How Medicare CDM Billing Works for Allied Health (Updated for GPCCMP 2025)

If you're an allied health professional in private practice, Medicare CDM (Chronic Disease Management) billing is probably the single most important revenue pathway you need to understand. It's how your patients access Medicare-subsidised sessions with you, and getting it right is the difference between a smooth claims process and rejected claims, confused patients, and money left on the table.

The system changed in July 2025. If you learned about CDM billing from a colleague, a uni lecture, or an article written before mid-2025, some of what you know is now wrong. This guide covers how the new system works, what you need from referring GPs, and the mistakes that trip people up most often.

1. What changed in July 2025

Before July 2025, the CDM pathway worked like this: a GP would prepare two separate documents for a patient with a chronic condition. First, a GPMP (GP Management Plan), which was the GP's plan for managing the patient's condition. Then a TCA (Team Care Arrangement), which was the document that brought allied health providers into the picture. Both had to exist before you could see the patient under Medicare.

From 1 July 2025, those two documents were replaced by a single one: the GPCCMP, which stands for GP Chronic Condition Management Plan. Instead of the GP preparing a GPMP and then a separate TCA, they now prepare one plan that covers both the management strategy and the team care component.

Why this matters for you

The day-to-day impact on allied health providers is modest but important to understand. The referral pathway is simpler. There's one plan instead of two. But the rules around that plan are slightly different, and if you're still talking to GPs about “TCAs” or your intake forms reference the old system, it creates confusion and can slow down the referral process.

The core mechanics are the same: GP identifies a chronic condition, creates a plan, refers the patient to allied health, you provide services and bill Medicare. But the paperwork behind it has been streamlined, and the item numbers the GP uses have changed. Your item numbers (the ones you bill as an allied health provider) remain the same.

The key terminology shift

Get used to saying GPCCMP instead of “GPMP and TCA”. When you're talking to GPs, when you're explaining the process to patients, and on your intake forms and website copy. The old terms aren't wrong (GPs and practice managers will know what you mean), but using the current terminology signals that you're across the changes and makes the administrative process smoother for everyone.

2. How CDM billing works from your side

Let's walk through the whole process from start to finish, from your perspective as the allied health provider.

Step 1: The GP prepares a GPCCMP

A patient visits their GP with a chronic or terminal medical condition. The GP determines that the patient would benefit from a multidisciplinary approach (meaning input from more than one type of health professional). The GP prepares a GPCCMP. This plan outlines the patient's condition, treatment goals, and which allied health services the GP is recommending.

You have no involvement in this step. It happens between the GP and the patient. But it's the foundation that makes everything else possible. Without a valid GPCCMP in place, there is no Medicare-subsidised pathway to you.

Step 2: The GP writes a referral to you

Once the GPCCMP is in place, the GP provides a written referral to the specific allied health profession they're recommending. The referral needs to name the profession (e.g., physiotherapy, podiatry, exercise physiology) and should include relevant clinical information to help you provide appropriate treatment.

The referral is separate from the GPCCMP itself. The plan is the GP's overarching document. The referral is what the GP gives the patient (or sends to you directly) to kick off treatment.

Step 3: The patient books in with you

The patient contacts your practice with their referral. At this point, you need to confirm a few things before you provide treatment:

• The patient has a valid GPCCMP in place (the referral should reference this)
• The referral names your specific profession
• You know how many of the patient's 5 allied health sessions have already been used this calendar year

That last point is critical and we'll cover it in detail in the next section.

Step 4: You provide the service and bill Medicare

You see the patient for a minimum of 20 minutes (this is a billing requirement, not a suggestion). After providing the service, you bill Medicare using your profession-specific CDM item number. You can bill online through HPOS (Health Professional Online Services, accessed via your PRODA account) or through your practice management software if it supports Medicare claiming.

The patient receives the Medicare rebate (either as a bulk-billed service where you accept the rebate as full payment, or as a privately-billed service where they pay your fee upfront and receive the rebate back from Medicare). Most allied health professionals in private practice charge a gap fee on top of the Medicare rebate.

