Is Exercise Physiology Covered by Medicare?

May 3, 2021

Many people are interested in knowing whether they are eligible for Medicare rebates when accessing physiotherapy and exercise physiology. The short answer is yes. To help you better understand what this entails, Movement 101 has shed more light on the topic.

People who wish to access Medicare rebates for exercise physiology and physiotherapy can do so under the Medicare Chronic Disease Management (CDM). The government’s Medicare CDM is a plan that allows individuals battling chronic disease, illness, or medical conditions to receive rebates for allied health services enjoyed. Exercise physiology and physiotherapy fall under this category.

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What Is A Chronic Illness/Medical Condition?

To understand whether you qualify for this government incentive, first, you need to understand what a chronic condition or medical illness is. Understanding this will help to determine whether you can benefit from this incentive.

A chronic illness or medical condition is defined as a condition that has been present for an extended period, say more than six months. Some of the conditions that are qualified under this category include diabetes and pre-diabetes, obesity and overweight issues, heart diseases, arthritis, osteoporosis, hypertension, depression, asthma, low back pain, anxiety, hypercholesterolemia and dyslipidemia, chronic obstructive pulmonary disease (COPD), polycystic ovarian syndrome (PCOS), chronic fatigue syndrome, musculoskeletal injury, cancer, cardiovascular disease, occupational injuries, back, neck, shoulder, and knee pain, respiratory diseases, and more.

If you suffer from any of these diseases, you can speak to your doctor about enjoying the advantages of the government incentives. However, you should note that this incentive is designed for patients who choose a structured approach to the care and management of their health condition.

First, consult a GP that will perform a health assessment and examination to determine whether you are a right fit for the Medicare Chronic Disease Management plan.

How Does the Chronic Disease Management Plan Help?

This plan will assist you and your GP in managing the chronic medical condition from which you suffer. The GP will be able to identify and manage your conditions using the best treatment approaches. In addition, the GP will also be required to prepare a team care arrangement with you and other allied professionals to ensure that optimal health is restored.

How Exercise Physiology Helps

Exercise physiologists aim to help patients to prevent or manage chronic and subacute diseases or illnesses. They also offer the needed help to restore optimal physical condition, health, and wellness to patients. The interventions offered by these professionals are usually exercised-based and include education on health and physical activities that can help in the management of specific health conditions. Exercise physiologists also offer advice and lifestyle modification recommendations that are focused on generally improving health and wellness. Some of the core areas these professionals address include;

  • Cardiovascular health – exercise physiologists help with conditions like heart diseases, heart attacks, blood pressure control, cardiac health issues, stroke, and more.
  • Respiratory health – patients will enjoy expert advice and recommendations in managing conditions like asthma, COAD, COPD, and sleep apnea.
  • Metabolic health – patients with diabetes, weight problems, thyroid issues, and others can seek help from exercise physiologists.
  • Cancer management – patients in pre, post, and cancer therapy stages can enjoy assistance from these professionals in putting together a health management plan.
  • Digestive and renal issues – patients suffering from digestive conditions, Irritable Bowel Syndrome (IBS), kidney diseases, and others can also take advantage of the management plan and solution offered.

Exercise physiologists also help address mental health issues like depression, anxiety, Post-Traumatic Stress Disorders (PTSD), Neurological conditions like MSA, Sciatica, MND, Parkinson’s disease, and more; Musculoskeletal conditions like MSK management, prevention, and rehabilitation, and others.

You are Eligible for a Medicare Rebate; What Next?

If you have visited your GP and have been cleared as eligible for a Medicare rebate, you will be referred to allied health professionals. The referral is designed for each service need. A patient may be referred to an allied health professional for one physiotherapy service and two exercise psychology services using different forms.

A patient is allowed up to five services annually that qualify for a Medicare rebate. The eligibility and appointment count are renewed and reset every calendar year.

However, patients will be required to pay the full fee of the services enjoyed upfront and then wait for their Medicare rebates of $53.80 to be processed and refunded. The $53.80 is the rebate amount enjoyed by the patient per consultation over the five eligible times.


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