Steps to be completed to claim Allied Health Services under Medicare

Step 1 – The patient has a chronic condition and complex needs and the need for referral to allied health professionals is identified. The GP prepares a GP Management Plan and Team Care Arrangements and discusses with the patient the care plan, the patient’s needs, the services to be provided by allied health professionals and the desired outcomes. 

Step 2 – The appropriate allied health professionals are contacted. With the patient’s consent, the general practice may provide them with a copy of the care plan to ensure that they agree and have the opportunity to provide input into the Care Plan and its aims. The GP can discuss, by two way communication (face-to-face, phone, fax, email etc), the services and treatments provided by each healthcare professional.                     

Step 3 – The GP notes in the TCAs the agreement of the AHPs to participate in the TCAs and the treatment and services they have agreed to provide. The AHPs sign off on the Care Plan, include any relevant comments and return the Care Plan to the general practice. 

Step 4 – On completion of Step 3, the patient may need to sign a Medicare form at the general practice. The patient is then given a ‘referral form for allied health services under Medicare’ that the patient needs to give to the AHPs to enable them to claim from Medicare.  The patient should be advised that while Medicare may pay some of the costs of services the patient may still have to pay some money as well – it is essential that the patient discuss this with the AHP before services are provided. The patient is eligible for up to five allied health consultations per calendar year under the Medicare CDM items.

Step 5 – The patient is eligible for treatment from the date specified on the allied health referral form. When Medicare has processed item numbers 721 and 723 the healthcare professional can claim the rebate for the services. 

Step 6 – The AHPs are to provide a report to the referring GP following the first and last service or more regularly if necessary.

Please note - Any consultations with the allied health professional prior to step 5 being completed are not rebateable under Medicare.

For further information visit the Medicare Quick Reference Guides web site:
www.medicareaustralia.gov.au/provider/business/education/quick-reference-guides.jsp