Chronic Condition Management Claiming Logic

As part of the ongoing support for the Chronic Condition Management (CCM) changes introduced from 1 July 2025, Bp Premier version Spectra SP1 Revision 3 delivers new claiming logic to improve the handling of relevant MBS item numbers across the finalise visit and invoicing workflows.

Finalise Visit MBS Item Enhancements

In Spectra SP1 Revision 3, Bp Premier will now suggest appropriate item numbers when a user finalises a visit involving the preparation or review of a chronic condition care plan. Bp Premier will determine the correct item based on provider type (VR or Non-VR) and visit mode (face-to-face or telehealth):

VR GPs:

  • Face-to-face: 965 (creation), 967 (review)
  • Telehealth: 92029 (creation), 92030 (review)

Non-VR Prescribed Medical Practitioners:

  • Face-to-face: 392 (creation), 393 (review)
  • Telehealth: 92060 (creation), 92061 (review)

The appropriate MBS item number will be displayed in the item picker based on these criteria.

Finalise visit GP chronic condition management plan item suggestion.

Co-claiming logic

In Spectra SP1 Revision 3, Bp Premier will now enforce co-claiming restrictions when CCM items are added during the finalise visit or invoicing workflows. These restrictions reflect current Medicare billing rules and are supported by system prompts where applicable.

The following co-claiming rules are applied:

  • 965 / 392 and 92029/92060 (telehealth creation) cannot be billed with any other attendance item number.
  • 967/393 and 92030/92061 (telehealth review) cannot be billed within a 3-month period unless there are extenuating circumstances.

Co-claiming restrictions for GPCCMP items and attendance items.

Information correct at time of publishing (18 September 2025).