Everything practices need to know about the new Chronic Condition Management Announcements
- Chronic Disease Management, MyMedicare
- Bryn Tardent-Powell
- June 3, 2025
The Strengthening Medicare Taskforce was established in 2022 with the objective of improving patient access to care, improving healthcare affordability and most notably today, improving prevention and management of ongoing and chronic conditions. In late August of 2024, we received news of the next round of changes proposed for the MBS. The changes included the cessation of the item 721, 723 and 732.
Understanding Chronic Condition Management
GP Chronic Condition Management Plans is the new term for the structured approach to managing one or more chronic medical conditions . These plans aim to simplify care for both patients, General Practitioners and Allied Health Professionals, ensuring continuity of care and easier access to necessary services, especially when multidisciplinary care is required.
The upcoming changes, effective from July 1st, 2025 achieve this by introducing new MBS items under the GP Chronic Condition Management Plan (GPCCMP) which replace the existing GP Management Plans (GPMP) and Team Care Arrangements (TCA) and review items.
What about the patients who are already on a GPMP or TCA?
The goods news is, any patient that has an existing GPMP or TCA prior to July 1st will be able to continue accessing care under that plan or arrangement for the following two years. This is fantastic news for GPs who have historically been very thorough with their chronic disease management, as those plans won’t have to be interrupted or redone due to the new CCMP framework.
Patients who are not currently on a GPMP or TCA on July 1st will be able to make use of the new CCMP item numbers, while patients on a GPMP or TCA prior to July 1st can continue to access care as they normally would for the following two years.
What are the biggest changes we can expect from July 1st?
Based on the latest information from the Department of Health and Aged Care, we’ve put together this timeline for practices and practitioners.
From July 1st, 2025, four new MBS items will be billable. These items replace the items currently used for GP Management Plans (229, 721, 92024, 92055), Team Care Arrangements (230, 723, 92025, 92056) and reviews (233, 732, 920278, 92059).
The 965, will be accessible from July 1st for the development of a Chronic Condition Management Plan face to face or through telehealth, replacing the GPMP and TCA items 721, 723 and their telehealth equivalents.
The item 732, used for the review of a GP Management Plan or team care arrangement is also replaced by the item 967 from July 1st, 2025.
How will practices be affected financially as a result of the new CCM incentives?
The department of health have officially announced the first benefit values for the items 965 and 967. They share what the department refer to as “equalised fees”, with both the 965 and 967 providing a benefit of $156.55.
Summary of MBS item changes for Chronic Condition Management
The biggest question we received when talking to practices and practitioners at the recent RACGP, Healthed and Business For Doctors conferences was whether these changes would increase or reduce billings received from CDM. CDM has long been a reliable and often necessary source of revenue for practices, who without it could potentially face closing their doors for good.
Whether your billings will increase as a result of the new GPCCMP and review comes down to one very simple thing. Whether there will be an increase to the number of reviews typically conducted for each patient.
Below we have put together a couple of tables containing hypothetical billing patterns, commonly seen in General Practice. Looking at several scenarios it becomes clear that if a practitioner were to make no changes to the frequency or composition of their services, that there would be a substantial reduction in the incentives billed. This is largely due to the item 965 replacing both the 721 and 723, preventing these from being billed for the same patient.
12 months of billing, existing bulk billing incentives
*in the creation of a new plan, we have included both the items 721 and 723, as the development of a GP Management Plan and Team Care Arrangement is common practice for patients with a variety of conditions managed by General Practitioners.
Looking at these numbers further, practitioners may be able to increase billings by completing additional reviews, as these now carry an equalised incentive of $156.55. If there was a change from 1 new plan and 1 review to 2 reviews, you would see a billings increase of $10.75. Hardly anything to jump for joy about, but certainly a better prospect than a reduction of $145.70 if no changes were made.
There is the possibility of 3 reviews being conducted on a new plan within a 12 month billing window, as these reviews can be billed every 3 months, however this would require the billing to take place exactly every 3 months on the day, which in the busy life of General Practice is simply unrealistic.
How does MyMedicare interact with the new chronic condition management plans?
Prior to the introduction of Chronic Condition Management Plans, the biggest shake up for General Practice was MyMedicare, a scheme commenced with the objective of enhancing the continuity of care between patients and their GPs. The Chronic Condition Management Plan is really designed to work alongside voluntary patient registrations to enhance continuity of care for patients with enduring conditions.
From July 1st, 2025, patients who are registered with a practice through MyMedicare, will only be able to access Chronic Condition Management Plans through their registered practice. Patients who are not registered with a practice can continue to access care through their usual GP.
Overall, this seems to be a step in the right direction for improving continuity of care, while also reducing the likelihood of the billing rejections we saw frequently with the item 721 when patients moved between practices due to availability or other reasons.
Changes coming to Medication Management Reviews
From July 1st, 2027, a GP Chronic Condition Management Plan will be required to access domiciliary medication management reviews (items 245 and 900). This is in addition to the existing criteria of the items 900 & 245.
Updates in Cubiko for identifying patients eligible for chronic condition management items
The Cubiko team are already making quick work of the latest changes, adding in plenty of support for the new chronic condition management items across a variety of metrics in Cubiko.
CDM to GPCCMP comparison dashboard
From today any practice with a Cubiko Insights subscription will be able to access the new Chronic Condition Management Plans dashboard. This dashboard provides practices with much needed forecasting into how these changes could impact them. This includes a comparison of existing CDM billings compared to the potential billings using the new items, as well as key insight into CDM billing by practitioner, number of reviews performed and more.
Identifying patients potentially eligible for CCMPs and reviews
From July 1st, Cubiko’s item optimisation metrics will display lists of patients potentially eligible for the item 965, 967 as well as 92029 & 92030 telehealth equivalents based on historical billings. Historical billings include previous GP management plans and team care arrangements. We’ll also be continuing support for historical CDM items, such as reviews for the two year’s following the introduction of chronic condition management items.
Identifying new chronic conditions management plans
Potential eligibility for the new CCMP will be available in Item Optimisation, Possible Service Opportunities Today, and MyCubiko. For patients who have never received a CCMP, GPMP or TCA, Cubiko will also use clinical indicators to flag patients who may be eligible for chronic condition care within the “New CCM patients” metrics. This metric is an update to the existing “Potential new CDM patients” metric.
Chronic condition management added to benchmarking and billing metrics
Finally, the new CCM billings will be taken into account on all benchmarking and billing metrics. Come July 1st, everything in Cubiko will seamlessly take into account these new items, ensuring you and your practice can continue to provide the best possible care for your chronic condition patients without interruption.
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