Item Optimisation overview

The Item Optimisation cabinet looks at your whole database of patients with a potential service opportunity, including those with an appointment and those without a future appointment. Use it to build a list of patients who may be eligible for specific services, review the list with their Practitioner, then contact them to book.

To find it, go to Planning and growth > Item optimisation.

In this article

• How Item Optimisation works
• Item Opportunities:
  • Chronic Condition Management
  • Health Assessments
  • Other opportunities
• Using the Summary tab
• Using Item Optimisation in your practice
• Additional resources
  
  

Practice managers, Receptionists, and Nurses can use this cabinet regularly to:

• Choose the service opportunities you want patient lists for
• Export the list to discuss with the relevant Practitioner
• Contact patients to book their appointment

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How Item Optimisation works

Eligibility is based on patient demographics and previous billings of face-to-face, telehealth, telephone, and non-VR item numbers at your practice. The cabinet has two tabs:

Tab	What you'll see	Best for
Item Opportunities	One metric per service item (for example, CCMPs, Health Assessments, and Nurse items), each with its own patient list	Working through one service type at a time
Summary tab	One consolidated row per patient, showing every opportunity they may be eligible for	Seeing the full picture for a patient, or coordinating follow-up across your team

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Item Opportunities

Each row in the tables below is a metric in the cabinet. Click into a metric to filter it and see the full list of potentially eligible patients.

Chronic Condition Management (CCM)

Each metric is a tile in the cabinet. Click into one to see the full list of potentially eligible patients and apply filters.

Metric	What it finds	Good to know	PMS
New CCMP	Patients who may be eligible for item 965 (CCMP), based on historical billings	Patient record is active. They have been billed a 721, 723, or 965 in the past, but not a 965 in the last 18 months or a 967 in the last 3 months	BP, MD, ZM
CCMP Review	Patients who may be eligible for item 967 (CCMP Review), based on historical billings	Patient record is active. They have been billed a 965 or 967 in the last 18 months, but not a 965 or 967 in the last 3 months	BP, MD, ZM
Potential new CCMP	Patients with an underlying condition who may be eligible for a care plan	Based on conditions in the patient's active past history and observations. Includes patients who have never had a care plan (GPMP, TCA, or CCMP), or haven't been billed for a care plan or review in the last 2 years. See the conditions we look for below	BP only

Conditions used for Potential new CCMP

Our search looks broadly at: blood cancer diagnosis (within the last 5 years), bone marrow transplants (within the last 2 years), chronic liver disease, chronic renal failure, coronary heart disease or failure, diabetes, haemoglobinopathies, high BMI, neurological conditions, transplant with immunosuppressant use, and non-haematological cancer diagnosed in the last year.

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Health Assessments

There are four time-based MBS health assessment items: 701 (brief), 703 (standard), 705 (long), and 707 (prolonged). Medical practitioners (other than a specialist or consultant physician) can use them for the assessments below. For the full process, see the Health assessment workflow.

Metric	What it finds	Good to know	PMS
75+ health assessment - time-based	Patients aged 75+ with no time-based Health Assessment billed at your practice in the last 12 months	Can be done every 12 months, so make it an annual recurring appointment. Booking it around the patient's birthday makes an easy reminder.	BP, MD, ZM
Aboriginal and Torres Strait Islander health assessment - Item 715	Aboriginal and Torres Strait Islander patients with no 715 Health Assessment in the last 9 months	Patients can have a 715 every 9 months, so it works well as a recurring appointment. Use this together with the 10987 nurse items for best patient outcomes.  More on the 715 health assessment is on the Department of Health and Aged Care website.	BP, MD, ZM
40-49 Diabetes risk health assessment - time-based	Patients with an AUSDRISK assessment in the past 3 months scoring 12+ (high risk)	Ages 40-49 (inclusive), or 15-54 (inclusive) for Aboriginal and Torres Strait Islander people. Patients who have had a 40-49 Diabetes Health Assessment in the past 3 years, or an item 699 in the past 12 months, are excluded from this list.  For the AUSDRISK tool, see The Australian Type 2 Diabetes Risk Assessment Tool.	BP only
45-49 health assessment - time-based	Patients aged 45-49 at risk of developing a chronic disease, with no Health Assessment billed since turning 45	Patients who have not had a Health Assessment billed since they turned 45. A patient is eligible for a 45-49 health assessment if they have a risk factor that puts them at risk of developing a chronic disease. This will exclude patients who have had a CCMP in the past, or who have been billed an item 699 in the past 12 months. See risk factors below.	BP only
Heart Health Check - Item 699	Patients eligible for item 699 with no time-based Health Assessments in the past 12 months	The Heart Foundation toolkit can help build heart health checks into routine care	BP, ZM
Menopause HA - Item 695	Female patients with an active record, no item 695 in the past 12 months, and a relevant symptom, diagnosis, or treatment	See the full criteria below , and the Menopause and perimenopause health assessment guide	BP only
Medicare Healthy Kids Check - time-based	Patients aged 3 with no time-based Health Assessment billed since their 3rd birthday	Patients are eligible from their 3rd birthday until their 4th, once per child. Use the Medicare Healthy Kids Check list to book a dedicated visit around a patient's third birthday, and check the MBS Online factsheet for the mandatory components.	BP, MD, ZM

