Wellness & Lifestyles is fully equipped to service clients in the community or aged care facilities who are on Chronic Disease Management (CDM) Plans using our bulk-billing software Pracsoft.

Medicare benefits are available for a range of specified allied health services for certain patients.  To receive allied health services patients must be referred by a medical practitioner (including general practitioner, but not a specialist or consultant physician).  Patients who have a chronic medical condition and complex care needs may be eligible for up to 5 individual allied health services.  Patients who have Type 2 Diabetes may be eligible for one individual assessment and up to 8 group sessions.  Patients with an assessed mental disorder may be eligible for 12 individual services and up to 12 group therapy services.

All Wellness & Lifestyles allied health professionals have Medicare provider numbers and are eligible to provide services under Medicare.

Exercise physiology – individual services

Exercise physiology service provided to a person by an eligible exercise physiologist if:

1. the service is provided to a person who has:
   (i) a chronic condition; and
   (ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
2. the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
3. the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
4. the person is not an admitted patient of a hospital; and
5. the service is provided to the person individually and in person; and
6. the service is of at least 20 minutes duration; and
7. after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (3):
   (i) if the service is the only service under the referral – in relation to that service; or
   (ii) if the service is the first or the last service under the referral – in relation to the service; or
   (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably be expected to be informed of – in relation to those matters

to a maximum of 5 services (including any services to which items 10950 to 10970 inclusive apply) in a calendar year.

Exercise physiology – group services

Assessment
Exercise physiology health service provided to a person by an eligible exercise physiologist for the purposes of ASSESSING a person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs, and preparing the person for the group services, if:

1. the service is provided to a person who has type 2 diabetes; and
2. the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan [ie item 721 or 725], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and
3. the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that contains all the components of the form issued by the Department; and
4. the person is not an admitted patient of a hospital; and
5. the service is provided to the person individually and in person; and
6. the service is of at least 45 minutes duration; and
7. after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (3); and
8. for a service for which a private health insurance benefit is payable – the person has elected to claim the Medicare for the service, and not the private health insurance benefit.

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services in items 81100, 81110 and 81120).

Group services

Exercise physiology health service provided to a person by an eligible exercise physiologist, as a GROUP SERVICE for the management of type 2 diabetes if:

1. the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and
2. the service is provided to a person who is part of a group of between 2 and 12 patients; and
3. the person is not an admitted patient of a hospital; and
4. the service is provided to a person involving the personal attendance by an eligible exercise physiologist; and
5. the service is of at least 60 minutes duration; and
6. after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contribute to, a written report to be provided to the referring medical practitioner; and
7. an attendance record for the group is maintained by the eligible exercise physiologist; and
8. for a service for which a private health insurance benefit is payable – the person has elected to claim the Medicare for the service, and not the private health insurance benefit.

to a maximum of eight (8) GROUP SERVICES (including services in items 81105, 81115 and 81125) in a calendar year.

Further information
For further information about Medicare Benefits Schedule items, please go to the Department of Health and Ageing’s website at www.health.gov.au/mbsonline. For providers, further information is also available from the Medicare Australia provider inquiry line on 132 150.

Contact our office by phone on 08 8331 3000 or via email for more information on how you may be able to save money by utilising these Medicare rebates for exercise physiology services.