Does Australia's Medicare Help With Physiotherapy Costs?
Before booking an initial physiotherapy appointment, the number one question people have is, "Does Medicare help me with the cost of my physiotherapy?" If so, how much will it be?
Most physiotherapy is a medical necessity and not just a 'nice to have'. People may have chronic or ongoing back pain, a bad shoulder that's making it hard to sleep, or a knee that's not functioning after a knee replacement. When treatment is medically necessary, the cost of physiotherapy has an impact on your ability to continue to receive treatment. This is particularly true when you have received a diagnosis from your doctor. The best way to determine your cost is to understand how Medicare's physiotherapy service operates, as this will help you plan for your treatments without the cost of surprise.
Does the Medicare program cover physiotherapy?
Yes, the answer is yes to this question. However, the resource will only cover physiotherapy under very specific scenarios.
In general, Medicare does not cover non-urgent or periodic physiotherapy services. If you make an appointment directly with a physiotherapist, you cannot look forward to Medicare covering the cost unless you have the necessary documentation from your doctor and/or the health and disability management team.
The only situations where Medicare pays for physiotherapy sessions are through a structured program called a Chronic Disease Management (CDM) program, which is sometimes also referred to as an Enhanced Primary Care (EPC) program, or in other words, an Enhanced Care Plan.
To be eligible, you must meet the following criteria:
You have been diagnosed by your doctor with a chronic health condition that has lasted six months or more
Your doctor has determined that your physiotherapy treatment will be part of your overall care
There is a GP Management Plan and Team Care Arrangement in place.
After you have met all of the above criteria and have been approved, Medicare will provide you with a maximum of five allied health sessions during a calendar year. Physiotherapy is just one of the allied health services that can be covered under the CDM program.
The five total sessions of allied health services are combined into one total for all allied health services that you will have access to via the CDM program. Physio, podiatry, dietetics and so on all come from the same funding pool.
How much will Medicare pay towards physiotherapy?
It's important to have realistic expectations in this area.
Medicare pays a standard rebate for each physiotherapy appointment (which is not a full payment). Medicare determines this rebate and is approximately $50-55 per visit (this will vary depending on the year).
Most physiotherapy appointments will cost the patient more than the rebate amount. The patient will pay the difference between the appointment price and the Medicare rebate, known as the "gap" in coverage.
So if you're asking how much is covered by Medicare for physiotherapy, the answer is partial support, not free.
What Medicare will not cover with Physiotherapy
It's equally important to understand what is not covered by Medicare.
Medicare does NOT cover:
Treatment of sports injuries if they are not part of a CDM plan
acute injuries that are not associated with a long-term chronic condition
5 or more treatment sessions in a calendar year
Preventative or performance-based physiotherapy treatment
If your injury or dysfunction was recent, short-term or performance-related, you will not have access to services through Medicare. Instead, you may want to consider using your private health fund or funding the service out of your own pocket.
Why does Medicare limit the number of physiotherapy treatments?
A limit of 5 physiotherapy sessions has surprised many people, especially since this number seems low, considering numerous health conditions require physiotherapy.
While the Medicare physiotherapy scheme offers limited financial assistance to clients with complex health needs, its primary purpose is to complement other forms of physiotherapy rather than replace long-term physiotherapy. That's why Medicare sessions are often strategically used by physiotherapists to maximise the value that patients receive from each visit by focusing on assessment, planning, and education.
How to effectively use your Medicare physio sessions
Since sessions are limited in regard to both time and frequency, it is critical to consider how exactly you use these sessions. A well-structured physiotherapy approach to treatment typically consists of the following elements:
A diagnosis and set of goals
A personalised exercise or mobility program
Education regarding pain, posture, loading, etc.
Strategies for rolling progress and managing load between sessions.
As long as your sessions are used effectively, even a small number of sessions can lead to significant recovery outcomes.
Medicare vs Private Physiotherapy
It is common for people to utilise both Medicare and private physiotherapy services. Medicare-funded physiotherapy helps reduce initial costs, while private physiotherapy allows for ongoing treatment, flexibility in scheduling, and continuity of care. This combination is often used for patients who suffer from conditions such as persistent back pain, arthritis, recovery from surgery, or nerve problems.
Given this blended approach to physiotherapy, choosing the right physiotherapist is critical. A physiotherapist who understands how to integrate Medicare funding into your long-term care will help you achieve better results and not just "tick boxes".
Do I need a referral for Medicare physiotherapy?
Yes, you require a referral from your GP.
Your GP's referral must have current information relating to a GP Management Plan and Team Care Arrangement to access a Medicare physio rebate. The referral must also contain the physiotherapy service provider's contact details.
Your physiotherapist will generally direct you to what documents are necessary and how to process a rebate for your Medicare-funded session.
Commonly asked questions
Is physiotherapy covered by Medicare for everyone?
No. Only patients who have chronic conditions as defined in the GP Management Plan can access this benefit.
Can I use Medicare physiotherapy each year?
Yes, as long as you remain eligible and your GP renew your plan.
Will Medicare physiotherapy be bulk billed?
Some clinic providers will bulk bill to cover all costs; however, some will charge a gap fee. It is provider-specific.
Does Medicare cover physiotherapy fees in Australia?
The answer to this question is "Yes". However, it will be a limited and structured way to provide partial support to eligible patients, rather than unlimited treatment. Knowing how Medicare physiotherapy works will allow you to plan for realistic expectations regarding your treatment and help to avoid frustration down the road.
Go to Physio for your next appointment
Power Physio works with both private and Medicare-funded patients to develop structured, practical treatment plans that fit into the realities of life. Their physiotherapists work to help patients move better, manage their pain, and build their confidence and independence over time, regardless of whether your sessions are funded through Medicare or self-funded.
If you are unsure of your eligibility for Medicare physiotherapy or need help with how to best use your sessions, contact Power Physio today and make an appointment with a team that works with you to fully understand your options and how to properly support you in your recovery.