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Medicare EPC Referrals & Rebates

Accessing Medicare rebates for chiropractic care with an EPC referral

Medicare FAQs for Chiropractic Care

Yes, but only under specific circumstances.

Chiropractic care is not automatically covered by Medicare. However, if you have a chronic condition and your GP places you on a special care plan called an EPC (Enhanced Primary Care) plan, you may be eligible for a Medicare rebate.

This plan is designed for patients who need ongoing care from multiple allied health providers. If you qualify, Medicare will contribute toward up to five allied health visits per calendar year, which may include chiropractic.

Each eligible visit currently attracts a Medicare rebate of approximately $58.30. (as of 2025)

How do I qualify?

To be eligible, you must:

  • Have a chronic condition that has lasted (or is expected to last) more than six months

  • Be referred by your GP under an EPC plan (also known as a GP Management Plan)

  • Have the correct Medicare forms (item numbers 721 and 723) submitted by your GP

  • Be referred specifically to a chiropractor for treatment

What happens at the clinic?

  • You pay the full consultation fee on the day

  • Your claim is submitted electronically by the clinic via Medicare Online

  • Your rebate is usually deposited into your bank account within 1–2 business days

Other important information

  • Medicare rebates cannot be backdated, so your EPC plan must be approved before your first visit

  • You cannot claim both Medicare and private health insurance for the same appointment

  • It’s important to confirm with your GP that all paperwork has been correctly completed and submitted before your visit

Yes. You have the right to choose your preferred chiropractor or clinic, as long as your GP lists “chiropractic” on your EPC referral.

Even if your GP recommends a specific chiropractor—such as a friend, colleague, or someone they regularly refer to—you are not obligated to attend that practitioner. You are free to use your referral with any qualified and registered chiropractor.

If you’re unsure, you can ask your GP to either keep the referral provider-neutral (simply listing “chiropractic”) or to name your preferred chiropractor directly on the referral paperwork.

Medicare rebates for chiropractic care are only available to people who meet specific eligibility criteria under the Enhanced Primary Care (EPC) program, also known as the Chronic Disease Management (CDM) plan.

You may be eligible if:

  • You have a chronic medical condition that has lasted or is expected to last six months or more

  • Your condition requires ongoing care from more than one health professional (for example, a GP and a chiropractor)

  • Your GP agrees that chiropractic care would be beneficial as part of your overall treatment plan

Eligibility is determined by your GP during a consultation. They will assess your condition, decide whether you qualify for an EPC referral, and if appropriate, complete and lodge the necessary Medicare paperwork (items 721 and 723).

 

Examples of chronic conditions that may qualify

  • Ongoing neck or back pain

  • Sciatica or nerve-related pain

  • Arthritis or degenerative joint issues

  • Persistent musculoskeletal problems

  • Postural syndromes or repetitive strain injuries

  • Conditions that require support from both a GP and allied health providers

To be placed on an EPC (Enhanced Primary Care) plan, you’ll need to visit your GP for an assessment. Your GP will decide whether you meet the eligibility criteria for a chronic condition and whether you would benefit from coordinated care involving allied health professionals, such as a chiropractor.

 

Steps to get started

  1. Book an appointment with your GP
    Let your GP know you’d like to discuss whether you’re eligible for an EPC or Chronic Disease Management plan.

  2. Your GP will assess your condition
    To qualify, your condition must be ongoing or expected to last more than six months. It must also require input from at least two health professionals (for example, your GP and a chiropractor).

  3. If eligible, your GP will complete the referral
    Your GP must fill out and lodge two Medicare forms: item numbers 721 (Care Plan) and 723 (Team Care Arrangement). These forms must specifically list chiropractic as one of the referred services.

  4. Ask for a copy of the referral
    The clinic will need this when you book your appointment. Some GPs will send it directly, but it’s always helpful to have a copy for yourself.

 

How long does it take?

Once your GP submits the referral to Medicare, it may take up to 2 weeks to be processed. You cannot claim any rebates for visits that occur before the EPC plan is active.

 

Tip

To get the most benefit, ask your GP to allocate the full 5 visits in the calendar year to chiropractic care if it fits your needs.

The referral is valid for the calendar year in which it was issued, and until all referred visits have been used. If you don’t use all five visits, they do not roll over into the next year.

