Education guide - Chronic disease individual allied health services Medicare items 10950-10970

Information for allied health professionals providing services to patients with a chronic medical condition and complex care needs.

We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available at the MBS Online website.

For Medicare benefits to be payable for these services:

  • the patient must be referred by their general practitioner
  • the services provided must be billed using the correct MBS item number
  • a report must be provided to the referring GP following the first and last service, or more frequently if clinically necessary

The referral form used must have been issued by the Australian Government Department of Health or be a form that contains all the components of this form.

Checking patient eligibility for allied health services - Medicare items 10950-10970

Patients are considered eligible for allied health services if their GP has completed the following prerequisite Chronic Disease Management items:

  • a GP management plan (GPMP) - item 721, and
  • team care arrangements (TCAs) - item 723

If your patient is a permanent resident of an Aged Care facility, their GP must have contributed to a multidisciplinary care plan prepared for them by the Aged Care facility or to a review of the care plan (item 731). Hospital in-patients are not eligible.

The GP determines the number and combination of services that are appropriate for the patient’s treatment requirements. Only the GP can determine whether the patient’s chronic condition would benefit from allied health services. It is not appropriate for allied health professionals to provide a part-completed referral form to a GP for signing, or to pre-empt the GPs decision about the services required by the patient.

If there is any doubt about a patient’s eligibility, you can call us to confirm the number of allied health services already claimed by the patient during the calendar year.

Requirements for Medicare items 10950-10970

The requirements for Medicare items 10950-10970 are:

  • personal attendance of at least 20 minutes is required
  • treatment is provided 1 to 1 not through group treatment

Claiming frequency

Eligible patients have a limit of 5 services per calendar year. The 5 services may be made up of:

  • 1 type of service, for example 5 physiotherapy services, or
  • a combination of different types of services, for example 1 dietetic and 4 podiatry services

Referral requirements

A separate referral form is needed for each service type. The referral is valid for the number of services outlined in the referral. Medicare benefits are not payable for services provided in excess of the number specified in the referral.

The referral form should be retained for 24 months for our audit purposes.

Reporting requirements

Where an allied health professional provides:

  • a single service to the patient under a referral, a written report must be provided back to the referring GP after the service
  • multiple services to the same patient under the 1 referral, a written report must be provided back to the referring GP after the first and last service only, or more often if clinically necessary

More information

Online:

Contact us for Medicare provider enquiries.

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Page last updated: 13 October 2016

This information was printed Sunday 4 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-chronic-disease-individual-allied-health-services 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.