MBS Primary Care Items – Allied Health Individual Services for patients with a chronic medical condition and complex care needs under Medicare

Medicare rebates for certain allied health services are available for patients with chronic conditions and complex care needs on referral from their GP.

Allied Health Services under Medicare - Fact Sheet

Information regarding the Medicare items for individual allied health services for people with chronic conditions and complex care needs.

People with chronic conditions and complex care needs – items 10950 to 10970

This fact sheet must be read in conjunction with the item descriptors and explanatory notes for items 10950 to 10970 (as set out in the Medicare Benefits Schedule - Allied Health Services book).

In summary:

  • A Medicare rebate is available for a maximum of five (5) services per patient each calendar year. (Note,

however, that allied health providers may set their own fees)

  • Patients must have a GP Management Plan and Team Care Arrangements prepared by their GP, or be Commonwealth-funded residents of an aged care facility who are managed under a multidisciplinary care plan.
  • GP refers to allied health professional.
  • Allied health professionals must report back to the referring GP.

Eligible Patients

Patients may be eligible if their GP has provided the following MBS Chronic Disease Management services:

  • A GP Management Plan (GPMP) - item 721 (or review item 732); and
  • Team Care Arrangements (TCAs) - item 723 (or review item 732)

For patients who are permanent residents of an aged care facility and Commonwealth funded, their GP must have contributed to a multidisciplinary care plan prepared for them by the aged care facility or to a review of the multidisciplinary care plan (item 731).
A chronic medical condition is one that has been (or is likely to be) present for six months or longer. It includes conditions such as asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke.
Patients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least two other health or care providers.

Referral arrangements

GPs determine whether the patient’s chronic medical condition would benefit from allied health services.
Patients need to be referred by their GP for services recommended in their care plan, using the referral form issued by the Department that can be found at or a form that contains all of the components of the Department's form.
NOTE: Allied health services provided through these referrals must be directly related to the management of the patient’s chronic condition/s, and the need for allied health services must be identified in the patient’s care plan.
It is not appropriate for allied health professionals to provide part-completed referral forms to GPs for signature, or to pre-empt the GP's decision about the services required by the patient.

Referral validity

A referral is valid for the stated number of services. If all services are not used during the calendar year in which the patient was referred, the unused services can be used in the next calendar year.
However, those services will be counted as part of the five rebates for allied health services available to the patient during that calendar year.
When all referred services have been used, or a referral to a different allied health professional is required, patients need to obtain a new referral.
GPs may undertake a review of the patient's GPMP and TCAs or, where appropriate, manage the referral process using a GP consultation item.

NOTE:It is not necessary to have a new GPMP or TCAs prepared each calendar year in order to access a new referral(s) for eligible allied health services. Patients continue to be eligible for rebates for allied health services while they are being managed under a GPMP and TCAs as long as the need for eligible services continues to be recommended in their plan.

The review item (732) is used to assess and manage the patient’s progress once a GPMP and TCAs have been prepared. It is expected that a GPMP and TCAs be reviewed at least once during a two-year period.

Service length and type

Services must be of at least 20 minutes’ duration and be provided to an individual patient. The allied health professional must personally attend the patient.

Eligible allied health professionals

Aboriginal Health Worker - item 10950
Audiologist - item 10952
Chiropractor - item 10964
Diabetes Educator- item 10951
Dietitian- item 10954
Exercise Physiologist - item 10953
Mental Health Worker* - item 10956
Occupational Therapist - item 10958
Osteopath - item 10966
Physiotherapist - item 10960
Podiatrist - Item 10962
Psychologist - item 10968
Speech Pathologist - item 10970
*includes Aboriginal health workers, mental health nurses, occupational therapists, psychologists and some social workers
Allied health professionals need to meet specific eligibility requirements, be in private practice and register with Medicare Australia. Registration forms are available from Medicare Australia at: or can be obtained by phoning 132 150.
Allied health services funded by other Commonwealth or State programs are not eligible for Medicare rebates, except where a subsection 19(2) exemption has been granted.

Reporting requirements - allied health professionals to GP

A written report is required after the first and last service, or more often if clinically necessary.
Written reports should include any investigations, tests, and/or assessments carried out on the patient, any treatment provided and future management of the patient’s condition or problem.

Receipt requirements

For a Medicare payment to be made the account/receipt must include the following information:

  • patient’s name;
  • date of service;
  • MBS item number;
  • allied health professional’s name and provider number, or name and practice address;
  • referring medical practitioner’s name and provider number, or name and practice address;
  • date of referral; and
  • amount charged, total amount paid, and any amount outstanding in relation to the service.

