Treatment Options

EPC / Chronic Disease Management (CDM) Plans

Do you require a Chronic Disease Management (CDM) Plan? Our expert team are here to help.

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What is a CDM (Formerly EPC) Plan?

Many patients still use the term “EPC” (Enhanced Primary Care), but the current Medicare program is officially called the Chronic Disease Management (CDM) Plan. This plan allows patients with chronic or complex medical conditions to access Medicare rebates for certain allied health services, including physiotherapy and chiropractic care.

The CDM plan is designed to:

  • Support patients with chronic conditions that have lasted at least six months
  • Coordinate care between your GP and allied health professionals
  • Provide subsidised access to physiotherapy, chiropractic care, podiatry, dietetics, and other approved services

Eligibility

You may be eligible if:

  • You have a chronic medical condition present for at least six months
  • Your condition requires care from at least three medical professionals, including your GP
  • You live in the community or are a permanent resident in a Residential Aged Care Facility (RACF)

Hospital inpatients are not eligible for these services.

From 1 July 2027, a GP Chronic Condition Management Plan (GPCCMP) will be required for ongoing access to allied health services.

Services Covered

Eligible patients can access up to 5 Medicare-subsidised allied health visits per calendar year, either:

  • All with one provider (e.g., 5 physiotherapy sessions)
  • Split between multiple providers (e.g., 3 physiotherapy, 2 dietetics)

Unused sessions do not carry over to the next year.

Referral Requirements

  • Your GP will determine if a CDM plan is appropriate
  • A valid referral is required before starting treatment
  • Referrals last for the timeframe specified on the referral (or 18 months if no timeframe is stated)

It is not appropriate for allied health professionals to pre-complete referrals or determine eligibility; the referring GP must decide this.

How to Access the Program

  • Speak to your GP: Discuss whether your condition meets the eligibility criteria for a CDM plan.
  • Obtain a Referral: Your GP will prepare a care plan and issue referrals to relevant allied health providers.
  • Book Your Appointment: Contact our clinic with your referral details.
  • Private Billing Policy at Spinal & Sports Care: At Spinal & Sports Care, eligible CDM consultations are privately billed. The Medicare rebate will cover part of the cost; however, most patients will incur an out-of-pocket fee. Patients experiencing financial hardship or those over the age of 70 will be bulk billed directly through Medicare, meaning no out-of-pocket costs.

    This policy exists because the amount Medicare pays per appointment does not cover the rising costs of running a medical practice, including wages, equipment, rent, and utilities. Introducing mixed billing ensures that we can maintain high-quality care and sustain our services in the long term.

Frequently Asked Questions

Any chronic medical condition lasting six months or longer, such as arthritis, diabetes, chronic pain, cardiovascular disease, or musculoskeletal conditions.

Up to 5 allied health sessions per calendar year across all providers combined.

Yes. For example, you may have 3 physiotherapy sessions and 2 chiropractic sessions under the same plan.

Yes. A new CDM plan is required each calendar year if further sessions are needed.

At Spinal & Sports Care, there will be a small out-of-pocket fee for most patients. However, patients over the age of 70 or those experiencing financial hardship will be bulk billed directly through Medicare.

No. Referrals cannot be backdated under Medicare rules.

Yes. We provide reports to your GP after treatment to ensure continuity of care.

They reset on 1 January each year, not 12 months from the referral date.