Medicare

Medicare CCM Program Patient Information

What is the Medicare CCM program?

The Medicare Chronic Condition Management Program (formerly known as the CDM – Chronic Disease Management Program), is a government designed program that allows eligible patients access to allied health services including podiatry under Medicare.

Eligible patients can receive up to 5 allied health treatments (including podiatry) per calendar year with rebates for treatments provided through Medicare. This can be spread across allied health services, but the combined total of services must not exceed 5. For example: 3 x podiatry + 2 x physio, or 5 x podiatry.

Who is eligible under the CCM program?

Patients may be eligible if they have a chronic medical condition that requires a structured multidisciplinary approach.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CCM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Whether a patient is eligible for CCM services is ultimately a clinical judgement for the GP
and takes into account the patient’s medical condition and care needs.

What should I do next?

If you feel that you might qualify for podiatry treatment under the Medicare CCM program, then you should make an appointment with your local GP to discuss. Your GP will ultimately decide if you meet the criteria.

How do I receive podiatry treatment under the CCM at Melbourne Podiatrists & Orthotics?

If you have been deemed eligible under the Medicare CCM program, to receive podiatry treatment you will require the following items which are prepared by your GP:

• GP Chronic Condition Management Plan (GPCCMP).
• A podiatry referral letter outlining the need for podiatry services (up to 5 per calendar year). The GP referral letter must include:
  • GP’s name and address
  • GP’s provider number
  • Date of referral
  • Reasons for referral

Referrals are valid for a period of 18 months from the date of the first service provided under the referral.

How many podiatry visits have I been allocated?

Your GP will decide how many podiatry visits to allocate you. Unfortunately, a GP may not always communicate in their referral letter to us, the precise number of allocated podiatry visits (can be up 5 per calendar year). If this is the case it is the patient’s responsibility to communicate with their GP to find out how many visits they have been allocated for.

We cannot track the number podiatry visits unless we know how many you have been allocated. Going over the number of allocated podiatry visits will mean that your Medicare claim will be rejected, and you won’t receive reimbursement for your consult.

What is the MPAO billing process for Medicare CCM patients?

If you have been referred to Melbourne Podiatrists & Orthotics by your GP for podiatry services under the Medicare CCM program:

• Melbourne Podiatrists & Orthotics will charge their normal consultation fees with full payment required on the day.
• We will then submit your claim to Medicare on your behalf on the same day.
• The Medicare rebate is paid into your nominated bank account usually the next day.
• There will be a small out of pocket cost for your podiatry service. This gap fee is necessary to help cover our operating costs and maintain our high standard of foot care.

NB. Melbourne Podiatrists & Orthotics is not responsible for knowing the number of allocated podiatry visits, unless it is clearly stipulated in the GP’s referral letter. It is the patient’s responsibility to communicate with their GP to find out the number of allocated visits to minimise the chance of a rejected Medicare claim.