For practices in Australia

GP Chronic Condition Management Plans: What Allied Health Practices Need to Know

Since 1 July 2025, the GP chronic condition management plan (GPCCMP) has replaced GP Management Plans (GPMPs) and Team Care Arrangements (TCAs) as the way patients with a chronic condition get Medicare-rebated allied health services. Many clients, and plenty of GPs, still call it a "care plan", "CDM" or "EPC plan". For your practice, the important parts are what counts as a valid referral, how many services Medicare will rebate, how long referrals and plans last, and what you have to send back to the GP.

This guide covers each of those from the allied health side. It's based on MBS Online and Services Australia guidance as at November 2026. MBS rules and fees change, so check the current item descriptors and notes before you rely on any detail.

What changed with the chronic condition management plan

The short version:

• One plan instead of two. GPs and prescribed medical practitioners now prepare a single GPCCMP. The old GPMP (item 721) and TCA (item 723) items, and their review items, ended on 30 June 2025.
• No team care step. The GP no longer has to collaborate with two other providers, and you don't have to confirm you'll be part of the patient's care team.
• Referral letters, not forms. Referrals written from 1 July 2025 are letters, like specialist referrals. The old "Referral form for chronic disease allied health services under Medicare" is no longer used.
• No named provider or session count required. A referral to "physiotherapy" can be taken to any eligible physiotherapist, and the GP doesn't have to say how many services.
• 18-month rules. New referrals last 18 months from the first service unless the GP states otherwise, and the patient's plan must have been prepared or reviewed in the last 18 months.

What hasn't changed: the services themselves, the 5-service yearly cap, the 20-minute minimum, and your obligation to report back to the referring GP.

Who can provide services, and the item numbers

These individual allied health items (MBS Group M3) can be claimed under a GPCCMP, a transitional GPMP and TCA, or a multidisciplinary care plan for a resident of a residential aged care home:

Video services are claimed under item 93000 and phone services under 93013, for every profession. Each service must be with the patient individually and last at least 20 minutes. You need a Medicare provider number at the location, and some professions need specific accreditation or credentialing to claim. Hospital in-patients aren't eligible. The service must also be recommended in the patient's plan. You won't always see the plan, so if a referral seems to fall outside it, check with the referring GP.

From 1 July 2026 the schedule fee for these items is $74.55, with a Medicare benefit of $63.40 (85%). Fees are indexed, so check MBS Online for the current amounts.

Psychologists should note that item 10968 is separate from Better Access. A client on a mental health treatment plan is referred under different rules and has different session limits.

What a valid referral letter must contain

For referrals written on or after 1 July 2025, the referral must:

• be in writing
• include the referring practitioner's name
• include the practice address, or the practitioner's provider number at that practice
• include the date the referral was made
• be signed (an electronic signature is fine) and dated
• explain the reason for the referral, including any information about the patient's condition the GP thinks you need
• state how long it's valid, if the GP wants something other than the default 18 months

It doesn't need to name you, and it doesn't need to say how many services. If the GP chooses to state a number of services, that's allowed.

A few rules that catch practices out:

• A referral is for one profession. A physiotherapy referral can't be used for chiropractic or exercise physiology, even if the plan mentions both.
• Anyone in your practice of the same profession can use it. If the treating OT is away, another eligible OT can see the client under the same referral. Whoever provides the service is responsible for any report that's due.
• There's no emergency exception. Unlike specialist referrals, a written referral must exist before you provide the service.
• Lost referrals. You can still provide the service if the referral was lost, stolen or destroyed, but this is meant to be rare. Record "lost referral" in place of the referral details.
• Don't write the referral for the GP. Services Australia says it isn't appropriate for allied health providers to give a GP a partly completed referral to sign, or to pre-empt what services the patient needs. Asking a client to request a referral is fine.
• You don't have to accept a referral, subject to anti-discrimination law. If you can't take the client on, let the referring GP know.

The full requirements are in MBS note AN.15.6.

How many Medicare-rebated services a patient can get

An eligible patient can claim up to 5 individual allied health services per calendar year (1 January to 31 December). The cap covers:

• every allied health profession combined, so 2 podiatry and 3 dietetics visits use the full 5
• face-to-face, video and phone services
• every practice the client attends, not just yours

Aboriginal and Torres Strait Islander patients can get up to 10 individual services a year (the extra 5 under Group M11). Patients with type 2 diabetes can also get one assessment for group services and up to 8 group sessions a year (items 81100 to 81125), on top of individual services.

If a referral or plan covers more services than Medicare will rebate, the patient decides which ones to claim. Get informed financial consent before the session, and remember a patient can't claim the same service from both Medicare and their private health fund.

