Medicare Rebates, CDM plans and Osteopathy

A couple of common questions that we recieve are:

"Do you need my Medicare card?"
"Is this covered under Medicare?".

Yes Osteopathy is included in Medicare for financial rebates but there are certain criteria that must be met.

Medicare rebates for Osteopathy are available under a plan called a Chronic Disease Management (CDM) Plan, which was formerly known as an Enhanced Primary Care (EPC) Plan. Your GP or medical practitioner organises this plan for you.

Are You Eligible For a CDM Plan?

To be eligible for a CDM plan, the following criteria must be met:

A Chronic Condition: One or more medical conditions that have been (or are likely to be) present for at least 6 months (i.e. 'chronic'), or terminal condition(s) OR be a resident of an aged care facility.
A Need for Multidisciplinary Care: this is when you require ongoing care from a multidisciplinary team consisting of your GP or medical practitioner, and at least 2 other health or care providers, such as an osteopath, podiatrist or dietician.

Examples When You May See An Osteopath Under a CDM plan

Situations and conditions that have been present for 6 months or more and which an osteopath may be involved in a CDM plan include:

Chronic back or neck pain
Arthritis (e.g. osteoarthritis, rheumatoid arthritis)
Severe sports injuries
Post-surgery rehabilitation (e.g. joint replacement)
Significant postural issues, e.g. scoliosis
Ongoing pregnancy-related issues (e.g. back or pelvic pain)
Consistent headaches or migraines linked to musculoskeletal tension
Fibromyalgia
Chronic fatigue syndrome
Longstanding joint and muscle pain (e.g. knees, hips, shoulders)

These are some examples but ultimately, it's up to your GP to determine whether you are eligible for a CDM plan.

Osteopath Dr Laura Malady at Prom Health treating the gluteal muscles — Osteopath Laura Malady treating a hip issue at Prom Health.

How Will a CDM Plan Benefit You?

There are two main ways that seeing an osteopath with a CDM plan may benefit you:

Cost Savings: By using a CDM plan, you can significantly reduce out-of-pocket expenses. As of July 2024, Medicare provides a rebate of $60.35 per session and you are eligible for up to 5 sessions per calendar year. This means that you could save up to $300 per year for five sessions, making it much more affordable to receive ongoing osteopathic care. It's important to note that there will likely be a small gap payment depending on the clinic's rates, so check with Prom Health for specific details.
Holistic, Coordinated Care: CDM plans encourage a multidisciplinary approach to health management, meaning that osteopaths can collaborate with GPs and other health professionals to deliver more comprehensive care. This improves treatment outcomes as care is tailored to the patient’s needs.

How Do I Get & Use a CDM Plan?

Book an Appointment with Your GP: The first step is to consult with your GP, who will assess your condition and determine if you meet the eligibility criteria for a CDM plan. Your GP will take into account the chronicity and complexity of your health condition and the need for multidisciplinary care.
Development of a GP Management Plan (GPMP): If eligible, your GP will create a GP Management Plan that outlines your health care needs, goals, and treatments. This plan acts as a roadmap for managing your chronic condition.
Team Care Arrangements (TCA): The GP will also develop Team Care Arrangements, which involve coordinating with two or more other health professionals (e.g. an osteopath, podiatrist, or dietitian). The TCA enables you to access the allied health services needed for your condition.
Referral to an Osteopath: Once the CDM plan is established, your GP can refer you to an osteopath under the plan. It’s essential to ensure that your GP specifies the clinic's name, such as "Prom Health," instead of just a single practitioner's name. This allows you the flexibility to see any of the osteopaths or other practitioners within the clinic, providing greater access to care and continuity, especially if you need to change practitioners or schedule appointments at your convenience.
Attend Osteopathy Sessions: You are eligible for up to five Medicare-subsidised allied health sessions per calendar year, which can be divided among various practitioners based on your needs. It’s crucial to inform your osteopath about the referral and bring the necessary paperwork to your appointments.

Common Questions About CDM Plans

Q: What if I already have a CDM plan with another practitioner or clinic? A: If you already have a CDM plan, you can still request to have Prom Health included as your chosen clinic for osteopathy or other allied health services. Speak with your GP about modifying the plan to include us.

Q: Can I see more than one practitioner at Prom Health under my CDM plan? A: Yes, if your GP specifies Prom Health on the referral rather than a single practitioner, you have the flexibility to access various practitioners within our clinic.

Q: How often do I need to renew my CDM plan? A: CDM plans are typically reviewed annually by your GP. However, if your health needs change, you can discuss adjustments or updates to your plan with your GP at any time.

Q: Will my private health insurance cover any additional costs? A: No. To claim a rebate for each consultation you must choose between using your CDM plan or private health insurance, not both. Often people complete their 5 CDM visits and then start using their private health insurance for additional appointments.

Q: Why Choose Osteopathy Under a CDM Plan? Osteopathy offers a holistic approach to treating chronic musculoskeletal conditions by focusing on the body as a whole. It uses manual therapy techniques, such as stretching, massage, and joint manipulation, to improve function, alleviate pain, and enhance overall well-being. For patients with chronic conditions, osteopathy can be an effective part of a broader health management strategy.

Take the Next Step with Prom Health

If you have a chronic condition that could benefit from osteopathy, we encourage you to discuss a CDM plan with your GP. Additionally, we are here to assist you with any questions that you may have about accessing care under a CDM plan.