CDM Allied Health — Occupational Therapy

Occupational therapy health service of at least 20 minutes provided to a patient with a chronic condition and complex care needs, on referral from the patient's GP under a chronic condition management plan.

Plain-English summary. See MBS Online for the verbatim descriptor of each item.

Time

At least 20 minutes

Frequency

Not capped

Referral

Required

Profession

Occupational Therapist (Medicare-eligible)

Requirements to bill

Conditions imposed by the descriptor that must be met to claim this item.

1Patient must have a chronic condition and complex care needs being managed by their GP under a current chronic condition management plan.
2GP must have referred the patient on the approved allied health referral form, naming occupational therapy as the service required.
3Service must be of at least 20 minutes duration.
4Provider must be a Medicare-eligible occupational therapist.
5Combined cap of 5 individual CDM allied health services per calendar year, across all CDM allied health providers and items.

Your notes must show

Documentation tests — what clinical notes need to demonstrate to survive a PSR audit.

Date, start time, end time, location, and item number claimed.
Referral details — referring GP, plan date, chronic condition targeted, sessions remaining.
How the service relates to the management plan goals.
OT assessment (functional capacity, occupational performance), intervention, and response.
Plan / next steps and communication back to the referring GP.
Confirmation a written report has been provided to the GP.

Common audit failures

Patterns the Professional Services Review scheme and Medicare audits flag.

Session duration not documented.
No current chronic condition management plan on file.
Notes describe an OT intervention without linking back to the management plan goals.
No written communication back to the referring GP.
Sessions billed beyond the 5-per-calendar-year combined cap.

Related MBS items

965

GP Chronic Condition Management Plan — preparation

967

GP Chronic Condition Management Plan — review (face-to-face)

10954

CDM Allied Health — Dietetics

10960

CDM Allied Health — Physiotherapy

Templates that document this item

Note templates inside Grounded Scribe that produce documentation aligned to this MBS item.

CDM Occupational Therapy (10958)

Chronic Disease Management occupational therapy session (MBS item 10958). Documents the chronic condition, functional goals from the referring chronic condition management plan (GPCCMP item 965 post-1-Jul-2025; legacy GPMP plans continue under transition arrangements until 1 July 2027), intervention provided (e.g. activity modification, equipment, energy conservation), and recommendations back to the GP. Structured for the Medicare claim and continuity of care.

In-depth reading in the Library

Medicare Audit-Ready Documentation: A GP's Guide to MBS Item Number Compliance

Professional Services Review audits can result in repayment demands, exclusion from Medicare, and public referral. Your clinical notes are the primary evidence in any PSR investigation. This guide details exactly what your documentation must contain to withstand scrutiny.

Source authority

Documentation tests on this page reference the descriptor conditions and PSR-audit patterns covered in our existing Library guides. Always confirm current rules against the official descriptor.

Item 10958 on MBS Online

Keep reading