Have you recently seen your doctor about managing a chronic health condition? If so, you may be eligible to receive a Chronic Disease Management Plan (CDM), also sometimes referred to as an Enhanced Primary Care Plan (EPC). Here’s a simple guide to understanding how the EPC program works and what it means for you.
What is the Chronic Disease Management Plan?
The CDM/EPC plan is part of the Medicare Benefits Schedule, which allows GPs to coordinate treatment plans with other health providers—like physiotherapists—for patients with chronic or terminal conditions.
Can You Get a Medicare Rebate for Physiotherapy?
Yes, you can! Here’s what you need to know:
Eligibility: The EPC plan is designed for individuals with chronic conditions (typically lasting more than three months).
Referral Requirement: You’ll need a specific referral from your GP, who will send you to a physiotherapy clinic of your choice (we’d love to be your clinic!).
Once your GP completes the EPC form, they’ll send it to your chosen provider, so you’re ready to go without any additional paperwork on your end.
How Many Visits Does the CDM Cover?
Under a CDM, you’re eligible for up to five Medicare-rebated visits per year for allied health services, including physiotherapy, podiatry, dietetics, and more. The total rebated visits are total across the services, meaning that you can split the visits between allied health disciplines. For example, you can use this for two rebated podiatry visits and three physio sessions for the year. Your CDM can be reset each calendar year but a new GP referral is required annually to be able to access new visits.
How Does the Rebate Work?
We are unable to bulk bill Medicare for physiotherapy, but you are able to receive a Medicare rebate which covers part of each session cost. Each session is paid upfront.
Here’s how it works at Newcastle Aquatic Physiotherapy:
Full Payment First: Pay the session fee upfront.
Instant Rebate: We process your rebate on the spot, returning $53.80 back into your account (either the same day or the next morning at the latest). Here’s a breakdown of what this looks like:
Initial Physiotherapy Assessment: $155.00. ($110 concession). Rebated approximately $60.35.
Gap Payment: $94.65 after rebate ($49.65 concession)
Follow-Up Physiotherapy Session: $110.00 ($90 concession). Rebated approximately $60.35.
Gap Payment: $49.65 after rebate ($29.65 concession).
Summary
Yes, Medicare rebates apply for physiotherapy under the EPC/CDM program.
You need a referral and a qualifying chronic condition.
The rebate is $53.80 per visit, up to 5 sessions per year (across all your referred services).
A small gap fee will apply, but we handle the rebate instantly for your convenience.
If you have questions about the EPC process, feel free to call or email us. Your GP is also a great resource for any additional queries.
We look forward to helping you move better, feel great, and enjoy life to the fullest!
#exercise #physiotherapy #frequentlyaskedquestions #gym #hydrotherapy
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