Medicare

Can I get a Medicare Rebate for my Headache Treatment?

Our headache clinicians work as part of the multidisciplinary team of Allied Health Professionals that keep you healthy. Because of that, there are ways that you can access funding for your treatment through Medicare.

Unfortunately, it’s not as simple as just swiping your Medicare card for each session. You will need to ask your GP to create a Chronic Disease Management (CDM) plan, formally known as an Enhanced Primary Care (EPC) plan. This CDM plan will have to include a physiotherapy referral specifically to our clinic in order for your sessions with us to receive a rebate.

Talk to your headache clinician in your initial consultation, and they will be able to give you all the information you need to discuss your CDM plan with your GP. Your clinician can even contact your GP directly to help organise your referral.

Do I have to meet certain requirements?

In short, is yes. 

You will require a Team Care Arrangement (TCA) to be arranged by your GP as part of your CDM. Your GP will decide whether you qualify for this or not.

A TCA is intended for people who suffer from chronic conditions. That is, that you have suffered from the condition for longer than 6 months, or you are likely to suffer from this condition for longer that 6 months.

Your TCA will need to involve at least 3 health professionals. This means that at least one other provider must be included in the arrangement, outside of your GP and your headache clinician. TCAs are able to be used with any allied health service, such as; podiatry, dieticians and exercise physiologists.

Finally, your GP will need to create a referral that is addressed directly to our clinic, in order for you to be eligible to receive your Medicare rebate.

How many treatment sessions are covered by the Medicare rebate?

With your CDM plan, you are entitled to receive up to 5 rebates per calendar year (1 January – 31 December). These rebates are to cover all allied health referrals. The CDM is open to; physiotherapy, dietetics, podiatry, exercise physiology, speech pathology etc. and your GP may refer you for 3 physiotherapy sessions and 2 exercise physiology sessions, for example.

How much does the Medicare rebate cover?

Currently, the Medicare rebate is set at $58.30 per consult (depending if you haven’t reached any Medicare thresholds), and this is standard across all services that you receive at our clinic. This means that the price is the same for an initial consult and any subsequent treatments. 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 about the Medicare CDM process, feel free to Contact Us our friendly team to discuss the process with them. Further information regarding your CDM/ TCA can be found on the Department of Health website.

Otherwise, come in and see us and we can assist you by liaising with your GP to get the process started and get on top of your headaches and migraines!

Common Headaches Treated