 90260 and 90261, and their respective telehealth items 92162 and 92163).

What is Involved – Assess and Plan

Items 90260-90261 and their equivalent telehealth items (92162 and 92163) provide access to specialist assessment and treatment planning. It is expected that items will be a single attendance. However, there may be particular circumstances where a patient has been referred by a GP for an assessment and management plan, but it is not possible for the consultant to determine in the initial consultation whether the patient is suitable for management under such a plan. In these cases, where clinically appropriate, other appropriate consultation items may be used. In those circumstances where the consultant undertakes a consultation (in accordance with the item requirements) prior to the consultation for providing the referring practitioner with an assessment and management plan. It is expected that such occurrences would be unusual for the purpose of diagnosis under item 90260.

Patient Assessment

In order to facilitate ongoing patient focussed management, an assessment of the patient must include:

• administering an outcome measurement tool during the assessment and review stages of treatment, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner;
• conducting a mental state examination;
• taking relevant history (biological, psychological, behavioural, nutritional, social);
• assessing associated risk and any co-morbidity; and
• making a psychiatric diagnosis for conditions meeting the eligibility criteria.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.
   

Where a consultant psychiatrist provides an EDTMP service, the service must also include:

• administering an outcome measurement tool, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner. Practitioners using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training; and
• conducting a mental state examination.

Consultation with the patient’s managing practitioner

A written copy of the EDTMP should be provided to the patient’s managing practitioner, within a maximum of two weeks of the assessment. It should be noted that two weeks is the outer limit and in more serious cases more prompt provision of the plan and verbal communication with the managing practitioner may be appropriate.

Additional Claiming Information (general conditions and limitations)

Patients seeking benefits for items 90250-90257 and 90260-90261 will not be eligible if the patient has had a claim within the last 12-months.

Items 90250-90257 cannot be claimed with Items 2713, 279, 735, 758, 235 and 244. Items 90261 cannot be claimed with Items 110, 116, 119, 132, 133.

Consultant psychiatrist and paediatrician EDTMP items 90260-90261 do not apply if the patient does not have a referral within the period of validity.

Before proceeding with the EDTMP the medical practitioner must ensure that:

(a) the steps involved in providing the service are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and

(b) the patient's agreement to proceed is recorded.

The medical practitioner must offer the patient a copy of the EDTMP and add the document to the patient's records. This should include, subject to the patient's agreement, offering a copy to their carer, where appropriate. The medical practitioner may, with the permission of the patient, provide a copy of the EDTMP, or relevant parts of the plan, to other providers involved in the patient's treatment.

The medical practitioner EDTMP cover the service of developing an EDTMP. A separate consultation item can be performed with the EDTMP if the patient is treated for an unrelated condition to their eating disorder. Where a separate consultation is performed, it should be annotated separately on the patient’s account that a separate consultation was clinically required/indicated.

All consultations conducted as part of the EDTMP must be rendered by the medical practitioner and include a personal attendance with the patient. A specialist mental health nurse, other allied health practitioner, Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker with appropriate mental health qualifications and training may provide general assistance to the medical practitioner in provision of this care.

Additional Claiming Information (interaction with Chronic Condition Management and Better Access)

It is preferable that wherever possible patients have only one plan for primary care management of their disorder. As a general principle the creation of multiple plans should be avoided, unless the patient clearly requires an additional plan for the management of a separate medical condition.

The Chronic Condition Management (CCM) items (items 231, 232, 392, 393, 729, 731, 965, 967, 92026, 92027, 92029, 92030, 92057, 92058, 92060 and 92061) continue to be available for patients with chronic medical conditions, including patients with complex needs. 

Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a CCM Plan, and to manage their eating disorder through an EDTMP. In this case, both items can be used. Where the patient receives dietetic services under the CCM arrangements (item 10954), these services will count towards the patients maximum of 20 dietetic services in a 12-month period. 

Where a patient has other psychiatric comorbidities, these conditions should be managed under the EDTMP. Once a patient has a claim for an EDTMP, the patient should not be able to have a claim for the development or review of a Mental Health Treatment plan by a GP (items 2700, 2701, 2715 and 2717) or medical practitioner in general practice (items 272, 276, 281 and 282) within 12-months of their EDTMP unless there are exceptional circumstances.

For the purpose of the 40 eating disorder psychological treatment count; eating disorder psychological treatment service includes a service provided under the following items: 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 2721, 2723, 2725, 2727, 283, 285, 286, 287 and items in Groups M6, M7 and M16 (excluding item 82350). 

Related Items: 110 116 119 132 133 231 232 235 244 272 276 281 282 283 285 286 287 392 393 729 731 735 758 965 967 2700 2701 2715 2717 2721 2723 2725 2727 82350 90250 90251 90252 90253 90254 90255 90256 90257 90260 90261 90271 90272 90273 90274 90275 90276 90277 90278 92026 92027 92029 92030 92057 92058 92060 92061 92146 92147 92148 92149 92150 92151 92152 92153 92162 92163 92182 92184 92186 92188 92194 92196 92198 92200