Medicare Physio With a GP Chronic Condition Management Plan

Under a GP chronic condition management plan (GPCCMP), Medicare pays a benefit towards up to 5 individual allied health services per calendar year, and physiotherapy can be some or all of them. The GP prepares the plan and writes a referral, each physio session must last at least 20 minutes, and the physio sends the GP a written report after the first and last service. For item 10960 (a face-to-face physio session), MBS Online lists a Medicare benefit of $63.40, on the schedule fee that applies from 1 July 2026. Anything the clinic charges above that is the patient's gap.

This guide is meant for Australian physiotherapists and practice owners, and for patients with a long-term condition who want to know what Medicare will pay towards. The rules are described in general terms, not as billing or medical advice for any one person. Australian Medicare is a different scheme from the US Medicare program that some other guides on this site cover, and New Zealand injury care runs through ACC (see the ACC physiotherapy guide). MBS fees change over time, so check the item page before you quote a figure to a patient.

What replaced GP management plans and team care arrangements?

On 1 July 2025, the GP chronic condition management plan replaced the GP management plan (GPMP) and team care arrangements (TCA). MBS note MN.3.1 describes the new items as "a streamlined and simplified approach to multidisciplinary care for patients with a chronic condition." According to the Australian Physiotherapy Association (APA), the GP no longer has to consult at least two collaborating providers. The old referral form has gone too. GPs now refer to allied health by letter, the way they refer to specialists.

Some things did not change. The APA says: "The number of Medicare supported allied health services in a calendar year has not changed." Patients can also use the same range of services as under the old plans.

Old plans keep working for a while. Services Australia says that patients with a GP management plan or team care arrangement in place before 1 July 2025 "can continue to access services consistent with those plans until 30 June 2027." For individual physio under item 10960, the old plans only count when the patient has both a GPMP and a TCA (item 10960 and AN.15.5). A referral written before 1 July 2025 stays valid until every service on it has been used (MBS note AN.15.5). New referrals have to meet the new rules, even when they are written under an old plan (AN.15.5 and the APA).

Who is eligible for Medicare physio under a chronic condition plan?

MN.3.1 sets three conditions, and all of them must be met:

The patient has a current plan. That means a GPCCMP prepared or reviewed in the last 18 months, a GPMP and TCA prepared before 1 July 2025 (item 10960 accepts these until the end of 30 June 2027), or a multidisciplinary care plan for someone living in residential aged care.
The physio service is consistent with that plan.
The patient has a referral for it from their GP or a prescribed medical practitioner.

The plan itself is for a patient with "at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal" (MBS note AN.15.3). There is no list of eligible conditions. The GP uses clinical judgement to decide whether a structured plan would help (AN.15.3), and the APA confirms that no condition list exists. The item 10960 wording also refers to a chronic condition and "complex care needs" managed by a medical practitioner other than a specialist or consultant physician.

Two more limits apply. Hospital in-patients cannot use these services (Services Australia). A patient registered with a practice through MyMedicare must get their GP chronic condition management plan through that practice, while a patient who is not registered can go to their usual doctor (AN.15.3 and AN.0.47). That rule is about the GP plan. The patient can still take the physio referral to any physiotherapist (MN.3.1).

How many physio sessions does Medicare cover each year?

Up to 5 individual allied health services per calendar year, from January to December. That total is shared across every allied health profession. MN.3.1 gives two examples: 5 physiotherapy services, or 1 dietetic service and 4 podiatry services. So a patient who has already used 2 Medicare-supported podiatry services this year has 3 left for physio.

Aboriginal and Torres Strait Islander patients can use up to 10 per calendar year (Services Australia and AN.15.3). Sessions by video (item 93000) or phone (item 93013) count too. MN.3.1 states that the limit of 5 "applies across all modes of service", and the treating physio must be satisfied that a video or phone session is appropriate. The telehealth guide covers how to run those sessions well.

The yearly count and the referral run on separate clocks. The APA puts it this way: "The time validity does not impact the number of sessions available." It also notes that some referrals are used across more than one calendar year. So check how many services the patient has left, not just the date on the referral.

What if the plan lists more than 5 services?

The patient decides. MN.3.1 is direct about it: "The MBS benefit is the patient's benefit. Ultimately it is up to the patient to decide how they use their MBS benefits." The same note lists other ways to pay for extra sessions: private health insurance extras cover, programs run by a state or a Primary Health Network (PHN), or paying privately. A patient cannot claim Medicare and private health insurance for the same service.

What must the GP referral include?

