I’ve Got an Enhanced Primary Care Plan (EPC). What Next?

So, you’ve just been to see your doctor about a chronic condition that you have. Your doctor has told you that they are going to put you on an Enhanced Primary Care Plan (EPC) and that you have up to 5 ‘free’ visits with a Physio.

Let’s break this down and go through any information you may need to know.

What Is An Enhanced Primary Care Plan?

An EPC is a plan on the Medicare Benefits Schedule where GPs are able to plan treatment for patients who suffer from a chronic or terminal medical condition with other medical providers.

Can I get a Medicare Rebate for Physiotherapy?

The short answer is YES! The long answer is yes, but there are a few conditions.

Firstly, you must meet the criteria, and that is generally centred around ‘chronic’ conditions, meaning something you have had for more than 3 months.

Secondly, you need to have the appropriate referral from your GP, who needs to send you to a Physiotherapy clinic (hopefully us! We’d love to help!)

Once the EPC form is filled out by your doctor, they will fax a copy to Total Balance so we can create a case file on our system and link you to Medicare. We can make the claim on your behalf.

One of our friendly admin staff will give you a buzz once they have the EPC referral and book in your initial appointment. It’s as simple as that and you don’t need to do any extra work!

How many visits will it cover?

EPC allows for a total of up to 5 rebated consults to any referred allied health practitioner, per year. That could include Physiotherapy, podiatry, dietetics, speech pathology etc. So for instance, your GP may refer you for 3 Physio consults and 2 Podiatry consults. This number is renewed each calendar year, but you will need a new referral each year to access them.

Is It Really Free?

While we would love to help you out with free treatment, unfortunately we cannot bulk bill Medicare for Physiotherapy at our practice, so there will always be a small gap payment.

How does the Medicare EPC rebate process work?

At our practice, the first step is to actually pay the full fee upfront but don’t worry, we process the Medicare claim at the same time, so once we receive notification of the expected benefit it should be back in your nominated account within 24-48 hours.

Summary

Yes you can get a Medicare Rebate for Physiotherapy using the EPC program.

You need a specific doctor’s referral and the right type of physical condition

You can up to 5 visits per year, including all your allied health visits allocated

There will always be a small gap fee

We can process the rebate on-the-spot via Medicare

If you have any specific questions at all regarding the EPC process, please call or email us, and we are more than happy to answer them!

Alternatively, your GP can also answer your questions.

We look forward to helping you move better, feel great and enjoy life!