How many CDM allied health sessions per year on Medicare?
Under the chronic condition management items, a patient can receive a maximum of 5 individual allied health services per calendar year, combined across all providers. A physiotherapy service, for example, is billed under item 10960. The 5-service cap is shared across all eligible allied health types; it is not 5 per profession.
MBS Online, item 10960
Services Australia, chronic condition management items
The 5-service annual cap
Medicare's chronic condition management allied health items allow up to 5 individual services in a calendar year. This total is shared across all allied health disciplines the patient sees, such as physiotherapy, podiatry, dietetics and exercise physiology. For instance, 3 physiotherapy and 2 podiatry sessions would use the full 5 for the year.
The referral requirement
The patient needs a GP chronic condition management plan and a written referral to the allied health provider. Each service must be consistent with that care plan. For item 10960, the service must be at least 20 minutes and relate to the patient's managed chronic condition.
The rebate
Each service attracts a Medicare benefit, and any amount charged above the rebate is paid by the patient. Schedule fees are indexed on 1 July each year, so confirm the current amount on MBS Online before quoting it.
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