GPCCMP FAQ - Specific Patient Groups &amp; Edge Cases

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How have medication review arrangements changed now that GPCCMP is in place?

The Bottom Line:

While the core Domiciliary Medication Management Review (DMMR) items themselves haven't changed, the main shift is that from July 1, 2027, a patient will need a GPCCMP to access these services. This solidifies the GPCCMP as the central framework for chronic condition management, including structured medication reviews with substantial fees justifying the comprehensive approach.

The Facts:

From 1 July 2027, a GP Chronic Condition Management Plan (GPCCMP) will be required to access domiciliary medication management reviews (MBS items 245 and 900)
This requirement is in addition to the existing criteria for MBS items 245 and 900
Patients with a GPMP and/or TCA in place prior to 1 July 2025 can continue to access these services under those plans until 30 June 2027
The DMMR process remains the same: GP assessment, referral to community pharmacy or accredited pharmacist, discussion of results, development of written medication management plan, and provision to patient's chosen pharmacy
Services are claimable once every 12 months per patient, with exceptions for significant changes in condition or medication regimen

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Are there any other MBS services that now require a GPCCMP — or are expected to soon?

The Bottom Line:

Beyond the main chronic disease management changes, the GPCCMP requirements are quite focused. From July 2027, you'll need a GPCCMP for ongoing allied health services and domiciliary medication management reviews, but that's essentially it.

The Facts:

From 1 July 2027, a GP chronic condition management plan will be required for ongoing access to allied health services
From 1 July 2027, a GP chronic condition management plan will be required to access domiciliary medication management reviews (items 245 and 900)
These changes do not affect multidisciplinary care plan items (231, 232, 729, 731, 92026, 92027, 92057, 92058)
Individual allied health services (up to 5 per calendar year, 10 for Aboriginal and Torres Strait Islander patients) require a GPCCMP that has been prepared or reviewed in the previous 18 months
Group allied health services for type 2 diabetes management continue to be available with a GPCCMP
Practice nurse and Aboriginal and Torres Strait Islander health practitioner services (items 10997, 93201, 93203) require a GPCCMP and are limited to 5 services per calendar year
Aboriginal and Torres Strait Islander health services (items 10950, 81300, 93000, 93013, 93048, 93061) are available to patients with a GPCCMP, with fees of $72.65 and 85% benefit ($61.80) for most services

Sources: RACGP Summary of changes to Chronic Disease Management (CDM) Framework, page 2; Upcoming Changes to Chronic Disease Management Framework – Overview – Factsheet, page 2; MBS Online explanatory note AN.15.3; MBS Online explanatory note AN.15.5, AN.15.6

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What happens to the 8 group sessions for Type 2 Diabetes under the new system?

The Bottom Line:

Patients with a GPCCMP can continue to access group services for type 2 diabetes management. The 8 sessions per calendar year remain available across dietetics, diabetes education, and exercise physiology services, with assessment fees of $93.25 and individual group session fees of $23.20, ensuring these vital services continue uninterrupted under the new framework.

The Facts:

Patients can access up to 8 group services for the management of type 2 diabetes per calendar year
This access is provided following an assessment of their suitability for group dietetics, diabetes education, or exercise physiology services
These services are available where they are consistent with the patient's GPCCMP
The item descriptors for these services have been updated due to the removal of GPMPs and TCAs, and the commencement of GPCCMPs
Assessment for group services (items 81100, 81110, 81120) has a fee of $93.25 with 85% benefit ($79.30), payable once per calendar year
Individual group sessions (items 81105, 81115, 81125) have a fee of $23.20 with 85% benefit ($19.75), to a maximum of 8 sessions per calendar year
Services are provided to groups of 2-12 patients and require at least 60 minutes duration
Group services are available for patients with type 2 diabetes who have either a GPCCMP or are residents of an aged care facility with a multidisciplinary care plan

Sources: Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, page 2; MBS Online explanatory note AN.15.3; MBS Online explanatory note AN.15.5, AN.15.6, MN.9.1, MN.9.2

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How do GPCCMP changes affect specialised clinics (skin cancer, aesthetics, etc.)?

The Bottom Line:

The GPCCMP framework is specifically designed for the structured management of chronic medical conditions that are long-term or terminal. Since specialised clinics like skin cancer or aesthetics generally fall outside the scope of chronic condition management as defined by the MBS, these clinics are unlikely to be directly affected by the GPCCMP requirements.

