You can receive a Medicare rebate for an osteopathic service if you are a patient in the Chronic Disease Management (CDM) program. The CDM program allows General Practitioners (GPs) to refer patients for up to five (5) allied health professional consultations in a calendar year for patients with chronic or terminal medical conditions or complex care needs.
For CDM services, you must be referred to an osteopath by a GP, who develops a GP Management Plan and Team Care Arrangement for you. It is up to the GP to decide whether you would benefit from osteopathy as part of your CDM plan.
Your GP is responsible for reviewing and revising your overall CDM care plan, even if an osteopath is involved in providing clinical care, advice and support. Your osteopath will provide reports to the GP as part of your management plan.
The Medicare items for osteopathic Chronic Disease Management services are:
MBS item 10966 Chronic Disease Management - Fee $63.25 (85% benefit = $53.80)
In most situations you can claim the 85% benefit, or $53.80.
Your osteopath may charge a “gap fee”, which is an amount you pay above what the Medicare benefit is. The amount varies between practices, but the practice should inform you that:
They will not accept the Medicare benefit as full payment for your treatment
That they will charge a gap fee, and what this charge will be
If your osteopath is bulk billing, you should not pay any out of pocket expense for the service.
Your osteopath may process a Medicare claim for you online or via their EFTPOS terminal, or they might give you a receipt which you can submit to Medicare - either online, by post or by visiting a Department of Human Services office.
All Medicare eligible services must be at least 20 minutes long.
For more information, please visit the Department of Health website.
You may be able to claim a Medicare rebate for some X-rays referred by an osteopath. These include examinations of the:
One or more regions of the spine
When referred for medical imaging, check with the imaging provider about the Medicare benefit amount and whether there are any gap fees.