Can I Claim My Physio On Medicare?

Can I Claim My Physio On Medicare?
In this blog learn more about medicare & how it supports physio

Your health matters and the costs associated with medical care can quickly mount up. People can often qualify for Medicare rebates to lessen the financial strain in Australia. Given the prevalence of musculoskeletal injury, many people frequently ask whether Medicare plans will pay for certain services like physiotherapy.

To assist you in starting your rehabilitation process, this blog explains in plain language how and when is physiotherapy services covered by Medicare.

Does Medicare pay for physio?

The simple answer is yes you can use medicare rebates for physiotherapy services.  If you satisfy the eligibility health requirements, Medicare plans could potentially pay for your physiotherapy appointments.

If you have questions and want to find out information on whether you qualify for Medicare benefits and what you must do to get them, please keep reading.

1. Confirm that you have a valid Medicare card.

To accept Medicare benefits, you must possess a Medicare card, which in general means you need to be an Australian citizen (and there by have a Medicare card).  Medicare will cover your physiotherapy in certain situations as explained further in this blog.

2. Fulfil the prerequisite health conditions.

If you have a chronic health issue with complex care needs and are being managed by a GP under a shared care plan or a GP Management Plan and Team Care Arrangement, you may be eligible to receive physiotherapy health services by the Medicare Benefits Schedule.

3. Obtain a recommendation from a GP.

You must complete the Medicare eligibility health requirements and obtain a referral by a general practitioner in order to receive a physiotherapy health services that is reimbursed by Medicare.

Your GP can assist you in determining whether your musculoskeletal health issue meets the Medicare requirements for physiotherapy services to claim Medicare (and whether they will write you up a referral).

4. Visit a medical facility that takes Medicare.

Medicare referrals are not accepted by all physiotherapy offices for a physical therapy service. To avoid paying the entire charge, patients are advised that you call and enquire about accepting a referral before booking in for a consultation for physiotherapy services about what you can claim.

5. Arrive at the appointment with your Medicare card and GP referral paperwork.

By doing this, you can save yourself the inconvenience of having to complete a Medicare claim in order to get your physiotherapy health care entitlement, as well as the time it would take by the receptionist to process your referral and payment for your physiotherapy services.

Are Physios Under Medicare?

IMPORTANT INFORMATION

How many physiotherapy appointments will Medicare cover?

In a given year, you are permitted up to five sessions of physiotherapy services with Medicare. Your doctor decides how many physiotherapy sessions are necessary to suit your treatment needs, health condition and how many sessions you will actually receive through Medicare.

Will there be a gap payment For My Treatment?

Depending on the physiotherapy clinic you’re visiting, you may need to pay a part gap costs that Medicare doesn’t cover for your health conditions. 

The Medicare Benefits Schedule states that starting in 2022, your Medicare rebate will cover $56.00 part of your physical therapy costs – would be great if there was no limit to their funded support, but unfrotunately this is not the case. You will be responsible for the additional fees (i.e. part payment) if the physiotherapy clinic levies them for their physio services for your health conditions.

To avoid any costly surprises with part costs when you leave the physiotherapy treatment room, we advise calling clinics ahead of time before you leave home to ask for information if that particular clinic accepts Medicare referrals and to enquire up front about the gap part payment costs.

Do Medicare sessions carry over until the following year For Patients?

Unfortunately, you cannot carry over your Medicare funded physiotherapy care appointments to the upcoming year. Attend all of your physiotherapy visits while your physiotherapy is funded via referral. 

Physiotherapists can frequently provide you with helpful physiotherapy exercises to enhance your general strength and wellbeing and prevent future re-injury for your condition.

How many physio appointments will Medicare cover?

In a given year, you get permitted up to five sessions of physotherapy care through Medicare for your health conditions. Your GP decides how many sessions are necessary to suit your treatment needs, condition and how many sessions you will actually receive when claiming Medicare.

What kind of medical condition is regarded as chronic by medicare?

You have what is deemed a chronic medical condition that has bothered you for a long time and has enduring effects such as disability from injuries. A medical illness is deemed chronic if it has been present for at least six months or is anticipated to do so. 

Examples that can be covered under referral include osteoporosis or arthritis, which can give people persistent and inconvenient joint injury.

What are deemed complex care needs by medicare?

If a patient needs continuing physical therapy treatment services from a multidisciplinary team that can include their GP or medical professional and from at least two other health or care professionals which may include:

  • Allied Health Physiotherapy 
  • Rehab Therapists
  • Senior Health Practitioners
  • Health Professionals
  • Occupational Therapy Practitioner
  • Physical Therapy Specialist

If there is sufficent consensus from the above primary care professionals, then the patient can be said to have a complex care needs that may be part covered via Medicare referral.

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