One of the most common questions we hear before a first appointment is whether physio, chiropractic or other allied health care can be claimed. The short answer is that it often can, but how much you get back depends on your situation, your private health cover, and whether you are eligible for a Medicare plan.
The rules can feel confusing, especially since Medicare's chronic condition plans changed in 2025. This guide gives a general overview to help you know what to ask. It is not financial or insurance advice, and your health fund and GP are the people to confirm the details for you.
Can I claim physio or chiro on private health insurance?
Physiotherapy, chiropractic, osteopathy, remedial massage, acupuncture and psychology are usually covered under extras (also called general treatment or ancillary) cover, not hospital cover. Whether a particular service is included, and how much you get back, depends entirely on your fund and the level of extras you hold.
Policies differ in several ways, including:
Which services are included at all.
The benefit paid per visit, which may differ for initial and follow-up appointments.
Annual limits, which may be per service or shared across several services.
Waiting periods for new policies or upgraded cover.
Whether the limits reset on a calendar year or on another date.
The easiest way to find out is to call your fund or check its app, and have the type of service ready, for example "physiotherapy initial consultation".
How does on-the-spot claiming work?
At The Good Joint we offer on-the-spot claiming through HICAPS. After your appointment, you simply present your health fund card, the benefit is processed straight away, and you pay any remaining gap. There is no need to lodge a claim yourself.
Bring your physical card or the digital card from your fund's app if it supports HICAPS. Our new client information page explains what to expect at your first visit.
Does Medicare cover physio or chiropractic?
Medicare does not generally cover allied health appointments on their own. You cannot simply book a physio or chiro and claim a Medicare rebate. However, if you have a chronic (ongoing) medical condition, Medicare may provide a rebate for a limited number of allied health visits through a GP plan.
From 1 July 2025, the previous GP Management Plan and Team Care Arrangement system (often called a "CDM" or "EPC" plan) was replaced by the GP Chronic Condition Management Plan, often shortened to a CCM plan or GPCCMP. People with existing plans made before that date have a transition period, so if you are unsure which applies to you, ask your GP.
How does a Chronic Condition Management plan work?
The general steps are:
You see your GP, who decides whether you have an eligible chronic condition, generally one that has been, or is likely to be, present for at least six months.
Your GP prepares (or reviews) a Chronic Condition Management plan with you.
If allied health care is part of your plan, your GP writes a referral to the relevant provider type, such as a physiotherapist, chiropractor or osteopath.
You bring the referral to your appointment, and the allied health provider claims or helps you claim the Medicare rebate.
Under current rules, Medicare provides a rebate for up to five allied health services per calendar year in total, not five per provider type. These can be split between different allied health providers, for example some physio and some osteo visits. The rebate is a set amount and usually does not cover the full fee, so there is commonly an out of pocket gap.
Eligibility, how many visits are allocated to each provider, and how often the plan needs reviewing are all decisions for your GP. They can explain how it applies to you.
Can I use Medicare and private health for the same visit?
No. You can generally claim a single appointment through either Medicare or your private health fund, but not both. Some people use their Medicare referred visits first, then use private health extras for further appointments later in the year. Your fund can confirm how this works with your policy.
What about DVA and WorkCover?
We also accept DVA clients and Queensland and NSW WorkCover claims. For a WorkCover claim, you will generally need an accepted claim number and the relevant details from your employer or insurer before your first visit. For DVA, eligibility and referral requirements depend on your DVA card and circumstances. Please contact us before booking if you are unsure what to bring, and see our work injury and return to work rehabilitation page for more information.
What should you ask your health fund before you book?
A quick call or a look at your fund's app before your first visit can save surprises at the front desk. Useful questions include:
- Is physiotherapy, chiropractic or the service I want included on my policy?
- How much will I get back for an initial visit, and for a follow-up?
- How much of my annual limit have I already used this year?
- Am I still serving a waiting period on any part of my extras cover?
- Does my limit for this service share a pool with other services, such as massage or dental?
What if you do not have extras cover?
You can still book directly, as no referral is needed for most appointments. If you live with a chronic condition, it may be worth asking your GP whether a Chronic Condition Management plan is suitable for you. If your injury happened at work, your claim may be covered under WorkCover once it has been accepted.
Whatever your situation, it can help to talk with your practitioner about how often you may need to be seen and what you can do at home between visits. A clear home exercise plan often helps people get more out of each appointment.
Frequently asked questions
Do I need a referral to see a physio or chiro?
No referral is needed for most appointments at The Good Joint. A GP referral is only needed if you are claiming under a Medicare Chronic Condition Management plan, and WorkCover or DVA claims have their own requirements.
Can I claim psychology or massage too?
Many extras policies include remedial massage and psychology, but coverage varies widely between funds and levels of cover. Psychology may also be claimable through a separate Medicare mental health pathway arranged by your GP. Check with your fund and GP for your situation.
How do I know how many Medicare visits I have left?
The limit applies per calendar year, across all your allied health providers. Your GP's referral and your Medicare claims history in your myGov account can help you keep track, and your GP can help if you are unsure.
Getting help on the Gold Coast
The Good Joint in Mermaid Beach offers physiotherapy, chiropractic, osteopathy, remedial massage and more under one roof, with on-the-spot HICAPS claiming and Medicare CCM plans, DVA and WorkCover accepted. If you have questions about claiming, our team is happy to help on 07 5651 6594. Explore all our services or book online.
Related reading: Do you need a referral to see a physio or chiropractor in Queensland? and How many physio sessions will I need?