Step 5: Reports and communication

After providing treatment, you're expected to communicate with the referring GP about the patient's progress. This isn't optional. It's a requirement of the CDM pathway, and it's also good practice for maintaining your referral relationships.

Send a brief report to the GP after the initial assessment and then at appropriate intervals or at discharge. This keeps the GP informed, supports any future GPCCMP reviews, and makes it more likely the GP will continue referring patients to you. The report doesn't need to be lengthy. A one-page summary covering what you found, what you did, and what you recommend is enough.

This matters because the communication loop is what keeps the CDM pathway working. GPs who never hear back from allied health providers stop referring. GPs who get clear, concise reports refer more. It's also an audit requirement. If Medicare reviews your claims, they'll expect to see evidence that you communicated with the referring GP.

3. The 5-session shared cap

This is where most of the confusion lives, and it's the number one thing to get right.

Under a GPCCMP, each patient is entitled to a maximum of 5 Medicare-subsidised allied health services per calendar year. That number is firm. Not 5 per provider, not 5 per profession. Five total, shared across every allied health profession the patient sees under CDM.

What “shared” means in practice

If a patient has a GPCCMP and their GP refers them to both a physiotherapist and a podiatrist, those two providers are drawing from the same pool of 5 sessions. If the patient sees the physio 3 times, they have 2 sessions remaining for any allied health provider under CDM for the rest of that calendar year. Not 2 for podiatry and 5 for physio. Two total.

This catches people off guard regularly. New practitioners often assume each profession gets its own allocation. They don't. It's a shared cap.

Worked example

The calendar year reset

The 5-session cap resets on 1 January each year. Not on the anniversary of the plan, not when the GPCCMP is reviewed. 1 January. So a patient who uses all 5 sessions by March gets nothing more until the following January. A patient who doesn't start treatment until November still only has 5 sessions for the remainder of that year.

This has practical implications for how you schedule and advise patients. If someone comes to you in October with 5 sessions available, you might discuss using 2-3 sessions before December and then continuing in January when the cap resets. That gives them more sessions over a shorter continuous period. Patients appreciate this kind of guidance because most of them have no idea how the cap works.

How to check remaining sessions

You can check how many CDM sessions a patient has used through HPOS (Health Professional Online Services). Log in with your PRODA credentials and look up the patient's claiming history. Your practice management software may also be able to query this, depending on which platform you use.

Get into the habit of checking before the first appointment. It takes 30 seconds and prevents the awkward conversation where you tell a patient after treatment that Medicare won't cover the session because their 5 visits are already used up. That conversation damages trust, even when it's not your fault.

4. Referral requirements under the new system

The referral is the document that connects you to the patient's GPCCMP. Without it, you can't bill Medicare. Here's what needs to be in place.

The GPCCMP must come first

The GP must have prepared a GPCCMP before writing the referral. This seems obvious, but it trips people up in fast-moving clinics where a GP might hand a patient a referral letter and say “I'll do the plan later.” If the plan isn't done at the time you provide the service, the claim is not valid. The GPCCMP has to exist before you treat the patient under CDM billing.

What the referral must include

The referral needs to be in writing (a letter, a printed form, or an electronic referral from the GP's clinical software). It should include:

• The patient's name and date of birth
• The specific allied health profession being referred to (e.g., “physiotherapy”, not “allied health”)
• The relevant clinical information (diagnosis, reason for referral)
• That the referral is made under a GPCCMP

The referral must name the profession, not a specific practitioner. A GP can refer to “podiatry” without naming a specific podiatrist. The patient then chooses which podiatrist to see. However, if a GP writes a referral to “allied health” without specifying the profession, that's not sufficient. You need profession-specific referrals.

