Refferals
What is Medicare?
Medicare is the universal healthcare system in Australia. It helps cover the costs of doctor’s appointments, medication, and other allied healthcare services such as physiotherapy and psychology. Once you enroll in Medicare, the system covers most or all of your healthcare costs. However, there are certain criteria one has to meet in order to receive these benefit.
Medicare physiotherapy sessions fall under what’s known as the Chronic Disease Management (CDM) plan. The idea behind it is that those who suffer from chronic conditions can take a multidisciplinary approach to their treatment.
So, in order to claim Medicare benefits for physiotherapy, you’ll need to follow the CDM guidelines. We’ll cover more on that down below.
What's covered by Medicare?
Most healthcare services are covered, at least in part, by Medicare. These include:
- GP or specialist visits
- Tests and scans such as MRIs and x-rays
- Eye tests and optometry
- Pregnancy, fertility treatments, and birth
- Chronic conditions
- Proof of birth
As you can see, this doesn’t include some other healthcare services such as:
- Ambulances
- Most dental services
- Glasses, contact lens, and hearing aids
- Cosmetic surgery
This is why many Australians opt for private health insurance to cover everything else that Medicare doesn’t take care of.
Is Physiotherapy covered by Medicare?
In short, yes – physiotherapy is covered by Medicare so long as it’s a chronic and complex musculoskeletal condition requiring specific treatment under the CDM.
Follow the steps below to find out if you are eligible and what you need to do to receive the Medicare benefits.
The Steps
01
Make sure you are enrolled in Medicare
You must have a Medicare card to accept Medicare benefits.
Note: You are only eligible for Medicare if you live in Australia and you’re any of these:
An Australian citizen
A New Zealand citizen
An Australian permanent resident
Applying for permanent residency
A temporary resident covered by a ministerial order.
You can also enroll if you’re a citizen or permanent resident of any of these:
Norfolk Island
Cocos (Keeling) Islands
Christmas Island
Lord Howe Island.
Additionally, if you are visiting Australia from a Reciprocal Healthcare Agreement country, you may also enrol and receive coverage from Medicare.
02
Meet the eligibility criteria
You can be eligible to receive physiotherapy treatment under the Medicare Benefits Scheme if you are experiencing: A chronic condition, and Have complex care needs
03
Receive a referral from your medical practitioner (e.g. GP)
To receive a physiotherapy review that is covered by Medicare, you will need a referral from any general practitioner and must meet the eligibility criteria outlined above. Your doctor will help you determine if your condition meets the criteria.
04
Book a Physiotherapy Appointment
Make an appointment with A Plus Physiotherapy and let us know you will be visiting us under a CDM plan.
05
Bring your Medicare Card and GP referral documents to the appointment
This will help the receptionist process your referral and payment and avoid the need for you to pay upfront and the hassle of processing a Medicare claim to receive your benefits.
Frequently Asked Questions - Medicare?
As soon as your GP has completed and sent us your CDM forms, you can book an appointment with the nominated physiotherapist in your Plan.
You can receive up to 5 physiotherapy sessions in a calendar year. The number of sessions you receive is determined by your GP who assesses how many sessions will be appropriate to meet your treatment needs.
Yes, you may be required to pay a gap. As of 2023, under the Medicare Benefits Schedule, your Medicare rebate will cover you for $58.30 (July 2023).
Our priority is to give you exceptional outcomes. Charging a remaining gap fee ($41.70) allows us the time to offer you a thorough assessment and management plan, follow up with your treatment outside of formal appointments, and align your physio treatment with treatment and opinions you’re also receiving from other medical/allied health professionals within your Care Team.
To avoid any costly surprises with part costs when you leave the physiotherapy treatment room, we advise calling clinics ahead of time before you leave home to ask for information if that particular clinic accepts Medicare referrals and to enquire up front about the gap part payment costs.
How do I receive my rebate?
We take care of the entire claims process for you:
- You pay the full fee of the consultation.
- We immediately swipe your Medicare card to access the rebate.
- You swipe your Debit or Cheque card. You immediately receive the rebate of $58.30 back to your card.
Please note the rebate cannot be returned to a credit card. Please ensure you have a debit or cheque card if you want to access an immediate rebate. If we cannot issue the rebate you can simply lodge your receipt through MyGov.
Alternatively:
- We process your claim via the online medicare claims portal
- You Pay the gap fee
Note: A Plus Physiotherapy is not responsible if you do not receive a rebate from Medicare, it is your responsibility to check your rebate entitlement.
Unfortunately, your physio sessions will not be transferred to the following calendar year. When your physio is covered by Medicare, make sure you attend all your appointments as physiotherapists can often provide you with useful exercises to improve your overall strength and wellbeing and prevent future re-injury.
Under the CDM plan, a chronic condition refers to an issue (e.g. arthritis, low back and neck pain etc) that has been or is expected to be present for at least six months.
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