Short answer: Medicare covers up to 5 chiropractic visits a year under a GP chronic condition management plan, but that's 5 allied health visits in total each calendar year, shared across chiro, physio, podiatry and others. Each eligible visit attracts a $63.40 rebate. Aboriginal and Torres Strait Islander people can be eligible for up to 10.
How many chiropractic visits does Medicare cover in a year?
With a GP chronic condition management plan (still often called a care plan or EPC) and a referral from your GP, you can have up to 5 Medicare-rebated allied health visits each calendar year.
The important word is total. The 5 visits cover every allied health provider you're referred to under your plan. Chiropractic is one of those professions. So are physiotherapy, osteopathy, podiatry, dietetics, exercise physiology, occupational therapy, speech pathology, psychology and others. The full list is on the Services Australia website.
Who can get a care plan?
Your GP decides whether you're eligible for a chronic condition management plan. Generally, it's for a condition that has lasted, or is likely to last, six months or more. Long-standing back or neck problems are common examples people ask their GP about.
To use your visits for chiropractic, your GP needs to prepare the plan and write a referral to a chiropractor. You're welcome to ask them to address it to Mornington Peninsula Chiropractic. Hospital in-patients aren't eligible for these services, according to Services Australia.
How the 5 visits can be shared
Your GP decides who to refer you to. Here's how the visits might look in practice:
| Referred to | How the 5 visits work |
|---|---|
| Chiropractor only | Up to 5 chiropractic visits in the calendar year |
| Chiropractor and physio | 5 visits split between them, for example 3 and 2 |
| Chiropractor, physio and podiatrist | 5 visits split across all three |
Each eligible visit attracts a Medicare rebate of $63.40, for chiropractic (item 10964) and physiotherapy (item 10960) alike. More on that in how much Medicare pays for physiotherapy.
When do the visits reset?
The limit applies per calendar year, so it runs from January to December, not 12 months from the date of your plan. Once you've used your 5 visits in a calendar year, further visits that year don't attract the care plan rebate.
Referrals have an end date too. According to Services Australia, a referral under a care plan is valid for the timeframe stated on it, or 18 months from the first service if none is stated. If your referral is getting old, check with your GP that it's still current before you book.
Making the most of your care plan visits
- Know who you've been referred to. If you have referrals to more than one provider, keep track of how many visits you've used with each.
- Medicare or health fund, not both. You can claim a visit on Medicare or on your private health extras, not both. Some people use their care plan visits and their extras at different times.
- Talk to us about cost. Care plan visits are rebated, not free. You pay on the day and claim back the rebate, so the difference between the fee and the rebate is your out-of-pocket cost.
Step-by-step instructions for getting a plan are in can I claim a chiropractor on Medicare?
How we approach this at MPCC
A care plan doesn't change how we look after you. Your first visit is a new patient appointment: your story, posture pictures, and a thorough chiropractic, orthopaedic and neurological check of your spine, joints and nerves, taking 30 to 40 minutes. Whether you're adjusted on the first visit is up to the clinical judgement of your chiropractor. Often more testing comes first.
Then a report of findings appointment, where we explain what we found and whether we can help. We don't decide how often to see you based on how many care plan visits you have. We recommend what your findings call for, explain it, and you choose. We send your GP a report, as Medicare requires.
Our fees: new patient appointment $195 ($125 when booked online through our website, new practice members only, one per person). Report of findings and standard appointments are $95. Our Medicare care plans page has a script to help you talk to your GP.