Medical practitioners can refer eligible patients with chronic diseases to allied health professionals. Allied health professionals can claim Medicare benefits for some services.
You can read about billing chronic disease individual allied health services.
These allied health professionals can provide services:
- Aboriginal health workers or Aboriginal and Torres Strait Islander health practitioners
- audiologists
- chiropractors
- diabetes educators
- dietitians
- exercise physiologists
- mental health workers
- occupational therapists
- osteopaths
- physiotherapists
- podiatrists
- psychologists
- speech pathologists.
To claim items for services the allied health professional must:
- attend the appointment in-person for at least 20 minutes
- treat the patient individually and not through group treatment.
If you’re an allied health professional, you can check your eligibility for Medicare benefits through the Medicare Benefits Schedule (MBS) items online checker in HPOS. You can also call Medicare.
Eligible patients can use 5 services per calendar year. The 5 services may be either:
- one type of service, for example 5 physiotherapy services
- a combination of different types of services, for example one dietetic and 4 podiatry services.
Patients are eligible for these allied health services if their medical practitioner has completed both:
- a General Practitioner Management Plan (GPMP)
- Team Care Arrangements (TCAs).
Patients in the community and permanent residents of a residential aged care facility (RACF) are eligible. Their medical practitioner must have previously contributed to at least one of the following:
- a multidisciplinary care plan prepared for them by the RACF if they are in an RACF
- a multidisciplinary care plan prepared for them by another medical practitioner if they are in the community
- a review of the care plan.
This includes when these patients are being discharged from hospital under the plan.
Hospital in-patients are not eligible for these services.
You can check patient eligibility in the Medicare Benefits Schedule (MBS) items online checker in HPOS.
You can also call Medicare.
The referring medical practitioner decides:
- the number and combination of services that are appropriate for the patient
- whether the patient’s chronic condition would benefit from allied health services.
It isn’t appropriate for allied health professionals to:
- provide a partly completed referral form to a referring medical practitioner for signing
- pre-empt the decision about the services that the patient requires.
Patients need a separate referral form for each allied health service type. The referral is valid for the number of services outlined in the referral. Patients and practitioners can only claim Medicare benefits for this number of services.
Medical practitioners must use the Department of Health and Aged Care referral form or a form that contains the same components.
The allied health professional should keep a copy of the referral form for 2 years.
The allied health professional must provide a written report to the referring medical practitioner after the first and last service. They can provide the reports more often if clinically necessary.
Reports should include all the following:
- investigations, tests and assessments carried out
- treatment provided
- recommendations on how to manage the patient’s condition in the future.