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. While the 5 rebated sessions are renewed every calendar year, you will need a new referral from your GP each year.
Rebate Coverage and Gap Payments
The current Medicare rebate (as at July 2023) is $58.30 per consult, regardless of which allied health service that your GP chooses. You will receive the rebate of $58.30 for an initial consult, and any subsequent review consults that you might be recommended for as well, up to 5 sessions in total.
Unfortunately, even with a TCA, we cannot bulk bill Medicare at our clinic, so there will always be a gap payment to cover the remainder of the fee.
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 have to pay the full amount up front. Once that amount has been paid, we will process the Medicare rebate on the spot, which is paid directly into your account, provided you have a debit card that is linked to a Cheque or Savings account. Please keep in mind that the rebate cannot be processed on a credit card.
Specifically, here are the steps:
- You pay the full fee.
- We swipe your Medicare card and claim the $58.30 rebate for you
- We swipe your DEBIT card again, and send the $58.30 back onto that card on-the-spot.
- (You cannot use a CREDIT card for this process)
If you do not have a debit card that is linked to a Cheque or Savings account, the Medicare rebate can be claimed online via the Medicare website.
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.
- You will get $58.30 rebate per appointment for up to 5 visits per year, which resets at the beginning of the calendar year.
- You pay the full amount for your session in the clinic, but we can process the rebate straight away, and 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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