Your Guide To Navigating Medicare Covered Physiotherapy
Understanding how Medicare funds allied health services like Physiotherapy can be difficult to wrap your head around. Physiotherapy is covered by Medicare but there is a certain criteria you will need to meet to be elegible. Below we will go through a few different area's to help you understand Medicare for Physiotherapy.
WHAT IS MEDICARE?
Medicare is Australia's healthcare system which is often used to cover doctor consults, medication and other allied health services like physiotherapy. It is one of the best healthcare systems in the world, providing equal access to all. The scheme covers most of your healthcare costs but there are certain criteria that has to be met in order to be eligible to receive physiotherapy under the scheme.
Medicare physiotherapy referrals are granted under the Medicare Chronic Disease Management (CDM) scheme. This scheme allows those who live with chronic conditions to take a multidisciplinary approach to their treatment. A chronic condition under the scheme is defined as a condition that has or is expected to last at least 6 months. From a physiotherapy point of view, this might mean that your GP will refer you to a physiotherapist for a chronic issue like chronic shoulder pain, a knee injury, arthritis or more.
In order to claim medicare benefits for physiotherapy it is important to understand and follow the CDM guidelines which we will cover below.
IS PHYSIOTHERAPY COVERED BY MEDICARE?]
Yes it is as long as it is a chronic and complex musculoskeletal condition requiring specific treatment under the CDM scheme. There are also other health care services and tests/scans like MRIs and X-rays which are covered.
Under the Medicare Benefits Schedule, Item 10960 covers physiotherapy if it is provided to a patient with a chronic condition requiring complex care.
WHAT'S DEFINED AS A CHRONIC CONDITION AND COMPLEX CARE?
A Chronic condition is defined as an issue or injury that has been or is expected to be present for at least 6 months. Although there is no list of conditions available that fall under this category, it is on a case by case basis and can include many conditions such as arthritis and diabetes.
A Complex conditions means that there must be three or more healthcare practitioners caring for you. This might include your GP, a physio and a dietitian for example.
WHAT ELSE IS INVOLVED?
-You will need to be referred to a physio by your GP, the service being completed out of the hospital and a session should be at least 20 minutes, with a maximum of 5 allied health services available.
HOW CAN I CLAIM A MEDICARE BENFIT FOR PHYSIOTHERAPY?
Once you have a referral from your GP to see a physiotherapist under Medicare item number 10960 (your condition is chronic and complex- see above for what this means), you will be able to use this referral for 5 consultations for various allied health providers, such as seeing a podiatrist or dietitian or you can choose to use them all on physiotherapy.
To claim your medicare benefits from physiotherapy, it is a smooth process once you have confirmed that you have a chronic and complex condition requiring physiotherapy:
1) Book with your GP to get a referral- ask them to fill out the Chronic Disease Management Paperwork (CDM)
2) Contact Home Therapy Australia and make an appointment with us, please submit your paperwork through our online bookings (see below) or email us on info@hometherapyaustralia.com.au
3) See your physiotherapist who will help you achieve your goals and manage your chronic and complex musculoskeletal condition
4) Pay for the appointment. From, here you can claim your medicare rebate on your own which will be a rebate of $54.60. After this, if you have private health insurance, you can use this to cover the rest.
Medicare is Australia's healthcare system which is often used to cover doctor consults, medication and other allied health services like physiotherapy. It is one of the best healthcare systems in the world, providing equal access to all. The scheme covers most of your healthcare costs but there are certain criteria that has to be met in order to be eligible to receive physiotherapy under the scheme.
Medicare physiotherapy referrals are granted under the Medicare Chronic Disease Management (CDM) scheme. This scheme allows those who live with chronic conditions to take a multidisciplinary approach to their treatment. A chronic condition under the scheme is defined as a condition that has or is expected to last at least 6 months. From a physiotherapy point of view, this might mean that your GP will refer you to a physiotherapist for a chronic issue like chronic shoulder pain, a knee injury, arthritis or more.
In order to claim medicare benefits for physiotherapy it is important to understand and follow the CDM guidelines which we will cover below.
IS PHYSIOTHERAPY COVERED BY MEDICARE?]
Yes it is as long as it is a chronic and complex musculoskeletal condition requiring specific treatment under the CDM scheme. There are also other health care services and tests/scans like MRIs and X-rays which are covered.
Under the Medicare Benefits Schedule, Item 10960 covers physiotherapy if it is provided to a patient with a chronic condition requiring complex care.
WHAT'S DEFINED AS A CHRONIC CONDITION AND COMPLEX CARE?
A Chronic condition is defined as an issue or injury that has been or is expected to be present for at least 6 months. Although there is no list of conditions available that fall under this category, it is on a case by case basis and can include many conditions such as arthritis and diabetes.
A Complex conditions means that there must be three or more healthcare practitioners caring for you. This might include your GP, a physio and a dietitian for example.
WHAT ELSE IS INVOLVED?
-You will need to be referred to a physio by your GP, the service being completed out of the hospital and a session should be at least 20 minutes, with a maximum of 5 allied health services available.
HOW CAN I CLAIM A MEDICARE BENFIT FOR PHYSIOTHERAPY?
Once you have a referral from your GP to see a physiotherapist under Medicare item number 10960 (your condition is chronic and complex- see above for what this means), you will be able to use this referral for 5 consultations for various allied health providers, such as seeing a podiatrist or dietitian or you can choose to use them all on physiotherapy.
To claim your medicare benefits from physiotherapy, it is a smooth process once you have confirmed that you have a chronic and complex condition requiring physiotherapy:
1) Book with your GP to get a referral- ask them to fill out the Chronic Disease Management Paperwork (CDM)
2) Contact Home Therapy Australia and make an appointment with us, please submit your paperwork through our online bookings (see below) or email us on info@hometherapyaustralia.com.au
3) See your physiotherapist who will help you achieve your goals and manage your chronic and complex musculoskeletal condition
4) Pay for the appointment. From, here you can claim your medicare rebate on your own which will be a rebate of $54.60. After this, if you have private health insurance, you can use this to cover the rest.
Please get in touch below for more details! We look forwards to working with you soon.