The Facts:

A GPCCMP is available to patients with at least one medical condition that has been (or is likely to be) present for at least 6 months or is terminal
It is up to the GP or PMP's clinical judgment to determine whether an individual patient with a chronic condition would benefit from a GPCCMP
The GPCCMP framework specifically targets chronic disease management and associated allied health services
There is no specific list of eligible conditions; clinical judgment determines appropriateness based on the chronic nature and management benefit

Sources: Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, page 3; Upcoming Changes to Chronic Disease Management Framework – Overview – Factsheet, page 2; MBS Online explanatory note AN.0.47; MBS Online explanatory note AN.15.3, AN.15.4

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How do we handle NDIS or DVA patients under the new GPCCMP structure?

The Bottom Line:

The new GPCCMP framework streamlines chronic disease management by replacing the old GPMP and TCA items. The good news is that these changes do not affect other MBS-supported allied health services such as Mental Health Treatment Plans or DVA services, which continue under their existing frameworks and item numbers, maintaining separate pathways for these specific patient groups.

The Facts:

The GPCCMP requirements do not apply to other MBS-supported allied health services such as Mental Health Treatment Plans, Eating Disorder Plans, Palliative Care, and DVA services
These other plans remain under their existing frameworks and item numbers
Specifically, the new referral requirements do not apply to Better Access psychological therapy services, focussed psychological strategies (allied mental health) services, eating disorder allied health services, or diagnostic audiology services
NDIS patients may still benefit from GPCCMPs for chronic condition management where clinically appropriate, but their NDIS-funded services continue under existing arrangements
The GPCCMP framework operates parallel to, rather than replacing, other specific health service frameworks
Patients with mental health conditions or eating disorders may be eligible for treatment through the Better Access mental health items or eating disorder items, which have specific eligibility criteria detailed in item-specific explanatory notes

Sources: Upcoming Changes to Chronic Disease Management Framework – Referral Arrangements for Allied Health Services – Factsheet, page 3; MBS Online explanatory note AN.15.3; MBS Online explanatory note AN.0.56, AN.36.2, AN.15.6

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Do the changes affect multidisciplinary care plan items or other multidisciplinary services available to patients?

The Bottom Line:

These changes do not affect existing multidisciplinary care plan items (like those for residential aged care facilities), which continue under their current framework with fees of $65.70 for PMPs and $82.10 for GPs.

The Facts:

The changes to the chronic disease management framework do not affect multidisciplinary care plan items (231, 232, 729, 731, 92026, 92027, 92057, 92058)
GPCCMPs are not available to patients in residential aged care facilities; allied health services for these patients are available through a multidisciplinary care plan
The requirement to consult with at least two collaborating providers, as described under the current Team Care Arrangements, will be removed
There is no requirement for allied health providers to confirm acceptance of the referral or provide input into the preparation of the GPCCMP
Multidisciplinary care plans allow the general practitioner/prescribed medical practitioner to contribute to a plan which may be coordinated by another provider
Items 232, 731, 92027 and 92058 are available for patients living in a residential aged care facility; items 231, 729, 92026 and 92057 are available for patients not in residential aged care

Sources: RACGP Summary of changes to Chronic Disease Management (CDM) Framework, page 2; Upcoming Changes to Chronic Disease Management Framework – Referral Arrangements for Allied Health Services – Factsheet, pages 1, 3; Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, pages 1, 3, 4; Upcoming Changes to Chronic Disease Management Framework – Overview – Factsheet, page 2; MBS Online explanatory note AN.15.3; MBS Online explanatory note AN.15.7, AN.15.8

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Can a GPCCMP be created for emergency or urgent chronic condition management needs?

The Bottom Line:

While the GPCCMP is designed for a structured, ongoing approach to chronic conditions, the good news is that a plan can be prepared or reviewed earlier than the usual timeframe if exceptional circumstances apply. This built-in flexibility allows you to adapt to urgent situations where a new plan or review is clinically relevant outside the typical 3-month or 12-month intervals, with full fee entitlements maintained.

The Facts:

Unless exceptional circumstances apply, a GPCCMP can be prepared once every 12 months if it is clinically relevant
Reviews can be conducted once every 3 months, if clinically relevant, unless exceptional circumstances apply
Plans may be prepared or reviewed earlier if exceptional circumstances apply
The MBS fee structure remains the same regardless of timing: $156.55 for GPs and $125.30 for PMPs for both preparation and review
Clinical relevance and exceptional circumstances are determined by the GP or prescribed medical practitioner's professional judgment

Sources: RACGP Summary of changes to Chronic Disease Management (CDM) Framework, page 2; Upcoming Changes to Chronic Disease Management Framework – MBS Items for GP Chronic Condition Management Plans – Factsheet, pages 2, 4; Upcoming Changes to Chronic Disease Management Framework – Overview – Factsheet, page 2; MBS Online explanatory note AN.0.47; MBS Online explanatory note AN.15.3, AN.15.4

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