Eligibility- GP Referral & Chronic Condition Plan

If you have a chronic health condition (or a condition that is likely to last six months or more) such as arthritis, chronic pain, musculoskeletal issues, neurological conditions, or other long term health concerns, you may be eligible for Medicare physiotherapy services. 

To access this care, you’ll need a referral from your GP under a care plan (known as a GP Chronic Condition Management Plan, previously known as an Enhanced Primary Care (EPC) plan, General Practitioner Management Plan (GPMP) or Team Care Arrangement (TCA). 

What’s Covered? Up to Five Allied Health Visits Per Year

Under Medicare’s allied health rebate scheme, eligible patients can get up to 5 allied health services per calendar year, inclusive of physiotherapy.

These five visits can be used for physiotherapy, or shared across different allied services (e.g. physiotherapy, podiatry, dietetics) depending on your healthcare needs and GP’s care plan. 

Your physiotherapy sessions will not be transferred to the following calendar year. When your physiotherapy is covered by Medicare, it is important that you attend all of your appointments as physiotherapists can often provide you with useful exercises to improve your overall strength and wellbeing and to prevent future re-injury. 

Rebate & Gap Payment

As the Medicare rebate for physiotherapy typically does not cover the full cost of a standard physiotherapy session, there is a 'gap payment'; the difference between the fee charged and the rebate amount. Medicare rebates $61.80 per session under the CDM plan. This amount is fixed as per Medicare regulations, regardless of how much the physiotherapist charges. 

At Plenty Physiotherapy, we’ll process your Medicare rebate (either on the spot or via a receipt) and let you know upfront what the gap payment will be so there are no surprises. 

Walk in appointments are welcome at our clinic, however, without a Chronic care plan referral from your GP on the day, you will be charged our regular consult fees.

How You Can Access Medicare-subsidised physiotherapy at Plenty Physiotherapy

1. Book an appointment with your GP to discuss your condition and request a GP Chronic Condition Management Plan with a referral to physiotherapy.

2. With referral in hand, contact Plenty Physiotherapy to schedule your appointment.

3. Pay the full fee at the time of service. Our reception team will provide a receipt so you can claim the Medicare rebate, or if verified, it will be rebated into your nominated Medicare bank account. We’ll let you know of any gap payment in advance.

4. Use your available allied health sessions under Medicare for physiotherapy (or other allied services) within the calendar year. Medicare allows up to 5 allied health sessions per calendar year, shared between services such as physiotherapy, podiatry, and dietetics. If you only need physiotherapy, you can allocate all 5 sessions.