Medicare Physiotherapy
Medicare can cover physiotherapy services under the provisions of a Chronic Disease Management Plan (CDM), previously referred to as an Enhanced Primary Care or EPC plan.
The Medicare Benefits Schedule (MBS) empowers general practitioners to manage and coordinate the medical care of patients suffering from chronic or terminal illnesses. This coordinated care strategy involves a team approach, incorporating the expertise of a GP and a minimum of two other healthcare providers.
Is Physiotherapy Covered by Medicare?
Yes! Your physio sessions can be partially funded by Medicare but you need to meet special requirements:
- you must have a chronic medical condition (meaning something that you have suffered with for over 6 months)
- you need to have the appropriate referral from your GP, who needs to send you to a specific physiotherapy clinic (please provide Build Physiotherapy details if you wish to be treated by our experienced physiotherapists)
Please note that your eligibility is up to your GP’s clinical judgement, taking into account your medical condition and care needs.
What is a chronic medical condition?
A chronic medical condition is described as one that has been present for longer than 3 months. Some of the chronic conditions are:
- Cancer
- Asthma
- Heart disease
- Diabetes
- Arthritis
- Stroke and other neurological illnesses such as Parkinson’s disease or multiple sclerosis
- Musculoskeletal injury that is not well managed
What is a Chronic Disease Management Plan (CDM)?
The Chronic Disease Management Plan (CDM), previously recognized as the Enhanced Primary Care Plan (EPC) or Team Care Arrangement (TCA), is a Medicare-backed program. It allocates funding for a maximum of 5 sessions per year, devised to assist patients contending with chronic conditions. The appropriateness of implementing this plan is subject to the discretion of your General Practitioner (GP).
How Many Physiotherapy Treatments Are Covered Under Medicare?
Medicare offers a rebate for up to five physiotherapy sessions per calendar year. However, the allocation of these sessions is ultimately at the discretion of your General Practitioner (GP). Your GP will consider your personal health situation and needs when determining the number of sessions to be allotted.
Chronic Disease Management (CDM) Plan also offers coverage for a range of other services in addition to physiotherapy. These include speech pathology, psychology, dietetics, and podiatry, allowing patients to access the necessary multidisciplinary care they need to manage their chronic conditions.
How much is the Medicare Rebate for physio?
The Medicare rebate currently stands at $56.00 for every session of physiotherapy. This rebate amount is applicable to both initial consultations and any subsequent consultations that might be suggested for your ongoing treatment.
It’s worth noting that this rebate is capped at a maximum of 5 sessions in an annual cycle. Therefore, patients utilizing this rebate will receive a total of up to $280.00 per calendar year in support for their physiotherapy treatment over the course of a year.
How do I claim the Medicare Rebate?
Claiming your Medicare rebate is a relatively straight-forward process and we can assist you in doing so. Here’s what the process looks like:
- Pay the full fee at the time of your appointment using a Debit or Credit Card.
- We will then process the claim on your behalf.
- The benefit of $56.00 will be paid into your Medicare nominated bank account within 24-48 hours.
How to book an appointment?
Give us a call at 043 138 1011 and make a request for your initial appointment.
- During the call, inform our friendly reception staff that you possess a CDM / EPC referral from your GP.
- For your initial appointment, please ensure to have the following:
- Your GP’s referral (This can be emailed or faxed to us).
- Your valid Medicare Card.
- Any relevant and recent scans or reports related to your area of injury.