December 20, 2023
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When people talk about "bulk-billing" in healthcare, they're usually referring to getting health care services that are directly billed to Medicare, with no out of pocket costs to them. There are many doctors that offer bulk-billed medical services so that people can access proper healthcare when they need it. In Australia, this means you can visit your doctor (General Practitioners), Specialists, Optometrists, Physiotherapists, Chiropractors, Exercise Physiologists, and get things like blood tests and x-rays without having to pay anything extra. All you need is a Medicare card to be able to start accessing these bulk-billed medical services.
Many people living in Australia can get access to Medicare, which covers Australian Citizens, New Zealand Citizens, Australian Permanent Residents, and those applying for Permanent Residency. People visiting Australia from Reciprocal Health Care Agreement (Belgium, Finland, Italy, Malta, Netherlands, New Zealand, Norway, Republic of Ireland, Slovenia, Sweden, and the UK) may also be eligible and can apply.
We get asked everyday if people can claim Physiotherapy on Medicare, and the answer is yes! There are certain rules for who is eligible though, and it's almost always the case where you'll need a referral from your GP under a Chronic Disease Management (CDM) Plan. This is sometimes called a Team Care Arrangements (TCA) and was previously known as an Enhanced Primary Care (EPC) referral.
With this referral, people with chronic diseases such as diabetes, heart disease, and/or cancer can potentially claim up to 5 sessions to see an Allied Health Practitioner, including Physiotherapists. Your GP will decide how many sessions you can see a Physiotherapist and if any other health professionals need to be part of the plan too. It's not uncommon to have 3 sessions allocated to Physiotherapy, and 2 sessions for you to see a Dietitian or Exercise Physiologist. You can claim a maximum of 5 rebated sessions per calendar year, which don't roll over if the aren't used.
At the time of writing this article in December 2023, the Medicare benefit for Physiotherapy is $58.30. This has been increasing slightly every year (by around $1-2) after a very long period of staying the same rate, known as the big Medicare Freeze.
For many Physiotherapy clinics, the amount Medicare pays can be used to pay for all or part of the fee to see a Physiotherapist. When people reach the Medicare safety net threshold, (set at $2414 in December 2023), the benefit you get back increases to be 85% of the full charge. In this case, instead of receiving the standard $58.30 back, your rebate would be 85% of what your Physiotherapist charges. For a Physiotherapy fee of $130, the rebate received will be $110.50 back from Medicare, leaving a "gap" payment of around $19.50 as an out of pocket cost. This applies if you have a referral from your GP and have not used the maximum sessions elsewhere.
Depending on the clinic and who you're seeing, some Physiotherapists are able to bulk-bill Physiotherapy sessions where the Medicare benefit covers the entire cost of the session. Often bulk-billing Physiotherapists will offer very a basic service, with a very limited assessment and treatment and we often hear reports from our patient's that they were in large rooms with multiple people being treated at the same. These sessions usually only last for the bare minimum 20 mins that Medicare requires.
Another option is to be referred to your the Physiotherapy department at your local hospital. These are usually at no cost to patients, but there is a considerable waiting time to be seen for non-urgent appointments (up to 6 months). Because these are usually teaching hospitals, it's not uncommon to be seen by Physiotherapy students.
In Sydney, the average cost to see a Physiotherapist ranges from around $90-150 per session. This fee depends on many factors though, such as the area you live, what competitors are charging, and the experience of the Physiotherapists.
In many cases though, the standard Medicare benefit is not enough to cover the full cost of the Physiotherapy session. This is where clinics may request a "gap payment" to cover the difference between the normal fee and what Medicare pays. E.g. If the normal fee is $130, and standard Medicare rebate pays $58.30, the gap payment the patient pays is $71.70.
At Westpoint Health, we have a team of Physiotherapists in Blacktown with different levels of experience, ranging from new graduates, those who have been working for a few years, to Physiotherapists who have undertaken post-graduate training to become APA Titled Musculoskeletal Physiotherapists. All our sessions are provided as one on one sessions in private room, where we allow for a full 45 minutes for the first session, and 30 mins for any follow up sessions, so we can really get to know you and any injuries you might have. We provide hands on treatment combined with a personalised exercise program that helps get you better and stop the problems from coming back.
The costs to see a Physiotherapist at Westpoint Health can be see on our Consultation Fees page here, and depends on who you'd like to see. The first session costs between $110-150, and with a Medicare referral the normal out of pocket cost is $42 to see our Physiotherapists, and $62 to see our APA Titled Senior Physiotherapists.
For those with private health insurance, most funds will cover around half the cost and people usually pay around $50-60 out of pocket after their rebate. It's best to check with your private health fund for a more accurate quote (we use the treatments codes 500 and 505). Unfortunately, it is not possible to claim both Medicare and Private Health Insurance rebates for the same consultation.
Yes! For pensioners and those going through financial hardship, our Physiotherapists can sometimes offer discounted rates and bulk-bill Physiotherapy sessions to make sure people are able to access treatment when they need it. Give us a call or email, and one of our Physiotherapists can speak to you directly about this. Bulk-billed Physiotherapy sessions with our Senior and APA Titled Physiotherapists is unavailable though.
If you'd been to see a Physiotherapist in Blacktown under a Medicare care plan before and would like to see us, ask your GP for a referral to our Physiotherapists at Westpoint Health. The easiest way to make a booking to see one of our Physiotherapists at Westpoint Health in Blacktown is to give us a call on 02 8662 0496. You can also book in online via our website, or via HotDoc or HealthEngine.
