Medicare can sometimes assist with your fees for up to your first 5 visits to our office. The system is called Chronic Disease Management or CDM. It’s the same as what used to be called Enhanced Primary Care or EPC.
How it works
You go to your GP and ask for referral. They must complete:
- A GP Management Plan (GPMP) – item 721 AND
- Team Care Arrangements (TCAs) – item 723 AND
- A Referral form
When you come in, we will bill you our normal fees, but you can claim up to 80% of them back from Medicare. You can even do it online.
Q. Who is eligible?
To be eligible for a Medicare rebate, you need to be placed on an Chronic Disease Management (CDM) plan by you GP, that specifically refers you to Dr Richard Sawyer.
Q. How do I get placed on an CDM plan?
If you have been suffering or will suffer from a condition for longer than 6 months or have numerous health issues then you qualify for the CDM program. Visit your GP and ask them to prepare a CDM plan.
Q. Can I use my private health insurance cover in conjunction with CDM?
No. You need to decide if you are going to use your Medicare rebate or your private health insurance as you can not claim from both for the same consultation. Once you have claimed all your Medicare rebates you can then claim any further consultations through your private health insurance.
Q. What is meant by chronic conditions and complex care needs?
Chronic conditions are defined as conditions which have been, or are likely to be, present for six (6) months or more. Complex care needs means that, in your GP’s opinion, you would benefit from care provided by a range of health professionals, who provide different services.
Q. Once I’m on an CDM plan, how do I get my Medicare rebate?
You take your receipts from our service and give them to Medicare. You can do it online. To be sure you can claim, you require:
- Your GP fills & submits both 721 & 723 Medicare forms correctly
- You have not already claimed your CDM allowance elsewhere (podiatrist, speech pathology etc.)
It’s probably a good idea to call Medicare to confirm your eligibility. You can call them on 132 011.
Q What if Medicare does not pay for my visits?
Any fees payable to us are paid by you in full on the day of service. If Medicare refuses to pay for whatever reason, we are not able to help. Again, probably best to call Medicare first so this can’t happen.
Q. I have already used my 5 CDM entitlements this year, can I have more?
You can have a maximum of 5 CDM visits each calendar year. If you want more, you will need to wait until January the following year to reapply for a further 5 CDM visits. Make sure your GP applies for the full 5 visits otherwise you may only be eligible for less.
Q. Am I always entitled to 5 CDM visits?
Only if your GP says so!. So if you want the 5 visits make sure you mention this to your GP to request the maximum 5 visits in the CDM forms.
Q. Does CDM cover for any X-Rays?
No, but if required, we can refer you for x-rays which are mostly bulk billed at our local radiology centre.