What Is an EPC Plan & How Does It Work?
HOW to get Chiropractic, Physiotherapy or Podiatry on an EPC Plan
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Can You Get Chiropractic, Physiotherapy or Podiatry on an EPC Plan?
Yes. Chiropractic, physiotherapy and podiatry are all eligible allied health professions under the EPC framework, (now called GP Chronic Condition Management Plan GPCCMP), provided the practitioner holds a Medicare provider number.Â
The way it works is simple. A GP identifies that a patient has a chronic medical condition that benefits from coordinated care, prepares the management plan, and writes referrals to allied health providers such as physiotherapists, chiropractors, podiatrists or others. The patient then attends those providers, pays for tha appointment at the time of service, then Medicare reimburses a set rebate directly to their bank account.Â
The Medicare rebate is the same regardless of which of these three professions delivers the service: $61.80 per session as of May 2026. The rebate is a flat amount, not a percentage of the clinic’s fee. The patient’s out-of-pocket gap is the difference between the clinic’s standard fee and the $61.80 rebate. Once a patient reaches the Extended Medicare Safety Net threshold for the calendar year, the rebate may increase to a higher percentage of the total fee. The Medicare rebate of $61.80 is rarely the full cost of an allied health session, so patients pay a gap that reflects the difference between the clinic’s standard fee and the rebate.Â
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How Many Medicare EPC Sessions Can You Get Each Year?
A patient with a GPCCMP can claim up to **five individual allied health sessions per calendar year**, with the cap resetting on 1 January. Aboriginal and Torres Strait Islander patients who have completed a 715 health assessment can access up to ten sessions per year.
The five-session cap is shared across all eligible allied health disciplines combined — it is not five per profession. A patient who uses three chiropractic sessions and two physiotherapy sessions in a calendar year has used their full allocation. Unused sessions do not roll over into the following year.
How Does Medicare EPC Claiming Work for Chiropractors, Physios and Podiatrists?
Most clinics process the claim electronically on behalf of the patient. The standard workflow is:
1. The patient pays the clinic’s full fee at the appointment.
2. The clinic submits the claim to Medicare via online claiming, quoting the MBS item number (10964 chiro, 10960 physio, 10970 podiatry) and referencing the GP referral.
3. Medicare deposits the $61.80 rebate into the patient’s nominated bank account, usually within one to two business days.
4. The allied health provider sends a written report back to the referring GP.
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What Do You Need Before Booking an EPC Appointment?
To book an appointment that will attract the Medicare rebate, the patient needs three things in place before the session:
- A current GPCCMP prepared or reviewed by their GP.
- A signed referral letter from the GP to the relevant allied health profession.
- An active Medicare card
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The clinic generally needs to receive the referral before or at the first appointment either emailed referrals direct from the GP or a signed hard copy brought to the appointment. Also it’s best to have your bank account details registered with Medicare to receive electronic rebates.
Do You Need a GP Referral for EPC Treatment?
Yes. A GP referral is mandatory for every Medicare-rebated allied health session under a GPCCMP. The referral must be written by the GP (or a Prescribed Medical Practitioner) who prepared or reviewed the plan.
What Should You Bring to Your First EPC Appointment??
For a smooth first session, patients should bring:
- The original GP referral letter (or confirmation it has been emailed to the clinic).
- A current Medicare card.
- Any relevant imaging, scans or specialist reports related to the condition.
- A list of current medications.
- Comfortable clothing appropriate for the type of physical assessment being performed.
Arriving 10 to 15 minutes early to complete intake paperwork is typical for a first visit.
What Are the Most Common EPC Claiming Mistakes?
Most rejected EPC claims trace back to a small set of avoidable issues:
- An expired or out-of-date management plan
- The patient has already used all five rebated sessions for the calendar year.
- Missing or incorrectly addressed referral
- Duplicate claim where the same session was already billed
- The GPCCMP submission was incomplete or incorrect by the GPÂ
- The provider is not registered with Medicare for that allied health profession.
Can You Use EPC for Multiple Allied Health Providers?
Yes. The five-session annual allocation can be split across multiple allied health disciplines or even multiple clinics within the same discipline. A GP can write separate referrals to a physiotherapist, a chiropractor and a podiatrist if all three professions are recommended in the GPCCMP. Since 1 July 2025, patients have additional flexibility — a referral no longer needs to specify a fixed number of sessions per provider, and patients can take a referral to any registered practitioner of that profession rather than being tied to a named clinic.
Can You Use EPC and Private Health Insurance Together?
Not for the same appointment. Medicare and private health insurance cannot both rebate the same session — the patient must choose one funding source per visit. The common practical approach is to use the five Medicare-rebated GPCCMP sessions first, then switch to private health insurance extras cover (where the patient holds an extras policy that covers that allied health profession) once the Medicare allocation is exhausted.
EPC/GPCCMP Registered Providers
The following practitioners are all registered Medicare providers, allowing eligible patients to claim EPC / GPCCMP Medicare rebates for approved appointments. For added convenience, we can process your Medicare claim electronically on your behalf at the time of your visit.
EPC/GPCCMP Frequently Asked Questions
Browse our general FAQ for quick answers. Didn’t find what you were looking for? Give us a call or send us an email—we’re here to help!
Do You Have to Pay a Gap Fee for EPC Appointments?
