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Enhanced Primary Care (EPC) for Allied Health Services

A  Medicare rebate system to help refund part of the cost of attending a private allied health service.

This program might be useful if you are on a waiting list for a public service and feel an initial assessment and guidelines to start prior to been seen might be helpful. For example:

  • you are on the waiting list for Early Childhood Intervention (Occupational Therapist, Physiotherapist, Speech Therapist)
  • you wanted an assessment / advice for feeding and growth issues (Speech Therapist / Dietician)
  • you require an assessment / review of your child’s feet and appropriate footwear (Podiatrist)
  • you would like a Psychologist review to evaluate your child’s learning profile and behavior prior to starting school (Psychologist)

EPC is for clients (adults or children) who have a chronic condition and complex care needs.  A chronic medical condition is one that has been (or is likely to be) present for six months or longer.  It can include conditions such as asthma, diabetes, and musculoskeletal conditions.

Patient’s (adults or children) have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and a least two (2) other health care providers.

In summary:

  • It provides a total of five (5) services per patient each calendar year
  • A Medicare rebate per service, with out of pocket expenses costs counting towards the extended Medicare safety net.
    • Patient must have an Enhance Primary Care (EPC) plan prepared by their GP
    • GP refers to allied health professional

Eligible allied health professionals include:

  • Audiologists
  • Chiropractors
  • Diabetes Educators Dietician
  • Occupational Therapists
  • Physiotherapists
  • Podiatrists
  • Psychologists
  • Speech Pathologists

Private health insurance
If you have private health insurance, you will need to decide if you wish to use Medicare or your private health insurance to pay for these services.

Claiming
Allied health professionals, like doctors, are free to set the level of their fees. If your allied health provider bulk bills, there will be no charge for these services. If not, you will be charged a fee and you can claim the rebate from Medicare.   Out-of-pocket expenses for these services count towards the extended Medicare safety net.  If you are unsure, or lose track of how many allied health services you have claimed in a year, you can check with Medicare Australia on 132 011.

If you have any questions, ask your doctor or practice nurse.

More information

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