Other services

Patients who have private health insurance will need to decide whether to use Medicare or their private health insurance to pay for these services. Private health insurance ancillary cover cannot be used to ‘top up’ the rebate.
Information about Medicare rebates for group allied health services for people with type 2 diabetes is available at
Information about allied mental health services is available at (follow the A-Z links to ‘M’ mental health).
Information about allied health services for a child with autism or any other pervasive developmental disorder is available at

Further information

Internet: or
MBS Online:

Eligibility criteria for allied health professionals providing Chronic Disease Allied Health (Individual & Group) Medicare services
Aboriginal Health Workers practising in the Northern Territory (NT) must be registered under the Health Practitioners Act (NT); in other States and the Australian Capital Territory they must have been awarded a Certificate Level III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation that meets training standards set by the Australian National Training Authority’s Australian Quality Training Framework.
Audiologists must be either a ‘Full Member’ of the Audiological Society of Australia Inc (ASA) and the holder of a ‘Certificate of Clinical Practice’ issued by the ASA; or an ‘Ordinary Member – Audiologist’ or a ‘Fellow Audiologist’ of the Australian College of Audiology (ACAud).
Chiropractors must be registered with the Chiropractors Board of Australia.
Diabetes Educators must be a Credentialed Diabetes Educator (CDE) as credentialed by the Australian Diabetes Educators Association (ADEA).
Dietitians must be an ‘Accredited Practising Dietitian’ as recognised by the Dietitians Association of Australia (DAA).
Exercise Physiologists must be an ‘Accredited Exercise Physiologist’ as accredited by the Exercise & Sports Science Australia (ESSA).

Mental Health Workers ‘Mental health’ can include services provided by members of five different allied health professional groups. ‘Mental health workers’ are drawn from the following:

  • psychologists;
  • mental health nurses;
  • occupational therapists;
  • social workers; and
  • Aboriginal health workers.

Psychologists, occupational therapists and Aboriginal health workers are eligible in separate categories for these items.
A mental health nurse must be a credentialed mental health nurse, as certified by the Australian College of Mental Health Nurses.
Mental health nurses who were registered in the ACT or Tasmania prior to the introduction of the National Registration and Accreditation Scheme (NRAS) on 1 July 2010, will have until 31 December 2010 to be certified by the Australian College of Mental Health Nurses.
To be eligible to provide mental health services for the purposes of this item, a social worker must be a member of the Australian Association of Social Workers (AASW) and certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008.
Occupational Therapists in Queensland, Western Australia, South Australia and the Northern Territory must be registered with the Occupational Therapists Board in the State or Territory in which they are practising; in other States and the Australian Capital Territory, they must be a ‘Full-time Member’ or ‘Part-time Member’ of OT AUSTRALIA, the national body of the Australian Association of Occupational Therapists.
Osteopaths must be registered with the Osteopathy Board of Australia.
Physiotherapists must be registered with the Physiotherapy Board of Australia.
Podiatrists must be registered with the Podiatry Board of Australia.
Psychologists must hold General Registration with the Psychology Board of Australia.
Speech Pathologists practising in Queensland must be registered with the Speech Pathologist Board of Queensland. In all other States, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of Speech Pathology Australia.

Medicare Rebates for Individual Allied Health Services - For Patients with a Chronic Medical Condition and Complex Care Needs

Patient Information

In summary:

  • Medicare rebate for a maximum of five services per patient each calendar year, with out-of-pocket costs counting towards the extended Medicare safety net
  • A patient must have a GP Management Plan (GPMP) and Team Care Arrangements (TCAs) (or a multidisciplinary care plan for residents of an aged care facility).
  • Your GP will decide whether you would benefit from these services and, if so, will refer you for appropriate allied health services.
  • Allied health professionals must be registered with Medicare Australia

Who is eligible?

You may be able to claim Medicare rebates for allied health services if you have a chronic (or terminal) medical condition that is being managed by your GP underboth of these Medicare Chronic Disease Management (CDM) items: a GP Management Plan (GPMP) and Team Care Arrangements (TCAs).
Residents of aged care facilities may also be eligible for Medicare rebates for allied health services if their GP has contributed to a multidisciplinary care plan prepared by the facility.

Chronic medical conditions

A chronic medical condition is one that has been (or is likely to be) present for six months or longer. It includes, but is not limited to, conditions such as asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke.

Management of your condition

Care planning can help you and your GP manage your condition by identifying your needs and the action required.
If you have a chronic (or terminal) condition, with or without complex care needs, a GPMP will enable your GP to provide a structured approach to your care. It is a plan of action in which you agree management goals with your GP.
If you also have complex care needs, TCAs will enable your GP to collaborate with at least two other care providers involved in your treatment. TCAs will identify who needs to be involved in your care and help coordinate the team-based arrangements.

Individual allied health services

Once you have a GPMP and TCAs in place, you can be referred for up to five allied health services each calendar year. It is important to understand that only your GP will decide whether you should be referred for these services.
The five services can be provided by a single allied health professional or shared across different professionals.
You can request that your GP refer you to an allied health professional you already know, or your GP can recommend one.
Allied health professionals need to meet specific eligibility criteria and be registered with Medicare Australia.