If you qualify under the Enhanced Primary Care (EPC) program, Medicare provides a rebate of approximately $61.80 per eligible visit to a chiropractor ( fees are based on 2025 Medicare schedule). You can access up to five rebated visits per calendar year, shared across all referred allied health services listed in your care plan.

These visits may be split between services like chiropractic, physiotherapy, or podiatry, depending on what your GP includes in your referral.

 

Do I have to pay anything myself?

Yes. You will need to pay the full consultation fee on the day of your appointment. The clinic will then submit your Medicare claim electronically, and your rebate will be deposited into your nominated bank account, usually within one to two business days.

Your out-of-pocket cost will depend on the total fee charged by the clinic, minus the Medicare rebate.

 

Example

  • Standard consultation fee: $75

  • Medicare rebate: $61.80

  • Gap payable by you: $13.20

Rebate amounts are set by Medicare and may change from time to time.

No, you cannot use your private health insurance and Medicare for the same consultation. Medicare rules state that you must choose either to claim the visit under the EPC program or through your private health fund—but not both.

If you are using your EPC entitlements, you will receive a Medicare rebate for each eligible visit, and your private health fund cannot be used for those same visits.

 

What happens when I’ve used all five EPC visits?

Once you have used all five Medicare-subsidised visits for the calendar year, you may then return to claiming through your private health insurance if your policy includes chiropractic cover. Any additional visits beyond the five EPC entitlements would be privately billed and can be claimed through your health fund, subject to your level of cover.

 

EPC and CDM are terms that are often used interchangeably, but they refer to parts of the same program.

CDM stands for Chronic Disease Management, which is the broader name for the Medicare program that provides rebates for certain allied health services, including chiropractic. EPC, or Enhanced Primary Care, is the older term that many people still use out of habit.

In practice, they both refer to the same Medicare system that allows GPs to create a care plan for patients with chronic conditions, giving access to up to five Medicare-subsidised allied health visits per calendar year.

 

In summary

  • CDM is the current, correct name for the program

  • EPC is the older term, but still commonly used

  • Both relate to the same process of being referred by a GP for subsidised care such as chiropractic treatment

A chronic condition is any health issue that has lasted, or is expected to last, for six months or more. These can include physical, mental, or ongoing functional problems that affect your daily life.

Common examples include:

  • Back or neck pain

  • Arthritis

  • Diabetes

  • Asthma

  • Sciatica or nerve-related issues

  • Joint degeneration or postural strain

  • Depression or anxiety (when combined with physical symptoms)

Complex care needs mean that your condition requires support from more than one healthcare provider. For example, if your GP is managing your condition and you would also benefit from seeing a chiropractor, physiotherapist, or another allied health professional, your care would be considered complex.

 

Why this matters

If your condition is both chronic and involves complex care needs, your GP may place you on a care plan that allows you to access Medicare rebates for up to five allied health visits per calendar year. Chiropractic can be included if your GP determines it’s appropriate.

If your condition changes significantly or you need to see a different type of allied health provider, your GP may need to update or issue a new referral. Always speak with your GP if you’re unsure.

Yes. Your GP may allocate the five Medicare-subsidised visits across multiple allied health services — for example, three chiropractic visits and two for podiatry. Make sure your GP lists all intended providers on your referral.

Yes. You can be referred to more than one type of practitioner, but the total number of visits still cannot exceed five in the calendar year.

Once your GP has completed and submitted the EPC referral paperwork, you can book your appointment with one of our Chiropractors.

At your appointment, you will:

  • Pay the full consultation fee on the day

  • Have your Medicare claim submitted electronically by the clinic through Medicare Online

The Medicare rebate (currently around $58.30 per visit) will be deposited directly into your nominated bank account, usually within one to two business days.

 

What you need to bring

  • A valid EPC referral from your GP that lists chiropractic as the referred service

  • Your Medicare card 

If you are unsure whether your referral has been properly lodged or how many visits you are entitled to, speak with your GP or contact Medicare directly before your appointment.

Yes, you can book an appointment with a chiropractor at any time without a referral. Chiropractors are primary healthcare providers, which means you do not need to see a GP first unless you’re planning to claim a Medicare rebate under an EPC plan.

