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Medicare Rebates for Individual Allied Health Services - For patients with a chronic (or terminal) medical condition and complex care needs

Patient Information

PDF printable version of Chronic and Complex Patient Brochure A4 size (PDF)

If you have any difficulty accessing the PDFs, please email Medical Benefits Division Webmaster

In summary:

• Medicare rebate for a maximum of five services per patient each calendar year, with out-of-pocket costs counting towards the extended Medicare safety net
• A patient must have a GP Management Plan (GPMP) and Team Care Arrangements (TCAs) (or a multidisciplinary care plan for residents of an aged care facility).
• Your GP will decide whether you would benefit from these services and, if so, will refer you for appropriate allied health services.
• Allied health professionals must be registered with Medicare Australia

Who is eligible?

You may be able to claim Medicare rebates for allied health services if you have a chronic (or terminal) medical condition that is being managed by your GP under both of these Medicare Chronic Disease Management (CDM) items: a GPMP and TCAs.

Chronic medical conditions

A chronic medical condition is one that has been (or is likely to be) present for six months or longer. It includes, but is not limited to, conditions such as asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke.

Management of your condition

Care plans can help you and your GP manage your medical condition by identifying your needs and the action required.

If you have a chronic (or terminal) condition, with or without complex care needs, a GPMP will enable your GP to provide a structured approach to you care. It is a plan of action in which you agree management goals with your GP.

If you also have complex care needs, TCAs will enable your GP to collaborate with at least two other care providers involved in your treatment. TCAs will identify who needs to be involved in your care and help coordinate the team-based approach.

Patients in aged care facilities

Residents of aged care facilities may also be eligible for Medicare rebates for allied health services if their GP has contributed to a multidisciplinary care plan prepared by the facility.

Individual allied health services

Once you have a GPMP and TCAs in place, you can be referred for up to five allied health services each calendar year. It is important to understand that only your GP will decide whether you should be referred for these services.

The five services can be provided by a single allied health professional or shared across different professionals.

You can request that your GP refer you to an allied health professional you already know, or your GP can recommend one.

Allied health professionals need to meet specific eligibility criteria and be registered with Medicare Australia.

Eligible allied health professionals

• Aboriginal health workers
• audiologists
• chiropractors
• diabetes educators
• dietitians
• exercise physiologists
• mental health workers
• occupational therapists
• osteopaths
• physiotherapists
• podiatrists
• psychologists
• speech pathologist

Private health insurance

If you have private health insurance, you will need to decide if you wish to use Medicare or your private health insurance to pay for these services. You cannot use private health insurance ancillary cover to ‘top up’ your Medicare rebate.

Claiming

Allied health professionals, like doctors, are free to set the level of their fees. If your allied health provider bulk bills, there will be no charge for these services. If not, you will be charged a fee and you can claim the rebate from Medicare.

Out-of-pocket expenses for these services count towards the extended Medicare safety net.

If you are unsure, or lose track of how many allied health services you have claimed in a calendar year, you can check with Medicare Australia on 132 011.

More information

More information is available at www.health.gov.au/mbsprimarycareitems

If you have any questions, ask your doctor or practice nurse.
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