If you have a chronic health condition; diabetes, heart disease, osteoporosis, arthritis, back pain, or any condition that has been present for six months or more, there’s a good chance Medicare will contribute to the cost of seeing an Exercise Physiologist.
The pathway is called a Chronic Disease Management (CDM) plan, and it’s one of the most underused Medicare benefits in Australia. Here’s how it works and exactly what to do.
What is a Chronic Disease Management plan?
A CDM plan is a structured care plan your GP puts in place when you have a chronic medical condition that requires ongoing management from more than one health professional.
Under a CDM plan, Medicare subsidises up to 5 allied health sessions per calendar year. These sessions can be with an Exercise Physiologist, Physiotherapist, Dietitian, Podiatrist, or other allied health professional, or a combination across providers.
The Medicare rebate for an individual Exercise Physiology session is $61.80 per session when you hold an active CDM plan. You pay our fee and the rebate is returned to you on the spot via the Medicare portal. A small gap fee applies.
Who is eligible?
You are likely eligible for a CDM plan if you have any of the following conditions being managed by your GP:
- Type 1 or Type 2 diabetes
- Cardiovascular disease, high blood pressure, or high cholesterol
- Osteoporosis or osteopenia
- Arthritis (osteoarthritis or rheumatoid)
- Chronic back, knee, hip, or shoulder pain
- COPD or asthma
- Obesity or metabolic syndrome
- Cancer (active or post-treatment)
- Neurological conditions including stroke, Parkinson’s disease, or MS
- Mental health conditions including depression or anxiety
This list is not exhaustive. If your condition has been present for 6 months or is likely to be, your GP can assess your eligibility.
Step 1 — Book an appointment with your GP specifically to discuss this
Don’t raise this at the end of a standard appointment. Book a dedicated GP appointment for a health assessment or care plan review. This gives your GP the time to properly assess your eligibility and complete the paperwork.
When booking, tell the receptionist: “I’d like to discuss a Chronic Disease Management plan and a referral to an Exercise Physiologist.” This lets the GP prepare.
Step 2 — What to say to your GP
Once you’re in the appointment, the simplest thing to say is:
“I’d like a Chronic Disease Management plan that includes Exercise Physiology at Beachside Exercise Physiology in Mordialloc.”
Your GP will assess whether you meet the criteria, prepare the plan, and write a referral to our clinic. Your GP can provide a referral letter directly, no specific form is required.
Step 3 — Bring the referral to your first appointment
Bring the referral letter or plan documentation to your first appointment at Beachside EP. We’ll process your Medicare rebate on the spot via the Medicare portal. No forms to fill out, no claiming online.
Your GP may refer you for all 5 sessions at once, or for a smaller number to review first. Either works.
What happens at your first appointment?
Your first session is an extended assessment where your Exercise Physiologist reviews your health history, assesses your current physical function, sets goals with you, and designs your initial program. We send a written report back to your GP after every review appointment.
What if my GP isn’t sure about referring me?
Some GPs are less familiar with Exercise Physiology than others. If your GP is hesitant, you can ask them to look up MBS item 10953, which covers individual Exercise Physiology sessions under the CDM pathway. You can also call us on 0409 051 260 and we’re happy to speak with your GP directly to explain what we do and how we can help your specific situation.
What if I don’t have a chronic condition?
You can still see an Exercise Physiologist without a Medicare referral and simply pay the standard fee privately. Many people start this way while waiting for a GP appointment, or if they don’t meet the CDM criteria. Private Health Insurance extras also often apply to Exercise Physiology — check your policy.
Ready to book your first appointment?
We can see you with or without a Medicare referral. If you’re not sure whether you’re eligible, call us and we’ll help you work it out.