From 1 November 2025, Medicare arrangements for allied health and mental health services delivered under GP Chronic Condition Management Plans (GPCCMPs) continue to be clarified across eligibility, referrals and reporting. This short update summarises what providers and practices need to know, with links to the official MBS item 10956 page and Services Australia referral guidance.
Key Summary
- Framework: Referrals are linked to a GP Chronic Condition Management Plan (GPCCMP), with transition rules for older plans.
- Access: Eligible patients can use up to 5 individual allied/mental health services per calendar year in any mix of eligible professions.
- Item 10956: Clarifies mental health worker services delivered as individual, in-person appointments of at least 20 minutes under the chronic condition management pathway.
- Eligibility & settings: Applies to community and RACF residents (hospital in-patients are not eligible under these items).
- Referrals & reporting: GP decides clinical need; referral validity is the stated timeframe (or 18 months if unspecified). Providers must report to the GP after the first and last service.
What Actually Changed in Nov 2025 — and Why It Matters
November updates are primarily about clarity and consistency across the chronic condition management pathway. For mental health worker services, the MBS item 10956 page sets out the descriptor for individual, in-person care of at least 20 minutes linked to a valid GPCCMP referral. These visits count towards the patient’s five-service annual cap for allied/mental health under chronic condition management.
In parallel, Services Australia has consolidated eligibility, referral and reporting rules for all allied and primary health professionals working to a GPCCMP. The aim is smoother referrals, clearer provider obligations, and fewer surprises for patients moving between professions within their five-service allocation.
Quick focus — Item 10956 (mental health worker): individual, in-person service ≥20 minutes; delivered under an active GPCCMP referral; contributes to the patient’s annual five-service cap.
Who’s Eligible — and How the Five-Service Rule Works
Provider eligibility (who can deliver services)
The Services Australia guidance lists the allied health professionals who can provide services under a GPCCMP: audiologists, chiropractors, diabetes educators, dietitians, exercise physiologists, mental health workers, occupational therapists, osteopaths, physiotherapists, podiatrists, psychologists and speech pathologists. In addition, primary care professionals Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners are eligible for relevant services.
To claim items, providers must attend in person for at least 20 minutes and treat the patient individually (not group treatment). Eligibility can be checked via the MBS items online checker in HPOS. See: Services Australia – allied health referrals under GPCCMP.
Patient eligibility (who can receive services)
Eligible patients can access up to five individual services per calendar year. These can be five of a single profession (e.g., five physiotherapy visits) or a combination (e.g., one dietetic and four podiatry services). Patients must have a GPCCMP in place. Those with a GP management plan or team care arrangement before 1 July 2025 can continue accessing services consistent with those plans until 30 June 2027.
Patients in the community and permanent residents of a residential aged care facility (RACF) are eligible where a GP has contributed to the relevant multidisciplinary care plan (or reviewed it). Hospital in-patients are not eligible for these items. Eligibility can also be checked via HPOS.
Referral validity & content
The referring medical practitioner (GP) decides whether the patient’s chronic condition will benefit from allied or Aboriginal and Torres Strait Islander health and wellbeing services. Referrals are valid for the timeframe the GP states; if no timeframe is stated, they are valid for 18 months from the date of the first service provided under the referral. Allied or primary care professionals should not provide partly completed referrals or pre-empt the service mix.
Referrals & Reporting: Practical Reminders for Clinics
- Use the GPCCMP as the anchor: Ensure the plan is active and clearly states the intended allied/mental health services aligned to the patient’s goals and chronic condition.
- Don’t pre-fill GP referrals: Allied or primary care professionals should avoid sending partly completed referral documents for signing, or pre-selecting service mixes. The GP’s clinical judgement leads.
- Track the five-service cap: Services across professions count toward the same annual allocation. Use your PMS and the HPOS checker to avoid over-claiming.
- Report back at the right times: Provide a written report to the GP after the first and last service (and more often if clinically necessary). Reports should outline investigations/tests/assessments, treatment provided, and recommendations for ongoing management.
- Keep it individual and in person: These items cover individual, face-to-face care of at least 20 minutes. Group services are different items and pathways.
Helpful references: MBS item 10956 and Services Australia’s GPCCMP referral guidance.
Conclusion
The November 2025 updates reinforce a consistent pathway for chronic condition management across allied and mental health. Anchor your processes to a current GPCCMP, confirm eligibility, track the five-service cap, and maintain clear reporting to the referring GP. These basics will keep care coordinated and compliant while giving patients timely access to the right mix of services.
Disclaimer: This blog is a general overview and should not be construed as professional legal, financial or medical advice.
FAQs
- How do the five services work across different providers?
Patients have a cap of five individual allied/mental health services per calendar year under GPCCMPs. Any eligible profession’s visits count toward the same cap.
- Are telehealth or group services covered here?
The items discussed focus on individual, in-person services of at least 20 minutes. Group and some telehealth services use different items and criteria—check MBS Online for specifics.
- How long is a referral valid?
For the timeframe stated by the GP. If no timeframe is stated, the default validity is 18 months from the date of the first service provided under the referral.
