+ Are Exercise Physiology Services covered by Medicare?

All of our exercise physiologists at Health and Hearts are registered with Medicare.  To make a claim with Medicare, you will require a specific referral from your doctor through Medicare’s Chronic Disease Management (CDM) initiative.
Medicare claiming is done at the time of the appointment via HICAPS terminal.  Payment for the appointment is made up front with EFTPOS, credit card or cash and rebates are returned back onto your EFTPOS card.  Payment from Medicare Australia may take a day to return into your account.

+ What is the Chronic Disease Management Programme?

Formally known as Enhanced Primary Care or EPC, the CDM programme links you with allied health professionals such as exercise physiologists, dieticians, and podiatrists to provide a multidisciplinary, team-based approach to your health care.  The Australian government recognises the
importance of lifestyle changes such as physical activity and exercise in the management of chronic health conditions and provides Medicare rebates towards the costs of these consultations.

+ Who is Eligible to Participate in the Chronic Disease Management Programme?

If you are diagnosed with a condition that have lasted for 6 months or more, you may be eligible to participate in Medicare’s Chronic Disease Management (CDM) initiative and be referred to an Exercise Physiologist. Chronic conditions may include, but are not limited to:

• Arthritis
• Asthma
• Anxiety or Depression
• Diabetes
• Cancer
• Stroke
• High blood pressure or cholesterol
• Metabolic Syndrome
• Heart Disease
• Neurological Conditions such as Stroke, Parkinson’s Disease or Multiple Sclerosis

+ Which Exercise Physiology Services are recognised by Medicare?

Exercise physiology consults referred through Chronic Disease Management Programme (Medicare Item 10953)
Exercise physiology consults referred through Aboriginal Health Services Group Services for Type 2 Diabetes (Medicare Item 81110 & 81115)

+ Can I claim a rebate for exercise physiology services?

Yes, you may be able to claim a rebate for exercise physiology services under certain circumstances.
If you have a chronic medical condition that is managed by your GP and referred to an exercise physiologist as part of your treatment plan, you may be eligible for a Medicare rebate for up to five sessions per calendar year.

+ How much is the Medicare rebate for exercise physiology services?

The Medicare rebate for exercise physiology services under the Chronic Disease Management Programme is currently $56 per session for up to five sessions per calendar year, and 17.50 for group service for the management of type 2 diabetes.

+ Do private health insurance policies cover exercise physiology services?

Yes, many private health insurance policies provide cover for exercise physiology services, either as a standalone service or as part of a broader allied health benefit. The level of cover and amount of rebate will vary depending on your policy.

+ How do I claim a rebate for exercise physiology services?

To claim a rebate for exercise physiology services, you will need to provide your exercise physiologist with your Medicare or private health insurance details. The exercise physiologist can then process the claim on your behalf.

+ Are there any other government schemes or programs that provide rebates for exercise physiology services?

Yes, there are a number of government schemes and programs that provide rebates for exercise physiology services, such as the National Disability Insurance Scheme (NDIS) and the Department of Veterans Affairs (DVA). Eligibility for these programs will depend on your individual circumstances.