Chronic Disease Management Medicare Items

Medicare Items listed at 2018

  • Preparation of a GP Management Plan GPMP (Item 721)
  • Review of a GP Management Plan (Item 732)
  • Co-ordination of Team Care Arrangement (TCAs – Item 723)
  • Co-ordination of a Review of Team Care Arrangements (Item 732)
  • Contribution to a multidisciplinary care plan being prepared by another health or care provider (Item 729)
  • Contribution to a multidisciplinary care plan being prepared for a resident of an aged care facility (Item 731)
  • Access to Allied Health GPMP (Item 721) and TCAs (Item 723)
  • Five Allied Health services per calendar year MBS (Items 10950 – 10970)
  • Practice Nurse Monitoring and Support MBS (Item 10997)

Fibromyalgia Chronic Disease Management

Just like Diabetes, Fibromyalgia can be managed at Primary care level using the Chronic Disease Management Program. FMS requires multidisciplinary integrated management from several providers.

Care can be improved using a pre-arranged care plan that coordinates services, enables outcomes to be monitored and reviewed and keeps records in one GP centre.

General Practice care plans are available for all Australians with chronic conditions who have complex cares needs requiring care from multiple providers.

Notes from Medicare Fact Sheets

Preparation of a GP Management Plan (GPMP – Item 721)

Provides a rebate for a GP to prepare a management plan for a patient who has a chronic or terminal medical condition with or without multidisciplinary care needs.

  • The minimum claiming period is once every twelve months, supported by regular review services
  • Involves the GP assessing the patient, agreeing management goals with the patient, identifying actions to be taken by the patient, identifying treatment and ongoing services to be provided, and documenting these and a review date in the GPMP

Review of a GP Management Plan (Item 732)

Provides a rebate for a GP to review a GP Management Plan (see above).

  • The minimum claiming period is once every three months; can be earlier if clinically required
  • Involves reviewing the patient’s GP Management Plan, documenting any changes and setting the next review date

Coordination of Team Care Arrangements (TCAs – Item 723)

Provides a rebate for a GP to coordinate the preparation of TCAs for a patient who has a chronic or terminal medical condition and who also requires ongoing care from a multidisciplinary team of at least three health or care providers.

  • In most cases the patient will already have a GPMP in place (but this is not mandatory)
  • The minimum claiming period is once every twelve months, supported by regular review services
  • Involves the GP collaborating with the other participating providers on required treatment/services, agreeing the arrangements with the patient, documenting the arrangements and a review date in the patient’s TCAs, and providing copies of the relevant document to the collaborating providers

Coordination of a Review of Team Care Arrangements (Item 732)

For patients who have current TCAs and require a review of their TCAs.

  • The minimum claiming period is once every three months; can be earlier if clinically required
  • Involves the GP (who may be assisted by their practice nurse or other) collaborating with the participating providers on progress against treatment/services and documenting any changes to the patient’s TCAs

Contribution to a multidisciplinary care plan being prepared by another health or care provider (Item 729)

For patients who are having a multidisciplinary care plan prepared or reviewed by another health or care provider (other than their usual GP).

  • The minimum claiming period is once every three months; can be earlier if clinically required
  • Involves the GP (who may be assisted by their practice nurse or other) collaborating with the providers preparing or reviewing the plan and including their contribution in the patient’s records

Contribution to a multidisciplinary care plan being prepared for a resident of an aged care facility (Item 731)

This is for patients in residential aged care facilities and is otherwise identical to Item 729 (immediately above).

Access to allied health items

Patients who have both a GPMP (Item 721) and TCAs (Item 723) have access to the individual allied health services on the Medicare Benefits Schedule.

  • Eligible patients can claim a maximum of five (5) allied health services per calendar year (MBS items 10950-10970)
  • Patients with a GPMP (Item 721) and type 2 diabetes can also access Medicare rebates for allied health group services (MBS items 81100 to 81125)
  • Patients need to be referred by their GP for services recommended in their care plan, using the referral form issued by the Department or a form that contains all the components of the Department’s form

Practice Nurse Monitoring and Support

Patients with either a GPMP or TCAs can also receive monitoring and support services from a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of the GP (MBS item 10997).