Dear Dr Armstrong
Thank you for your email dated 15 September 2017.
Can you please confirm if a patient receives a 721/723 in November and uses 2 of the allied health
services that in the new year that the patient would receive another 5 services even if the plan is not
reviewed or renewed.
A referral for allied health services under a GPMP and TCAs or review 732, is valid for the referred
number of services. That is, if the referral is for 3 podiatry services, once the patient has received the
3 services the referral has expired. When all referred services have been used, the patient would
need to obtain a new referral from their GP.
Or, another patient has been referred for 4 chiropractic sessions, the referral is ‘active’ until the
patient receives the 4 services, then the referral has been completed. The patient will need to see
their GP to obtain a new referral for further allied health services.
Using your example, if a patient is referred for 5 physiotherapy services in November 2016 and uses
2 allied health services before the end of the calendar year, the ‘unused’ services can be provided in
the new calendar year 2017 under that referral. The remaining 3 services are ‘rolled over’ to the new
calendar year.
When the patient has used up all of their 5 physiotherapy sessions they will need to see their GP
about a new referral for further allied health services.
Note: The services in the new calendar year (from the 2016 referral) are counted towards the
patient’s quota of 5 Medicare eligible allied health services in 2017. That is, the patient is not eligible
for both the unused services from the 2016 referral and a further 5 referred services in 2017 greater
than a total of five in a calendar year.
A calendar year for individual allied health services is from 1 January to 31 December. The calendar
year does not start from the date of referral nor the date of the first referred allied health service.
Could you please advise what is the expected time for GPs to do a new GPMP? I would like to think it
would be if the patient had a new issues otherwise it would be a review….. but I have never had
clarification of this.
The recommended frequency for claiming item 721 GP Management Plan and item 723 Team Care
Arrangements (TCAs) is two yearly, that is, once every two years.
In general, a new GPMP or TCAs should not be prepared unless required by the patient’s condition,
needs and circumstances. The minimum claiming interval for items 721/723 is twelve months.
Where there has been a significant change in the patient's clinical condition or care circumstances,
more frequent claims can be made in ‘exceptional circumstances’. The medical practitioner can also
consider claiming the review item when changes to the plans have occurred.
Can you please advise if a 732/732 is needed on an ongoing bases for the patient to access allied
health services such as physiotherapy and chiropractic treatment. Is there a maximum time frame
that the patient should be accessing these services?
It is expected and strongly encouraged that once a GP Management Plan (GPMP) and Team Care
Arrangements (TCAs) are in place, they will be regularly reviewed. The recommended frequency is
every six months. That is, a review service under 732 should be provided once every 6 months where
possible.
I trust this information is of assistance.
Yours sincerely
Lynda Baird