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Enhanced Primary Care Plans (EPC)

What is an EPC?

The Enhanced Primary Care (EPC) plan was introduced to help people reduce the costs of their allied health services under Medicare. Not only that, it was designed to help plan and document the overall treatment plan for people with chronic health conditions.

It was removed from the Medicare Benefits Schedule way back in 2005 and replaced by Chronic Disease Management plan (CDM). However, many people still refer to them as EPCs even though it is almost two decades since they were officially called that. We still do too!

DO I QUALIFY FOR AN EPC?

The EPC/CDM plan was introduced to help create an overarching plan of management for people with chronic or terminal conditions. It is aimed at people who need a team looking after them in addition to their GP.

Some of conditions that qualify include: cardiovascular illness, stroke, cancer, asthma, osteoporosis and many musculoskeletal conditions.

To find out more about the physio services that we provide, check out this page with a summary.

How many visits will it cover?

The maximum number of visits you can receive for all allied health providers is five visits each calendar year.

How these five visits are distributed is something that you and your GP will decide together depending on your needs and the best way to use these resources.

The EPC visits have their own Medicare codes. You can only use these particular codes 5 times per calendar year across all different allied health providers.

Please note: these EPC visits can only be used for 1:1 physio treatment. They cannot be used for group treatment sessions.

Click on this link to read more information about Chronic disease individual allied health services Medicare items

'MY GP SAID THAT I WOULD GET 5 FREE VISITS'

This is a common misconception about the EPC program. Even if your GP or practice nurse has said that these sessions are free, this isn’t quite true.

It is the same situation as bulk-billing. Some GPs bulk bill. Most charge a gap these days.

Whether the visits are free depends on whether the practice is prepared to accept the Medicare rebate without a gap. 

We really have no choice. We need to charge a gap to make ends meet!

So then the decision is whether you want to see one of our fabulous physios and pay a gap, or see another physio.

A good way of looking at it is that the rebate amount is usually larger than a private health insurance rebate. 

In other words, you are getting physio visits with a bigger than usual rebate. Not free, but definitely cheaper for the same top notch service.

NB: if you have reached the Medicare Safety Net level for the year because you have paid a lot of out of pocket costs, the rebate goes up significantly, so the gap would be minimal.

WHAT IF I WANT TO SEE A DIFFERENT PHYSIO?

If your EPC form has a different physio practice name on it, you need to get a new form from your GP

If it is a different physio in the same practice, that is fine as long as the form says the practice name on it.

If the form doesn’t specify the name of the physio or the practice but just the specialty, they you can see anyone of that profession as long as they are registered with Medicare Australia.

CAN I USE MEDICARE FOR PHYSIO TREATMENT?


You can only access Medicare under the EPC/CDM plan as laid out above.

If you don’t qualify for an EPC, or if you have used your 5 allied health visits in the calendar year, you are bang out of luck.

HOW DOES THE MEDICARE EPC REBATE PROCESS WORK?

If you have a valid EPC referral, you pay the full amount at the time of the visit. You can pay for the session with cash, credit or debit card.  

 If you would like to receive the rebate into your account, this can be done at the time of the consult via the HICAPS terminal), BUT CAN ONLY BE DONE WITH A DEBIT CARD.  

Medicare simply will not pay the rebate into a credit account for allied health services.  

 If you do not have a savings/debit card then the paperwork is sent to Medicare and processed manually into their account listed with Medicare (via BSB and Acct number).  This can take up to 28 days.

 

CALL US TODAY ON 8356 1000 if you have any questions about the EPC scheme

 

Here is why people choose Adelaide West Physio + Pilates

We have been providing premium physio services at our Fulham clinic since 2009. We help people of the western suburbs of Adelaide, but we also other parts of Adelaide and country areas.

Low back pain relief is our specialty – more than an area of interest, we are dedicated to helping to transform lives that are affected by low back pain and other persistent pain conditions.

Evidence-based approach – you’ll get the best results from treatment that is based on evidence and research. We abhor pseudoscience and its use in health care today.

Clear diagnosis and plan of attack – find out definitively what is wrong and have it explained clearly to you, plus receive a written report of assessment findings and treatment plan.

Experienced therapists – take advantage of our combined experience of over 50 years.

Further qualifications – we have a Credentialled McKenzie Therapist and Watson Headache Certified Practitioner on staff

Ongoing professional development – we invest in our staff and their education, with twice weekly internal professional development sessions and external continuing education

Get empowered – find out what you can do to help yourself, learn how to stay painfree.

Friendly and welcoming – we boast the friendliest and most helpful therapists and front desk staff on the planet.