Key Takeaways
- Medicare covers physiotherapy for patients with chronic or terminal conditions under the CDM plan, which requires a GP referral and a coordinated care plan.
- To be eligible for Medicare-funded physiotherapy, you need a valid Medicare card, a CDM plan managed by a GP, and specific criteria, such as a chronic condition for at least six months.
- Under the CDM plan, Medicare allows five allied health services per year. However, you may still have a gap payment if the physiotherapy clinic charges more than the Medicare rebate.
Is Physiotherapy Covered by Medicare? Find Out What You Need to Know
Patients must have a chronic medical condition—defined as one that will last for at least six months—to be eligible for Medicare-funded physiotherapy services.
- For patients with chronic medical conditions
- Multidisciplinary approach to treatment
- Managed by a General Practitioner (GP)
- Coordinated care from multiple healthcare providers
Understanding Medicare Coverage for Physiotherapy
The coverage is for patients with chronic or terminal conditions and complex care needs managed under the Chronic Disease Management (CDM) plan.
Eligibility Requirements for Medicare-Funded Physiotherapy
Valid Medicare Card
The first and most important requirement to get Medicare benefits for physiotherapy is having a valid Medicare card.
This card proves you are enrolled in Medicare and eligible for the benefits.
Whether you are an Australian citizen, an Australian permanent resident applying for Medicare or a New Zealand citizen living in Australia, having a valid Medicare card is a must.
Make sure you are enrolled and carry your Medicare card to all your healthcare appointments to access your Medicare benefits.
This card proves your eligibility and is the key to getting rebates for your physio sessions. Without it, you can’t claim Medicare benefits for your treatment.
Chronic Disease Management Plan
The Chronic Disease Management (CDM) plan is the key to accessing Medicare-funded physiotherapy. This plan is for patients with chronic conditions that will last for at least six months.
Conditions like asthma, diabetes, and arthritis often qualify for a CDM plan, which allows patients to receive coordinated care from multiple healthcare providers.
To be eligible for Medicare-covered physiotherapy, patients must have a GP Management Plan and Team Care Arrangements (TCA) in place.
These arrangements outline the specific healthcare services required and coordinate care among multiple providers including physiotherapists. Following the CDM guidelines is important to claim Medicare benefits for your physio sessions.
GP Referral
A GP referral is another requirement for Medicare-funded physiotherapy services. This referral must be obtained from your general practitioner and renewed yearly to continue receiving benefits.
The referral ensures your physio sessions are part of the coordinated care plan under the Chronic Disease Management (CDM) scheme.
To access these services, your GP will provide a referral form issued by the Department of Health and Aged Care.
This form is required for your physio to claim the Medicare rebate on your behalf. Remember, a new referral is needed for the start of each calendar year, so plan your appointments accordingly.
How Many Physiotherapy Sessions Are Covered by Medicare?
A commonly asked question is about the number of physiotherapy sessions Medicare covers. Under the Chronic Disease Management plan, Medicare allows up to 5 allied health services per patient per year.
This means you can have up to 5 physiotherapy sessions per year based on your GP’s assessment and the treatment plan.
Your GP will play a big role in determining how many physio sessions you need. During your consultation, your GP will set up a treatment plan that outlines the goals and number of sessions required to manage your condition.
Stick to this plan, and you will get the most out of your physio treatment.
Remember, unused physio sessions do not roll over to the next calendar year. If you don’t use all five sessions in the year, you lose them.
So, to maximise Medicare benefits, booking and completing your sessions early in the year is best.
Gap Payments and Additional Costs
Medicare covers a large portion of the physiotherapy cost, but patients may still have to pay the gap if the clinic charges more than the Medicare rebate.
As of 2024, the Medicare rebate for physiotherapy is around $60.35 per session. If the clinic’s fees are more than this amount, the patient will have to pay the difference, known as the gap.
To manage these costs, talk to the clinic about their fees and ask about any gap payments.
Understanding the financial side of your treatment will help you plan and budget, especially when considering private health insurance.
Finding an Eligible Physiotherapy Clinic
To access your Medicare benefits, find a physiotherapy clinic that accepts Medicare referrals. Not all clinics are eligible to provide Medicare-covered services, so make sure to check this before you book an appointment.
