Medicare – Chronic Disease Management Plans

The Chronic Disease Management (formerly Enhanced Primary Care or EPC) enables 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.

Patient Eligibility

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 general guidance

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.

Your GP may refer you for up to five (5) individual services or eight (8) group services

*Group services are for those with Type 2 diabetes and can be used in addition to the individual services.

*Exercise Physiology can be a claimable service under Medicare if your GP refers you to us for chronic disease management under a GP management plan. If you would like more information how to access these services under Medicare, please contact us or contact your GP for further information.