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Is Podiatry covered by Medicare?

Is Podiatry covered by Medicare?

Posted 28 Oct

Australia is very blessed to have one of the best healthcare systems in the world. Our national health system is called Medicare and it allows all Australian residents to receive safe, affordable and - in some cases - free health care.

However, it can sometimes be tricky to understand exactly what is and isn't covered by Medicare. Some doctor's appointments are completely covered, and some are subsidised. Some specialists are included and other charges full price. So, if you're wondering whether a trip to the podiatrist will be covered under the medical scheme, then we have you covered with our guide!

Read on to find out whether is podiatry services are covered by Medicare or if you'll be able to get a Medicare Rebate.

Is there a Medicare rebate for podiatry?

The answer to this question isn't as clear-cut as you'd expect. If a patient was to attend a podiatry clinic on their own accord, the visit wouldn't be covered by Medicare benefits and they could expect to pay the full amount out of their pocket. However, if a patient was referred to a podiatry clinic by a doctor and is eligible for the Chronic Disease Management (CDM) program, formerly known as enhanced primary care plan, then they are able to claim up to five visits for podiatry per calendar year.

What is the CDM program and how do I become a part of it?

You might have heard of the Medicare CDM program which stands for Chronic Disease Management Program. It is an initiative put into place by the Australian health system that allows patients who have chronic conditions to access better access allied health services, like a podiatrist or exercise physiologist.

A condition usually needs to exist for 3-6 months to be considered chronic as part of this program. To be approved for the program you'll need to visit your GP or a medical practitioner where he or she will complete a full assessment to determine whether you're eligible.

If your GP agrees that your ailment is chronic and that you fit the requirements to be a part of the program they will give you a referral. They will also put together a Team Care Arrangement (TCA) and GP Management Plan - this is essentially a program that will include information on your needs, goals, actions and treatment for your chronic condition. This is the appropriate referral form required for us to process using this funding method.

Once you have your CDM referral and TCA you can book in with the recommended type of specialist and be eligible for Medicare rebates for up to five allied health services with a registered allied health practitioner per calendar year. It's important to keep in mind that your GP will specify what kind of allied health professionals can assist you with your particular condition.

At the conclusion of the program or the calendar year, whichever is sooner, a new referral is required.

What does the Medicare rebate cover?

As of July 2021, the current Medicare rebates will cover $53.80 per podiatry consultation. We are not a bulk billing service so there is a small gap fee payable on the day of the appointment. Please note that the gap fee may vary depending on the type of appointment so be sure to check with our team.

How do I receive the rebate?

The Medicare rebate process is the same at any clinic. There are several ways to receive the rebate, full fee payment or part pay or bulk billed.

Using your debit card for full fee payment, the rebate on the spot Medicare rebate back can be debited back onto your account registered with Medicare or if you have your bank details registered electronically with Medicare, then the amount for the rebate will be automatically transferred into your bank account. This is a very quick process and the money should go into your bank account almost immediately.

If you don't have your bank details registered electronically with Medicare, then you can either log in to your MyGov account and claim the rebate there, or you can head into a Medicare service center and claim your rebate there in the form of cash or bank deposit.

FAQ's

What allied health services are eligible for a Medicare rebate using the CDM program?

Podiatry is valid for the Medicare rebate through the program. Other services that are valid include:

  • Chirotherapy
  • Dietetics
  • Occupational therapy
  • Physiotherapy
  • Psychology
  • Speech Pathology
  • Exercise physiology

You can find a full list of allied health service providers here.

How many visits can I use my Medicare rebate for podiatry?

You will be allowed to use five Medicare rebates within one calendar year. If the chronic issue is related to your feet and your GP agrees that podiatry is the best treatment for your condition, then you can use only five visits for your podiatry needs.

Will my doctor choose what kind of referred allied health practitioner that I can use my Medicare rebate for?

Yes, just because you're granted approval to be a part of the CDM program doesn't mean you can pick and choose which specialists you will see to use your five possible rebates. Your GP will make a plan with you for what kind of specialist is best to treat your condition. This plan will be noted down on a referral form along with your team care arrangement and your rebates will be valid for that kind of treatment only.

How do I book an appointment using my CDM program benefits?

Save time by booking online here or contact our team via email or phone. Let our team know when you are making the appointment and they will inform you what paperwork you'll be required to bring along with you to your initial consult.

What do I need to bring to the appointment?

Please bring along the paperwork from your doctor and your Medicare card.


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