Medicare Benefits Schedule - Note MN.12.4

Publication date: 1 November 2025

SUMMARY

This note outlines the requirement for items 93201 (video), 93203 (telephone), and 10997 (face to face) for the provision of services for the management of a patient’s chronic condition. The service is provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner and must be consistent with the patient’s GP chronic condition management plan (see AN.0.47), multidisciplinary care plan (see AN.15.7), or the former GP management plan and team care arrangement items (see AN.15.5).

A patient is eligible for up to 5 services per calendar year.

USE OF THE ITEMS

These items are intended for ongoing care, monitoring and support, as well as routine treatment consistent with the patient’s GP chronic condition management plan (see AN.0.47), GP management plan, team care arrangement (see AN.15.5), or multidisciplinary care plan (see AN.15.7) between more structured reviews by a GP or prescribed medical practitioner. The services are provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner.

What types of services can be provided?

Any services provided to the patient using these items must be consistent with their GP chronic condition management plan or multidisciplinary care plan. Examples of the types of services that can be provided include but are not limited to:

• Providing immunisations consistent with the plan
  
  
• monitoring a patient’s progress between reviews and recording the results
  
  
• dressing wounds
  
  
• providing advice to the patient on the self-management of their condition

We have a nurse practitioner at the practice. Can they provide the services under items 93201, 93203 or 10997?

Yes. Nurse practitioners are registered nurses with an endorsement as a nurse practitioner. Therefore, provided they are working in general practice or a health service with a relevant section 19(2) exemption to the Health Insurance Act 1973 they meet the definition of a practice nurse for the purposes of this item.

Nurse practitioners may also provide services using the nurse practitioner attendance items (see MN.14.12). If a nurse practitioner provides a service to a patient on behalf of a medical practitioner and an attendance service on the same day the services must be independent services and clinically necessary. Both items cannot be claimed for the same service/time.

A practice nurse is assisting in preparing or reviewing my patient’s plan. Can I use items 93201, 93203 or10997 for their time?

No. The items for preparing and reviewing GP chronic condition management plans (see AN.0.47) and multidisciplinary care plans (see AN.15.7 and AN.15.8) are complete medical services and provide the full MBS benefit for the services. You cannot co-claim a second item for the provision of these services.

Is it ever appropriate to co-claim a planning or review item and items 93201, 93203 or 10997?

Yes. Co-claiming may be appropriate where the service provided by the practice nurse or Aboriginal and Torres Strait Islander health practitioner is separate from, but consistent with, the patient’s plan development or review. The following are examples of scenarios where co-claiming would be appropriate:

Review and wound treatment (e.g., diabetic wounds)

A patient with a chronic medical condition and an existing GP chronic condition management plan attends a consultation in which the GP and patient review the patient’s plan and fully meet the requirements of item 967.

The patient and GP discuss a wound the patient has developed, which is caused by their chronic medical condition. They include treatment of the wound and teaching the patient about wound care in the patient’s GP chronic condition management plan.

The practice nurse is available to dress the wound that day. The practice nurse, for and on behalf of the GP, dresses the wound and provides advice to the patient on caring for the wound. The practice nurse has provided a separate, clinically relevant service, as outlined in the patient’s plan.

It is therefore appropriate to claim both the item 967 and 10997 on the same day provided all the requirements of each item have been completed.

Plan/review and need for immunisation identified

A patient, during attendance with their GP, is assessed as having a chronic medical condition. The GP and the patient have agreed to establishing a GP chronic condition management plan and the plan is being completed in this appointment.

As part of the plan, the GP identifies that the patient’s chronic medical condition puts them at a higher risk of a disease for which there are vaccines available, but that the patient’s vaccinations are not up to date. The GP and patient agree that keeping the patient’s vaccinations up to date should be included in their GP chronic condition management plan.

The practice nurse is available to see the patient that same day. The patient gives consent for the vaccine to be administered and the practice nurse, for and on behalf of the GP, checks that the patient is eligible for the vaccination and administers the vaccine. The practice nurse has provided a separate, clinically relevant service, as outlined in the patient’s GP chronic condition management plan.

It is therefore appropriate to claim both items 965 and 10997 on the same day provided all the requirements of each item have been completed.

Plan/review and administration of parenteral medication (e.g., B12 injection, or denosumab)

A patient with an existing GP chronic condition management plan for their chronic medical condition has booked two appointments on the same day.

The first is for a parenteral medication to help treat their chronic medical condition. It is not appropriate for the patient to self-administer the medication and the need for the treatment is identified in the patient’s GP chronic condition management plan. The patient has also booked their regular review of the plan.

