Co-claiming of GP consults and CDM items banned

30 Oct 2014

In the 2013-14 Federal Budget the Government announced that it would be preventing GPs from claiming a GP standard consultation item and a GP Chronic Disease Management item for the same patient on the same day, effective from 1 November 2014.

As per the Explanatory Notes A.37 in in the Medicare Benefits Schedule, which can be downloaded from here, a restriction has been introduced to the Health Insurance (General Medical Services Table) Regulations to prevent co-claiming of GP consultation items with Chronic Disease Management items 721, 723 or 732 for the same patient on the same day. 

The GP consultation items affected are:

3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 597, 599, 598, 600, 5000, 5023, 5040, 5043, 5060, 5063, 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228.

From 1 November 2014, if a consult and CDM item (for example, items 23 and 721) are claimed together, performed on the same day by the same provider, only the CDM item will attract a Medicare benefit. Associated consult items will be rejected.

The AMA has strongly opposed this measure since it was announced and put forward an alternative solution to achieve the Government’s policy objective, without unfairly impacting on patients or GPs.