While we would love for the government to invest more in Australian’s musculoskeletal health, currently the only way to see a Physiotherapist using Medicare is if your GP has referred you under a Chronic Disease Management Plan – formally and still commonly called an Enhanced Primary Care Plan or EPC for short.
What’s an EPC?
An EPC (or Chronic Disease Management Plan) is a plan created by your GP for their patients who suffer from a chronic or terminal medical condition to see other medical providers – such as physiotherapists!
What’s an EPC?
An EPC (or Chronic Disease Management Plan) is a plan created by your GP for their patients who suffer from a chronic or terminal medical condition to see other medical providers – such as physiotherapists!
Am I eligible to get an EPC?
A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions, and stroke. There is no list of eligible conditions, so it is up to the clinical judgement of your GP and the general guidelines set out in the Medicare Benefits Schedule.
A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions, and stroke. There is no list of eligible conditions, so it is up to the clinical judgement of your GP and the general guidelines set out in the Medicare Benefits Schedule.
What’s the process?
First you need to make an appointment with your GP. Let reception know this is what you are wanting to discuss with your GP as they often need to allow extra time, and depending on the Practice, you may also need to see their clinic nurse.
Once your GP has created your referral, they will either fax it to our clinic or give it to you directly.
If your GP clinic has faxed your referral to us, one of our receptionists will call you to make an appointment. If you were handed the referral directly, simply call our clinic to make an appointment.
You will need to bring your referral with you on the day (if it was handed to you), as well as your Medicare card and a card with either a savings or cheque account attached to it (see below regarding gap payments)
How many appointments will my plan cover?
There is a total of 5 consultations available under an EPC per calendar year, with the 5 consultations available to be made with different allied health practitioners such as physiotherapy, podiatry, dietetics etc
For example, your GP could refer you for 3 sessions with a physiotherapist and 2 with a dietitian bringing your total consults to 5 for the year.
Unfortunately it is not 5 consultations with each allied health practitioner.
It is up to your GP how many consultations they allocate to each provider. The 5 consultations can be renewed each calendar year, but you would need a new referral from your GP.
Do I need to pay a gap?
Yes, there is a small gap to pay on the day.
How does the Medicare EPC rebate process work?
At our clinic, the first step is to pay the full fee upfront, but don’t worry, we use your card that has either a savings or cheque account, to refund $58 back onto it from Medicare which will arrive almost instantly.
You will need to bring your card with either savings or cheque on it to every appointment. Unfortunately the rebate cannot be processed onto a card under credit and in this digital aged, we also need the physical card to process your rebate – it cannot be processed using your phone or smart watch.
This works out to be:
Initial or long appointment to be paid in full - $88 or $78 with concession card*
Medicare rebate - $58
Gap payment works out to be - $30 or $20 with concession
Standard appointment to be paid in full– $83 or $76 with concession*
Medicare rebate - $58
Gap payment works out to be – $25 or $18 with concession
*Appointments with Senior Physiotherapist's Julie Peacock and Jonathan Schubert do attract higher rates, as does Neuro/Vestibular sessions with Physiotherapist Peter Choi and Women's Health sessions with Physiotherapist Jess Hartley under Medicare. For costings please contact the clinic.
Summary
If you have any questions regarding the EPC process, please call the clinic 08 8296 7594 and speak to one of our team, or alternatively you can speak with your GP.
We look forward to helping to reduce your pain and help you move and feel better, so you are able to get back to the things you enjoy!
First you need to make an appointment with your GP. Let reception know this is what you are wanting to discuss with your GP as they often need to allow extra time, and depending on the Practice, you may also need to see their clinic nurse.
Once your GP has created your referral, they will either fax it to our clinic or give it to you directly.
If your GP clinic has faxed your referral to us, one of our receptionists will call you to make an appointment. If you were handed the referral directly, simply call our clinic to make an appointment.
You will need to bring your referral with you on the day (if it was handed to you), as well as your Medicare card and a card with either a savings or cheque account attached to it (see below regarding gap payments)
How many appointments will my plan cover?
There is a total of 5 consultations available under an EPC per calendar year, with the 5 consultations available to be made with different allied health practitioners such as physiotherapy, podiatry, dietetics etc
For example, your GP could refer you for 3 sessions with a physiotherapist and 2 with a dietitian bringing your total consults to 5 for the year.
Unfortunately it is not 5 consultations with each allied health practitioner.
It is up to your GP how many consultations they allocate to each provider. The 5 consultations can be renewed each calendar year, but you would need a new referral from your GP.
Do I need to pay a gap?
Yes, there is a small gap to pay on the day.
How does the Medicare EPC rebate process work?
At our clinic, the first step is to pay the full fee upfront, but don’t worry, we use your card that has either a savings or cheque account, to refund $58 back onto it from Medicare which will arrive almost instantly.
You will need to bring your card with either savings or cheque on it to every appointment. Unfortunately the rebate cannot be processed onto a card under credit and in this digital aged, we also need the physical card to process your rebate – it cannot be processed using your phone or smart watch.
This works out to be:
Initial or long appointment to be paid in full - $88 or $78 with concession card*
Medicare rebate - $58
Gap payment works out to be - $30 or $20 with concession
Standard appointment to be paid in full– $83 or $76 with concession*
Medicare rebate - $58
Gap payment works out to be – $25 or $18 with concession
*Appointments with Senior Physiotherapist's Julie Peacock and Jonathan Schubert do attract higher rates, as does Neuro/Vestibular sessions with Physiotherapist Peter Choi and Women's Health sessions with Physiotherapist Jess Hartley under Medicare. For costings please contact the clinic.
Summary
- Yes you can get a Medicare Rebate for Physiotherapy but only under a Chronic Disease Management Plan or EPC
- You need a doctor’s referral and to meet the requirements or eligible conditions
- You can get a $58 rebate on up to 5 visits per year
- Yes, there is a gap to pay on the day
- We process the rebate on-the-spot, straight back into your debit/savings accounts (not credit)
If you have any questions regarding the EPC process, please call the clinic 08 8296 7594 and speak to one of our team, or alternatively you can speak with your GP.
We look forward to helping to reduce your pain and help you move and feel better, so you are able to get back to the things you enjoy!
*Prices current as of July 2023 and may be subject to change
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