Exercise Physiology

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Exercise Physiologists can use the Medicare System to see patients only if the patient has a referral from their GP called an ‘Enhanced Primary Care’ plan (EPC) which offers them up to 5 sessions per calendar year.

These EPCs are generated by the GP and signed and dated by them and submitted to Medicare, which then allows the Medicare Item Number 10953 to work for Medicare patient rebates or for bulk billing of the session.  There is a different item number that can be used for indigenous people as well, which will be on the EPC.

Even if the EPC allows say 3 sessions with an Exercise Physiologist, if the patient also went to see a podiatrist or physic or other allied health professional that mistakenly used one of those sessions, the processing for us would no longer allow 3 sessions with an EP.  So sometimes, this has been an issue for us as we can process the sessions successfully.

EPCs are valid for 12 months from the date of issue.  At the start of a new calendar year, the patient is eligible for a new set of 5 sessions.  If they are still using sessions from an older EPC from the previous calendar year, these will count towards the 5 sessions for the new year, so there’s no way of having more than 5 sessions each year.

Not all patients are eligible for an EPC.  So you can suggest patients ask their GP for an EPC, but GPs have to follow strict guidelines to be able to offer an EPC to a patient.  The main criteria is that it’s a chronic health condition (like obesity or diabetes) or a long term injury.  Treatment for acute new injuries are not usually eligible through the EPC system.

The referral date on an EPC is the date the GP signed the EPC, not the date we received it.  The referral date has to be prior (or on the same day) as the first session.

We create cases in Cliniko to track and process EPCs.  There is a lovely integration between these Medicare cases and Medipass through Cliniko, so that when you process the session attached to an EPC case, the detail auto fill and even the payment will come through automatically within 24 hours and insert the payment for us in Cliniko.  You can check this has happened correctly if the red invoice ticket turns black.  If there is any difference in the price we entered in Cliniko and the payment amount, this self reconciliation will not occur and the invoice will remain looking unpaid in Cliniko.