Call us: (08) 9752 4174

Medicare Rebates FAQs

Home Medicare Rebates FAQs

Medicare Rebates FAQs

Medicare Rebates and Allied Health Services at Busselton Physiotherapy Centre

Will my therapy be partly or fully covered by Medicare?

The short answer is “it depends”.

The more comprehensive answer is that we are a private physiotherapy and allied health clinic and there is no automatic eligibility for Medicare rebates or bulk billing.

However, a system exists for some Medicare rebates to be available for a limited number of allied health services per year under specific circumstances. This system is known as the Chronic Disease Management program. It was previously known as the EPC, or Enhanced Primary Care program. For certain clients, bulk billing may be applied.

Who is eligible?

Your GP is the person who determines your eligibility, does the required planning and provides the referral for allied health Medicare rebated sessions. This process is generally supported by your GP’s practice nurse who assists in the coordination of care and care between GP sessions.

To be eligible you must have a health problem requiring therapy that is chronic, complex and requires 3 or more people to be involved in your care.

What does chronic mean in terms of my eligibility?

This means that it is a long standing health issue and has been in existence for at least 6 months. For example, this is likely to include arthritis but not a new sprain or strain to a previously pain free part of the body.

What is complex care?

This is where a patient is considered by the GP to have a more complex problem(s) that could benefit from a plan and process that will: identify your health and care needs; set out the services to be provided by your GP; and list the actions you can take to help manage your condition.

This will mean that the GP can develop a GP management plan to help provide an organised approach to your care.

What is deemed to be the required health care team?

The patients care will also require the care of 3 or more health or care providers to be eligible. If this is the case, the GP has the option to develop a Team Care Arrangement. Both the GP Management Plan and Team Care arrangement are developed in conjunction with the patient and are required to be in place prior to the GP referring patients for allied health sessions. The patient seeing only their GP and the allied health practitioner about their care does not entitle them Medicare Rebates for allied health.

How many sessions are covered?

Where the GP has set up the GP Management and Team Care Plans, they can elect to refer patients for up to a total of 5 Allied Health sessions. This will require a voucher to be completed and provided to our practice. This outlines the required allied health service type and number of sessions covered. All 5 sessions may be allocated to the one provider or they may be spread across a number of providers or clinics.

A new referral can be made each calendar year at the GP’s discretion, but a maximum of 5 allied health services can only be rebated in any one year. This can sound complicated but essentially, if you don’t use your allocated sessions in any one calendar year your will still be able to use them in the following calendar year. However, if the services are used from the prior voucher and referral, you can only use the balance up to a total of 5 in the following year. For example, you cannot use the residual, say 2 sessions from the prior year plus the new 5 under the current year’s referral.

What type of treatments are covered under these Medicare rebated session?

The primary focus of Medicare rebated sessions for Chronic Diseases is to help you to improve your self-care and learn strategies that will assist your longer term self-management of your health and wellbeing.

Will I be bulk billed under Medicare?

Generally, no. Our standard fees apply with the Medicare rebate covering part of the cost of your sessions. But there are exceptions.

For Physiotherapy, pensioners will be bulk billed. Evidence of a client’s current pension status is required at the time of commencing a course of treatment.

For Dietitian services, a gap applies for the initial 1 hour session for both pensioners and non-pensioners. A reduced gap is payable for pensioners. Any follow up consultations for the same condition for Dietitian services will not incur a gap.

For Exercise Physiology services no gap is payable. Clients will be liable for any expenses for any equipment, gym or pool access that may occasionally be associated with their services.

No Medicare rebates are available for our Remedial Massage Therapy services.

See our fee schedule page for more information on current fees.

How do I receive my rebate?

Our practice uses the TYRO system for electronic claiming and payments. Where patients are claiming a Medicare rebate that includes a gap, the full payment must be made at the time of treatment. This can be made using cash, debit or credit card. The Medicare rebate is then paid into a Debit account, that is a savings or cheque account, using the TYRO system. You must bring your eligible current Medicare card to each session to enable this rebate to be applied.

Any no-gap or bulk billed services will be directly claimed through the TYRO system at the practice.

What happens if my Medicare claim is rejected for any reason?

If for any reason your Medicare claim is rejected, you will be liable for full payment of your account. Patients with private health cover may be able to claim a rebate for these services in such scenarios.

Some people elect to use their private health insurance rather than Medicare to pay services when they have been referred under a GP Management Plan. Cover, rebates and annual limits vary across different policies and patients are recommended to contact their insurer regarding such information.

More information is available on the Federal Government department of health website. If you believe you may be eligible, it is recommended that you speak with your GP regarding eligibility for such services and optimizing your management across your health care team.