Medicare Rebates: Is Physiotherapy Covered By Medicare?
Physiotherapy is an IMPORTANT TREATMENT OPTION for many acute but also chronic conditions, including backpain, headaches, tennis elbow, sports injuries, etc. On some occasions, you could get a rebate for your physio sessions through Medicare!
In this post, we want to help you guide when you could get this rebate and what you need to do for that. It can be a simple process if you know how it works!
CAN I GET A MEDICARE REBATE FOR PHYSIOTHERAPY?
YES you can (under certain conditions)
To get a rebate through Medicare, you will need a specific ‘EPC PLAN’ (short for ‘enhanced primary care plan’) or easier ‘CARE PLAN’. This has to be referred by a GP.
A Care Plan is for people with a chronic condition, meaning a condition which they have had for over 3 months.
MEDICARE PHYSIOTHERAPY: HOW MANY SESSIONS CAN I GET?
With a Care Plan, you are eligible to have UP TO 5 SESSIONS with a health care provider per calendar year (between Jan 1st and Dec 31st each year). A health care provider can be one of the following: Physiotherapist, chiropractor, osteopath, dietitian, exercise physiologist, podiatrist, speech pathologist,...
Anyone who is eligible for medicare can have UP TO 5 SESSIONS PER CALENDAR YEAR with this Care Plan. Here’s how it works: there are 5 sessions in total per calendar year!
You might have 2 sessions for a podiatrist and 3 for physio OR 4 for physio and 1 for osteopathy OR 3 for a dietitian and 2 for exercise physiologist, etc. This TOTALS 5, so there can never be more than 5 rebates per calendar year.
To get the full 5 sessions for 1 specific health care provider, the GP has to refer you to a specialist doctor as well.
If the GP doesn't refer you to a specialist doctor, he or she will usually split up the 5 sessions as in the examples above.
There are different care plans for mental issues (e.g. a referral to see a psychologist), but that’s a separate referral and is not included in these 5 sessions.
MEDICARE REBATE COVER AND GAP PAYMENTS
The rebate depends on the year. As of November 2021, the rebate is $55.10 PER PHYSIOTHERAPY
You will get the same rebate of $55.10 for an initial consult as well as all the other follow-up consults that you might be recommended by as well, up to 5 sessions per calendar year.
At Physio K, we provide a Quality service and will invest our time solely to you. Therefore, we do not bulk bill Medicare for physiotherapy at our practice, so there will always be a gap payment.
This is around $55 for your initial consult (which is half an hour of comprehensive assessment, diagnosis, planning and treatment) and around $45 for any subsequent consults.
HOW DO I GET THE MEDICARE REBATE?
At Physio K, we have made this process SUPER EASY. We are working with a system called Medipass, which does all the hard work for you!
WHAT YOU NEED TO DO: ABSOLUTELY NOTHING! You don't need to do anything to get the rebate. It will appear within 2 business days in the account that’s linked with Medicare, not necessarily the account you paid the consultation with.
The short summary is:
Yes, you can get a Medicare rebate for physiotherapy, using the EPC Program
You will need a ‘EPC care plan’ from your GP if your condition is considered as ‘chronic’
You can get a $55.10 rebate for up to 5 visits per calendar year, which resets on the 1st of Jan.
We can process the rebate on-the-spot, you don’t need to do anything!
If you have any questions regarding these Medicare rebates – please call or email us, and we will be more than happy to answer them.
Alternatively, get to your GP ASAP and ask for a referral to see a physiotherapist who can help you get moving well, feeling great, pain free and back to doing what you love.