Eligible allied health professionals

  • Aboriginal health workers
  • audiologists
  • chiropractors
  • diabetes educators
  • dietitians
  • exercise physiologists
  • mental health workers
  • occupational therapists
  • osteopaths
  • physiotherapists
  • podiatrists
  • psychologists
  • speech pathologists

Other allied health services available under Medicare
Medicare benefits are also available for a range of other allied health services for certain patients. You may be eligible if you:

  • are of Aboriginal or Torres Strait Islander descent;
  • have type 2 diabetes;
  • have an assessed mental disorder;
  • are a child with autism or any other pervasive developmental disorder;
  • are a woman who is concerned about either a current pregnancy or one that occurred in the previous 12 months.

Private health insurance

If you have private health insurance, you will need to decide if you wish to use Medicare or your private health insurance to pay for these services. You cannot use private health insurance ancillary cover to ‘top up’ your Medicare rebate.

Claiming

Allied health professionals, like doctors, are free to set the level of their fees. If your allied health provider bulk bills, there will be no charge for these services. If not, you will be charged a fee and you can claim the rebate from Medicare.
Out-of-pocket expenses for these services count towards the extended Medicare safety net.
If you are unsure, or lose track of how many allied health services you have claimed in a calendar year, you can check with Medicare Australia on 132 011.

More information
More information is available at
If you have any questions, ask your doctor or practice nurse.

Simpler Administrative Arrangements for Allied Health

Allied health Medicare items for people with chronic and complex medical conditions (MBS items 10950 – 10970 and 81100 - 81125).
On 1 January 2009, the requirement that a Medicare rebate for the prerequisite Chronic Disease Management (CDM) care planning items must be claimed before associated allied health services can be provided and claimed was removed.
These new arrangements were implemented to overcome delays experienced by patients and allied health providers when they claim the Medicare rebate for an allied health service where they have a valid referral, but where a claim for the CDM item(s) has/have not been processed.
It is important to note, however, that the eligibility requirements for these allied health services have not changed. Patients must still have a chronic medical condition and complex care needs and be managed by their GP under a GP Management Plan (MBS item 721) and Team Care Arrangements (MBS item 723). Where the patient is a resident of an aged care facility, the GP must have provided MBS item 731 by contributing to a care plan developed by the facility.
The Health Insurance (Allied Health Services) Determination 2008 still requires that:

  • Medicare benefits for allied health services be available only to eligible patients on referral from a GP;
  • the GP must first complete the necessary care planning services;
  • allied health services must be recommended in the patient’s care plans; and
  • allied health providers must have a signed referral form from a GP before they are legally able to provide allied health services that are eligible for a Medicare benefit. This form requires the GP to indicate the number and type of allied health services required. (Note that a specific referral form is prescribed by the Determination).

Allied health professionals cannot pre-empt the GP’s decision about the services required by the patient.
Medicare Australia audit and compliance activities will continue to ensure that GPs meet the requirements of these items before making referrals to allied health providers.
If there are any further questions about these changes, please contact Medicare Australia on 132 150 or the Department of Health and Ageing on (02) 6289 4297.

Chronic Disease Allied Health Services in Residential Aged Care Facilities - Eligibility for Medicare Rebates

All Commonwealth-funded residents of aged care facilities, regardless of their classification as high or low care, are eligible for Medicare rebates for up to five (5) allied health services (MBS items 10950 – 10970) each calendar year, where their GP has contributed to a multidisciplinary care plan prepared by the aged care facility and referred them for services.
However, while Medicare does not discriminate between high- and low-care residents, approved providers of residential aged care have different service obligations depending on the resident’s classification. Medicare allied health services should not replace services already expected to be provided to residents by the facility as a requirement under the Aged Care Act (1997).

High-care residents

High-care residents should not be routinely referred for allied health services under Medicare.
Under the Aged Care Act (1997), approved providers of residential aged care have an obligation, where an assessed care need has been identified, to provide allied health services to high-care residents at no additional cost to the resident:

  • except for intensive long term rehabilitation services following serious injury, surgery or trauma (see Schedule 1 to the Quality of Care Principles 1997 and Residential Aged Care Manual 2005).

High-care residents should therefore be already receiving allied health services, at no cost to them, through the aged care facility. It is important that approved providers of residential aged care continue to meet their obligations under the Act.

Low-care residents

Aged care facilities are required to assist low-care residents to access health practitioner and therapy services, including arranging for the practitioner or therapist to visit the home if necessary. While this level of assistance must be provided at no cost to the resident, the resident may be asked to bear the actual cost of the service. Therefore, low-care residents are most suited for referral to chronic disease allied health services under Medicare, where their GP has contributed to a multidisciplinary care plan using MBS item 731 and identified the need for these services.