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Chronic Disease Managed (CDM) plans
Previously known as Enhanced Primary Care (EPC) plans

CDM EPC plans

What is a CDM?

A CDM is a personalised medical plan designed for you by your GP or medical practitioner for the treatment of chronic or complex conditions. The plan will recommend treatment of one or more eligible allied health services.  CDM is listed on the Medicare Benefits Schedule and comes with a Medicare benefit (currently a $58 rebate). You and your allied health provider will need to meet the eligibility criteria.

Eligible allied health providers

  • Aboriginal and Torres Strait Islander health practitioners
  • Aboriginal health workers
  • Audiologists
  • Chiropractors
  • Diabetes educators
  • Dieticians
  • Exercise physiologist
  • Mental health workers
  • Occupational therapists
  • Osteopaths
  • Physiotherapists
  • Podiatrists
  • Psychologists
  • Speech pathologists

Who is an eligible patient?

Medicare benefits are available if you have:

    1. A chronic condition
    2. Complex care needs being managed by a medical practitioner including a GP, but not a specialist under a shared care plan or under both a GP Management Plan and Team Care Arrangements (see Medicare Benefits Schedule for detailed breakdown)

Referral

For a Medicare benefit to be payable, you must be referred to us by your GP or medical practitioner using a referral form that has been issued by the Australian Government Department of Health and Aged Care or a form that contains all the components of this form. The referral needs to be signed and dated by the GP.

You will need to present the referral form to us at your first consultation unless your GP or medical practitioner has previously provided it directly to us. Please confirm we have received it.

Referral validity

Medicare benefits are available for up to 5 allied health services per patient per calendar year.

If you have not used all of your allied health services under a referral in a calendar year, it is not necessary to obtain a new referral for the “unused” services. However, any “unused” services received from 1 January will count as part of the total of 5 services for the new calendar year.

A CDM referral expires after 12 months.

Number and type of services

Medicare benefits are available for up to 5 allied health services per calendar year. The 5 allied health services can be made up of one type of service (ie. 5 osteo services) or a combination of different types of services (ie. 3 osteo services and 2 dietic services)

When you have used all of your referred services or require a referral for a different type of allied health service recommended in their Chronic Disease Management plans, you will need to obtain a new referral from your GP or medical practitioner.

Service length and time

The service must be at least 20 minutes in duration and provided as an individual appointment, not to a group.

Out-of-pocket expenses

Medicare benefits are rebated directly to you. Therefore, you will need to pay the full services amount (ie. standard osteo appt = $105) to us and Medicare will provide you with a rebate of $58. This leaves you with $47 out of pocket expenses.

How to claim the rebate

You can claim the rebate in several ways:

  1. Take the receipt to Medicare. Please let us know if you plan to claim your appointment at Medicare as we need to provide a different code than if you are claiming through your private health.  Your receipt needs to include:
    1. Medicare service code – 10966
    2. GP provider number
    3. Referral date
  2. Claim rebate on the spot – To claim on the spot using our Hicaps machine you will need to bring your Medicare card and a debit card (with a pin) to enable us to put the rebate back into your preferred account.
  3. Medipass – If we have stored your Medicare details on Medipass we can claim your rebate and it will automatically go back into the bank account you have provided Medicare. Please bring your Medicare card the first time you wish to use this method so we can add your details to the Medipass system.

More information

For comprehensive detail relating to your CDM and the Medicare Benefits Schedule go to:

Australian Government Department of Health and Aged Care

Medicare Benefits Schedule – Item 10966 Osteopathy

https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10966&qt=ItemID

Or

Speak to us in reception or on 9830 7044

 

-ends-

Spring Osteo Clinic
Shop 2, 486 Whitehorse Road
Surrey Hills
03 9830 7044
[email protected]
www.springosteo.com.au

Reference:

https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10966&qt=ItemID

NB. This information is current as at December 2023. It is subject to change without notice.

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Shop 2, 486 Whitehorse Road Surrey Hills vic 3127
Open: Monday–Friday 7.30am–8pm, Saturday 7.30am–1pm