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EPC Medicare Chiropractic Rebate

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Q. Can I get a Medicare Rebate for Chiropractic?

You can now qualify to receive a Medicare rebate for Chiropractic.
It is possible for people with chronic conditions and complex care needs to receive a Medicare rebate for up to five (5) Chiropractic visits per calendar year.

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, that specifically refers you to a Chiropractor 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 he 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 which have been, or are likely to be, present for six (6) months or more. Complex care needs means that, in your GP’s opinion, you would benefit from care provided by a range of health professionals who provide different services.

Q. Once I’m on an EPC plan, how do I get my Medicare rebate?

Once you pay for your Chiropractic consultation on the day of service,you will be given a receipt that you can take to your nearest Medicare outlet. You can either go in person to receive your rebate immediately or lodge your forms via mail. The process is similar to claiming other Medical rebates.

Q. What if I need treatment before my EPC is approved?

Providing that the treatment occurred after the date your GP referred you for Chiropractic treatment, 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 Chiropractic treatment is BEFORE your GP Chiropractic referral.

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 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 your 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 treatment, they must visit their GP and ask if they qualify for the EPC program. It is illegal for one person to receive a 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 other than a Medical Specialist, chances are you have used part or all of your EPC entitlements. Check with your GP what you are currently entitled to or call Medicare on 132 150.

Q. Am I always entitled to 5 EPC visits?

Only if your GP says so! So if you want the 5 visits make sure you mention this to your GP to request the maximum 5 Chiropractic visits in the EPC forms as sometimes they issue less as they may wish to refer you to another service such as Podiatry.

Q. Does EPC cover for any X-Rays?

No, but the majority of X-rays requested by our Chiropractors at Brunswick Health are bulked billed at local radiological centers. This excludes CT Scan & MRI.

 

If you think you could benefit from Chiropractic care, ask your GP to refer you to a Chiropractor at Brunswick Health.

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