Important reminder about Chronic Disease Management billing

17 Nov 2016

Among the news updates in the Department of Human Services (DHS) November news for health professionals is an article about the important things for GPs to keep in mind when billing for Chronic Disease Management (CDM).

Chronic Disease Management (CDM) items let you plan and coordinate health care for patients diagnosed with chronic or terminal medical conditions. It’s important to bill the correct item for CDM patients to receive the correct amount from Medicare.

If you claim both an attendance item and a CDM item for the same patient on the same day, you’ll only be paid for the CDM item. If your patient needs to see a different GP on the same day, Medicare benefits are still paid to that GP.

This rule prevents co-claiming of GP attendance items:

3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 597, 599, 598, 600, 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228

with CDM items:

721, 723 or 732

by the same health professional for the same patient on the same day.

A patient’s eligibility for CDM under Medicare hasn’t changed. For more information about the billing process for CDM patients go to the following guides for health professionals on the DHS website:

Education Guide: Chronic Disease GP Management Plans and Team Care Arrangements

Education Guide: Chronic Disease Management services to support Indigenous health

There is also an education page to support a better understanding of Medicare and PBS requirements.