From 1 July 2025, changes to the Medicare Chronic Disease Management (CDM) items will come into effect, including updates to GP Management Plans and referral processes. These changes may affect allied health professionals. The following items were sought by Allied Health Professions Australia (AHPA) from the Department of Health and Aged Care, in response to questions raised by member professions.
Indexation of allied health items
Indexation will be applied to MBS allied health items from 1 July 2025 at a rate of 2.4%. These items fall under the “most of the General Medical Services items” category, as outlined on the 1 July 2025 MBS news page. Confirmation can be obtained by searching the relevant item numbers in the XML file on the MBS Online downloads page, or by referring to the Health Insurance Legislation Amendment (Indexation) Determination 2025 available on the Federal Register of Legislation—see 12 Subsection 11(1).
GP planning item limitations
There are no restrictions or dependencies between GP planning items. Patients who are eligible for more than one plan may have more than one, without timing or interaction limitations. These items represent separate treatment pathways.
GP referrals for M10 items
There is no change to existing arrangements. GPs may refer for assessment and treatment under the MBS M10 item group, but not for complex neurodevelopmental disorders. These require referral by a specialist or consultant physician in psychiatry or paediatrics. A complex neurodevelopmental disorder is defined as requiring support and showing impairment across two or more neurodevelopmental domains. If a patient is suspected of having an eligible disability (see MN.10.3), a GP may refer for allied health assessment and treatment services. Note that stuttering, speech sound disorder, and cleft lip and/or palate will be added to the list from 1 March 2026.
Valid referrals to allied health providers
Referrals must include either the address of the practice or the provider number of the practitioner at that location. These updated requirements align allied health referral arrangements with those already in place for referrals to medical specialists and are supported by current systems.
Referral validity and annual service limits
The total number of Medicare-supported allied health services per calendar year remains unchanged: up to five services annually (10 for Aboriginal and Torres Strait Islander peoples). This is independent of the date the care plan was prepared. Referrals are valid for 18 months from the first service provided, unless a different period is specified. This aligns with the new requirement that patients must have had their GP Chronic Condition Management Plan prepared or reviewed in the previous 18 months to access MBS-supported allied health services. Providers can check a patient's eligibility using the MBS items online checker as part of the Health Professional Online Services (HPOS). Patients can view their care plan history through their Medicare Online Account.
Number of services on referrals
Referrals are no longer required to specify the number of services. However, referring practitioners may still include this information if they choose. The revised framework promotes flexibility and patient choice. Referrals also no longer need to specify the name of the allied health provider. Both patients and providers will need to monitor service availability. For most patients, the number of services intended can be established at intake. Providers can check patient eligibility via HPOS tools. Patients can check their care plan history through their Medicare Online Account.
Reporting requirements for allied health providers
There are no changes to the reporting requirements. The reporting requirements set out in the Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 state: “after the service, the eligible provider [the allied health provider] gives a written report to the referring medical practitioner mentioned in paragraph (a):
- (i) if the service is the only service under the referral—in relation to that service; or
- (ii) if the service is the first or last service under the referral—in relation to that service; or
- (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters.”
Reports must be provided following the first and last services. For most patients, it will be possible to establish the number of services the patient intends to access under the referral at the point of intake. This will be based on their need to distribute services amongst different provider types, as reflected in their GPCCMP. The reporting frequency will therefore be clear, noting that allied health providers must also provide a report to the referring practitioner when there is a clinical need to do so. Associated changes to the GP items also promote more frequent reviews, allowing the GP to issue new referrals in response to the patient’s clinical needs. The 18-month validity for referrals mean that patients must return to their referring practitioner to obtain new referrals.
As has been the case under the existing items, there are occasions when the patient does not return for the planned number of services. The advice for these circumstances remains the same. If the provider suspects that the patient will not return, they should provide the final report to the referring provider. There is no consequence for over-reporting. If it is subsequently discovered that it was not the final visit there would be no consequence if another final report is written for the same patient. Referrals are required for MBS-supported allied health services regardless of how frequently the GP reviews the plan. Where there is a valid referral in place for a particular allied health service at the time the review is undertaken it is not necessary for the GP to issue a new referral at that time.
Tracking Medicare visits and provider choice
The new referral arrangements are designed to improve the transfer of relevant clinical information to whichever allied health provider the patient chooses to access. As is currently the case, a referral does not always correctly indicate the total number of services remaining in a calendar year, especially where a referral has been carried over more than one calendar year or where a patient has changed providers. Providers can check a patient’s eligibility for services using the MBS items online checker in HPOS Check MBS Item numbers - Health professionals - Services Australia or the care plan history in HPOS Patient details in HPOS - Health professionals - Services Australia. Patients can check their history using the care plan service history functions in their Medicare Online Account.