Start by asking if the clinic accepts Medicare referrals and if they have any gap fees.
Eligible allied health professionals like physiotherapists must meet specific criteria to provide Medicare-covered services.
You can proceed with your treatment plan by making sure your chosen clinic and physiotherapist meet these requirements, knowing you will receive Medicare benefits.
How to Claim a Medicare Rebate for Physiotherapy Services
There are several steps to claim a Medicare rebate for physio, starting with getting a GP referral and being part of a Chronic Disease Management (CDM) plan.
Your physiotherapist can help coordinate with your GP to set up the Team Care Arrangements (TCA) and organise all the paperwork.
Keep all your documentation, including your GP referral and CDM paperwork, to speed up the Medicare claim process.
If the rebate can’t be issued on the spot, you can lodge your receipt with Medicare for reimbursement. Follow these steps, and you will receive the Medicare benefits you are entitled to for your physiotherapy sessions.
At The Alignment Studio we can utilise our Practice management software to facilitate your Medicare rebate.
Tips for Maximising Your Medicare Benefits
To get the most out of your Medicare, you need to plan and stick to your treatment plan. Make sure you attend all your allocated physiotherapy sessions under your Medicare plan to use up the benefits. Missing sessions will mean lost treatment and potential setbacks in your recovery.
Also, following your exercises as prescribed will help with the effectiveness of your physio treatment and prevent future re-injury.
Booking your physiotherapy sessions early in the year will ensure you get in within the Medicare appointment limits so you can use up all your allocated sessions.
Common Conditions Covered by Medicare for Physiotherapy
Medicare covers physiotherapy for chronic conditions like arthritis and osteoporosis. Arthritis with ongoing joint pain often requires long-term management through physio. Medicare-funded physiotherapy can help with symptoms and joint function.
Osteoporosis, a condition that weakens bones and increases fracture risk, is another common condition covered by Medicare for physiotherapy.
Regular physiotherapy sessions can help strengthen the bones, reduce the risk of fractures, and improve overall health and mobility.
Complex Care Needs Under Medicare
For patients with complex care needs, ongoing care from a multidisciplinary team, including your GP and at least two other health care providers, is often required. Medicare’s physio coverage is part of this multidisciplinary approach to care for chronic conditions.
To receive these benefits, a GP Management Plan and Team Care Arrangement must be in place. These arrangements involve multiple healthcare providers working together to provide holistic care and cover all aspects of patient health. This is especially important for patients with complex care needs.
Summary
In summary, Medicare covers physiotherapy for eligible patients with chronic conditions and complex care needs. To access these benefits, make sure you have a valid Medicare card, are on a CDM plan, and have a GP referral.
By following the guidelines outlined in this guide, you can claim Medicare rebates for your physiotherapy sessions.
Remember to get the most out of your benefits by attending all sessions, following your exercises and booking early in the year.
With the right information and approach, you can get the most out of your Medicare physiotherapy treatment. So, if you’re still wondering, “Is physiotherapy covered by Medicare?” The answer is yes, but make sure you meet all the necessary criteria.
Frequently Asked Questions
Is physiotherapy covered by Medicare?
Yes, physiotherapy is covered by Medicare for eligible patients with chronic conditions and complex care needs managed by a GP under the Chronic Disease Management plan.
How many physiotherapy sessions are covered by Medicare annually?
Medicare covers up to five physiotherapy sessions per year, as long as they are recommended by a GP and included in the treatment plan.
What is a gap payment in physiotherapy?
A gap payment in physiotherapy refers to the difference between the clinic’s fee and the Medicare rebate, which patients are responsible for paying.
Do all physiotherapy clinics accept Medicare referrals?
No, it’s essential to confirm with the clinic whether they accept Medicare referrals before seeking treatment.
What documentation is needed to claim a Medicare rebate for physiotherapy?
Pete Hunt is a highly skilled physiotherapist with nearly three decades of experience working in sports physiotherapy and private practice. The Director of The Alignment Studio, he has a special interest in musculoskeletal and sports injuries, orthopaedic rehabilitation and postural syndrome. With a caring, communicative approach, Pete uses a combination of joint and soft tissue mobilisation and exercise prescription to treat his clients. He’s also passionate about education for injury prevention and lasting results.