If you are paying privately or using your private health insurance, a referral is not required.

 

When is a GP referral necessary?

A referral is only needed if you want to claim part of the visit cost through Medicare. In that case, your GP must assess you for eligibility and prepare the proper paperwork for the EPC plan.

If you are unsure whether to go through Medicare or private health, seek guidance from your treating chiropractor at your next visit to help you decide what’s best for your care and claiming options.

If you need chiropractic care before seeing your GP and being placed on an EPC plan, you are still welcome to book and attend treatment. However, Medicare will not reimburse any appointments that take place before the EPC referral is completed and lodged.

This means you’ll need to pay privately for any treatment you receive prior to your GP’s referral. If you have private health insurance that covers chiropractic, you may be able to claim a rebate through your fund for these earlier visits.

Once your EPC referral is in place, your Medicare rebates will only apply to appointments dated on or after the referral date.

If Medicare does not pay your rebate, it is usually due to one of the following reasons:

  • Your GP did not lodge the EPC paperwork correctly

  • The referral did not include chiropractic care

  • You have already used your five allowed visits for the calendar year

  • The visit occurred before the EPC referral was submitted

As the rebate is issued by Medicare, it is considered a matter between you, your GP, and Medicare. Due to privacy laws, the clinic is unable to access or resolve rebate issues on your behalf.

 

What should I do next?

Contact Medicare on 132 150 to find out why the claim was declined. Once you have that information, speak with your GP to see if the issue can be corrected or if you are eligible for further entitlements.

If Medicare does not cover the visit, you will still be responsible for the full consultation fee.

 

No, Medicare limits you to a maximum of five allied health visits per calendar year under the EPC program. These visits are shared across all referred services (e.g. chiropractic, physiotherapy, podiatry), not per practitioner.

Once you’ve used all five visits, you will not be eligible for more Medicare rebates until 1 January of the following year, when your annual entitlement resets.

 

What are my options now?

If you still require ongoing care, you can:

  • Continue treatment as a private patient and pay the full consultation fee

  • Use your private health insurance (if your policy includes chiropractic cover) to help reduce your out-of-pocket cost

If you plan to return to the EPC program next year, make sure your GP prepares a new referral form with the correct number of visits included.

If you’ve seen any allied health professionals this year under Medicare (such as a chiropractor, physiotherapist, podiatrist, dietitian, or others), it’s possible that you’ve already used some or all of your five available EPC visits.

To check how many EPC visits you have used:

  • Contact Medicare directly on 132 150

  • Have your Medicare card ready when you call

  • Ask how many CDM or EPC allied health visits you’ve used so far this calendar year

Medicare will be able to tell you how many visits have been claimed and how many remain. Your GP can also review your care plan and referral history if needed.

Not necessarily. While the maximum number of Medicare-subsidised allied health visits is five per calendar year, the final number is decided by your GP.

Your GP will assess your condition and determine how many visits you should receive, and for which services. In some cases, you may be given fewer than five visits, or the visits may be shared across multiple types of care (for example, three for chiropractic and two for podiatry).

 

Tip:
If you believe you would benefit from the full five visits for chiropractic care, speak to your GP during your consultation and request that the full number be allocated to chiropractic on your referral.

No, the EPC program does not cover the cost of X-rays.

However, if your chiropractor recommends X-rays as part of your assessment, they can refer you to a local radiology clinic that offers bulk billing. This means there is no out-of-pocket cost for eligible Medicare cardholders when using a bulk-billed service.

Please note that bulk billing typically applies to standard X-rays only. More advanced imaging, such as CT scans or MRIs, may not be bulk billed and could involve an additional cost, depending on the provider and the referral source.

Final Thoughts

Navigating Medicare and EPC referrals can feel confusing at first, but understanding your options can make a real difference in accessing affordable care.

If you have a chronic condition and think chiropractic care could support your health, speak with your GP about an EPC plan. Once approved, you can use your Medicare-subsidised visits with the chiropractor of your choice — and if you’re unsure how to begin, read our FAQ’s to get started.

Most importantly, remember that you’re in control of your healthcare. Ask questions, get clear on your entitlements, and make informed decisions that support your long-term wellbeing.