What is Enhanced Primary Care (EPC) or Chronic Disease Management (CDM)

A Chronic Disease Management program is a way for your General Practitioners (GPs) to assist in the management of the health and well-being of patients with chronic or terminal conditions.  These are classified as medical conditions that have been or which will be present for a minimum of 6 months.

Patients may be eligible for Medicare rebates for Physiotherapy through the GPs’ referral.

However, Medicare doesn’t publish a list of eligible chronic conditions and patients are assessed on a case-by-case basis, so it can be a bit tricky to navigate Medicare physiotherapy.  As a general rule, patients on an EPC Physio Plan in Perth are only able to claim five allied health sessions of 30-minutes each and will be required to pay a small gap fee.

The team at Trained Physio and Fitness Perth has extensive experience with patients on an EPC Plan and bulk-billed physio appointments.  We’ll get you sorted.

What do I need before my Medicare Physio consultation?

  1. Approved EPC Referral Care Plan
  2. Referral for Physiotherapy from your GP
  3. Approved Claim Number
  4. Medicare card
  5. Bank card to pay for the small gap fee
  6. Any other medical documentation associated with your injury including reports, scans, MRI results etc.

Medicare Physio Treatment FAQ's

An EPC plan is basically a plan drawn up by a GP in response to Medicare’s requirement for a multidisciplinary approach to the management of a patient suffering from a chronic condition or a terminal illness.  It basically means that management of their condition requires complex care involving more than one healthcare provider.

An EPC plan for physio means a GP has drawn up a plan for patients who suffer from a chronic or terminal medical condition which includes physiotherapy.  This could be anything from arthritis to a recurring shoulder injury to muscular dystrophy.

To qualify for an EPC plan for physiotherapy, your condition has to be verified as complex or chronic.  Complex care requires intervention from at least three healthcare providers such as GPs, podiatrists, dieticians, chiropractors, exercise physiologists and physiotherapists, while chronic medical conditions are long-term (lasting six months or longer).

Medicare doesn’t publish a list of conditions or injuries that it covers under its EPC plan. Your GP will make a clinical judgement and determine if you are eligible. Examples of conditions that are typically covered by an EPC plan are arthritis, osteoporosis, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke.

Under Medicare’s EPC plan, you are limited to FIVE allied health appointments per calendar year.  You can decide whether you want to allocate all of these to physiotherapy or whether you want to divide them up between various disciplines.

Yes. However, please advise the practice that you are a Medicare patient at the time of making an appointment so that they can confirm what you need to bring.

The Medicare rebate is currently set at $56 per session and there is usually a small gap to pay. Many physiotherapy practices including ours at Trained Physio and Fitness in Perth require payment in full after each session and are able to process your Medicare rebate on the spot (provided you have your Medicare card with you).  If you have a low-income healthcare card or are on a disability pension, you may qualify for bulk-billed physio.

If you’ve made an EPC Plan for Physio at our Perth studio, you will need to bring the following to each appointment:

  • Your approved EPC Referral Care Plan
  • Your GP’s referral for Physiotherapy
  • Your approved Medicare claim number
  • Your Medicare card
  • A bank card to pay the small gap
  • Any other medical documentation associated with your injury including specialists’ reports, scans, MRI results etc

If you’re being treated under Medicare physiotherapy at Trained Physio and Fitness in Perth, you’ll get the same high level of care and treatment as everyone else!  Our experienced physios use a range of techniques to treat patients including massage, joint manipulation, movement therapy, stretching and exercise physiology as well as dry needling, myofascial release and trigger point therapy.

You generally need to pay for your appointment yourself and then submit the claim to Medicare.  Some physio practices, ours included, are able to process your Medicare rebate on the spot (provided you have your Medicare card).

Your first step is to see your GP.  They will determine whether your condition or injury falls into the category of ‘complex’ or ‘chronic’ and whether you are eligible to claim for physiotherapy consultations under Medicare’s EPC plan.  They will need to give you a referral letter (or they can fax or email it directly to your chosen physiotherapy practice).

Once your eligibility has been determined and you have a letter of referral, you can make an appointment under an EPC plan for physio.  Our Perth practice looks forward to helping you move better and feel better.


Want to move better and feel better?

We welcome all patients on an EPC Physio Plan in Perth.  If you have a referral from your GP and are eligible for a Medicare physiotherapy rebate, call our friendly team on 08 9325 7602 and start your healing today.

Need more information?

If you are unsure of what steps to take or need more information, please call our friendly staff on 08 9325 7602.

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