You can check whether a patient is still eligible for a rebated service through the MBS items online checker in HPOS, or by calling the Medicare provider line. Clients can also see their claims in their Medicare online account through myGov.

The two 18-month rules

There are two separate 18-month clocks, and both have to be running for a service to be rebated.

1. The referral. Unless the GP states a different period, a referral is valid for 18 months from the date of the first service you provide under it, not the date it was written.

2. The plan. The patient's GPCCMP must have been prepared or reviewed by their GP in the last 18 months at the time of your service. Patients registered with a practice through MyMedicare get their plan from that practice.

They can run out at different times. Say a GP prepares a client's plan on 3 March 2026 and writes a physiotherapy referral on 10 March, and the first physio session is 20 March 2026:

• the referral is valid until around 20 September 2027
• but unless the GP reviews the plan, it falls outside the 18-month window in early September 2027

So the plan lapses first. Sessions after that won't be rebated until the GP reviews it, even though the referral is still current. Recording both dates for each client lets you prompt them to see their GP before the gap, rather than finding out at claiming.

Transition rules for GPMP and TCA patients

Clients whose plans were put in place before 1 July 2025 are covered by transition rules (AN.15.5):

• Old plans work until 30 June 2027. A patient with a GPMP and TCA made before 1 July 2025 can keep accessing services consistent with those plans until then. They don't need a new plan when the calendar year resets.
• Old referrals stay valid until used. A referral on the old form, written before 1 July 2025, stays valid until all the services it specifies have been provided. You can accept one from a new client.
• New referrals under old plans are letters. Any referral written since 1 July 2025 must meet the new requirements, whichever plan it sits under.
• GPMPs and TCAs can't be reviewed. If a client's needs change, the GP should prepare a new GPCCMP.
• 1 July 2027 is a hard stop. From that date, a client needs a GPCCMP (or a multidisciplinary care plan) to keep accessing rebated allied health services. Services left on an old referral can't be claimed after that date without one.

With the deadline under a year away, it's worth finding every active client still on a GPMP or TCA now, and asking them to book a GP appointment well before July 2027.

Claiming and reporting back to the GP

Claiming

Use the item for your profession, or 93000 or 93013 for video or phone. Whether you bulk bill or the client claims their rebate, the account or claim must show the referring practitioner's name, their provider number or practice address, and the date of the referral. Services Australia's billing rules for chronic condition items list the items and conditions.

Written reports

You must send a written report to the referring GP after:

• the first service under a referral
• the last service under a referral
• the only service, if there's just one
• any service involving matters the GP would reasonably expect to be told about

The report should cover any investigations, tests and assessments, the treatment provided, and your recommendations for future management. Keep a copy: documents created to meet an MBS item's requirements must be kept for at least 2 years, and the referral should be kept too in case of a compliance check.

Because referrals no longer state a number of services, "the last service" isn't always obvious. Practical triggers are discharge, the client using their last rebated service for the year, or the referral nearing its expiry. A letter template for initial and discharge reports keeps them consistent and quick to send.

How to track each client's remaining sessions

Most billing mistakes with these plans come from not knowing where a client is up to. For every client referred under a chronic condition management plan, record:

• Plan type: GPCCMP, or GPMP and TCA under transition (and that it ends 30 June 2027)
• Plan date: when it was prepared or last reviewed
• Referring GP: name, provider number or practice address
• Referral: date written, any stated validity or number of services, and a copy of the letter
• First service date: this starts the referral's 18 months
• Services used this calendar year: at your practice, plus any the client tells you they've had elsewhere
• Reports: dates of the first and last reports to the GP

Then check before each appointment, not after:

1. Is the plan within 18 months of preparation or review?
2. Is the referral still valid, and for your profession?
3. Does the client have rebated services left this calendar year? For clients who also see other providers, check the MBS items online checker in HPOS.
4. If not, has the client agreed to pay a private fee?

Caspen's Cases are built for this. Create a case for each referral with its issue and expiry dates and an allowance of appointments set to the rebated services the client has left this calendar year, link the referring GP, and attach the referral letter. Appointments are tracked against the allowance automatically, you choose whether missed or cancelled appointments count, and alerts tell the right people when sessions are running low or the referral is about to expire.

Where to check the rules

• Services available under a GP chronic condition management plan (Services Australia)
• MN.3.1: individual allied health services for chronic conditions (MBS Online)
• AN.15.6: referral requirements (MBS Online)
• AN.15.5: transition arrangements (MBS Online)

For interpretation questions, the Department of Health, Disability and Ageing answers MBS queries at askMBS@health.gov.au, and Services Australia handles billing questions on the provider enquiry line, 13 21 50.

Want referrals, session counts and GP letters in one place? Start a free Caspen trial and track your first chronic condition referral as a case.