How to Use Your Medicare EPC Plan for Physiotherapy in Australia

One of the most common questions I hear from new patients is: "Can I use Medicare for physiotherapy?" The short answer is yes — but only under specific circumstances, and the process involves a few steps that aren't always clearly explained.

If you have a chronic or complex health condition, you may be entitled to Medicare-rebated physiotherapy sessions through the Enhanced Primary Care (EPC) scheme. This guide explains exactly how it works, who qualifies, and what to expect at your appointment.

The Enhanced Primary Care (EPC) scheme — now formally called the Chronic Disease Management (CDM) program — is a Medicare initiative that allows people with chronic or complex medical conditions to access allied health services, including physiotherapy, with a Medicare rebate.

Under this scheme, your GP can refer you for up to 5 allied health sessions per calendar year (January to December). These sessions can be used with a physiotherapist, occupational therapist, podiatrist, dietitian, or other eligible allied health provider.

The rebate is currently $60.35 per session (as of 2026). If your physiotherapist charges more than this, a gap fee applies. At Dalton Physiotherapy, we will advise you of any gap before your appointment.

To access physiotherapy under an EPC plan, you must:

1. Have a chronic medical condition — defined as one that has been (or is likely to be) present for 6 months or longer
2. Have a GP Management Plan (GPMP) prepared by your GP (Medicare item 721)
3. Have a Team Care Arrangement (TCA) in place (Medicare item 723), which involves at least two other healthcare providers in your care

Common conditions that qualify include:

• Osteoarthritis and joint pain
• Chronic low back pain
• Diabetes (with musculoskeletal complications)
• Cardiovascular disease
• Osteoporosis
• Neurological conditions (e.g. Parkinson's disease, stroke)
• Obesity with functional limitations
• Chronic respiratory conditions

Your GP determines eligibility — if you have a chronic condition affecting your physical function, it is worth asking whether an EPC referral is appropriate for you.

Ask your GP whether you are eligible for a GP Management Plan and Team Care Arrangement. If you already have a GPMP in place, ask whether physiotherapy can be added to your Team Care Arrangement.

Your GP will prepare the referral documentation and specify the number of sessions (up to 5).

Your GP will provide you with a referral letter specifying:

• Your name and Medicare number
• The referring GP's provider number
• The number of sessions authorised (up to 5)
• The condition being managed

Contact Dalton Physiotherapy and let us know you have an EPC referral. Bring your referral letter and Medicare card to your first appointment.

We process your Medicare rebate at the time of payment. You pay the full fee and receive the $60.35 rebate back to your nominated bank account, usually within 24–48 hours via Medicare's online claiming system.

Sessions reset each calendar year. Your 5 sessions are allocated per calendar year (1 January to 31 December), not per 12-month period from your referral date. If you use 3 sessions in November, you can access 5 new sessions from January.

You can split sessions across providers. Your 5 sessions can be used across different allied health disciplines — for example, 3 with a physiotherapist and 2 with a podiatrist. You don't have to use all 5 with the same provider.

A gap fee usually applies. The Medicare rebate of $60.35 rarely covers the full cost of a physiotherapy session. Your physiotherapist will advise you of the gap before your appointment.

Your GP reviews the plan annually. EPC plans are reviewed by your GP each year. If your condition is ongoing, your GP can renew the plan and referral.

EPC is separate from private health insurance. You cannot claim both Medicare and private health insurance for the same session. If you have extras cover, you may choose to use your private health rebate instead — particularly if it is higher than the Medicare rebate.

Physiotherapy under an EPC plan is most commonly used for:

• Chronic musculoskeletal pain — back pain, neck pain, hip and knee osteoarthritis
• Falls prevention — balance and strength programmes for older adults
• Post-surgical rehabilitation — following joint replacement or other orthopaedic procedures
• Neurological rehabilitation — improving function after stroke or with Parkinson's disease
• Respiratory physiotherapy — breathing exercises for COPD or chronic respiratory conditions
• Diabetes management — exercise prescription and musculoskeletal management

Dalton Physiotherapy is a Medicare-approved provider. We accept EPC referrals and process Medicare rebates on the spot.

If you're unsure whether you qualify, speak to your GP at your next appointment and ask specifically about a GP Management Plan and Team Care Arrangement for physiotherapy. Many patients who would benefit from physiotherapy are unaware this funding pathway exists.

To book, call 0404 320 503 or book online. Bring your EPC referral letter and Medicare card to your first appointment.