GP Referral (Medicare)

 REPS Movement has a $5 Gap on all Medicare services.

Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services

Click HERE for a referral form 

Summary

• A Medicare rebate is available for a maximum of five services per patient each calendar year. Additional services are not possible in any circumstances.
• If a provider accepts the Medicare benefit as full payment for the service, there will be no out-of-pocket cost. If not, the patient will have to pay the difference between the fee charged and the Medicare rebate.
• Patients must have a GP Management Plan and Team Care Arrangements prepared by their GP, or be residents of a residential aged care facility who are managed under a multidisciplinary care plan.
• Referrals to allied health providers must be from GPs.
• Allied health providers must report back to the referring GP.

The Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers. 

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS.

Patients who have a chronic medical condition and complex care needs and are being managed by their GP under a GP Management Plan (item 721) and Team Care Arrangements (item 723) are eligible for Medicare rebates for certain allied health services on referral from their GP.

Referrals for allied health services

If you have both a GPMP and TCAs prepared for you by your GP, you may be eligible for Medicare rebates for specific individual allied health services that your GP has identified as part of your care. The need for these services must be directly related to your chronic (or terminal) medical condition. If you have type 2 diabetes and your GP has prepared a GPMP, you can also be referred for certain allied health services provided in a group setting. 

Click here to be directed to Department of Health website.

Click here download patient information sheet

Group Allied Health Services under Medicare for Patients with Type 2 Diabetes - Patient Information

Click HERE for a referral form 

Summary

Maximum of one assessment service and eight group services per patient each calendar year, with out-of-pocket costs counting towards the extended Medicare safety net.

• Patients must have a GP Management Plan prepared by their GP.
• Your GP will decide whether you would benefit from these services and, if so, will refer you.
• Allied health providers must be registered with Medicare Australia.
• If a provider accepts the Medicare benefit as full payment for the service, there will be no out-of-pocket cost. If not, you will have to pay the difference between the fee charged and the Medicare rebate

Who is eligible?

Patients with a GP Management Plan

If you have type 2 diabetes and your GP has prepared a GP Management Plan, you may be referred for group allied health services to help you manage your diabetes.

Patients who will most benefit from group services are likely to be those who demonstrate a readiness to change, are able to contribute to group processes effectively and have a potential for self management.

Click here to be directed to Department of Health website.

Click here download patient information sheet.