If you are a doctor or allied health professional and would like to refer a client to us, please feel free to print out the referral sheet below. Please include any clinically relevant information and some contact details so we can keep you informed of your client’s progress.

Is physio covered by Medicare?

In short YES. However there are conditions to this.

You must see your GP to see if you are eligible for a specific referral called a Chronic Disease Management Plan (CDM) This may also be referred to as an EPC. Here is what the CDM form looks like CDM Form. Only if you have a CDM referral will your visit be partially by Medicare.

HOW DO I QUALIFY FOR A CDM PLAN?

The CDM plan was introduced to help create a plan of management for people with chronic or terminal conditions. These conditions will generally have been present for 6 months or more. The CDM plan assist people who require multidisciplinary, team-based care from a GP and at least two other health or care providers using a Team Care Arrangement (TCA). Your CDM needs to be written out to Vital Action Physio or it can be specifically written out to one of our physio’s.

HOW MANY VISITS WILL IT COVER?

You can be covered for up to 5 visits per calendar year. This is determined by your GP and it will be noted on your CDM plan.

'MY GP SAID THAT I WOULD GET 5 FREE VISITS'

The most common misconception about the TCA process is that it is totally free but this isn’t quite true. At Vital Action Physio we charge you a heavily discount rate of $75 and you will receive a rebate of $58.30 from Medicare.

One way of looking at it is that the rebate amount for Medicare is usually larger than a private health insurance rebate, so whilst not free, it is still good value when you consider the cost of private health Insurance premiums.

NB: if you have reached the Medicare Safety Net level for the year because you have paid a lot of out of pocket costs, the rebate goes up significantly, so the gap would be minimal.

HOW DOES THE MEDICARE REBATE PROCESS ACTUALLY WORK?

If you have a valid CDM plan, you are responsible for paying the full amount at the time of your appointment. If you would like to receive the rebate into your bank account, this can be done at the time of the consult or you can submit the invoice to Medicare yourself.

Unlike with a GP visit, Medicare doesn’t pay the rebate into a credit account for allied health services. If you do not have a savings/debit card then the paperwork is sent to Medicare and processed manually into their account listed with Medicare (via BSB and Acct number). This can take up to 28 days.

02 7251 1475
admin@vitalactionphysio.com.au