Is Physiotherapy Covered by Private Health Insurance? A Complete Guide by The Physio Spot
Private health insurance can help reduce out-of-pocket costs for a wide range of health
services that aren’t covered by Medicare — including physiotherapy, exercise physiology,
remedial massage, podiatry, and dental care.
But with so many insurers and policy types, it can be confusing to understand exactly what
you’re covered for.
In this guide, The Physio Spot breaks down everything you need to know about private health
insurance and physiotherapy, including:
Does Private Health Insurance Cover Physiotherapy?
In most cases, physiotherapy is covered under private health insurance — but only if
your policy includes extras cover.
Basic hospital-only policies generally do not include physiotherapy. These policies usually
cover things like private hospital treatment and ambulance services only.
To claim for physio consultations, assessments, treatment plans or rehabilitation services,
you’ll need extras cover that includes physiotherapy. This may also cover additional
services depending on your fund, such as:
- Antenatal physiotherapy during pregnancy
- Dry needling
- Hydrotherapy
- Group exercise or clinical exercise classes
Most insurers require that your physiotherapist is accredited and recognised by the fund —
which The Physio Spot clinics are.
Why Should You Get Extras Cover for Physiotherapy?
Physiotherapy is rarely a one-off appointment. Treatment often involves a personalised care plan that may include:
- Initial assessments
- Follow-up appointments
- Exercise prescription
- Ongoing rehabilitation
Having extras cover helps reduce ongoing costs and makes regular physiotherapy more
accessible. This means better long-term outcomes for issues like pain, mobility limitations
and chronic health conditions.
Physiotherapy Extras Cover Can Help If You:
- Have recurring neck, back or joint pain
- Play sport or have a physically demanding job
- Are recovering from an injury or surgery
- Have a movement disorder
- Are managing a chronic illness
- Experience complications during or after pregnancy
- Have poor posture or workplace-related pain
You don’t need to be an athlete to benefit from physio — everyone can improve movement,
reduce pain and enhance quality of life with regular physiotherapy.
Waiting Periods for Physiotherapy Insurance Claims
Most extras policies include a waiting period, generally around 2 months, before you can
claim physiotherapy services.
Some health funds run promotions offering no waiting periods, so it’s worth shopping
around.
Once your waiting period has been served, you can usually switch insurers or upgrade your
policy without needing to wait again — provided your level of cover doesn’t decrease.
What Are Health Insurance Extras?
Extras (also known as “ancillary cover”) help reduce the cost of everyday healthcare services
outside of hospital settings. While Medicare covers essential medical treatments, it does not
cover extras.
Extras cover often includes services such as: Dental, Optical, Psychology, Physiotherapy,
Remedial Massage, Exercise Physiology, Chiropractic, Podiatry & Home nursing
How Physio Claims Are Calculated
Depending on your policy, your rebate may be:
- Percentage-based — e.g., 50% back per physiotherapy consultation
- Set benefit — e.g., $45 per physio session
Extras rarely cover the full cost, but they significantly reduce out-of-pocket expenses.
Do You Have to Pay for Physio With a GP Referral?
Yes — a GP referral alone does not make physiotherapy free.
You will still have either:
- A gap payment after your extras fund rebate, or
- The full amount out-of-pocket if you don’t have extras cover
The only exception is when physio is provided as part of a hospital inpatient service, which
may be covered by Medicare.
Always keep your receipts, as most health insurers place a time limit on claiming.
Can You Claim Physiotherapy Through Medicare?
Yes — but only in specific situations.
Medicare covers physio through:
- Public Hospital Admission
- Chronic Disease Management (CDM) / EPC Plans
Medicare does not cover standard private physiotherapy appointments outside of these
programs.
What Is an EPC / CDM Plan?
The Enhanced Primary Care (EPC) program is now called the Chronic Disease
Management (CDM) Plan.
This plan is available for people who have a chronic medical condition expected to last
longer than six months, such as: Musculoskeletal conditions, Diabetes, Heart disease,
Asthma, Stroke, Cancer
With a CDM plan, you may be eligible for up to five Medicare-subsidised allied health
visits per calendar year, including physiotherapy.
How to Get an EPC/CDM Plan
Book an appointment with your GP. A CDM plan must be coordinated by:
- Your GP, plus
- Two other healthcare professionals
If eligible, your GP will create a plan and provide referrals to services such as physiotherapy.
How Long Do EPC Referrals Last?
CDM/EPC plans renew every calendar year. This means you can receive up to five
subsidised physiotherapy sessions each year to help manage your chronic condition.
Physio Appointments at The Physio Spot
The Physio Spot (Camden & Harrington Park) accepts:
- Private health insurance with extras cover
- Medicare CDM/EPC referrals
- NDIS
- Workers Compensation
- CTP / Motor Accident Insurance
- DVA Referrals
Whether you’re managing a chronic condition, recovering from an injury or simply want to
move and feel better, our experienced physiotherapists are here to help.
Want help maximising your private health insurance benefits before they reset?
Book your appointment with The Physio Spot today!
