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Read the relevant item descriptions, fact sheets and explanatory notes on the MBS Online website.
If your patient has a chronic medical or terminal condition, they may be eligible for services under:
- General Practitioner Management Plans (GPMP)
- Team Care Arrangements (TCAs)
- Mental Health Case Conferences (MHCC).
The patient’s usual medical practitioner or someone at the same practice should bill GPMP and TCAs items. You’re a patient’s usual medical practitioner if you either:
- have provided the majority of services to the patient in the past 12 months
- will provide the majority of services in the following 12 months.
General practitioner (GP) Management Plans
Once your patient agrees with their GPMP, offer them a copy and add a copy to their medical record. You can bill items 229 or 721 to prepare a GPMP.
Team Care Arrangements
You can bill items 230 or 723 to prepare TCAs for patients needing treatment for any of the following conditions:
- chronic disease
- mental health (MH)
- eating disorder (ED).
Mental Health Case Conferences
Your patient is eligible for MHCC if they’re being managed under either:
- a mental health treatment plan
- an eating disorder treatment and management plan.
This table shows the Medicare Benefits Schedule (MBS) items that can be billed for MHCCs.
| Health professional | Attend, organise and coordinate case conference | Attend and participate in case conference |
|---|---|---|
| GP | 930, 933, 935 | 937, 943, 945 |
| Non GP medical practitioner | 969, 971, 972 | 973, 975, 986 |
| Psychiatrist or paediatrician | 946, 948, 959 | 961, 962, 964 |
| Allied health professional | N/A | 80176, 80177, 80178 |
Billing requirements
To be eligible for a GPMP, your patient must have a chronic or terminal medical condition.
If they need ongoing treatment from a multidisciplinary team, they’re also eligible for TCAs.
While many patients will be eligible for both a GPMP and TCAs, you can bill and claim the services independently.
| Cohort | Prepare a GPMP | Coordinate TCAs | Contribute to a multidisciplinary plan or review of a plan | Review of a GPMP or TCAs |
|---|---|---|---|---|
| Patients in the community | 229, 721 | 230, 723 | 231, 729 | 233, 732 |
| Private in-patients being discharged from hospital | 229, 721 | 230, 723 | 231, 729 | 233, 732 |
| Public in-patients being discharged from hospital | N/A | N/A | 231, 729 | N/A |
| Private in-patients being discharged from hospital who are residents of aged care facilities | 229, 721 | 230, 723 | N/A | 233, 732 |
| Care recipients in residential aged care facilities | N/A | N/A | 232, 731 | N/A |
Billing chronic disease management (CDM) items
You can bill these MBS item numbers for CDM.
| Service description | Item number | Claiming frequency |
|---|---|---|
| Preparation of a GPMP | 229, 721 | Once every 12 months |
| Coordination of the development of TCAs for CDM | 230, 723 | Once every 12 months |
| Coordination of the development of TCAs for MH or ED | 230, 723 | Once every 12 months |
| Contribution to a Multidisciplinary Care Plan or to a review for a patient who isn’t in a residential aged care facility | 231, 729 | Once every 3 months |
| Contribution to a Multidisciplinary Care Plan or to a review for a resident in an aged care facility | 232, 731 | Once every 3 months |
| Review of either a GPMP, TCAs for CDM or TCAs for MH/ED | 233, 732 | Once every 3 months |
You can provide these services more frequently in exceptional circumstances. For example, when there is a significant change in a patient’s condition.
You can bill and claim the review items 3 times on the same day, once for a review of each:
- GPMP
- TCAs for CDM
- TCAs for MH/ED.
We suggest that practices call and encourage patients to attend an appointment to review their care plan.
Make a note on the patient’s account or include service text for electronic claims. This includes:
- exceptional circumstances
- significant change in clinical condition
- GPMP review, TCAs CDM review or TCAs MH/ED review.
This helps us to assess the claim.
Read the explanatory notes on MBS Online for more information on Chronic Disease Management items.
Co-claiming restrictions
You can’t bill and claim these CDM and general attendance items for the same patient on the same day.
| General attendance items | CDM items |
|---|---|
| 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 123, 124, 151, 165, 179, 181, 185, 187, 189, 191, 203, 206, 301, 303, 585, 588, 591, 594, 599, 600, 733, 737, 741, 745, 761, 763, 766, 769,772, 776, 788, 789 2197, 2198,2200, 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5071, 5076, 5200, 5203, 5207, 5208, 5209 5220, 5223, 5227, 5228, 5261, 91790, 91792, 91794, 91800, 91801, 91802, 91803, 91804, 91805, 91806, 91807, 91808, 91890, 91891, 91892, 91893, 91900, 91903, 91906, 91910, 91913, 91916, 91920, 91923, 91926, 92210 and 92211. | 229, 230, 233, 721, 723, 732, 92024, 92025, 92028, 92055, 92056 and 92059 |
If your patient needs to visit a different practitioner on the same day, we’ll pay benefits for both consults.
Read more about Mental Health Case Conferencing items on the MBS Online website.