Coordinated Veterans' Care (CVC) Program

Last updated: 
17 November 2020

In response to the COVID-19 pandemic, the CVC Program can be delivered via telehealth where appropriate, and relevant item numbers claimed as usual. See CVC COVID-19 Update for details.

The CVC Program proactively manages Veteran Gold Card holders with chronic conditions. Providers and participants work as a team to improve their health care in a general practice setting. It aims to decrease unplanned hospitalisation.

CVC Program information for providers

The CVC Program is a proactive coordinated care program. It aims to improve participant quality of life and decrease the risk of unplanned hospitalisation.

Within a general practice setting, the participant, their general practitioner (GP) and a nurse coordinator work as a team to develop a care plan to:

  • meet the health needs of the participant
  • manage the participant's ongoing care

The program promotes:

  • health literacy
  • self-management
  • best practice coordination of care through a person-centred approach

Who can take part

The Coordinated Veterans’ Care (CVC) Program is a proactive coordinated care program. It's for Veteran Gold Card holders who:

  • have a chronic health condition
  • are at a risk of unplanned hospitalisation

They must also not be a resident of a residential aged care facility.

CVC Toolbox

The CVC Toolbox includes:

  • an eligibility tool
  • information on creating a care plan
  • information on when and how to claim
  • a claim calculator
  • links to other health services in your area
  • an Information Hub with links to useful resources

Your feedback on the CVC Toolbox provides vital information on what works and what may need updating. To help us continue to improve please send any feedback to cvcprogram [at]

Improvement and feedback

We will continue to improve our delivery of the CVC Program. Thank you to all those who continue to provide feedback.

We post surveys and requests for feedback here. Please check back to provide your comments and have input into how we shape the CVC Program.

How to claim

Claim through Medicare. If you are a GP and take part in the CVC Program you can claim payments as shown in the following table.

You can get full details about how to claim CVC payments in the CVC Toolbox.

Payments GPs can claim

Claimable amounts effective from 1 July 2020

GP Type

Initial assessment and program enrolment

Item number

Completion of 90 day period of care – review of care plan and eligibility

Item number

Total amount year 1

Total amount year 2

GP with practice nurse







GP without practice nurse







Date of service

Claim payments on a 90 day basis for a period of ongoing clinical care. The start of this period is the date of service. We make the payments 90 days after the date of service.

To calculate dates of service or claim dates please use either the:

Both tools calculate the date of service and the claim date for each CVC participant.

Notes for CVC Program providers

The Notes for CVC Program providers set out legal requirements for those working with the CVC Program, including:

  • GPs
  • Practice Nurses
  • Aboriginal and Torres Strait Islander Health workers

The Notes:

The role of a community nurse (CN) in the CVC Program

Where a GP does not have access to a practice nurse, they may choose to work with a CN provider. The role of the CN in this situation is to coordinate care for the CVC participant. Nurses that work with clients in the CVC Program coordinate their care and need to be in contact with the client's GP regularly.

CVC social assistance

CVC social assistance is a short-term service of up to 12 weeks. It is available to CVC Program participants. CVC social assistance helps clients reengage in community life through:

  • social contact
  • accompaniment to a social activity

Refer a client for CVC social assistance

To refer a client for CVC social assistance send a referral for an assessment to a Veterans' Home Care (VHC) Assessment Agency. Phone 1300 550 450 to find the nearest VHC assessment agency.

Guides and brochures

We have more information on the CVC Program in these documents:

Contact the CVC team

If you have questions about the CVC Program you can:

Evaluation reports

The CVC Program was evaluated over a 4 year period from May 2011 to May 2015.

Findings from the reports continue to inform program improvements.

Grosvenor Management Consulting

Grosvenor made an independent evaluation of the CVC Program objectives. The focus is on performance and cost effectiveness.


Bupa analysed CVC service use and outcome data.

Flinders University

The Flinders report is a qualitative study on the implementation of the CVC Program and service delivery in general practice.

Service partners

We contract external organisations to help with delivery of the CVC Program.

Bupa Medical

Bupa undertakes monitoring and evaluation, including trend analysis of the CVC Program.