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Medicare and Credentialled Diabetes Educators

Logo of CDEBecoming a Medicare provider

Medicare Australia recognises Credentialled Diabetes Educators (CDEs) as the providers of diabetes education.  To learn more about becoming a Medicare provider or to download the application form for initial and/or additional provider numbers, please visit the website of Medicare Australia.

Maintaining your credentialling status

Medicare Australia considers the Australian Diabetes Educators Association (ADEA) as the regulatory body for CDEs. The ADEA expects all CDEs to participate in the Re-Credentialling Program and lodge applications for re-credentialling according to instructions on the Recredentialling page. All CDEs who have been granted CDE status as a membership benefit must maintain a financial full ADEA membership. Please be aware that ADEA reports all practitioners with lapsed CDE status to Medicare, including those due to non-financial membership, within one (1) month which results in loss of provider status.

Consultations

Individual

People with diabetes can claim rebates for five (5) consultations with allied health care professional per year as part of Medicare’s Chronic Disease Management (CDM) framework.  Diabetes education provided by a CDE is in included in the total number of these five (5) visits. The specific MBS item number for diabetes education is 10951.

Group services in type 2 diabetes

People with type 2 diabetes are eligible to claim rebates for attending group programs conducted by a CDE, a dietitian or an exercise physiologist. The rebates include one (1) individual consultation to assess if attendance in group education is suitable as well as eight (8) hours of group consultations. The MBS item number for diabetes education is 81100 for the individual assessment and 81105 for group services.  Group consultations are in addition to any individual consultations. To learn more, please read our Introduction of Group Items or our Guide to allied health group MBS items in type 2 diabetes. Alternatively, you can view our  web – presentation about MBS items for group services in type 2 diabetes located on the Our presentations page.

Indigenous specific

Indigenous people with diabetes can claim rebates from five (5) follow-up allied health consultations.  The MBS item number for diabetes education is 81305. Consultations are in addition to any individual consultations under the CDM framework or group program attendance.

Eligibility

The person with diabetes must be referred by their General Practitioner (GP).  The GP must undertake consultation identified by MBS Item numbers specific to the type of referral e.g.  General Practice Management Plan and Team Care Arrangements for individual consultations, prior to the person with diabetes consulting a CDE.

The referral must be completed on the referral form designated by Medicare to the specific type of consultation e.g. individual, group.

Medicare Audits & Referral Logs

Medicare periodically audits and recovers payment from CDEs that cannot substantiate claims for services. The documentation required to substantiate a claim depends on the type of Medicare service provided:

1. Individual Chronic disease management consultations

To substantiate each MBS item number 10951 claimed, CDEs must keep the following documentation (which can be tracked with the Chronic Disease Management (CDM) referral log

2. Follow-up individual consultations for indigenous people

To substantiate each MBS item number 81305 claimed, CDEs must keep the following documentation (which can be tracked with the Indigenous follow up referral log:

3. Group services for type 2 diabetes

To substantiate each MBS item number 81105 claimed, CDEs must keep the following documentation (which can be tracked with the type 2 group referral log:

ADEA encourages CDEs to review these logs periodically and ensure no documentation is missing. Good record keeping practices help CDEs to demonstrate Medicare compliance.

Need more information?

Details about all referral and eligibility criteria for all diabetes education services are available from the website of the Australian Department of Health and Ageing.

The ADEA recommends that CDEs considering employment in the primary care sector, general practice or private practice, visit Medicare Australia’s online training program Chronic Disease Management for Allied Health Professionals. Visiting Medicare Australia’s online training program Chronic Disease Management for General Practitioners may also be beneficial.

The ADEA also suggests that CDEs join the Private Practice Special Interest Group (PP SIG) to network and exchange information with peers who also provide diabetes education consultations through Medicare.