Physiotherapy, also known as physical therapy, is a vital part of treatment for many medical conditions, including fibromyalgia, arthritis, and chronic back pain. It involves the treatment of diseases, disorders, and injuries through physical methods such as massage and exercise. Medicare will generally cover costs such as public hospital stays, eye tests, and other minor medical procedures, but many people are unaware or unsure of exactly what Medicare is and its benefits. With the help of South Port Central Physio, a Southport Central Physio and Sports Injury Clinic, we will explain to what extent Medicare covers physiotherapy.
What Is Medicare?
Medicare is a publicly funded healthcare program aimed at giving citizens free or subsidized medical and healthcare services. Operated by the Department of Human Services, Medicare is the primary funder of healthcare for all Australian citizens and permanent residents.
Citizens can claim a Medicare rebate for treatment from registered professionals such as midwives, doctors, and other legal health professionals who have been issued a Medicare Provider Number.
Can I Claim a Medicare Rebate For a Physiotherapy Session?
The short answer is yes. Medicare does cover physiotherapy sessions and obtaining it should be a simple process, but claiming Medicare isn’t always so straightforward.
To claim Medicare rebate for physiotherapy, you will have to pass a few criteria and you will likely come across the word “chronic” more times than you’d like. This is because according the Department of Human Services, Medicare is reserved for “people with chronic conditions and complex care needs”.
They define a chronic condition as “an illness that has been or is likely to be present for six months or longer such as asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions. However, the CDM items are designed for patients who require a structured approach and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary team. Patients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least two other health or care providers.”
It all sounds very complex, but it simply means if you have a broken finger or a slight fever, you might want to forget about Medicare, as the chances of your general practitioner giving you a Medicare referral are next to none.
The first step to getting Medicare is seeing a general practitioner for approval. Once your general practitioner approves your eligibility for Medicare, he gives you a referral to a specific hospital or medical professional who will then render you free or subsidized treatment, physiotherapy included.
How Many Visits Does Medicare Cover?
The referral from your general practitioner entitles you to five consultations per year under the Medicare program to any health practitioner recommended by him. These visits could cover anything from physiotherapy to speech therapy, podiatry, exercise physiology, etc.
How your five visits are carried out fully depends on the recommendation of your GP, who could recommend three physiotherapy sessions and two podiatry sessions or three physiotherapies, one podiatry, and one speech therapy session depending on your condition.
Your five Medicare-covered visits are renewed annually, but you’ll be subject to new review and approval from your GP to get a fresh Medicare referral.
How Much Does the Medicare Rebate Cover?
Medicare rebates don’t always cover the full cost of your physiotherapy treatment. The rebate for a physiotherapy consultation is currently $52.95 per treatment. The amount of money which you will have to pay yourself (usually 15% – 25%) of the general cost is known as a gap payment’.
For example, a doctor’s consultation fee might be $50 for one standard session, and your Medicare rebate will likely be around $36.30, leaving a gap payment of $13.70 for you to pay. For physiotherapy, the gap payment will largely depend on the practitioner you see and how much they charge.
How Is a Medicare Rebate Claimed?
Claiming your Medicare rebate is one of the simpler parts of the entire process. Here’s how it works:
- You pay the full physiotherapy consultation fee upfront from your debit card.
- They swipe your Medicare Referral Card on their registered machine and enter your general practitioner’s provider number and a few other details.
- They process the payment which links directly Medicare and accesses the rebate for you.
- They swipe your debit card, which returns the $52.95 rebate back into your bank account.
Although the process of getting Medicare is sometimes strenuous, the good news is that, yes, Medicare does cover a sizeable portion of your physiotherapy bills.
To successfully register and claim Medicare Rebate for your physiotherapy sessions:
- You must be suffering from a chronic illness.
- You’ll need a referral from a general practitioner to a licensed physiotherapy clinic.
- The referral gives you a rebate of $52.95 for up to five visits a year
- You must renew your referral with your GP annually if you want to continue using the Medicare program.