Funding your session - More info
Medicare's GP Chronic Conditions Management Plan
Exercise physiology (EP) services can be accessed through Medicare GPCCMP. This program allows patients with chronic conditions to receive support from allied health professionals, including EPs. For eligible patients, a GPCCMP can also provide access to up to 5 Medicare-subsidised allied health sessions per 12-month period, which can be shared across services including EP, physiotherapy and dietetics, to name a few.
Who is eligible?
You may be eligible if you have at least one medical condition that has lasted, or is expected to last, 6 months or more (or is terminal) and your GP believes you would benefit from a coordinated management plan. There isn’t a fixed list of qualifying conditions — eligibility is based on clinical judgement.
What does it involve?
Your GP will meet with you to create a personalised plan that outlines:
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your current health concerns and needs
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goals for treatment and self-management
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which health professionals may be involved in your care
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recommended treatments and services
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when the plan should be reviewed
If you think you may qualify, speak with your usual GP to see whether a GPCCMP would be appropriate for your situation.
What if I already have a GPCCMP - is it free for me to see Lauren?
No, it means that Medicare will refund you the subsidised amount allocated for EP services for each session. There will be an out-of-pocket amount. At the end of each session, I will provide you with a receipt to submit to Medicare. You will be responsible for claiming your reimbursement with Medicare either online or in-person at a Medicare office (in Batemans Bay or Narooma).
For more information, go to https://www.servicesaustralia.gov.au/requirements-for-chronic-condition-management-plan?context=20#accordion3
Private Health Insurance with Extras Cover
If you have private health insurance (PHI) with extras cover, you may be able to claim part of the cost of your EP sessions, depending on your level of cover and insurer. And no, you don't need a referral from your doctor to claim. Your insurer pays back a portion of the session cost.
Here’s what to do:
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Check that your policy includes exercise physiology under "Extras Cover" - Not all extras policies include EP, and rebate amounts can vary.
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Pay for your session in full on the day and keep a copy of your receipt (NOTE: HICAPS facilities are not available at my practice)
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Submit a claim through your health fund - most PHI make it easy to do this online
A couple of useful things to know
Private health insurance and Medicare generally can’t be used together for the same appointment. If you attend under a GPCCMP and receive the Medicare rebate, you typically can’t also claim private health for that same service. Once your Medicare-supported sessions are used, you may still be able to continue using private health (if included in your policy).
If you’re unsure, a quick call to your insurer asking “Do I have cover for EP and what is my rebate and annual limit?” will usually give you the clearest answer.
Department of Veteran Affairs
To have sessions covered through DVA, you’ll need a referral from your GP or medical specialist that outlines the clinical need for EP treatment before your initial appointment. Coverage and the number of approved sessions can vary depending on whether you hold a Gold Card or White Card, if you are classified as totally and permanently incapacitated (TPI) and whether the treatment relates to an accepted condition. So it’s worth confirming your eligibility with DVA or your treating practitioner before your first appointment.
For more information, go to https://www.dva.gov.au/what-we-help-with/health-support/allied-health/exercise-physiology-services
National Disability Insurance Scheme
If you are funded through the NDIS, you may be able to use your plan to access EP services if they are considered reasonable and necessary for your goals.
EP services are usually claimed under Capacity Building – Improved Health and Wellbeing, and in some cases Improved Daily Living, depending on your plan. Services are billed to your plan management organisation or to you directly if you are self-managed.
Please note that I do not accept participants who are NDIA managed.
It’s important to check your individual funding plan either with your Support Coordinator or with your Local Area Coordinator prior to making a booking for an initial assessment.
For more information, go to https://blog.daar.com.au/blog/ndis-funded-exercise-physiology-eligibility-process
My Aged Care
Exercise physiology services may be funded through a My Aged Care package if they are assessed as necessary to support a person's health, independence, and ability to remain living safely at home. This is typically determined during a My Aged Care assessment and included in the person's individual care plan.
Exercise physiology is commonly funded to help improve strength, balance, mobility, falls prevention, recovery after illness or injury, and the management of chronic health conditions.
A GP referral is generally not required for My Aged Care funding. However, sessions are arranged through the person's approved aged care provider.
If you are unsure whether your package covers exercise physiology, speak with your care provider, who can confirm your available funding and assist with organising services.