Medicare

Can I get a Medicare Rebate for my Headache Treatment?

Allied Health professionals play a vital role in any multidisciplinary team, to treat many conditions. Headache treatment is no different, and there are ways that you can access rebates or funding for your treatment through Medicare.

Unfortunately, it isn’t as simple as turning up with your Medicare card. Medicare funding for treating your headaches at our clinic requires a Chronic Disease Management (CDM) plan, which was formally known as an Enhanced Primary Care (EPC) plan.

To be able to access Medicare funding as quickly as possible, it is important that you discuss this with your clinician during your initial assessment, as they can give you the information you need to access the funding. As our clinicians are experts in your condition, they can help by getting in touch directly with your GP to help organise the CDM plan.

Do I have to meet certain requirements?

The short answer, is yes. 

A Medicare rebate for your headache treatment can be accessed under the CDM program.

The CDM program, also known as a Team Care Arrangement (TCA), must be approved by your GP. It is up to your GP’s discretion whether you qualify for the CDM program or not.

Firstly, you must meet the criteria, and that is generally centred around ‘chronic’ conditions, meaning something that you have suffered with, or expect to suffer with, for more than 6 months.

Secondly, you need to have the referral form from your GP, who needs to send you to our clinic specifically.

Thirdly, there must be at least one other healthcare provider, for a total of three healthcare providers, that is part of the TCA. This can be a specialist, or another allied health professional. Another GP is usually not accepted as the third member of the team.

How many treatment sessions are covered by the Medicare rebate?

The Medicare rebate can cover you for up to 5 sessions per calendar year, i.e. 5 sessions between January 1^st – December 31^st. It is up to the discretion of your GP as to how many are allocated to a particular allied health practitioner.

Services covered under the CDM may include physiotherapy, dietetics, podiatry, speech pathology, psychology etc. So, for instance, your GP might refer you for 3 physiotherapy consults, and 2 podiatry consults.

How much does the Medicare rebate cover?

The current Medicare rebate is (depending if you haven’t reached any Medicare thresholds) is $58.30 per consult, regardless of the specific service that you choose. That means that the rebate is the same for an initial consult, and any subsequent review consults that you might be recommended for as well. Unfortunately, we are not a bulk-billing practice, so there will always likely be a deficit between the full consult fee and the rebate received back from Medicare.

How do I claim the Medicare rebate?

The Medicare rebate can be claimed once the CDM/TCA has been approved by all of the parties involved, i.e. your GP, Medicare, the third healthcare practitioner that is involved in the TCA, us and yourself.

When paying for your session at our clinic, you will be charged the full amount for the session. Once that amount has been paid, we will process the Medicare rebate, which is paid directly into your account, via our Tyro terminal with a debit card that is attached to a savings or cheque account.

Please note: the rebate cannot be returned to a credit card. Please ensure you have a debit card if you want to access an immediate rebate. If we cannot issue the rebate you can simply lodge your receipt with Medicare.

Specifically, here are the steps:

1. You pay the full fee of the consultation.

2. Our Tyro (Healthpoint) system communicates with Medicare to assess and access the rebate for you.

3. We swipe or tap your DEBIT card, and the rebate will go back onto that card on-the-spot.

SUMMARY

To wrap it all together:

• Yes, you can get a Medicare rebate for your headache treatment, using the CDM Program.
• You need a specific doctor’s referral, and it will need to be considered by your GP to be a “chronic” condition.
• If eligible, you can be approved for a Medicare rebate for up to 5 visits per calendar year.
• You pay the full amount in the clinic, but we can process the rebate on-the-spot, straight back onto your debit card.

If you have any questions at all regarding the CDM process – please call or email us via the Contact Us page, and we are more than happy to answer them.

For further information regarding a CDM plan, you may wish to visit the Department of Health website.

Alternatively, come in to see us ASAP and we can assist you with liaising with your GP, and can help you overcome your debilitating headaches!

Common Headaches Treated