How Do Medicare Chronic Disease Management Care Plans For Chiropractic Work?
How do Medicare referrals for Chiropractic work?
If you have a chronic condition (such as diabetes, chronic pain, heart disease etc) your GP may initiate a Chronic Disease Management (CDM) Care Plan (previously called an “EPC”).
The GP will provide you with a referral that has between 1 and 5 treatments available for your Chiropractor. They may also refer you for some of the 5 treatments to another professional, such as a Podiatrist or Physiotherapist.
You cannot use more than 5 treatments per calendar year, across the various professionals.
You are entitled to use the treatments within the life of the care plan (usually a year) to receive a rebate of $56.00 (correct in 2022) out of the cost of the consultation.
You may have up to 5 treatments (spread across the various providers) per calendar year.
The 5 treatments limit resets on the 1st of January, each year, so if you finish the year with 3 treatments available, they disappear and are not accumulated into the next calendar year.
If you are Aboriginal/Torres Strait Islander you may be entitled to an additional 5 consultations per calendar year, under a slightly different referral that your GP will know about.
Frequently Asked Questions
My GP wrote 6 treatments on my care plan. Does that mean I get 6 treatments?
No. You can only have 5 treatments per calendar year (January-December). It doesn’t matter what the GP writes— Medicare will only rebate 5 treatments per calendar year.
My GP wrote 5 treatments for Chiropractic & 5 treatments for Podiatry. Do I get 5 treatments for each practitioner?
No. You can only have 5 treatments per calendar year, spread across all the providers on the list. It doesn’t matter what the GP writes— Medicare will only rebate 5 treatments per calendar year.
I told my GP that I wanted a Medicare referral for Chiropractic and they refused. Are they allowed to do that?
Medicare has strict definitions of who can be referred for a Chronic Disease Management Plan. If your GP doesn’t think you fit the criteria then they will say no. This should probably be taken as a good sign as it means your GP doesn’t think you have a chronic condition (like diabetes or heart disease)!
Are the Chiropractic consultations bulk billed?
Not any more. While we used to bulk bill, with rising wages, interest rates and other costs, it is no longer sustainable to bulk bill CDM treatments as Medicare rebates have not kept up with inflation (not even close). Besides providing you with treatment your Chiropractor is also required to take time outside your consultation to write two detailed letters back to your GP at the first and last consultations under the care plan. In 2022 the rebate for Chiropractic was $56 and our current fees can be found here.
What do I do with my referral, if I receive one?
Let us know that you have a CDM referral when you book in to see the Chiropractor as a new or returning patient. If you are booking online there is a place where you can let us know about this.See an example, here.
Booking Online Info Box
Got any questions for us? Want to book? Click on one of the buttons, below.