Facts About Enhanced Primary Care (EPC) Plans

18 Apr Facts About Enhanced Primary Care (EPC) Plans

The Australian Government removed Enhanced Primary Care (EPC) items from the Medicare Benefits Schedule in 2005 and replaced them with Chronic Disease Management (CDM) items.  The terminology Chronic Disease Management (CDM) Plan never took off and people still refer to their ‘Care Plans’ as EPC Plans.  For today’s BLOG I’ll use the simple terminology, Care Plan.

Care Plans are a government scheme through which, under certain circumstances, Physiotherapy (and other allied health providers such as podiatrists, dieticians, etc.) treatment attracts a Medicare rebate.  A Care Plan is designed for patients who require a structured approach to their care and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multi-disciplinary team.

To be eligible for a Care Plan, your GP must identify that you have a chronic medical condition that has been, or is likely to be, present for six months or longer. While there is no actual list of eligible conditions; examples on the Department of Health’s website include: musculoskeletal conditions, asthma, cancer, cardiovascular disease, diabetes and stroke. 

Under a Care Plan, you may have a total of 5 visits to allied health providers in one calendar year. Those 5 visits may be to one allied health provider or be spread between several providers.  You will need to coordinate with your GP how you would like your visits distributed. Your GP will then issue the Care Plan referral(s) accordingly.  

Care Plans may be issued by your GP at any time of the year and remain open until the number of services the GP has specified on the referral form(s) have been used. Any unused services at 31 December can continue to be used but are subject to the maximum limit of five Medicare rebateable allied health services visits in any calendar year period (i.e. 1 January – 31 December). When patients have used all of their referred services or require a referral for a different type of allied health service than that recommended in their care plan, they need to obtain a new referral from their GP. 

The current Medicare rebate, at the time of this blog, is $53.80.  If you are referred to Physio Fit Studio in your Care Plan, we ask that you pay your account with us at the time of consultation. We can process your Medicare rebate on the same day via our HICAPs machine if you have an EFTPOS card attached to a savings or cheque account.  Medicare will NOTallow us to provide rebates to your credit card account.  If you do not have an EFTPOS card attached to a savings or cheque account, we can issue you a receipt for you to claim your rebate directly with Medicare. Please ring our office to enquire about current charges for consultations.