Medicare Chronic Disease Management

If you suffer from a chronic disease, Medicare benefits are available for Exercise Physiology services.  Eligible patients are those who have a chronic medical condition and currently managed by their GP.  A referral to Exercise Physiology services must be directly related to management of your chronic disease.

Medicare Chronic Disease Eligibility

Only your GP can determine whether your chronic disease would benefit from Exercise Physiology services.  The need for such services must be identified in the patient’s care plan.  A chronic medical condition is one that has been or is likely to be present for at least six months (e.g. asthma, cancer, cardiovascular illness, diabetes, musculoskeletal conditions and stroke).

How can you access the Medicare Chronic Disease Management program?

Your GP must refer you under the Medicare Chronic Disease Management Scheme.  They will determine if you are eligible for Chronic Disease Management items and associated allied health items.  It is essentially a matter for the GP to determine, using their clinical judgement and taking into account both the eligibility criteria and the general guidance.

How many services are available through the Medicare Chronic Disease Management program?

Medicare benefits are available for up to five allied health services per eligible patient, per calendar year.  Services are bulk billed under the scheme, however out calls will incur a small gap fee.

Chronic Disease conditions and Exercise Physiology

The following conditions can be referred to an Accredited Exercise Physiologist registered with medicare

Cardiopulmonary – Myocardial Infarction, Coronary Artery Disease, Peripheral Vascular Disease, Hypertension, Chronic Obstructive Pulmonary Disease, Asthma

Metabolic – Obesity, Diabetes, Dyslipidaemias, Impaired Glucose Tolerance

Musculoskeletal – Osteoarthritis, Osteoporosis, Back Pain, Fibromyalgia

Neural – Motor Neuron Disease, Stroke, Spinal Cord Injury, Parkinson’s Disease, Multiple Sclerosis

If you believe you may qualify for team care arrangements (TCA) and would benefit from exercise physiology, it is best to discuss your eligibility with your general practitioner.  Download the referral form