Diabetes Annual Cycle of Care – Billing Tips Sheet
Annual Cycle of Care Checklist
Date last SIP claimed: …………………………………………………. OR Start date:………………………
# Minimum requirements to
# Minimum
(0-6
(6 -12
Annual
be completed
frequency
months)
months)
Due by:
Due by:
Due by:
Measured BP
Every 6 months
Measure weight and height
Every 6 months
(BMI)
Examine feet
Every 6 months
Test for Microalbuminuria
Annually
## Measure HbA1C
Annually
Measure TG, Total and HDL
Annually
cholesterol, eGFR
Review medication
Annually
Provide self-care education
Annually
Perform dietary review
Annually
Review level of physical activity Annually
Check smoking status
Annually
Completion of comprehensive
Every 2 years
eye examination (optometrist ophthalmologist)
Bi-annual
Due by:
# Frequency of review, measures and tests should be consistent with current best practice guidelines. Patients’ individual status
should be considered by the clinician to determine appropriate management.
## When requesting HbA1c on pathology forms please notate specifically HbA1c Item 66551: Performed to monitor the
management of established diabetes. This ensures the data used for Diabetes Outcome Payment is accurate.
When all items are completed as required, the consultation item number is replaced by the below SIP numbers –
this attracts an extra $35 per consultation on-top-of the usual schedule fee:
GP attendance item
numbers
Level B - 23
Level C - 36
Level D - 44
SIP Number
Equals
Equals
Equals
2517
2521
2525
$ for SIP
number
$37.05
$71.70
$105.55
Add to payment for visit if SIP item
number used claimed
$40
$40
$40
Please note:
The SIP item number = consultation item number + $40 SIP payment
Either the consultation number or SIP item number can be claimed (not both on the same day).
The visit does not need to be a diabetes-specific review; any consultation can be substituted with the SIP number. The treating
medical practitioners must be confident they have fulfilled all service requirements as specified in the item descriptor for this
service prior to billing.
The following can be claimed annually.
Items 721 and 723 for GP Management Plan (GPMP) and Team Care Arrangements (TCAs) may be billed for a patient, either on
the same date of service, or within the same year as Service Incentive Payment (SIP) items, for example diabetes cycle of care
items 2517 – 2526 & 2620 – 2635. The rationale behind this is that the GPMP and TCAs set out the care to be provided in the
future and SIP items cover the care provided over the previous 11-13 months.
However, an SIP item and a GPMP/TCAs review item 732 should not be claimed within three (3) months of each other, as both
services involve reviewing the patient's progress in the preceding months for the same condition.
Diabetes Annual Cycle of Care
While every care has been taken in the preparation of this publication, including the data contained within, Gold Coast Primary Health
Network (GCPHN) accepts no responsibility for decisions or actions taken as a result of any data, information, statement or advice,
expressed or implied within.
Disclaimer: Please ensure compliance with MBS online which contains a full listing of Medicare services subsidised by the Australian Government.
www.mbsonline.gov.au
GCPHN March 2016