What is it?
Did you know that eligible people can access a rebate for up to 5 occupational therapy sessions via Medicare?
Through Medicare, clients can access a rebate for occupational therapy supports for up to 5 sessions. A client can access a maximum rebate of $56.00 per session.
Most initial sessions for occupational therapy will take at least one hour to complete. WHR charges an hourly rate of $193.99 (indexed 1st July each year).
- 60-minute session – $193.99 (Medicare rebate of $56.00) leaves clients with a gap payment of $138.39 for the initial session.
- 90-minute session – $290.99 (Medicare rebate of $56.00) leaves clients with a gap payment of $235.89 for the initial session.
Who is eligible for the Medicare rebate?
To access the Medicare rebate, your GP will need to send a referral to our admin team on your behalf. Referrals can be sent to firstname.lastname@example.org or via post. Please speak to your GP to find out if you are eligible.
Medicare provides the following information around eligibility:
‘Medicare benefits are available for certain services provided by eligible allied health professionals to people with chronic conditions and complex care needs who are being managed by a GP or medical practitioner using certain Chronic Disease Management (CDM) Medicare items or are enrolled in a Health Care Home. The allied health services must be recommended in the patient’s plan as part of the management of their’
‘Supports are required to meet a criterium set by Medicare which includes but is not limited to:
- The person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
- The service is provided to the person individually and in person; and
- The service is of at least 20 minutes duration; and
- To a maximum of five services in a calendar year’
Where will you receive your supports?
Sessions are held in our clinic, at home or in the community. It is important to keep in mind that we do charge an hourly rate ($193.99/hr) for travel time. Travel is charged for any appointments outside the clinic.
How to access the rebate
WHR Allied Health provides invoices to clients directly for the services provided. We will email or post an invoice for the full amount to you which is required to be paid within 7 days.
Once you have paid your invoice, we will send you a tax invoice receipt which you will need to make your claim via Medicare.
Please note WHR Allied Health do not offer online claiming from our practice. After WHR Allied Health provides a receipt for the paid invoice, clients will be able to lodge their claims via the following options:
- Online claim (see the Services Australia article on how to submit an online claim)
- Express Plus Medicare mobile app
- Contacting the Medicare telephone claims line on 1300 360 460, accessible 24 hrs/7 days
- Going to the nearest Medicare offices to claim in person
More information and examples of how you might utilise the Medicare rebate
Following the initial session, the treating therapist might recommend additional intervention sessions to support you to work towards improving health and wellbeing outcomes as outlined in the GP referral. The therapist will discuss with you how sessions are likely best set up (duration, location) based on clinical need.
Medicare is not informed of the regularity or duration of any session without you providing them with your receipts or in the instance WHR is audited by Medicare. You do not need to submit receipts to Medicare unless you wish to make a claim for the rebate.
Examples of how the rebate can be claimed dependent on support duration:
- 30-minute session – $96.99, (rebate of $56.00) leaving a gap payment of $34.83
- 45-minute session – $145.49 (rebate of $56.00) leaving a gap payment of $90.39
- 60-minute session – $193.99 (rebate of $56.00) leaving a gap payment of $138.89