Education guide - Chronic disease GP Management Plans and Team Care Arrangements

Information for general practitioners about GP Management Plans (GPMP), Medicare item 721 and Team Care Arrangements (TCAs), Medicare item 723.

This information should be used as a guide only and be read together with the Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available on the MBS Online website.

A chronic medical condition is a condition that has been, or is likely to be, present for at least 6 months. Including, but is not limited to:

  • asthma
  • cancer
  • cardiovascular disease
  • diabetes mellitus
  • musculoskeletal conditions, and
  • stroke

Determining patient eligibility for GPMP item 721 and TCAs item 723

Determining patient eligibility for GPMP item 721 and TCAs item 723.

To be eligible for a GPMP the patient must have a chronic or terminal medical condition.

To be eligible for TCAs the patient must have a chronic or terminal medical condition that requires ongoing treatment from a multidisciplinary team.

Where the patient has a chronic or terminal medical condition but does not require ongoing treatment from a multidisciplinary team they are eligible for a GPMP only.

Patients criteria MBS item Once you have completed Refer patients
Chronic or terminal medical condition GPMP item 721 A GPMP With type 2 diabetes for individual assessment for group allied health services.
Medical or terminal condition and require ongoing treatment from a multidisciplinary team.
  • GPMP item 721 and
  • TCAs item 723
Both a GPMP and TCAs For individual allied health services.

GPMP item 721 and TCAs item 723 are available to patients in the community, and private patients who are being discharged from hospital.

  • items 721 and 723 are not available to public in-patients of a hospital or care recipients in a residential aged care facility
  • item 731 is available to care recipients in a residential aged care facility

GPMPs and TCAs are not designed simply as mechanisms to provide Medicare rebates for allied health services. They are tools to coordinate the care of people with chronic conditions and help to reduce the need for ad hoc consultations.

GPMP item 721 requirements

  • explain to your patient the steps involved in preparing the plan and record their agreement to proceed
  • assess to identify and or confirm the patient's health care needs, health problems and relevant conditions
  • agree on management goals and identify actions to be taken with your patient
  • identify treatment and services for your patient and make any necessary arrangements
  • the GPMP must be a comprehensive written plan describing the above
  • offer a copy of the plan to your patient and add a copy to the patient's medical record

TCAs item 723 requirements

  • explain to your patient the steps involved in the development of the TCAs and record their agreement to proceed
  • consult with at least 2 collaborating providers, who will provide a different kind of treatment or service to the patient
  • prepare a document describing:
    • treatment and service goals for the patient
    • treatment and services that collaborating providers have agreed to give
    • actions to be taken by the patient and specify a date to review the TCAs. MBS item 732 is recommended every 6 months
  • discuss with the patient the collaborating providers who will contribute to the TCAs and provide treatment and services
  • offer a copy of the TCAs to the patient, give copies of the relevant parts of the document to the collaborating providers and add a copy of the document to the patient's medical record

Multidisciplinary team for the purpose of TCAs

A GP plus at least 2 other collaborating health or care providers, 1 of whom may be another medical practitioner, who will be providing ongoing treatment or services for the patient.

Each of the health or care providers must be providing a different type of ongoing treatment or service. The non-GP collaborating providers need not be providers of Medicare eligible services.

A patient's informal or family carer does not count as 1 of the other 2 health or care providers but can be involved in the process.

GPMP and TCAs should be undertaken by the patient's usual GP. The patient's usual GP is considered to be the GP, or a GP working in the medical practice, who has provided the majority of care to the patient over the previous 12 months or will be providing the majority of GP Services to the patient over the next 12 months.

CDM items claiming restrictions

General practitioners are restricted from billing Chronic Disease Management (CDM) items and GP attendance items for the same patient, on the same day.

This restriction prevents co-claiming GP attendance items:

3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 597, 599, 598, 600, 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228

with chronic disease management (CDM) items:

721, 723, or 732

If a GP claims both an attendance item and a chronic disease management item for the same patient on the same day, benefits will only be paid for the chronic disease management item.

If the patient needs to see a different GP on the same day, Medicare benefits will be paid for that consultation.

Claiming frequency

The recommended frequency of GPMP or TCAs is once every 2 years, with regular reviews, recommended every 6 months, of the patient's progress against the plan. This should be applied with regard to the patient's requirements.

In general, a new GPMP or TCAs should not be prepared unless required by the patient's condition, needs and circumstances. The minimum claiming period is 12 months. Where there has been a significant change in the patient's clinical condition or care circumstances, more frequent claims can be made. If you are unsure whether the patient currently has a GPMP and or TCAs in place, contact us.

We suggest that practices create a system to call and encourage patients to attend an appointment for a review of their care plan. The MBS review item is 732 for reviewing a GPMP and TCAs. Item 732 can be claimed twice on the same day for a review of a GPMP and for a review of TCAs, as long as the MBS item descriptor and explanatory notes for item 732 are met.

More information

Online:

Contact us for Medicare provider enquiries.

Read more information about our website disclaimer.

Page last updated: 10 October 2016

This information was printed Saturday 3 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-chronic-disease-gp-management-plans-and-team-care It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.