The practice nurse, for and on behalf of the GP, administers the medication. The patient has their review of the GP chronic condition management plan with the doctor. The practice nurse has provided a separate, clinically relevant service, as outlined in the patient’s GP chronic condition management plan, in addition to any contribution to the reviews of the GP chronic condition management plan.

It is therefore appropriate to claim items 967 and 10997 on the same day provided the requirements of each item have been completed.

It’s January. Do I need to review my patient’s plan to trigger their eligibility for the 5 services this calendar year?

No, patients’ 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.

However, patients with a GP chronic condition management plan must have had their plan prepared or reviewed in the previous 18 months to continue to access services.

My patient only used 3 services last year. Do the unused services rollover to this year?

No, unused services do not rollover. Patients are eligible for up to 5 services per calendar year.

Can my patient access more services by using face to face and telehealth, or seeing a practice nurse and an Aboriginal and Torres Straight Island health practitioner?

No, patients are eligible for up to 5 services per calendar year in total. The 5 services can be made up of any combination of 93201, 93203 and 10997.

My patient is a Torres Strait Islander. Can they access additional services under their GP chronic condition management plan using MBS item 10987?

No. The GP chronic condition management plan does not provide access to item 10987. Item 10987 is only available for eligible patients who have had a health assessment.

The item descriptor states that the service must be provided under the supervision of a medical practitioner. Does that mean the medical practitioner must be in the same room as the person delivering the service?

No. Supervision at a distance is acceptable, however, in order to claim Medicare benefits, the medical practitioner must be in Australia and be readily contactable to provide timely clinical advice as required and retains overall responsibility for the patient’s care.

Can I provide remote supervision from overseas?

No. The Health Insurance Act 1973 requires the person rendering the service to be in Australia. As the medical practitioner’s Medicare Provider Number is used to claim the service, they are considered to be the person who renders the service.

I am overseas and my patient needs to see the practice nurse. I prepared the patient’s GP chronic condition management plan. Can another GP in the practice provide item 10997?

Yes. Any medical practitioner can take responsibility for, and provide the required supervision, for item 10997 (and its telehealth equivalents) for a patient. However, the service provided must be consistent with the patient’s plan and rendered by a provider in Australia.

ELIGIBLE PATIENTS

These items are available for patients with at least one chronic condition and who have one of the following plans in place for the management of that condition:

• a GP chronic condition management plan prepared or reviewed in the previous 18 months
  
  
• until 1 July 2027, a GP management plan
  
  
• until 1 July 2027, Team Care Arrangements, or
  
  
• a multidisciplinary care plan

Patients are eligible for up to 5 services (total) under these items each calendar year. The service provided must be consistent with their management plan.

To be eligible for the telephone and telehealth items the patient must have an established clinical relationship with the claiming medical practitioner (see AN.1.1).

ELIGIBLE PRACTITIONERS

These items are medical practitioner items, however, the service is provided on the medical practitioner’s behalf by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner.

This means that the medical practitioner claims the MBS item and retains responsibility for the health, safety and clinical outcomes for the patient.

The terms practice nurse and Aboriginal and Torres Strait Islander health practitioner are defined in the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The Regulations define a practice nurse as “a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19(2) of the [Health Insurance] Act applies.”

The Regulations define an Aboriginal and Torres Strait Islander health practitioner as ”a person:

a) who is registered under the national law in the Aboriginal and Torres Strait Islander health practice profession; and

b) who is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the [Health Insurance] Act applies.”

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 can be found on the Federal Register of Legislation at www.legislation.gov.au. These items are set out in the following instruments:

• Health Insurance (General Medical Services Table) Regulations 2021 – item 10997

• Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 – items 93201, 93203

Related Items: 10997 93201 93203

• Previous - Note MN.12.3
• Next - Note MN.12.5

 

Service provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic condition, if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person is not an admitted patient of a hospital; and

(c) the person has in place:

(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, or team care arrangements, prepared before 1 July 2025; or

(iii) a multidisciplinary care plan; and

(d) the service is consistent with the plan or arrangements

Applicable up to a total of 5 services to which this item, item 92301 or item 93203 applies in a calendar year

Fee: $14.00 Benefit: 100% = $14.00

(See para AN.14.3, AN.15.3, AN.15.5, MN.12.4 of explanatory notes to this Category)

Video attendance provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic condition, if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person has in place:

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

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

(iii) a multidisciplinary care plan; and

(c) the service is consistent with the plan or arrangements

Fee: $16.55 Benefit: 85% = $14.10

(See para AN.15.3, MN.12.4 of explanatory notes to this Category)

Phone attendance provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic condition, if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person has in place:

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

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

(iii) a multidisciplinary care plan; and

(c) the service is consistent with the plan or arrangements

Fee: $16.55 Benefit: 85% = $14.10

(See para AN.15.3, MN.12.4 of explanatory notes to this Category)