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Is Physiotherapy covered by Medicare?

Physiotherapy treatment can be covered in part by Medicare but, unfortunately, there are some hoops to jump through before you can show up to the clinic with your Medicare card.

Medicare funding, for treating your injury or condition, by our physiotherapists, requires a Team Care Arrangement (TCA), which may also be referred to as a Chronic Disease Management (CDM) plan, or Enhanced Primary Care (EPC) plan.

To be able to access funding from Medicare for your physiotherapy appointments, it is important that you speak about this with your physiotherapist during your first visit, as they can provide you with the information needed to access the funding. As our physiotherapists are experts in your condition, they can help by getting in touch with your doctor directly to help organise the TCA.

Medicare Physiotherapy treatment process

The Medicare rebate covers up to five (5) treatment sessions per calendar year, i.e. five sessions between Jan 1st – Dec 31st each year. This is reset on the 1st of Jan the following year. It is up to the discretion of your treating doctor as to how to allocate those sessions within the different disciplines of healthcare providers.

There are multiple services that may be covered under the TCA. These services may include physiotherapy, speech pathology, psychology, dietetics, podiatry, etc. 

For example, your GP might refer you for 3 physiotherapy consults, and 2 exercise physiology consults. 

Rebate Coverage and Gap Payments

The current Medicare rebate (depending if you haven’t reached any Medicare thresholds) is $58.30 per consult, regardless of the specific service that you choose. That means that the rebate is the same for an initial consult, and any subsequent review consults that you might be recommended for as well. Unfortunately, we are not a bulk-billing practice, so there will always likely be a deficit between the full consult fee and the rebate received back from Medicare.

 

How do I claim these Medicare rebates?

The Medicare rebate can be claimed once the TCA has been approved by your GP, and any other parties involved, i.e. Medicare, your physiotherapy clinic, the third healthcare practitioner that is involved in the TCA, and yourself.

When paying for your session at our clinic, you will be charged the full amount for the session. Once that amount has been paid, we will process the Medicare rebate, which is paid directly into your account, via our Tyro terminal with a debit card that is attached to a savings or cheque account.

Please note: the rebate cannot be returned to a credit card. Please ensure you have a debit card if you want to access an immediate rebate. If we cannot issue the rebate you can simply lodge your receipt with Medicare.

Specifically, here are the steps:

  1. You pay the full fee of the consultation.
  2. Our Tyro (Healthpoint) system communicates with Medicare to assess and access the rebate for you.
  3. We swipe or tap your DEBIT card, and the rebate will go back onto that card on-the-spot.

Summary

“Is Physiotherapy covered by Medicare?

  • Yes, you can get a rebate from Medicare for your physiotherapy treatment, using the TCA Program.
  • You need a referral from your GP, and your condition will need to be considered to be a “chronic” condition.
  • If eligible, you can be approved for a Medicare rebate for up to 5 visits per calendar year.
  • You pay the full amount in the clinic, but we can process the rebate on-the-spot, straight back onto your debit card.

If you have any questions at all regarding the TCA process – please call or email us via the Contact Us page (online enquiry form is at the bottom of the page), and we are more than happy to answer them.

For further information regarding a TCA plan, you may wish to visit the Department of Health website

Alternatively, come in to see us and we can assist you by liaising with your doctor, and can help you overcome your condition!

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