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MBS Primary Care Items

Group allied health services under Medicare for patients with type 2 diabetes – items 81100 – 81125

Information for GPs

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People with type 2 diabetes can receive Medicare rebates for group allied health services provided by eligible diabetes educators, exercise physiologists and dietitians, on referral from a GP.

The group items provide another referral option for GPs in the management of patients with type 2 diabetes.

Patients who will most benefit from group services are likely to be those who demonstrate a readiness to change, are able to contribute to group processes effectively and have a potential for self management.

These services are in addition to the five individual allied health services available to eligible patients each calendar year under items 10950 to 10970. (A separate fact sheet – Allied health services under Medicare – People with chronic conditions and complex care needs – items 10950 to 10970 - provides details).

Which patients are eligible?

A patient must have type 2 diabetes. Before referring patients, the GP must put in place:

• a GP Management Plan – item 721 (or review item 732); or
• for a resident of a residential aged care facility, the GP must have contributed to, or reviewed, a care plan prepared by the facility (item 731)¹ .

GPs are also encouraged to attach a copy of the relevant part of the patient’s care plan to the referral form that is forwarded to the allied health professional (AHP). Patients being referred by a GP for allied health group services under items 81100 to 81125 do not need to have a Team Care Arrangements service (item 723).
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However, if the GP also wishes to refer the patient for individual allied health services under items 10950 to 10970, it will be necessary to provide a Team Care Arrangements (item 723) in order to meet the eligibility requirements of those items.

¹ Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, residents may not need to be referred for allied health group services under these items as the self management approach may not be appropriate.

Eligible allied health professionals

Only diabetes educators, exercise physiologists and dietitians who are registered with Medicare Australia are eligible to provide services under items 81100 to 81125.

Information about where to find an allied health professional offering group services under Medicare is available on the web sites of each of the relevant peak allied health organisations:
Australian Diabetes Educators Association
Exercise and Sports Science Australia
Dietitians Association of Australia

Referral requirements

To access allied health group services, patients must be referred by their GP to an eligible diabetes educator, exercise physiologist or dietitian. The GP may refer a patient either to a specific diabetes educator, exercise physiologist or dietitian, or to an allied health practice offering these services.

The allied health professional will initially conduct an individual assessment under items 81100, 81110 or 81120 to prepare the patient for an appropriate group services program.

A Medicare rebate is only payable for one allied health assessment service each calendar year.
If there is any doubt about whether a patient has already claimed an assessment item in that calendar year, the GP can check with Medicare Australia on 132 150

Referral form

Patients need to be referred by their GP using the referral form issued by the Department that can be found at the MBS Primary Care Items page or a form that contains all the components of the Department’s form.
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GPs are also encouraged to attach a copy of the relevant part of the patient’s care plan.

Allied health group services

If the patient is assessed by an eligible allied health professional as suitable for group services, the patient may then receive up to eight (8) group services each calendar year.

Allied health group services may be delivered by one type of allied health professional (eg 8 diabetes education services) or by a combination of providers (eg 3 diabetes education services, 3 dietitian services, and 2 exercise physiology services). The combination of group services to be offered will be determined as part of the assessment by the allied health professional.

In some areas, different types of group services may be offered by allied health providers (eg courses targeting newly diagnosed patients, refresher courses or courses covering specific types of treatment and self management).

Reporting requirements

On completion of both the assessment service and group services program, the allied health professional must provide, or contribute to, a written report back to the referring GP in respect of each patient. After the assessment service, the GP will receive a written report outlining the assessment undertaken, whether the patient is suitable for group services and, if so, the nature of the group services to be provided. After the group services program, the GP will receive a written report describing the group services provided for the patient and indicating the outcomes achieved.

Out-of-pocket expenses and Medicare Safety Net

Allied health professionals are free to determine their own fees for the professional service. Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient. Out-of-pocket costs for eligible services will count toward the Medicare safety net for that patient.

Private health insurance

Patients will need to decide if they wish to use Medicare or their private health insurance cover to pay for these services. Private health insurance ancillary cover cannot be used to ‘top up’ the Medicare rebate.

More information

Further information about items 81100 to 81125 is available on the Department of Health and Ageing website a the MBS Primary Care Items page.

Information about these items, including explanatory notes and item descriptors, is also contained in the Medicare Benefits Schedule available online at MBS Online.