What is Enhance Primary Care Referral?
Enhanced Primary Care (EPC) for Allied Health Services is a medicare rebate system to help refund part of the cost of attending a private allied health service. These include general practitioners, nurse practitioners, midwives, practise nurses and allied health providers. Please see the below links for more information.
- Aboriginal and Torres Strait Islander people
- Autism—Helping Children with Autism program
- Disability—Better Start for Children with Disability initiative
- Diabetes type 2—allied health
- Children in Out of Home Care
- Chronic Disease Management (formerly Enhanced Primary Care or EPC)—GP services
- Chronic Disease Management—allied health individual services
- Health assessments
What is the process?
If you have a diagnosed chronic or terminal medical condition, you may be entitled to a limited number of Medicare-subsidised allied health services, i.e., physiotherapy, dietitian, and podiatry.
To access these services, Medicare has strict criteria that must be met.
You must have a chronic medical condition that meets the Medicare definition.
A chronic medical condition is one that has been or is likely to be present for at least six months, including but not limited to:
- asthma.
- cancer.
- cardiovascular illness.
- diabetes mellitus.
- mental health conditions (including dementia).
- musculoskeletal conditions; and
- stroke; or
- terminal illness.
You must also require the services of two other health providers (apart from your doctor). You will first need to ask your doctor if you are eligible and if so, what services you may access. If you are eligible, you will be asked to make an appointment with our nurse to draw up the paperwork for the management plan and the team care paperwork to access allied health services. This will take between 30 and 45 minutes. You will also need a follow-up appointment with your doctor to complete the plans. Once this process is complete, you can access the eligible services.
Under management plans, you may be eligible for up to 5 visits per calendar year. This is spread among all allied health professions. This comes off the tally if you see another allied health professional under the plan. We ask upfront if the appointments have been used elsewhere, but sometimes, this can result in the plan being overserviced. This will result in the payment by the client to cover the cost of the appointment, which is $56. With all GP management plans, a $25 fee is applicable to every appointment under the plan. If you have any further questions, please refer to Sarah, our practice manager.
Your bill is invoiced directly to Medicare with a small GAP payment from you.
Reference:
Www1.health.gov.au. (2020). Department of Health | Primary care (GP, nursing, allied health). [online] Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/mbs-primary-care?Open=&utm_source=health.gov.au&utm_medium=redirect&utm_campaign=digital_transformation&utm_content=mbsprimarycareitems [Accessed 25 Feb. 2020].