There is a lot of confusion about who can claim what from Medicare when it comes to Chiropractic, Physiotherapy or Podiatry services. Below is a list of FAQ’s to help you understand the process and find out if you are eligible for any rebates.
Q. Can I claim a Medicare Rebate for Chiropractic, Physiotherapy or Podiatry Services?
You may qualify to receive a Medicare rebate for Chiropractic, Physiotherapy or Podiatry services.
It is possible for people with chronic conditions or complex care needs to receive a Medicare rebate for up to a maximum of five (5) visits per calendar year for Chiropractic, Physiotherapy or Podiatry services.
Q. Who is eligible?
To be eligible for a Medicare rebate, you need to be placed on an Enhanced Primary Care (EPC) plan by your GP, which specifically refers you to a Chiropractor, Physiotherapist or Podiatrist at Brunswick Health.
Q. How do I get placed on an EPC plan?
If you have been suffering or will suffer from a condition for longer than 6 months or have numerous health issues then you qualify for the Medicare EPC program.
Visit your GP and ask them to prepare an EPC plan, which means they must lodge 721 & 723 Medicare forms with Medicare. Depending on how and when your GP lodges these forms, it can take a number of days or weeks. If your GP lodges electronically on the day, then it should only take a few days. Ask your GP when they are likely to complete this process.
Q. Can I use my private health insurance cover in conjunction with EPC?
You need to decide if you are going to use your Medicare rebate or your private health insurance, as you can NOT claim from both for the same consultation. Once you have claimed all your Medicare rebates you can then claim any further consultations through your private health insurance.
Q. What is meant by chronic conditions and complex care needs?
Chronic conditions are defined as conditions that have been or are likely to be, present for six (6) months or more. Complex care needs mean that in your GP’s opinion, you would benefit from the care provided by a range of health professionals who provide different services. Usually, it would involve 3 health care providers eg Chiropractor, Podiatrist & GP. It can be any allied health provider as long as they are registered with Medicare.
Q. Once I’m on an EPC plan, how does the billing process work at Brunswick Health?
To be able to receive the 5 rebates from Medicare, your GP must provide you with a form called “Enhanced Primary Care (EPC) Program Referral form for individual Health Services under Medicare”. Check your GP has filled in the number of Chiro/Physio/Podiatry services he or she wishes you to undertake, for example, “5 Chiropractic (10960)”. This means you are entitled to a maximum of 5 rebates for Chiropractic services for the year. Should your GP write 2, then you will only be entitled to 2 rebates, so best to discuss your needs carefully with your GP before any forms are submitted to Medicare.
Q. If I have an EPC plan, do I still have to pay on the day when I see a practitioner at Brunswick Health?
Yes, you pay the full podiatry consultation fee on the day but we will lodge your claim on your behalf electronically so you can receive the rebate directly from medicare into your bank account. The medicare rebate is $55.10 per visit (2022 financial year).
Q. What if I need treatment before my EPC is approved?
Providing the treatment occurred after the date your GP referred you for Chiropractic, Physiotherapy or Podiatry care, you should be able to claim your rebate. You may suffer delays if your GP has not lodged the correct forms in time. Medicare will not provide a rebate if the date of your Chiropractic, Physiotherapy or Podiatry consultation is BEFORE your GP’s EPC referral date.
Q. What if I need treatment before I see my GP in regards to an EPC Plan?
Unfortunately, Medicare will not pay for any visits PRIOR to the date the EPC plan was started. This means you must see your GP FIRST before you see us if you want to claim a Medicare rebate. You can still come in for treatment but you will have to pay on the day and claim via your private health insurance if you have Chiropractic, Physiotherapy or Podiatry cover.
Q. What if Medicare does not pay for my visits?
Your GP is the primary referrer for this service hence it is a matter between your GP and Medicare. In most cases, it is usually due to an error with the forms the GP lodged or you have exceeded your maximum of 5 visits per calendar year. For any issues regarding this matter contact your GP.
Q. I have already used my 5 EPC entitlements this year can I have more?
Currently, you are only eligible for a maximum of 5 EPC visits each calendar year, hence you will need to wait until January the following year to reapply for a further 5 EPC visits. Make sure your GP applies for the full 5 visits otherwise you may only be eligible for less, depending on what your GP submits to Medicare.
Q. If I don’t use my 5 EPC visits in one year can these roll onto the next year?
No, if you don’t use your 5 visits each year you will forfeit them.
Q. If I don’t use my 5 EPC visits can my wife, husband or child use them?
No, the rebate is only for you. Should a family member require Chiropractic, Physiotherapy or Podiatry consultations, they must visit their GP and ask if they qualify for the EPC program. It is illegal for one person to receive treatment and for another person to claim for that same treatment.
Q. I’m not sure if I have used my EPC entitlements this year?
If you have been referred by your GP to see another Health Professional in the same year, chances are, you have used part or all of your EPC entitlements. To check log into your myGov app using your smartphone or call Medicare on 132 150 direct. Alternately you can check with your GP as to what you are currently entitled to. Due to privacy issues, Medicare will not release your information to a third party such as our reception staff.
Q. Am I always entitled to 5 EPC visits?
Your GP has the final say as to what and how many medicare EPC visits you are entitled to. The maximum each year under the EPC scheme is 5 visits in total (not each profession).
Q. Does EPC cover for any X-Rays?
No, but the majority of X-rays are bulked billed at a local radiological centre when referred by our Chiropractors, Physiotherapist or Podiatrist at Brunswick Health. This excludes CT Scan, Ultrasound & MRI.
If you think you could benefit from Chiropractic, Physiotherapy or Podiatry, ask your GP to refer you to Brunswick Health.
