Can I Get a Medicare Rebate for Exercise Physiology?

The quick answer, YES! The longer answer, is yes, but there are a couple of conditions. A Medicare rebate for Exercise Physiology can be accessed under the CDM Program, which is the Chronic Disease Management (formerly Enhanced Primary Care or EPC). To be able to access a Medicare rebate for Exercise Physiology should be very easy, unfortunately Medicare rebates are not always straight forward.

To qualify for a Medicare rebate, you must have a chronic condition or injury. A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions, depression, stroke and many others. As exercise specialists we help people with these types of conditions every day. We would love to help explain the Medicare rebate process so you can see how it can work for your Exercise Physiology needs.

  • If you qualify you will receive a $55.10 rebate for a maximum of 5 sessions in a calendar year.

  • Clients with type 2 diabetes also qualify for an additional referral under Medicare (Allied Health Group Services Referral). This referral entitles you to an initial assessment plus eight group exercise sessions with our Accredited Exercise Physiologists.

  • Clients of Aboriginal or Torres Strait Island decent can also receive an additional 5 consultations

How Can I get A Referral?

First, you must meet the criteria, which is principally centred around ‘chronic’ conditions (it’s in the name!).

Secondly, you need to have the appropriate referral form from your GP, who needs to send you to a specific Exercise Physiology clinic. (If you are in the Illawarra we hope that can be us, we’d love to help!)

How Many Visits Will the Medicare CDM Rebate Cover?

The Medicare CDM Program allows for a total of up to five rebated consults to any referred allied health practitioner, per year. That could include: Exercise Physiology, Podiatry, Dietetics, Physiotherapy, Speech Pathology, etc.

So, for instance, your GP may refer you for three Exercise Physiology consults and two Dietician consults. The 5 sessions start again each year, however you will need a new referral each year. The referral can be issued at any time of the year (not necessarily calendar year), however only five visits are able to be claimed each calendar year.

How Much Does the Medicare Rebate Cover?

The current Medicare rebate (as of July 2021) is $55.10 per consult, irrespective of the specific service that you choose. That means that the rebate is $55.10 for an initial consult and any subsequent review consults that you might be recommended for as well. This is designed for a 20 minute consult. At Prescribe Exercise we really want to help you and understand that an extended consult for your initial assessment may be required to take you through some specific assessments and design a plan specifically for you, if this is the case a small gap payment will be required, give us a call and we can step you through the price structure.

How Does the Medicare Rebate Process Work?

At our clinics we have set up a system where all you need to do is pay the full fee at your consultation, we then process the Medicare rebate and you will have the rebate in your account on the on the spot.

It can be a little confusing so here is the summary:

  1. Yes, you can get a Medicare rebate for Exercise Physiology utilising the CDM Program.

  2. A doctor’s referral outlining the number of Exercise Physiology services is required

  3. You can get a $55.10 rebate for up to five visits per year.

  4. We can process the rebate on-the-spot, straight back onto your debit card.

If you have any questions at all regarding the our exercise physiology services and Medicare please call on (02) 4259 0384 or email us via the Contact page and we are more than happy to answer them.

Alternatively, speak to your GP as soon as possible to ask them whether you are eligible for a CDM referral to see an Exercise Physiologist at Prescribe Exercise.

We will get you back on your feet, feeling better, moving more and pain-free, so you can get back to doing what you love.

Prescribe Exercise are your local exercise physiology specialists. We provide exercise rehabilitation to assist manage and prevent injury and chronic disease in the Wollongong and Illawarra area with clinics in Wollongong and Warrawong.

Our programs will assist to achieve personal excellence, we do this by taking the time to educate and empower you with the highest quality care and exercise best practice available. We genuinely care for our clients and want to make a difference in your life, we will help you to get better and stay better so that you can regain control of your health once again.

If you would like to book in for Exercise Physiology you can head on over to our online bookings by CLICK HERE

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