CDM MBS Items
CDM MBS Item 721 – GP Management Plan (GPMP)
For patients who have a chronic or terminal condition without multidisciplinary needs who would benefit from a structured care approach.
Who is eligible?
This service can be provided to:
• Patients in the community
• Private in-patients (including residents of an aged care facility) being discharged from hospital, where a GP from their usual practice prepares the GPMP. In this case the GPMP is claimed as an in-hospital service (Medicare rebate 75% of the schedule fee).
This service is not available to:
• Public in-patients being discharged from hospital
• Residents living in an aged care facility.
MBS frequency and minimum claiming periods
Medicare Fee (100% from 1st November 2005) : $127.70
Recommended Frequency : 2 yearly
Minimum claiming Period : 12 months* (see "*Exceptiopnal circumstances" below)
The recommended frequency of this service is once every two years, with regular reviews of the patient’s progress against the plan, except in the discharge setting, where a new GPMP may be required following separate hospital admissions.
CDM MBS Item 723 – Team Care Arrangement (TCA)
For patients with a chronic or terminal medical condition and who require ongoing care from a multidisciplinary team of at least three health or care providers (including their GP).
Who is eligible?
This service can be provided to:
• Patients in the community;
• Private in-patients (including residents of an aged care facility) being discharged from hospital, where a GP from their usual practice is coordinating the development of the TCA and providing in-patient care.
• Patients who have a current GPMP or to those patients whose care is, in the opinion of the providing GP, appropriately managed at the GP level without a GPMP.
This service is not available to:
• Public in-patients being discharged from hospital;
• Residence of aged care facilities (except where they are private in-patients being discharged).
MBS frequency and minimum claiming periods
Medicare Fee (100% from 1st November 2005): $101.15
Recommended Frequency: 2 yearly
Minimum claiming Period: 12 months* (see "*Exceptiopnal circumstances" below)
The recommended frequency of this service is once every two years with regular review of the patient’s progress against the TCA. However in the discharge setting a new TCA may be required following separate hospital admissions
CDM MBS Item 725 – GPMP Review
For patients who have a current GPMP in place that will benefit from a review of that GPMP. A review is the principal mechanism for ensuring the continued appropriateness of the GPMP and the management of the patient’s chronic condition.
Who is eligible?
This service is available to:
• patients in the community
• Review GPMPs prepared for private in-patients (including private in-patients who are residents of aged care facilities) being discharged from hospital; in most cases such post-discharge reviews would be undertaken when the patient is living in the community setting.
This item also applies to:
• A multidisciplinary community care plan to which item 720 applies, or
• A multidisciplinary discharge care plan to which item 722 applies, prepared by that GP
However, it is not a service associated with a service to which items 734 to 779 apply.
MBS frequency and minimum claiming periods
Medicare Fee (100% from 1st November 2005) : $63.85
Recommended Frequency : 6-monthly
Minimum claiming Period : 3 months* (see "*Exceptiopnal circumstances" below)
CDM MBS Item 727 – TCA Review
For patients who have a TCA in place who will benefit from a review of the TCA.
Who is eligible?
This service is available to:
• patients in the community
• Review TCAs prepared for private in-patients (including those private in-patients who are residents of aged care facilities) being discharged from hospital; in most cases such post-discharge reviews would be undertaken when the patient is living in the community setting.
This item also applies to:
• A multidisciplinary community care plan to which item 720 applies, or
• A multidisciplinary discharge care plan to which item 722 applies, prepared by that GP
However, it is not a service associated with a service to which items 734 to 779 apply.
MBS frequency and minimum claiming periods
Medicare Fee (100% from 1st November 2005) : $63.85
Recommended Frequency : 6-monthly
Minimum claiming Period : 3 months* (see "*Exceptiopnal circumstances" below)
Exceptional circumstances
A.30.51 There are minimum time intervals for payment of rebates for EPC chronic disease management items (as detailed above), with provision for claims to be made earlier than these minimum intervals in exceptional circumstances. 'Exceptional circumstances' apply where there has been a significant change in the patient's clinical condition or care circumstances that require a new GPMP or TCA or a new review, rather than, for example, amending the existing GPMP or TCA.
A.30.52 Where a service is provided in exceptional circumstances, the patient's invoice or Medicare voucher (assignment of benefit form) should be annotated to briefly indicate the reason why the service involved was required earlier than the minimum time interval for the relevant item (eg annotated as clinically indicated, discharge, exceptional circumstances, significant change etc).
CDM MBS Item 729 – Contribution by a GP to a multidisciplinary care plan or review prepared by another provider
This item is for patients who are having a multidisciplinary care plan (which may include TCA) prepared or reviewed for them by another health or care provider (i.e. other than their usual GP).
Who is eligible?
This service can be provided to:
• patients in the community
• Private in-patients being discharged from hospital
• Public in-patients being discharged from hospital
This service is not available to:
• Patients who are residents of aged care facilities (see item 731)
MBS frequency and minimum claiming periods
Medicare Fee (100% from 1st November 2005) : $62.30
Recommended Frequency : 6-monthly
Minimum claiming Period : 3 months* (see "*Exceptiopnal circumstances" below)
CDM MBS Item 731 – Contribution by a GP to a multidisciplinary care plan or review prepared by another provider for residents in aged care facilities
This item is for a patient whom is a resident of an aged care facility that is having another health or care provider (i.e. other than their usual GP) contribute to a multidisciplinary care plan or review.
Who is eligible?
This service can be provided to:
• Residents of aged care facility only
MBS frequency and minimum claiming periods
Medicare Fee (100% from 1st November 2005) : $62.30
Recommended Frequency : 6-monthly
Minimum claiming Period : 3 months* (see "*Exceptiopnal circumstances" below)
* Exceptional circumstances
There are minimum time intervals for payment of rebates for EPC chronic disease management items, with provision for claims to be made earlier than these minimum intervals in exceptional circumstances. “Exceptional circumstances” apply where there has been a significant change to the patient’s clinical condition or care circumstances that require a new GPMP or TCA or a new review, rather than, for example, amending the existing GPMP or TCA.
