GPCCMP explained: the plan does not need a Team Care Arrangement, an allied health referral, or a “listed” condition

The GP Chronic Condition Management Plan (GPCCMP) replaced the GP Management Plan and Team Care Arrangement on 1 July 2025. A year on, the habit has not moved with the rules. In most centres we audit, doctors still believe a chronic condition plan must come with an allied health referral, that two other providers have to be consulted, and that only a narrow list of diseases counts. All three beliefs are wrong under the current framework, and each one costs patients care and practices revenue.

What changed on 1 July 2025

• One plan instead of two. The GPMP (721) and the TCA (723), plus their reviews (732) and telehealth equivalents, were replaced by a single GPCCMP: item 965 to prepare and 967 to review for GPs; 392 and 393 for prescribed medical practitioners; 92029, 92030, 92060 and 92061 by video.
• No collaborating providers. The TCA requirement to consult with at least two other providers is gone. The GP prepares the plan with the patient, and a practice nurse, Aboriginal and Torres Strait Islander Health Practitioner or Aboriginal Health Worker may assist.
• Not on the same day as a consultation — by the same practitioner. MBS Online: the planning and review items cannot be co-claimed by the same practitioner on the same day for the same patient as the general attendance items (3, 23, 36, 44 and the rest of the list). A different GP in the practice can see an acute problem that day; the same GP cannot bill both. There is no clinical-necessity carve-out, unlike health assessments such as 699 and 695. Practices that have been billing both should check their history rather than assume a paid claim was a correct one.
• Direct referral, when it is needed. If the patient needs allied health, the GP refers them directly under the plan — up to five individual services a calendar year (ten for Aboriginal and Torres Strait Islander patients), plus group diabetes services. The allied health provider does not confirm acceptance or contribute to the plan.
• Same rebate for prepare and review. Preparation and review now attract the same benefit, which removes the old incentive to write a new plan every year rather than review the one that exists.
• MyMedicare link. Patients registered with MyMedicare access GPCCMP items through the practice they are registered with. Unregistered patients see their usual GP.

Who is eligible — the part doctors get wrong

The Department’s test is one sentence: a chronic medical condition that has been, or is likely to be, present for at least six months, or is terminal. There is no list of eligible conditions; the factsheet says so in those words. It is the GP’s clinical judgement whether a patient with a chronic condition would benefit from a plan. Patients in residential aged care are the one exclusion.

So the question is not “is this disease on the list?” but “does this patient have an ongoing condition that needs structured management?” On that test, in a typical general practice list, the plan is under-used for asthma, obesity and weight management, chronic pain and back pain, osteoarthritis, GORD, iron deficiency, hyperlipidaemia, migraine and osteoporosis — conditions that are managed for years and reviewed in an ad-hoc way because nobody wrote the plan.

The three-month review rhythm

A GPCCMP can be reviewed once every three months where clinically relevant, and prepared once every twelve months if necessary. A new plan is not required annually — an existing plan can continue to be reviewed. The workable rhythm we set up in Best Practice is: prepare once, then a recall for review at three-month intervals tied to the condition (spirometry and inhaler technique for asthma, weight, blood pressure and lipids for cardiometabolic patients), run by the nurse and completed by the GP.

What this means for your practice

1. Templates. If your Bp templates still say “GP Management Plan” or “Team Care Arrangement”, replace them. A GPCCMP template needs problems and needs, goals, treatments and services, arrangements, and a review date, pre-filled from the record.
2. Recall rules. A three-month review recall on every plan, and a report of plans with no review in the last quarter.
3. Nurse workflow. The nurse assists with preparation and review and can provide up to five services a year on the doctor’s behalf. That is the capacity most practices are not using.
4. Doctor education. One short session on the six-month test and the removal of the TCA changes billing behaviour more than any template does.
5. The 30 June 2027 date. Allied health access under old GPMPs and TCAs ends then. Every active old plan needs transitioning to a GPCCMP at its next review.

We build the templates, recalls and reports into Best Practice as part of our Bp templates work and cover the item rules in practice manager and nurse training. The rebate is $160.60 for 965 and 967 as at 1 July 2026 (MBS Online); it indexes each July, so check before you bill.

Quick answers

Jamal Al-SharifiFounder & Principal Consultant, DocHelp

Fifteen years in medical practice operations. MBA, Melbourne Business School. Two medical centres built and sold; ten-plus centres overseen today. About Jamal →