Are Podiatry Services Are Covered by Medicare?

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This is a very common topic that I cover with newer patients almost weekly so I thought I would give a very brief overview. Anything Medicare related tends to be quite technical and often you will feel the eyes glazing over as you read, so try to bear with me on this and I’ll keep it short and sweet!

You’ve just been to see your doctor about a chronic condition that you have. Your doctor has told you that they are going to put you on an Enhanced Primary Care Plan (EPC) and that you have up to 5 ‘free’ visits with a Podiatrist or an allied health professional of your requirement (physio, chiro, osteo, diabetes educator and nutritionist).

What is it?

An EPC is a plan on the Medicare Benefits Schedule where GPs are able to plan treatment for patients who suffer from a chronic or terminal medical condition with other medical providers.

Firstly, you must meet the criteria, and that is generally centred on medically diagnosed chronic condition/s, meaning something you have had for more than 3 months or are under the care of a specialist for. Secondly, you need to have the appropriate referral from your GP, who needs to send you to a Podiatrist. Once the EPC form is filled out by your doctor, they will fax a copy to the chosen provider so that they can get you on their system.

Generally, podiatry services are not covered by Medicare. However, if you have a chronic medical condition like diabetes or osteoarthritis you may be eligible to access podiatry services under an EPC.  In order to access the scheme a general practitioner referral is required. This may entitle you with up to 5 podiatry visits per calendar year. If you think this may apply to you, then you will need to contact your doctor to arrange a referral and discuss your eligibility.

Often times, the GP will make mention of the service being ‘free’ or covered completely under Medicare. This is often a throw away statement that is generally no longer the case for the majority of Podiatrists or Physiotherapists.

How does the Medicare EPC rebate process work?

Sutherland Podiatry requires you to pay the consultation amount in full at the conclusion of your visit and then we will apply for the rebate on your behalf, and it will be deposited into an account of your choosing.

I thought it was free?

It’s not. Sutherland Podiatry Centre is one of the many clinics in Sydney that are required to charge a gap fee for this service. Why? Because we allocate the same amount of time for an EPC patient as we do for a non-eligible EPC patient, thus all of our consultations and clinicians offer and deliver the same level of care and attention to detail regardless of EPC status to our patients. We believe that is the right way to treat patients, and consequently there is a gap to pay. The good news is that if you are on an EPC, the required gap is still considerably smaller to pay than the full amount, and is often greater than the rebate of a private health fund.

Free non-gap Bulk billing services for Podiatry are available but they are in short supply and you may need to travel out of area to access them.

In Summary

To wrap it all together

  • Yes you can get a Medicare Rebate for Podiatry using the EPC program.
  • You need a specific doctor’s referral and the right type of physical condition.
  • You can get $55.10 rebate or up to 5 visits per year, including all your allied health visits allocated.
  • There will always be a small gap fee.
  • We can process the rebate on-the-spot, straight back into your debit/savings accounts.

I hope you didn’t nod off during all of that! If you think you’re eligible for this service, go chat to your GP, bring us the paperwork and we will take care of the rest. If you are not sure if you are eligible, discuss this with your GP.  Otherwise you can contact us on 9542 3491.

Have a wonderful week,

Scott

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