Risk factors for the 45-49 Health Assessment

Risk factors may include, but are not limited to:

• Lifestyle: smoking, physical inactivity, poor nutrition, or alcohol use
• Biomedical: high cholesterol, high blood pressure, impaired glucose metabolism, or excess weight
• Family history of chronic disease

Menopause and perimenopause (item 695) criteria

A patient may show on this list if their record is active, their birth sex is female, they haven't been billed an item 695 in the past 12 months, and they are experiencing or being treated for any of: premature ovarian insufficiency, menopause, early menopause, perimenopause, menorrhagia, post menopausal bleeding, oligomenorrhoea, dysmenorrhoea (primary or secondary), amenorrhoea (primary, secondary, or post pill), menstrual irregularity, flushing, ovarian failure (primary and secondary), dysfunctional uterine bleeding, menopause hormone therapy, surgical menopause, oophorectomy, salpingo-oophorectomy, salpingo-oophorectomy (laparoscopic), abdominal hysterectomy with bilateral salpingo-oophorectomy, or oestrogen replacement therapy.

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Other potential opportunities

Metric	What it finds	Good to know	PMS
Item 10997	Patients who may be eligible for item 10997	Based on billing history at your practice: 721, 723, or 732 billed before 1 July 2025, a 965 or 967 in the past 18 months, or a multidisciplinary care plan (731) in the last 18 months. Excludes patients with 5 or more 10997s this calendar year and those rejected for a 10997 this calendar year. Click here to see MBS Eligibility	BP, MD, ZM
Item 10987	Patients who may be eligible for item 10987	Patients with an item 715 billed in the past 12 months and fewer than 10 x 10987s this calendar year. Click here to see MBS Eligibility	BP, MD, ZM
Item 731	Patients who may be eligible for item 731 (GP contribution to a multidisciplinary care plan for an RACF resident or a patient being discharged from hospital)	Patients with a previous item 731 billed (including Telehealth, Telephone, and non-VR equivalents), but not in the past 3 months. Click here to see MBS Eligibility	BP, MD, ZM
Medication Management Review - DMMR and RMMR	Patients who may be due a medication management review	Patients are eligible if they were last billed an item 900, 903, or equivalent DVA or prescribed medical practitioner item more than 12 months ago (irrespective of current medications), or are currently on 5 or more medications**. See the Medication management review workflow **The 5+ medications criteria is only available to Halo customers (Bp) and requires clinical consent.	BP, MD
Mental Health Treatment Plan - 2700, 2701, 2715, 2717	Patients with previous MHTP billings who may be due a new plan	Patients who (based on historical billings) may be eligible for a Mental Health Treatment Plan (MHTP). This excludes patients who have had a MHTP in the past 12 months. See the Mental health treatment plan workflow	BP, MD, ZM
Patients who have an active Mental Health Treatment Plan	Patients with an MHTP billed in the last 12 months	Patients who (based on historical billings) have had a Mental Health Treatment Plan (MHTP) billed in the past 12 months and may need a consult for review. Note: MHTP review items are billed as a standard consult item.	BP, MD, ZM
DVA CVC Program - UP01, UP02, UP03, UP04	DVA Gold and White Card holders who may have a chronic disease and have no CVC item billed in the past 90 days	A chronic disease is assumed if they've previously had a Chronic Disease Management or Chronic Condition Management item billed. See the DVA CVC program workflow and the DVA website	BP, MD
Patients who may be eligible for lung cancer screening - attendance item	Patients who may be eligible for lung cancer screening	May include patients who have already been screened or diagnosed. Ex-smokers are not included. See the criteria below.	BP only
Eating Disorder Treatment and Management Plan - 90250, 90251, 90252, 90253 + telehealth equivalents	Patients who may be eligible for an Eating Disorder Treatment and Management Plan (EDTMP)	Patients with no EDTMP billed in the past 12 months (or never billed) who meet the eligibility criteria below. Cubiko can't confirm eligibility, so a Practitioner needs to investigate further	BP only
Eating Disorder Treatment and Management Plan Review  - 90264 + telehealth equivalents	Patients who may be eligible for a review of their existing EDTMP	After an EDTMP is provided, it must be managed and reviewed over the next 12 months and after each course of treatment. See the review details below	Bp only

