Medicare rebates

Are you eligible for a Medicare (Enhanced Primary Care Program) rebate for podiatry consultation?

You may be eligible if your GP has provided the following MBS Chronic Disease
Management services:

• A GP Management Plan (GPMP) 
• Team Care Arrangements (TCAs)

For patients who are permanent residents of an aged care facility and Commonwealth funded, their GP must have contributed to a multidisciplinary care plan prepared for them by the aged care facility or to a review of the multidisciplinary care plan.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer. It includes, but is not limited to, conditions such as asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. Patients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least two other health or care providers.

Only the GP can determine whether a patient is eligible for the Medicare allied Health Services.

Patients are considered eligible if their GP has completed the following prerequisite Chronic Disease Management items in the previous 2 years:

  • A GP management plan (GPMP).

  • Team Care Arrangements (TCAs).

Referral validity

A referral is valid for the stated number of services. If all services are not used during the calendar year in which the patient was referred, the unused services can be used in the next calendar year.

However, those services will be counted as part of the five rebates for allied health services available to the patient during that calendar year.

When all referred services have been used, or a referral to a different allied health professional is required, patients need to obtain a new referral.

GPs may undertake a review of the patient's GPMP and TCAs or, where appropriate, manage the referral process using a GP consultation item.

EPC_Allied_Health_Referral_Form

In summary:

  • A Medicare rebate is available for a maximum of five (5) services per patient each calendar year. (Note, however, that allied health providers may set their own fees)
  • Patients must have a GP Management Plan and Team Care Arrangements prepared by their GP, or be Commonwealth funded residents of an aged care facility who are managed under a multidisciplinary care plan.
  • GP refers to allied health professional.
  • Allied health professionals must report back to the referring GP at the end of the first and final.