Since 1 July 2025, the referral is a letter, not a form. MBS note AN.15.6 sets out what it must contain: the name of the referring practitioner, the practice address or their provider number at that practice, and the date of the referral. The letter must be in writing and signed, and an electronic signature is fine. It must also explain why the patient is being referred, with information about their condition.

The referral does not have to name a physio. The patient can take it to any physiotherapist they choose, though not to another profession. MN.3.1 uses the example that a physio referral "cannot be used to access chiropractic services." The referral also does not have to state a number of services, although the GP may add one. It lasts for the time written on it, or for 18 months from the first service if no time is given.

Services Australia says it is not appropriate for allied health professionals to give a GP a partly completed referral to sign, or to pre-empt the GP's decision about which services the patient needs. You can decline a referral. AN.15.6 leaves acceptance to each practitioner, subject to anti-discrimination law, and asks you to let the referring practitioner know if you cannot take the patient on.

What physios need before claiming item 10960

A short checklist, drawn from MN.3.1 and the Services Australia billing rules:

A Medicare provider number, and the qualification requirements set out in the Determination that governs these items.
A check that the patient has services left this year. Use the MBS items online checker or the care plan history in Health Professional Online Services (HPOS). Patients can see their own care plan service history in their Medicare online account.
A session of at least 20 minutes. The Services Australia billing rules say the patient must be treated individually and, for the face-to-face item, in person.
Informed financial consent before the service, including whether the patient wants to use one of their Medicare-supported services on it.
The written reports to the referring doctor, covered in the next section.
Records kept for 2 years. MN.3.1 says this includes the reports you send back to the referring doctor.

Financial consent under the shared Code of conduct is explained in the cancellation policy guide. Read that section before you write up fee information for care plan patients.

Reporting back to the GP

The Determination requires a written report to the referring practitioner in three situations, quoted in MN.3.1. The first is when the service is the only one under the referral. The second is the first or last service under the referral. The third is any other service that involves matters the referring doctor "would reasonably expect to be informed of". Services Australia adds that you can report more often when there is a clinical need.

According to Services Australia, a report should include the investigations, tests and assessments you carried out, the treatment you gave, and your recommendations for future management of the patient's condition.

Patients do not always come back for the planned last visit. The APA's advice is to send the final report if you suspect a patient will not return. It adds that there is no consequence for over-reporting, so writing a second final report later is fine if they do come back.

What follows is suggested practice, not an MBS rule. If your SOAP notes already hold the findings and the reasoning, the report is mostly a summary of them. A named outcome measure with a first score and a repeat score gives the GP something concrete to read. For help picking one that fits the problem, see the outcome measures guide.

How the Medicare rebate and the gap work

MBS Online lists a schedule fee of $74.55 for item 10960, with a Medicare benefit of 85%, which is $63.40. Those figures come from the item page, where the schedule fee was last updated on 1 July 2026.

A clinic that bulk bills accepts the Medicare benefit as full payment for the service (Services Australia). In healthdirect's words, "Bulk billing means you don't have to pay for your medical service provided by a healthcare professional." A clinic that charges more than the benefit leaves the patient to pay the difference. The healthdirect page is written about doctors: it says the difference between the doctor's charges and the Medicare benefit "is known as a 'co-payment', 'gap payment', 'gap fee' or 'out-of-pocket' cost." This guide calls the same difference on a physio bill the gap.

Clinics set their own fees, and this guide quotes no typical price. MN.3.1 asks for informed financial consent. As suggested practice, tell the patient your fee and their likely gap before the first session, and put it in writing.

Making 5 sessions count

Five sessions a year is not much for a condition that has lasted 6 months or more. What follows is suggested practice, not an MBS rule. One way to plan them is to use the first session for assessment and a home program, then space the rest out as reviews to check technique and progress the program. The patient does most of the exercise in the weeks between visits.

That puts weight on the home program. Keep it short, with a clear dose for each exercise, and make sure what the patient takes home matches your notes. For exercise choice and dosing, see the home exercise program guide. For common chronic problems, the knee osteoarthritis and low back pain pages show staged programs you can adapt.

PocketPhysio helps with that part. Pick exercises from the library, then choose the sets and reps or a hold time. There is room for a cue too, written the way you talk to patients face to face. Each exercise in the library has video plus a spoken voice guide, which lets the patient follow along between visits.

The program reaches them through a link, SMS, email or the Pocket Physio Care patient app. Patients who prefer WhatsApp can get it there instead. At the review, last visit's program is ready for you to progress.