Lung cancer screening criteria

• Aged between 50 and 70
• An active smoker, or quit smoking in the last 10 years
• A smoking history of at least 30 pack-years
• No signs or symptoms suggesting lung cancer

Who is eligible for an EDTMP?

Eligibility is based on previous billings at your practice, for patients diagnosed (as per DSM-5) with at least one of:

• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorder
• Other specified feeding or eating disorder

Patients with anorexia nervosa are automatically eligible. Patients with any other diagnosis must also have a global EDE-Q score of 3 or higher, with their condition characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour occurring 3 or more times per week. These patients must also have at least two of the following:

• Clinically underweight with a body weight less than 85% of expected weight, where weight loss is directly attributable to the eating disorder
• Current or high risk of medical complications due to eating disorder behaviours and symptoms
• Overnight inpatient admission for an eating disorder in the previous 12 months
• Inadequate treatment response to evidence-based eating disorder treatment over the past six months despite active and consistent participation

InsideOut has an online screener and the Eating Disorder Examination Questionnaire (EDE-Q), which is automatically scored, graphed, and normed online. See questionnaire here. 

EDTMP reviews

After a health professional provides an EDTMP, it must be managed and reviewed over the next 12 months and after each course of treatment. A course of treatment is defined as up to 10 EDT services. The review should:

• Assess the patient's progress
• Determine whether further treatment is needed
• Update the EDTMP, if required

During a review, the patient may be referred for further services if clinically indicated. A referral can include up to 10 additional EDT services at a time. Before a patient accesses more than 20 EDT services, the managing practitioner and a consultant psychiatrist or consultant paediatrician must review their EDTMP. The specialist review can happen at any time during treatment, but it must be completed, and the relevant MBS item claimed before the patient accesses more than 20 EDT services.

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Using the Summary tab

The Summary tab gives you a patient-centred view. Each row is one patient, showing:

• Identifying details
• Every potential service opportunity identified for them
• Appointment and Practitioner information
• MyMedicare registration status
• A shared Actions column for tracking follow-up

When to use it

• Find patients with several opportunities: see everything they may be eligible for in one row - triage the most important opportunity for this patient.
• Use the dates filter to review booked patients: check what else they could have done at their visit. Or focus on patients with no appointment.
• Spot MyMedicare-registered or eligible patients alongside their opportunities
• Coordinate follow-up across your team

Summary tab filters

The Summary tab uses the same filters as the rest of the cabinet, plus these:

Filter	What it does
Opportunities (under Patients)	Narrows the list to one service opportunity, for example CCMP, Health Assessment, or Nurse item
Patients with past attended appointments	Shows patients who attended in the last 28 days. Handy for spotting opportunities missed at their last visit. Use the Next booked column to see if they've rebooked
Patient name column filter	Finds one patient and shows what else they may be eligible for, so you can prioritise which service to offer

For more information on all Cubiko filters, see Cubiko Filters article.

Tracking follow-up with the Actions column

Use the Actions column to record the follow-up status for each patient. Statuses are shared with everyone at your practice, so your team can see where each patient is up to. Hover over an action to see who last updated it.

How to customise and use your table features: Customisable Tables: Your Data, Your Way!

Export the patient list

Use the download button to export the full list as a CSV or Excel file to work through offline. See Printing and downloading data in Cubiko.

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Using Item Optimisation in your practice

Step 1: Choose your focused service opportunity

Step 2: Filter your patient list

Step 3: Export your list for the Practitioner

Step 4: Contact patients

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Additional resources

• 715 health assessments (Department of Health and Aged Care)
• The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK): estimate a patient's 5 year risk of type 2 diabetes for the 40-49 assessment
• Heart Foundation Toolkit for General Practice: build heart health checks (item 699) into routine care
• DVA Coordinated Veterans' Care program
• MBS Online: Medicare Healthy Kids Check factsheet
• RACGP AJGP: A guide to the 3 year old health check for general practice

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