In most cases, yes. The Medicare rebate is rarely the full cost of an allied health session, so patients pay a gap that reflects the difference between the clinic’s standard fee and the rebate. The exception is bulk-billed clinics, which accept the Medicare rebate as full payment for that session. Bulk-billing for GPCCMP sessions is at each clinic’s discretion. Many clinics that previously bulk-billed have moved away from the practice as the rebate has not kept pace with rising operating costs.
What Happens After Your 5 EPC Sessions Are Used?
Once the five rebated sessions for the calendar year are used, no further Medicare rebate is available under the GPCCMP until 1 January of the following year, when the allocation resets. Patients can continue treatment by paying the clinic’s full fee, or by claiming on private health insurance extras cover where applicable. The GPCCMP itself remains active and does not need to be re-prepared annually — only reviewed at appropriate intervals.
Can EPC Referrals Expire?
The plan itself does not expire under the new framework. A GPCCMP can be used indefinitely once prepared, provided it is reviewed by the GP within the previous 18 months — this is the threshold that keeps allied health access live. The referral document attached to the plan is valid until all the referred services are used.
How Long Does an EPC Referral Last?
A referral remains valid until every session it authorises has been provided. Unused sessions at 31 December roll into the next calendar year, but only up to the annual five-session cap — they cannot be stockpiled.Â
Can You Change Providers During an EPC Plan?
Yes. Since 1 July 2025, patients have explicit flexibility to change allied health providers under a GPCCMP. A referral to “physiotherapy services” can be taken to any Medicare-registered physiotherapist of the patient’s choice, rather than being locked to the clinic named on the referral. If the patient wants to switch to a different allied health profession not covered by the original referral, the GP needs to issue a new referral.
What Conditions Commonly Qualify for an EPC Plan?
Medicare does not publish a closed list of qualifying conditions — eligibility is decided by the GP based on whether the condition is, or is likely to be, present for six months or longer. In practice, conditions that frequently meet the threshold include:
– Chronic musculoskeletal pain such as osteoarthritis, chronic low back pain or chronic neck pain
– Diabetes (Type 1 and Type 2)
– Cardiovascular disease, including hypertension and post-stroke recovery
– Asthma and other chronic respiratory conditions
– Cancer (during and after treatment)
– Inflammatory conditions such as rheumatoid arthritis
– Chronic foot pathology including plantar fasciitis and diabetic foot complications
– Long-term post-surgical or post-injury rehabilitation needs
The deciding factor is duration and the benefit of coordinated allied health input — not the diagnosis itself.
Is EPC the same as a Chronic Disease Management plan?
Yes. There is no requirement to spread the five sessions across different providers or different professions. A patient can use all five at a single chiropractor, physiotherapist or podiatrist if that is what the GPCCMP supports. Equally, the sessions can be split — the choice sits with the GP and patient.
Can I use EPC for back pain treatment?
Yes, where the back pain is chronic — meaning it has been present for six months or longer, or is expected to last that long. Chronic low back pain is one of the most common reasons GPs issue allied health referrals under a GPCCMP. The referral can go to a physiotherapist, chiropractor or osteopath, depending on the GP’s clinical judgment and the patient’s preference.
Can I use EPC for plantar fasciitis or foot pain?
Yes, when the foot condition is chronic. Plantar fasciitis, Achilles tendinopathy, diabetic foot complications and chronic forefoot pain are all routinely managed under GPCCMP referrals to a podiatrist using MBS item 10970. The same five-session annual cap apply.
Can I use all 5 EPC sessions at one clinic?
Yes. There is no requirement to spread the five sessions across different providers or different professions. A patient can use all five at a single chiropractor, physiotherapist or podiatrist if that is what the GPCCMP supports. Equally, the sessions can be split — the choice sits with the GP and patient.
Can my GP renew my EPC plan?
he GPCCMP does not need formal renewal — it remains in place once prepared. What it does need is a review by the GP within the previous 18 months for the patient to keep accessing allied health services. Reviews can be performed every three months if clinically warranted. Patients with older GPMP/TCA plans from before 1 July 2025 can have those plans rolled into a new GPCCMP at the next review.
Can children access EPC plans?
Yes. There is no minimum age for a GPCCMP. A child with a chronic condition lasting or expected to last six months — for example, juvenile idiopathic arthritis, severe asthma or a developmental musculoskeletal issue — can have a plan prepared by their GP and access the same five rebated allied health sessions per year.
Do pensioners get extra EPC sessions?
No. Pension status does not increase the GPCCMP allocation, which remains capped at five allied health sessions per calendar year for all eligible patients. The only group with a higher cap is Aboriginal and Torres Strait Islander patients who have completed a 715 health assessment, who can access ten sessions per year. Pensioners may, however, reach the Extended Medicare Safety Net threshold sooner, which can increase the rebate amount once that threshold is crossed.
Can EPC be used for telehealth appointments?
Yes. Allied health services under the GPCCMP can be delivered by video or telephone, in addition to in-person visits. Telehealth sessions attract the same MBS item numbers and rebate as face-to-face equivalents (using items 93000 for video and 93013 for telephone), and the practitioner must be satisfied that telehealth is clinically appropriate for that consultation. Some disciplines — and some session types, such as initial assessments — are still better suited to in-person delivery.
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