Medicare Benefits Schedule - Note MN.9.1

Publication date: 1 November 2025

SUMMARY

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

Assessments of suitability for group allied health services are available to patients with type 2 diabetes with a GP chronic condition management plan (see AN.15.3) or residents of a residential aged care facility that have a multidisciplinary care plan (see AN.15.8). Until 1 July 2027 these services are also available to patients that have a GP management plan (see AN.15.3).

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

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

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

USE OF THE ITEMS

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

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

The requirements of the items for assessments of a patient’s suitability for group allied health services are set out in the Health Insurance (Section 3C General Medical Services - Allied Health and other Primary Health Care Services) Determination 2024 (Health Determination) and the Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 (Telehealth Determination). 

Is there a minimum length for the assessment?

Yes, the Health and Telehealth Determination specifies that the assessment must last at least 45 minutes.

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

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

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

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

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

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

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

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

How long does a referral last?

For referrals written on or after 1 July 2025, referrals will be valid for the length of time specified in the referral, or if no timeframe is specified, 18 months from the date of the first service provided under the referral.

For referrals written where the assessment was undertaken prior to 1 July 2025 the referral with the completed assessment must specify the number of services. The referral remains valid until all services are provided.

For further information on referrals see AN.15.6.

Should the referral be for a specific allied health professional?

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

For further information on referrals see AN.15.6.

ELIGIBLE PATIENTS

To be eligible for this MBS service a patient must:

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

ELIGIBLE PRACTITIONERS

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

Name of Service	Face to Face	Video/Telephone
Diabetes education	81100	NA
Dietetics	81120	93284/93286
Exercise physiology	81110	NA

RECORD KEEPING AND REPORTING REQUIREMENTS

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

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

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

RELEVANT LEGISLATION

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

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

Related Items: 81100 81110 81120 93284 93286

• Previous - Note MN.8.4
• Next - Note MN.9.2

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

(a) the patient has type 2 diabetes; and

(b) the patient is being managed by a medical practitioner (other than a specialist or consultant physician) under:

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

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

(iii) a multidisciplinary care plan; and

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

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

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

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

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

Fee: $93.25 Benefit: 85% = $79.30

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

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

(a) the person has type 2 diabetes; and

(b) the patient is being managed by a medical practitioner (other than a specialist or consultant physician) under:

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

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

(iii) a multidisciplinary care plan; and

(c) the patient is referred to an eligible exercise physiologist by the medical practitioner; and

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

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

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

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

Fee: $93.25 Benefit: 85% = $79.30

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

Video attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a) the person has type 2 diabetes; and

(b) the patient is being managed by a medical practitioner (other than a specialist or consultant physician) under:

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

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

(iii) a multidisciplinary care plan; and

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

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

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

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

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92386, or items 81100, 81110 and 81120 apply)

Fee: $93.25 Benefit: 85% = $79.30

(See para MN.9.1, MN.9.2 of explanatory notes to this Category)

Phone attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a) the person has type 2 diabetes; and

(b) the patient is being managed by a medical practitioner (other than a specialist or consultant physician) under:

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

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

(iii) a multidisciplinary care plan; and

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

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

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

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

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92384, or in items 81100, 81110 and 81120 apply)

Fee: $93.25 Benefit: 85% = $79.30

(See para MN.9.1, MN.9.2 of explanatory notes to this Category)

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

(a) the person has type 2 diabetes; and

(b) the patient is being managed by a medical practitioner (other than a specialist or consultant physician) under:

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

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

(iii) a multidisciplinary care plan; and

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

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

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

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

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

Fee: $93.25 Benefit: 85% = $79.30

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