What is covered by Medicare?

Medicare will cover treatment for those with chronic medical conditions under the Chronic Disease Management Scheme (CDM). Read below to find out if this applies to you.

What is Chronic Disease Management (formerly EPC)?

Chronic Disease Management (formerly Enhanced Primary Care or EPC) is a government incentive which allows individuals with a chronic medical illness or condition to receive Medicare rebates for a maximum of 5 allied health services, such as physiotherapy, each calendar year. A chronic medical condition is one that has been (or is likely to be) present for six months or longer, e.g. musculoskeletal conditions. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Your GP will prepare a CDM plan and refer you to an allied health practitioner (such as Cremorne Physio) if you qualify for treatment. Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out by Medicare.

How much is the Medicare rebate?

Currently, the Medicare rebate for CDM is $52.95 per service, with out-of-pocket costs counting towards the extended Medicare safety net.

Is there an out of pocket cost to me?

We are able to process Medicare rebates on the spot. However, there will be a gap to pay between the full Cremorne Physio consultation fee you pay and the Medicare rebate you recieve back on the spot. For more information on fees and rebates, contact our friendly reception team.

Can I use my private health card as well?

It is not possible to use both a CDM claim and your private health insurance for the same physio treatment. If you prefer, you may opt to use private health insurance, but you cannot claim the CDM rebate as well.

What happens if I need more than five physio sessions?

Once you have used your five CDM sessions in a calendar year, you have the option to continue on with treatment. However, there will be no Medicare rebate for these treatments.

By |2019-02-12T19:56:12+00:00February 12th, 2019|0 Comments