Is Physio Covered by Medicare?

Is Physio Covered by Medicare?

If you’ve been referred to a physio, or sought their advice on your own, you might be wondering, is physio covered by Medicare?

Generally, not everyone who seeks out the assistance of a qualified physiotherapist will be entitled to a rebate on the service. However, some people with chronic conditions and complex care needs may be eligible to receive a rebate for up to five sessions in a calendar year.

We explain more below.

Is Physio Covered by Medicare?

Do you have a chronic (or terminal) medical condition and complex care needs that require treatment from two or more other health care providers?

If so, then you may be entitled to a rebate on up to five (5) physiotherapy sessions per year, as part of Chronic Disease Management (CDM) – GP Services (Previously known as the Enhanced Primary Care or EPC).

General Practitioners can prepare two types of plans for Chronic Disease Management (CDM): GP Management Plans (GPMP), and Team Care Arrangements (TCAs).

Team Care Arrangements are in addition to a GP Management Plan and are for those who require multidisciplinary care for their chronic condition and complex care needs.

 The Department of Health website states: “If you have both a GPMP and TCAs prepared for you by your GP, you may be eligible for Medicare rebates for specific individual allied health services that your GP has identified as part of your care. The need for these services must be directly related to your chronic (or terminal) medical condition.”

Residents of a residential aged care facility who are managed under a multidisciplinary care plan may also be eligible.

Find out more about the eligibility criteria set out under Medicare Benefits Schedule Item 10960 here.

**It’s important to note that eligible patients are entitled to a rebate on a total of five allied health services each year between January 1 and December 31. Which means, you may receive your rebate for other services deemed necessary to treat your condition. Other eligible allied health providers include Occupational Therapists, Podiatrists, Speech Pathologists, Dietitians and Audiologists.

Chronic Disease Management Plan Medicare: The Process for Claiming Physio Services

  • Step 1: See your GP to determine eligibility

You firstly need to discuss this with your GP and meet the required criteria to be eligible for the program.

  • Step 2: Receive a referral for Physio

Once you are eligible, your GP will send a referral through to either your physiotherapist of choice or one your GP recommends.

  • Step 3: Treatment begins

We will then agree to the Care Plan and begin treatment as soon as possible.

  • Step 4: Making a claim with Medicare

On the day of your appointment, you are required to pay the service fee. Our staff will then process your medicare claim through our online portal using your Medicare card details.  Just like when you see your GP, the medicare rebate is credited into your registered bank account. At the time of publishing, the current Medicare rebate total is $55.10 per session you attend.

Important Note: The medicare rebate does not always cover the full Physiotherapy consultation fee. You may have a small out of pocket fee which we call “the gap”. This fee is to cover the allied health professional’s time, as the Care Plan amount is significantly less than the normal charge of allied health professional sessions. This fee may also vary depending on which practitioner you would like to see, as senior Physiotherapist’s fees are higher and whether you hold a Pension card.

  • Step 5: We let you GP know about your progress

As part of your chronic disease management, Allied health providers, like physios, must report back to the referring GP.

Your plan and progress will be reviewed frequently by your GP, so your health practitioners can determine if your goals are being met and if any changes need to be made.

Find out more about Chronic Disease Management Plan and Physiotherapy

Do you have more questions about chronic disease management and physiotherapy? We are more than happy to help, so please give us a call today on (07) 3289 6122.