Chronic Disease Management - Provider Information

Fact Sheet

Page last updated: 09 February 2016

Printable version of Fact sheet - Chronic Disease Management (CDM) - Provider Information Medicare items (PDF 473 KB)

This fact sheet must be read in conjunction with the item descriptors and explanatory notes for items 721 to 732 (as set out in the Medicare Benefits Schedule).

The Chronic Disease Management (CDM) Medicare items are for General Practitioners (GPs) to manage the health care of people with chronic or terminal medical conditions, including those requiring multidisciplinary, team-based care from a GP and at least two other health or care providers.

Eligibility

A person who has a chronic or terminal medical condition (with or without multidisciplinary care needs) can have a GP Management Plan (GPMP) service.

A person with a chronic or terminal medical condition and complex care needs, requiring care from a multidisciplinary team, can have a GPMP and Team Care Arrangements (TCAs).

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions. However, these items are designed for patients who require a structured approach to their care and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary team.

Overview of the Items

There are six CDM items that provide rebates for GPs to manage chronic or terminal medical conditions by preparing, coordinating, reviewing or contributing to CDM plans.

A review item is the key component for assessing and managing the patient’s progress once a GPMP or TCAs have been prepared.

GPMPs and TCAs can be reviewed by a GP from the same practice or, if the patient changes practices, by a new GP. Using the CDM items, GPs can contribute to other provider’s multidisciplinary care plans and to a review of these plans. GPs can be assisted by practice nurses, Aboriginal and Torres Strait Islander health practitioners, Aboriginal health workers and other health providers in preparing and reviewing the CDM items, but the GP must meet all the Medicare requirements of the items.

Preparation of a 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, documenting these and including a review date in the GPMP.

Review of a GPMP - 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 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 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.
  • 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 to 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 TCAs - Item 732

  • For patients requiring a review of their current TCAs.
  • The minimum claiming period is once every three months; however, this 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; however this 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 a Residential 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) may be eligible for the individual allied health services on the Medicare Benefits Schedule.

Similarly, residents of residential aged care facilities) may also be eligible for these allied health items when a GP has contributed to a care plan prepared for the resident by the residential aged care facility and referred them for allied health services under item 731.

Eligible patients can claim a maximum of five allied health services in the period 1 January to 31 December (generally referred to as ‘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. Please note that GPs’ CDM allied health referrals may be issued at any time of the year, and remain open until the number of services the GP has specified on the referral form have been used. Any unused services at 31 December can continue to be used, but will be subject to the maximum limit of five Medicare-rebateable CDM allied health services available in any calendar year period (i.e. 1 January – 31 December). When patients have used all of their referred services, or require a referral for a different type of allied health service than that recommended in their care plan, they need to obtain a new referral from their GP.

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).

More Information

The explanatory notes and item descriptors for these items are in the Medicare Benefits Schedule (MBS) available at: MBS Online website.

For inquiries about eligibility, claiming, fees and rebates, call the Department of Human Services (Medicare): patient inquiries 132 011; provider inquiries 132 150.