If you have a chronic or long-term condition, you may be eligible to access Medicare-funded physiotherapy—up to 5 sessions per year—through something called a Chronic Disease Management (CDM) Plan, sometimes also referred to as an EPC (Enhanced Primary Care) referral.
Many people are unaware they qualify, and they miss out on valuable support for managing their condition.
What Is a Chronic Disease Management Plan (CDM)?
A CDM Plan is a government-funded program that allows people with chronic medical conditions to receive allied health services—like physiotherapy—under Medicare. You can get up to 5 sessions per calendar year, shared across eligible allied health services (e.g. physiotherapy, podiatry, dietitian, etc.).
What Conditions Are Eligible?
To qualify, you must have a chronic condition, which means something that has lasted for 6 months or more, or is expected to last that long. It doesn’t need to be severe—just ongoing.
Some common examples include:
- Long-term back or neck pain
- Arthritis (such as osteoarthritis or rheumatoid arthritis)
- Diabetes (type 1 or 2)
- Chronic tendon or joint issues
- Asthma or other long-term respiratory issues
- Heart disease or high blood pressure
- Rehabilitation after surgery (e.g. knee or hip replacement)
- Chronic headaches or jaw pain
Your GP will determine if your condition qualifies and if a care plan is appropriate.
How to Get the Referral
Here’s how to start the process:
- Book a GP Appointment: Make a standard appointment with your usual GP. Mention that you’re managing a long-term issue and are interested in a CDM or EPC referral for physiotherapy.
- Discuss Your Condition: Your GP will assess your condition, confirm if it qualifies, and create a care plan. They may also coordinate with other health providers you’re seeing.
- Receive a Referral: If eligible, your GP will provide a referral letter specifically for physiotherapy. You can take this to a physio of your choice.
Tip: Some clinics can receive referrals directly from your GP by fax or email. Ask your physio clinic for their details.
What Does Medicare Cover?
- Medicare will subsidise part of the cost for each physio session.
- Medicare rebates may not cover the full cost, so you might have to pay the difference (called a gap fee).
- Some physio clinics bulk bill these sessions, meaning you pay nothing out of pocket.
- Other clinics may charge a gap fee depending on their rates.
- Always ask your physiotherapist about costs before your appointment so you know what to expect.
- Many clinics offer lower rates or special support for pensioners or people with a concession.
- If you do not have Medicare, some clinics do accept private health insurance, which can reduce your out-of-pocket cost.
How Can Physio Help?
Once you’ve got your referral, your physiotherapist will:
- Conducting a comprehensive physical examination
- Identify areas of tightness, weakness, or poor movement
- Provide treatment to reduce pain
- Create a personalised management plan and home exercise program to support long-term recovery
- Help you manage flare-ups and prevent worsening of your condition
How Often Can I Use the Plan?
- You can access up to 5 sessions per calendar year
- These 5 sessions can be split between different allied health services (e.g., 3 physio + 2 podiatry)
- The count resets every January 1st, and you will need to return to your GP each year for a new referral
Still Not Sure If You Qualify?
Many people are surprised to learn they’re eligible. If you’ve been dealing with an ongoing issue that affects your daily life, it’s worth talking to your GP.
We’re happy to have a chat, explain how it works, guide you through the process, and even liaise with your GP if needed. Our goal is to help you make the most of your Medicare plan and support your recovery every step of the way.
Contact us today to start your recovery or to ask any questions regarding a physiotherapy referral under Medicare!
