Enhanced Primary Care (EPC)

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Children’s Occupational Therapy

Chronic Disease Management (also called Enhanced Primary Care)

One of the ways that many clients are able to access medicare funding for Occupational Therapy services, is through the EPC funding. This plan is available for those with a chronic condition, which is a medical condition that is ongoing for at least six months, e.g. asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke. Medicare rebates are for up to five (5) eligible sessions per calendar year. The sessions can be made up of five of one type of service (e.g. OT) or a combination of different types of service (eg. 1 dietician, 1 speech pathology and 3 OT sessions).

Key Points about this funding are:

  • Access to the funding is provided by a GP and is allocated at their discretion.

  • A Medicare rebate is available for up to five (5) therapy / assessment sessions per child each calendar year (Jan – Dec).   The standard rebate for OT as of Mar 2014 is $52.95.

MBS Scheduled Fee and Rebates

MBS Item No. Key Features MBS Scheduled Fee MBS Rebate (Mar 2014)
10958 Occupational Therapy health service provided by an eligible Occupational Therapist, at least 20 minutes in duration $61.10 $52.95

Who can refer?

Referrals can only be made by a GP.

Reporting

Your therapist will report back to the referring doctor after the initial session, and after the final session. The report will include information about:

  • any investigations, tests, and/or assessments carried out;
  • any treatment provided; and
  • proposed future management of the condition or problem.

More information

More information can be found on the Department of Health and Ageing‘s website.