For patients: how to get Medicare physio with a chronic condition

Talk to your GP. If you have had a condition for 6 months or more, or expect to, ask whether a GP chronic condition management plan would help you.
If physio is part of your plan, your GP gives you a referral letter. You can take it to any physiotherapist you choose.
Before your first visit, ask the clinic what it charges and what your gap will be.
Keep count. You have up to 5 Medicare-supported allied health services each calendar year across all professions, and you can check your care plan service history in your Medicare online account.
When your referral runs out, go back to your GP for a new one.

Some people want more than 5 sessions. You can use private health insurance extras cover or pay privately for the rest, but you cannot claim Medicare and your health fund for the same session.

When not to wait for your next session

A care plan is for planned care. The six warning signs listed here use exactly the same wording as this site's condition pages. In Australia, "call emergency services" means triple zero (000), which healthdirect describes as "the national emergency service phone number." For same-day advice, contact your GP, or call the healthdirect helpline on 1800 022 222 (NURSE-ON-CALL in Victoria).

Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away.
Chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
Emergency: you have had cancer, now or in the past, and your back or neck pain feels like a tight band around your body, or comes with pain spreading down an arm or leg, weakness, numbness or pins and needles in your arms or legs, trouble walking, or trouble controlling your bladder or bowels. Call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through. This can be cancer pressing on the spinal cord (metastatic spinal cord compression), which needs treatment straight away.
Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
A calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.

This is a selection, not every warning sign there is. Each condition page lists the signs for its own body area.

The short version

Under a GP chronic condition management plan, Medicare supports up to 5 individual allied health services per calendar year (10 for Aboriginal and Torres Strait Islander patients), shared across all professions and including video and phone sessions. The patient needs a current plan and a GP referral letter. The letter does not have to name the physio or the number of sessions, and it lasts 18 months from the first service unless it says otherwise.

Physios claim item 10960 for sessions of at least 20 minutes and report to the GP after the first and last service. The benefit listed on MBS Online since 1 July 2026 is $63.40, and the patient pays any gap above it. Older GP management plans and team care arrangements from before 1 July 2025 still work until 30 June 2027.

References

Australian Government Department of Health, Disability and Ageing. MBS Online. Item 10960 (physiotherapy health service). Description updated 1 July 2025, schedule fee updated 1 July 2026. Accessed 28 September 2026. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10960
Australian Government Department of Health, Disability and Ageing. MBS Online. Note MN.3.1, Individual allied health and Aboriginal and Torres Strait Islander health and wellbeing services (health services) for treating chronic conditions. Publication date 1 November 2025. Accessed 28 September 2026. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=MN.3.1
Australian Government Department of Health, Disability and Ageing. MBS Online. Note AN.0.47, GP chronic condition management plans. Publication date 1 November 2025. Accessed 28 September 2026. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.0.47
Australian Government Department of Health, Disability and Ageing. MBS Online. Note AN.15.3, Overview of MBS items to support the management of chronic conditions in general practice. Publication date 1 November 2025. Accessed 28 September 2026. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.15.3
Australian Government Department of Health, Disability and Ageing. MBS Online. Note AN.15.5, transition arrangements. Publication date 1 November 2025. Accessed 28 September 2026. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.15.5
Australian Government Department of Health, Disability and Ageing. MBS Online. Note AN.15.6, referral requirements. Publication date 1 November 2025. Accessed 28 September 2026. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.15.6
Services Australia. Services available under a GP chronic condition management plan. Page last updated 30 June 2026. Accessed 28 September 2026. https://www.servicesaustralia.gov.au/services-available-under-gp-chronic-condition-management-plan
Services Australia. MBS billing rules for chronic condition allied health and other primary health care items. No date shown. Accessed 28 September 2026. https://www.servicesaustralia.gov.au/mbs-billing-rules-for-chronic-condition-allied-health-and-other-primary-health-care-items
Australian Physiotherapy Association. Changes to Medicare chronic disease management. No date shown. Accessed 28 September 2026. https://australian.physio/advocacy/changes-medicare-chronic-disease-management
Services Australia. About bulk billing MBS claims. No date shown. Accessed 28 September 2026. https://www.servicesaustralia.gov.au/about-bulk-billing-mbs-claims
healthdirect Australia. Bulk billing for medical services. No date shown. Accessed 28 September 2026. https://www.healthdirect.gov.au/bulk-billing-for-medical-services
healthdirect Australia. Calling triple zero (000). No date shown. Accessed 28 September 2026. https://www.healthdirect.gov.au/calling-triple-zero

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-28.

Medicare-funded physio under a GP chronic condition management plan