Is physiotherapy covered by Medicare?

Joint and muscle pain can creep up on you. One day you realise that you’ve been living in pain for a while.

Pain that stops you doing the things you love, like playing with the kids, walking the dog, or playing your favourite sport. 

It may even keep you out of work—and when that happens, it can impact your livelihood.

For some conditions, seeing a physiotherapist is a key step towards getting a diagnosis and treatment for chronic pain.

While physiotherapy is usually covered by private health care, there are some situations where your physiotherapy sessions may be covered by Medicare.

Here’s how it works.

What health services and conditions are usually covered by Medicare?

There are many different services and conditions that your Medicare can cover. These include:

  • Visits to your GP or a specialist
  • Most of the typical surgeries and procedures performed by doctors 
  • Blood and urine tests, x-rays, and eye tests performed by an optometrist.

Generally though, Medicare does not cover dental services, ambulance use, or cosmetic surgery procedures. And while some of these may not be relevant to you, one service that most people use at some point in their lives is physiotherapy.

The good news is that Medicare can cover partial treatment costs, and provide you with a number of discounted physiotherapy sessions. It comes under their Chronic Disease Management (CDM) scheme, and ensures that you get multidisciplinary support for the treatment you need.

Who is eligible for Medicare?

To be eligible for Medicare, you must be one of the following:

  • An Australian citizen, permanent resident
  • A New Zealand citizen or permanent resident
  • A citizen of Norfolk Island, Cocos (Keeling) Islands, Christmas Island, and Lord Howe Island

Then, to access physiotherapy as part of your Medicare, you must meet the criteria.

This means that you must either experience a chronic condition, or have complex care needs. This is effectively ongoing care supported by three or more healthcare providers under a shared care plan. 

As an example, this could be your GP, physiotherapist, and occupational therapist.

Under this criteria, a chronic condition is determined as something that you’ve been living with for six months or more, that causes you pain or discomfort, and impacts your daily movement and living. 

For example, it could be ongoing joint pain, caused by osteoarthritis. This is considered a chronic condition. 

But if you recently twisted your knee playing football, this wouldn’t be considered a chronic condition, and your rehabilitation therefore isn’t eligible for Medicare.

How many discounted physiotherapy sessions can be accessed under Medicare?

Once you have received your assessment, you can then receive up to 5 discounted physiotherapy sessions per calendar year.

Your GP will advise you on how many sessions you actually need for your rehabilitation or physiotherapy treatment, and how they can be best used to treat your condition.

How do I claim the Medicare rebate for physiotherapy?

While your physiotherapy services will partly be covered by Medicare, you will need to access this assistance before attending your physiotherapy session.

Accessing physiotherapy services through Medicare is a multi-step process.

First, you need a referral from your GP. They will verify that you have a chronic condition that physiotherapy can assist with. They will then fill out the paperwork to prove your eligibility under Medicare’s CDM scheme.

Once you have this referral, you can book an appointment directly with one of our Bunbury physiotherapists – be sure to bring your CDM paperwork with you to your first appointment. 

Then, once you’ve finished your first session, you can choose to manage your Medicare claim yourself, or our friendly team can submit your claim on your behalf.

How much of a Medicare rebate do I get?

Currently, the Medicare rebate for physiotherapy services sits at approximately $56.00 per consultation, and is available every calendar year for ongoing care.

It’s important to note that Medicare does not cover the full physiotherapy fee. It’s not bulk-billed. As such, there may be a gap that you need to pay before you get your rebate. 

This will depend on the physiotherapy clinic that you choose – so be sure to check with your clinic first to determine the full amount of your service, and calculate what you can expect to pay as a gap.

Got further questions? Contact our Bunbury physio clinic

If you experience chronic pain, you may be eligible to receive the Medicare rebate. So don’t let chronic pain stand in the way of doing the things you love—get the physiotherapy support you need, when you need it.

Get in touch with our multidisciplinary team to book an appointment with your chosen specialist, or discuss how we can help you access our physiotherapy services.