How long referrals last

Under the GPCCMP system, a referral is valid for the duration of the calendar year in which it was written, or until the GPCCMP is reviewed or replaced, whichever comes first. In practical terms, for most patients, you're looking at a referral that covers the current calendar year.

When the calendar year ticks over and the patient's session cap resets, they'll need a new referral if they want to continue seeing you under CDM. This usually coincides with the GP reviewing or renewing the GPCCMP, so it tends to happen naturally. But don't assume a referral from last year is still valid. Check.

Can a patient self-refer?

No. CDM billing requires a GP referral under a GPCCMP. Patients cannot self-refer for Medicare-subsidised allied health services through this pathway. They can, of course, see you as a private patient without a referral, but there will be no Medicare rebate under CDM. Some professions (like physiotherapy) allow self-referral for private services, but the CDM pathway always requires the GP to initiate it.

5. Common billing mistakes

These are the errors that come up again and again, particularly for practitioners in their first year or two of private practice. Most of them are straightforward to avoid once you know about them.

Using the wrong item number

Each allied health profession has its own CDM item number (see the table below). A physiotherapist must use the physiotherapy item number, not the generic or another profession's code. This sounds basic, but it happens. Particularly when practitioners are setting up their billing software for the first time and select the wrong code from a dropdown list. A single wrong digit means a rejected claim.

Double-check your item number when you first set up your practice management software, and again after any software updates. Some systems auto-populate item numbers, and if the default is wrong, every claim you submit will be wrong.

Billing without a valid GPCCMP in place

You see a patient, they tell you their GP has “done the paperwork”, and you bill Medicare. But if the GPCCMP wasn't actually completed before you provided the service, that claim is invalid. Medicare can (and does) audit these. The fix is simple: always sight the referral before the first appointment, and confirm it references a GPCCMP.

If a patient arrives without a referral, you have two options. See them as a private patient (full fee, no Medicare claim), or reschedule once they have the referral sorted. Don't bill Medicare and hope it works out. It won't, and if it gets flagged in an audit, you'll need to repay the claim.

Not checking remaining sessions

You treat the patient, submit the claim, and it gets rejected because they've already used their 5 sessions with other providers. Now you have an awkward conversation about payment. The patient is frustrated because they didn't know. You're frustrated because you could have prevented it.

Build the session check into your intake process. Before the first appointment, check HPOS or ask the patient how many CDM sessions they've used this year. Even a quick “Have you seen any other allied health professionals under this plan?” at booking gives you a rough idea.

Not understanding the calendar year reset

Some practitioners think the 5-session cap runs from the date of the GPCCMP, not the calendar year. Others think it resets when the plan is reviewed. Neither is correct. It resets on 1 January, full stop. If you're advising patients about their remaining sessions, make sure you're counting from the right date.

Sessions under 20 minutes

The minimum service time for a CDM allied health consultation is 20 minutes. That's face-to-face clinical time with the patient, not including admin, notes, or waiting. If you bill for a session that was under 20 minutes, the claim is technically invalid.

This matters in a couple of scenarios. Quick follow-up appointments where the patient's issue is straightforward and you're done in 12 minutes. Appointments that run short because the patient arrives late. In both cases, you either need to extend the session to meet the 20-minute threshold or bill it as a private consultation instead of a CDM item.

Keep time records. Note the start and end time of each CDM consultation in your clinical notes. If you're ever audited, this is what Medicare will look at.

Forgetting to communicate with the GP

This isn't a billing error per se, but it's an audit risk and a referral relationship killer. The CDM pathway expects you to report back to the referring GP. If you see a patient for 5 sessions and the GP never hears from you, they'll remember. And not in a good way.

6. Transition arrangements (old plans)

If your patients had GPMPs and TCAs prepared before July 2025, you don't need to panic. The government built in transition arrangements so that existing plans don't suddenly become invalid overnight.

Plans created before 1 July 2025

GPMPs and TCAs that were in place before the changeover remain valid. A TCA created under the old system can still be used to access Medicare-subsidised allied health services. You can continue to bill against these old plans as normal.

