Short answer: Yes, Medicare covers part of chiropractic care if you have a chronic condition and your GP puts you on a chronic condition management plan and refers you. Medicare then pays $63.40 per eligible visit, for up to 5 allied health visits a calendar year in total. You pay on the day and claim the rebate back.
Does Medicare cover chiropractic? Here's when
Medicare doesn't cover every chiropractic visit. It helps in one specific situation: when your GP has prepared a GP chronic condition management plan for you and written a referral to a chiropractor. Many people still call this a care plan or an EPC.
Chiropractors are one of the allied health professions included, along with physiotherapists, osteopaths, podiatrists, dietitians, exercise physiologists and others. You can see the full list on the Services Australia website.
The rebate is paid per eligible visit, not for a block of care, and it's paid to you after you've paid for the visit. It doesn't change the fee, so the difference between the fee and the rebate is what you pay out of pocket.
Who's eligible is your GP's call. Generally, a care plan is for a condition that has lasted, or is likely to last, six months or more.
What Medicare pays for chiropractic
| What | Detail |
|---|---|
| Rebate | $63.40 per eligible visit (Medicare item 10964) |
| Visits | Up to 5 a calendar year, shared across all allied health |
| You need | A GP chronic condition management plan, and a referral from your GP |
| How you pay | Pay us on the day, then claim the rebate back from Medicare |
The 5 visits are a total, not 5 per profession. If your GP refers you to a physio and a chiropractor, the visits are split between them. Aboriginal and Torres Strait Islander people can be eligible for up to 10. For the detail, read how many visits you can have on a Medicare care plan.
How to claim a chiropractor on Medicare, step by step
- Book a GP appointment. Ask reception for a longer appointment and tell them it's for a chronic condition management plan.
- Talk to your GP. Explain your problem, how long you've had it and how it affects your life, and that you'd like to see a chiropractor.
- Your GP decides. They check you're eligible, prepare your plan and write a referral. You're welcome to ask them to address it to Mornington Peninsula Chiropractic.
- Book with us. Online or by phone. Bring your referral and Medicare card, or email the referral through before your visit.
- Pay and claim. You pay on the day and claim the rebate back. We send your GP a report, as Medicare requires.
Our Medicare care plans page has a simple script you can use with your GP.
Good to know
- Referrals have an end date. Services Australia says a referral under a care plan is valid for the timeframe written on it, or 18 months from the first service if none is stated. If yours is getting old, check with your GP before you book.
- Medicare or health fund, not both. You can claim a visit on Medicare or on your private health extras, not both.
- You don't need a referral to see us. You only need one to claim the Medicare rebate.
- X-rays are separate. If your history and check point to X-rays, we refer you, and the imaging clinic we refer to bulk bills X-rays our chiropractors request.
Wondering about bulk billing? See do chiropractors bulk bill in Australia?
How we approach this at MPCC
Coming in under a care plan doesn't change how we look after you. Your first visit is a full new patient appointment: your story, posture pictures, and a thorough chiropractic, orthopaedic and neurological check of your spine, joints and nerves. Then a report of findings appointment, where we explain what we found in plain English and whether we can help. Whether you're adjusted on the first visit is up to the clinical judgement of your chiropractor.
Our fees: new patient appointment $195 ($125 when booked online through our website, new practice members only), and $95 for the report of findings and standard appointments. The front desk will explain your rebate on the day. See fees and health funds.