Medicare chronic condition management plans and allied health

A patient arrives with a GP referral for Medicare-rebated physio, podiatry or dietetics under a chronic condition management plan. The rebate is real money to them, and getting it right is partly your job: the referral has to be valid, the service has to meet Medicare's requirements, the number of rebated sessions is limited, and the GP expects to hear back from you. Miss one and either the claim fails or the patient pays more than they were told.

This guide sets out how the arrangements work as a structure. Item numbers, rebate amounts and session limits are published on MBS Online, and the rules were reformed recently, so check the current explanatory notes before you rely on any detail here.

What changed in 2025

From 1 July 2025, GP Management Plans and Team Care Arrangements were replaced by a single GP chronic condition management plan. A patient with a chronic condition whose plan has been prepared or reviewed recently enough can be referred by their GP for Medicare-rebated individual allied health services. There is a transition: patients whose old-style plans were made before 1 July 2025 can keep using them until 30 June 2027, and a referral written before that date stays valid until its services are used. Check the current item descriptor and notes on MBS Online before you accept an older referral.

What the referral needs to show

The referral is your authority to provide rebated services, so read it before the first visit, not at the invoice. For referrals written since 1 July 2025, it is a letter rather than the old referral form, and it generally needs to show:

• Who the patient is
• The referring practitioner's name, and their practice address or their provider number at that practice
• The date of the referral, and the referring practitioner's signature (an electronic signature can count)
• The type of allied health service the patient is referred to; it does not have to name you
• The reasons for the referral, with the information about the patient's condition the GP thinks you need

A newer referral may state how long it lasts and how many services it covers, but it does not have to; MBS Online explains how long a referral lasts when no period is stated. Older referrals written before 1 July 2025 had to state the number of services. If something is missing or unclear, ask the GP's practice for a corrected referral before you claim, not after a rejection.

Session limits run per calendar year, across all providers

Medicare limits the number of rebated individual allied health services a patient can receive under these arrangements in a calendar year. The limit is shared across all eligible allied health disciplines combined, not set per discipline, and it runs on the calendar year rather than from the date of the plan. Confirm the current limit on MBS Online.

That has two practical consequences:

• The patient may have used sessions elsewhere. If they saw a podiatrist in March, your physiotherapy sessions draw on what is left. Ask at intake, and record what the patient tells you.
• Late-year referrals need a conversation. A patient referred late in the year may reach the annual limit partway through a course of treatment. Talk about it before you book the sessions, and check on MBS Online how the limit and the referral work across the new year.

Each service also has to meet the item's own conditions, such as being recommended in the patient's plan, provided to the patient individually, for at least the minimum time the item sets, by a practitioner registered with Medicare. Read the descriptor for your discipline's item.

Reporting back to the GP

The arrangements expect you to keep the referring GP informed in writing. The shape of the requirement is a written report after the first and the last service under the referral (or after the only service, if there is just one), and after any other service that involves something the GP would reasonably expect to be told. Confirm the current requirement in the item's explanatory notes on MBS Online.

A useful report is short:

• What you assessed and found, in plain terms
• Your goals and the treatment plan
• Progress against those goals, in later reports
• What you recommend next, including anything the GP should act on
• How many rebated sessions the patient has used with you

GPs read a lot of letters. A one-page report with a clear recommendation gets read; three pages copied from your notes do not.

Billing: bulk billing or a gap

You can bulk bill the service and accept the Medicare benefit as full payment, or charge your own fee and let the patient claim the rebate, leaving them a gap to pay. Either way, the invoice or receipt needs the details a claim depends on, such as the patient's Medicare number, your provider number, the referring GP, the referral date, the item and the date of service. Check rebate amounts on MBS Online, and remember that your fee is your decision while the rebate is not.

How AspireOS keeps track

In AspireOS, a Medicare (EPC) referral sits on the patient's case with its referral date, sessions and expiry. Each visit draws the case down, so you can see what is left at a glance, and you are warned before the referral expires. The count only knows the sessions delivered in your practice, so note what the patient tells you about other providers in their file. Bulk billing is supported, and each invoice names exactly what would stop the claim before it goes anywhere.

Online Medicare claiming through Tyro Health is awaiting Tyro's approval, so for now you lodge claims through your existing channel and use Reconcile to match what Medicare pays against your invoices. For the report back, the Letters register drafts progress letters from the record, and Updates due lists the GP updates owed so none slips through. See how AspireOS handles referrals and funding and the full feature list.

You can start free, set up a chronic condition referral on a test patient, and watch the case count down before your next real referral arrives.