The initiative allows a person with a complex and/or chronic medical illness to claim a Medicare rebate for up to five visits (in total) to certain allied health professionals within a calendar year. The person must be referred by a GP who is managing them under a GP Management Plan and Team Care Arrangements (TCA). The GP is required to develop written Team Care Arrangements (TCA) in conjunction with at least two other allied health professionals, and to then provide referrals to those allied health services the team believes will be of most benefit to the patient/client.

The GP Chronic Disease Management (CDM) items have replaced the earlier Enhanced Primary Care (EPC) items, and the new Team Care Arrangements (TCA) have replaced the earlier EPC Multidisciplinary Care Plan items. 

The psychologist may be called upon by a GP to assist in developing a TCA, but cannot use the Medicare item to claim for this time. The Medicare item can only be used for provision of psychological services to the individual client/patient.

Allied health services (chronic disease management initiative) - psychology item 10968

Psychologists planning to deliver these items must read the full description of the items, together with explanatory notes, in the Medicare Benefits Schedule - Allied Health Services - 1 November 2009 - Acrobat icon - small 

Referral requirements

A client with a chronic/complex medical illness must be referred by their GP using a Referral form for chronic disease management allied health (individual) services under Medicare (click to download referral form). Services from a psychologist must be recommended in the client's GP Management Plan and Team Care Arrangements as part of the management of their condition. If a client has not used all of their allowable allied health services in a calendar year, it is not necessary to obtain a new referral for the 'unused' services.
Eligible clients

Clients must have chronic conditions and complex care needs that are being managed under a GP Management Plan and Team Care Arrangements. To be eligible to receive services, clients must have received the following two MBS items in the previous two years:

  • GP Management Plan
    - MBS item 721 (or review item 725 AND
  • Team Care Arrangements
    - MBS item 723 (or review item 727)

A chronic medical condition is one that has been, or is likely to be, present for at least six months. Chronic medical conditions include (but are not limited to):

  • Asthma
  • Cancer
  • Cardiovascular Illness
  • Diabetes Mellitus
  • Musculoskeletal Conditions
  • Stroke

A client is considered to have complex care needs if they require ongoing care from a multidisciplinary team including the GP and two or more other health care providers.
Services to be provided

Individual session(s) of at least 20 minutes duration.
Eligibility to provide items Psychologists must be fully registered with the Psychologist's Registration Board in their State or Territory and be a registered provider with Medicare Australia.
Limits to number of sessions provided The initiative provides for five allied health sessions in total over a calendar year, which includes all allied health services. The number of sessions for psychological services that can be rebated therefore depends on the number of referrals to other allied health services, with a maximum possible number of sessions being five.
Reporting requirements

If providing only a single session under one referral a brief report must be supplied to the GP after that one session. If providing multiple sessions under one referral, a report must be provided after the first and last sessions only, or more often if deemed necessary. Written reports should include:

  • Any investigations, tests and/or assessments carried out;
  • Any treatment provided;
  • Future management of the client's condition or problem
Schedule fee and rebate See How to bill for services provided.

Summary of the process for providing psychological services under the chronic disease management initiative

Step 1: The GP identifies a patient/client with a chronic, complex condition for whom other health services are deemed to be of assistance.

Step 2: The GP (or practice nurse) contacts two or more other health service providers (could be allied health, specialist medical services or community health facilities) by phone or by some other means to assist with writing the Team Care Arrangements (TCA). On this basis, the GP decides on the most useful services to manage the condition or problems that are part of the condition, and writes a TCA that nominates the allied health services to which the GP wishes to refer. Although two or more services should be consulted before the TCA is written, the referral may be to only one service, if appropriate, or more if felt necessary.

Step 3: The GP fills out the Referral form for chronic disease allied health (individual) services under Medicare (the referral form), nominating the services he/she wishes to access for the patient (for example, physiotherapist, psychologist, speech pathologist).

Step 4: The patient/client then takes the referral form to a specified or patient-selected service provider. The service provider then enacts the service specified on the referral form and signs the form.

Further information

For further information about Medicare Benefit Schedule items, please go to the Australian Government Department of Health and Ageing website. Further information is also available from the Medicare Australia provider inquiry line on 132 150.

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