How long old plans last

A TCA created before 1 July 2025 remains valid until whichever of these comes first:

• The existing GPMP is due for review (GPMPs were typically reviewed every 6 months to 2 years, depending on the patient's condition)
• 30 June 2027 (the hard cutoff date for old-system plans)

So the longest an old-system TCA can remain in play is until 30 June 2027. After that date, every patient who wants Medicare-subsidised allied health services through CDM will need to be on a GPCCMP.

What happens at review or expiry

When the old GPMP comes up for review, the GP will prepare a GPCCMP instead of renewing the GPMP and TCA. From that point, the patient is on the new system. The referral process and session cap work as described in this guide.

In practical terms, most patients will transition to the GPCCMP system naturally over the course of 2025 and 2026 as their existing plans come up for review. By mid-2027, everyone will be on the new system.

Mixed scenarios

During the transition period (now through June 2027), you may have some patients on old TCAs and others on new GPCCMPs. The billing process from your side is the same. Your item numbers are identical regardless of whether the underlying plan is a TCA or a GPCCMP. The 5-session shared cap and the calendar year reset apply in both cases. The difference is purely in the GP's paperwork, not yours.

7. Key item numbers by profession

These are the main CDM item numbers you use as an allied health provider when billing Medicare for services provided under a GPCCMP (or a transitional TCA). Each profession has its own specific item number. You cannot use another profession's code, even if you hold dual registration.

When to use these item numbers

You bill one of these item numbers each time you provide a CDM allied health service to a patient who has a valid GPCCMP (or transitional TCA) and a current referral. The service must be at least 20 minutes of face-to-face clinical time. Each claim counts as one of the patient's 5 annual sessions.

If you provide services outside the CDM pathway (e.g., private patients without a GPCCMP, WorkCover, NDIS, DVA), you'll use different item numbers or billing codes specific to those schemes. The item numbers listed above are only for CDM Medicare billing.

Initial vs subsequent consultations

Unlike some other Medicare pathways, CDM allied health billing uses a single item number per profession for all consultations. There is no separate item number for initial assessments vs follow-up appointments. Whether it's the patient's first visit or their fifth, you use the same code. The rebate amount is the same for each session.

Putting it all together

CDM billing is not complicated once you understand the structure. A GP identifies a chronic condition, prepares a GPCCMP, and refers the patient to you. You provide the service (minimum 20 minutes), bill Medicare with your profession-specific item number, and communicate with the GP about the patient's progress. The patient gets up to 5 sessions per calendar year, shared across all allied health providers.

The GPCCMP change in July 2025 simplified the GP's side of the process without changing much on yours. Your item numbers are the same, the 5-session cap is the same, and the referral requirements are broadly similar. The main thing that changed is the terminology and the underlying plan structure.

Where practitioners get into trouble is the operational detail: not checking remaining sessions, not sighting the referral before treatment, billing sessions under 20 minutes, or losing track of the calendar year reset. These are process issues, not knowledge gaps. Build the checks into your intake and scheduling workflow, and they become automatic.

If you're setting up a new practice or reviewing your existing billing processes, here's a quick checklist:

1. Confirm your item number is correct in your practice management software
2. Add a referral check to your intake process (sight the referral, confirm GPCCMP, file a copy)
3. Check remaining sessions via HPOS before the first CDM appointment
4. Record start and end times for every CDM consultation in your notes
5. Send a report to the referring GP after the initial assessment and at discharge
6. Update your forms and website to reference GPCCMP instead of GPMP/TCA
7. Know the transition deadline: old TCAs expire by 30 June 2027 at the latest

Get these right and CDM billing becomes a reliable, predictable part of your revenue. Get them wrong and you're chasing rejected claims, dealing with compliance issues, and leaving money on the table with every missed session.

This guide covers the fundamentals. For profession-specific detail including your exact rebate amount, registration body requirements, and software recommendations, check out the profession-specific pages on this site.