If you have a chronic medical condition, you may be eligible for up to 5 rebated sessions in a calendar year with allied health care visits under a Chronic Disease Management Referral (previously known as an EPC or Enhanced Primary Care plan). The Medicare rebate for these sessions is usually $60.35 per session (or if you’ve exceeded the Medicare safety net for the year, it will be rebated at a higher rate). To be eligible, you must have:

• A chronic or terminal medical condition which has been present for 6+ months
• A condition that requires ongoing treatment from a multidisciplinary team, with at least 2 other medical or allied health practitioners involved in your care (in addition to your GP)

Some examples of conditions which are likely to be covered with a Chronic Disease Management referral are:

• Chronic musculoskeletal conditions
• Asthma
• Cancer
• Cardiovascular disease
• Diabetes (Type 1 & 2) 
• Kidney disease
• Stroke

This Chronic Disease Management Referral entitles you to up to 5 Medicare rebates for 1:1 allied health services in a calendar year. These referrals are valid for 2 years. 

You can choose to direct all of these 5 sessions towards one specific type of allied health discipline, or split them up between any number of different disciplines. For example, you could direct all 5 sessions towards your Physiotherapist, or 2 sessions towards your Physio and the remaining 3 towards your Podiatrist.

The types of allied health practitioners that you can see through a Chronic Disease Management referral include:

• Aboriginal Health Worker 
• Audiologist 
• Chiropractor 
• Diabetes Educator 
• Dietitian
• Exercise Physiologist 
• Mental Health Worker 
• Occupational Therapist 
• Osteopath 
• Physiotherapist
• Podiatrist 
• Psychologist 
• Speech Pathologist 

How to obtain a Chronic Disease Management Referral

To start the process of obtaining a Chronic Disease Management Referral, you first need to see your GP who will confirm if you are eligible. If you are eligible, the GP will set up the required documentation with you. Sometimes, your GP’s Practice Nurse will be involved in the process too. 

The required documents to set up a Chronic Disease Management referral are: 

• GP Management Plan (a summary of your medical history and management plan) and 
• Team Care Arrangement (an agreement between your GP and other medical or allied health practitioners that they are managing your care together). 

These documents help medical and allied health practitioners coordinate the care of people with chronic conditions and communicate to achieve a shared goal and reduce the need for consultations with your GP.

Once these documents are completed, a Chronic Disease Management referral can be created and sent to the relevant practitioners. You will need a referral indicating the number of sessions allocated to the allied health discipline. If you have been referred to more than one discipline, then you will need a separate CDM Referral form for each discipline. They can share the same GPMP. Once the documentation is received by the relevant practitioners, you can access the Medicare rebates following your visits with your chosen allied health practitioner.

How can I use my Chronic Disease Management Referral at Move for Better Health?

Move for Better Health & it’s entire allied health team (which consists of Physiotherapists, Exercise Physiologists, Podiatrists & Psychologists) accepts Chronic Disease Management Referrals, as well as many other types of Medicare and third party referrals.

To use your referral at the time of your appointment, our practice must have your referral on file. Ideally your referral should be sent to us prior to your appointment by the GP, however you can bring in a signed hard copy of the referral on the day if needed. Your allied health practitioner must provide a written report to the referring medical practitioner after the first and last service when using this service.

At the time of billing, we will request payment in full for the service you received. We will then submit your claim to Medicare through our online claiming system, so your Medicare rebate can be refunded into your nominated bank account within a short time frame (usually within 24-48 hours).

The rebate you will receive for each visit under a CDM is $60.35, unless you have reached the Medicare safety net, at which point the rebate is increased to a higher percentage of the total cost of the service (often 80% – 100% of the total cost, depending on the individual circumstances). 

Unfortunately you are not able to claim with both Medicare and Private Health Insurance for the same service. However when you have exhausted your allocated Medicare sessions, we can switch to using private health insurance – if you have cover for that allied health discipline – so that you still only need to pay the gap that’s leftover after the private health insurance rebate has been paid. 

The costs of each service depends on which type of allied health practitioner you need to see, the type of service you require, and whether you have any government concessions. To find the exact costs and gaps involved with our services, please contact us to find out more.