Medicare Chronic Disease Management

Medicare benefits are available for certain services provided by eligible allied health professionals.  Eligible people who have a chronic or terminal medical condition and complex care needs.  They are being managed by their GP using certain chronic disease management (CDM) Medicare items. The allied health services must be directly related to management of the patients chronic condition/s.

Medicare CDM Eligibility

Only the GP can determine whether the patient’s chronic condition would benefit from allied health services and the need for such services must be identified in the patient’s care plan.  A chronic medical condition is one that has been or is likely to be present for at least six months (e.g. asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke).

How can you access the Medicare CDM program?

Your GP must refer you under the Medicare CDM Scheme.  They will determine if you are eligible for CDM items and associated allied health items.  It is essentially a matter for the GP to determine, using their clinical judgment and taking into account both the eligibility criteria and the general guidance.

How many services are available through the Medicare CDM program?

Medicare benefits are available for up to five allied health services per eligible patient, per calendar year.  Services are bulk billed under the scheme, however out calls will incur a small gap fee.

Chronic Disease conditions and Exercise Physiology

The following conditions can be referred to an Accredited Exercise Physiologist registered with medicare

Cardiopulmonary – Myocardial Infarction, Coronary Artery Disease, Peripheral Vascular Disease, Hypertension, Chronic Obstructive Pulmonary Disease, Asthma

Metabolic – Obesity, Diabetes, Dyslipidaemias, Impaired Glucose Tolerance

Musculoskeletal – Osteoarthritis, Osteoporosis, Back Pain, Fibromyalgia

Neural – Motor Neuron Disease, Stroke, Spinal Cord Injury, Parkinson’s Disease, Multiple Sclerosis

If you believe you may qualify for team care arrangements (TCA) and would benefit from exercise physiology, it is best to discuss your eligibility with your general practitioner.  Download the referral form