MBS Primary Care Items

Medicare Rebates for Allied Health (Individual) Services - For Patients with Chronic Medical Conditions and Complex Care Needs

Patient Information Brochure

PDF printable version of Chronic and Complex Patient Information Brochure (PDF 182 KB)
PDF printable version of Chronic and Complex Patient Brochure A4 size (PDF 122 KB)
If you have any difficulty accessing the PDFs, please contact mbd.web@health.gov.au

In summary:

• Medicare rebate for a maximum of five (5) services per patient each calendar year, with out-of-pocket costs counting towards the extended Medicare safety net
• 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 GP Management Plan (GPMP) and Team Care Arrangements (TCAs).

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.

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 planning can help you and your GP manage your 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 your 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 arrangements.

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 the GP refer you to an allied health professional you already know, or your GP can recommend one.
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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 pathologists

Other allied health services available under Medicare

Medicare benefits are also available for a range of other allied health services for certain patients. You may be eligible if you:

• are of Aboriginal or Torres Strait Islander descent;
• have type 2 diabetes;
• have an assessed mental disorder;
• are a child with autism or any other pervasive developmental disorder;
• are a women who is concerned about either a current pregnancy or one that occurred in the previous 12 months.

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

For more information on Medicare rebates for allied health services talk to your GP or go to the Department of Health and Ageing web site at www.health.gov.au and follow the A-Z links to the program you are interested in, or go to www.health.gov.au/mbsprimarycareitems

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