Chiropractic and Medicare

Do you bulk bill Chiropractic Health care on Medicare?

Can you bulk bill chiropractic health care on Medicare?

We are frequently asked if we bulk bill Medicare for chiropractic health services, and the short answer is No.

The reason that chiropractic health services, along with physiotherapy, occupational therapy, speech therapy, eye therapy, podiatry and psychology are not bulk billed to Medicare, is that they are not covered by Medicare.

Medicare covers both In Hospital and Out Of Hospital services, and as no chiropractic health services are covered for In Hospital care, we will not discuss these items here.

The Out of Hospital Medicare Benefits Schedule (listed below) by the Australian Government explains what services are covered by Medicare and may be bulk billed in some circumstances and chiropractic health care is not listed as a Medicare item.

As in all aspects of life, here too there is one exception. Chiropractic Health care may be prescribed by a medical doctor under the Chronic Disease Management program, whereby a limited number of consultations will be reimbursed by Medicare – but not bulk billed.

Medicare provides Out of Hospital benefits for:

  • consultation fees for doctors, including specialists
  • tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests
  • eye tests performed by optometrists
  • most surgical and other therapeutic procedures performed by doctors
  • some surgical procedures performed by approved dentists
  • specified items under the Cleft Lip and Palate Scheme
  • specified items for allied health services as part of the Chronic Disease Management program—call Medicare on 132 011 for more information.

 Medicare does not provide Out of Hospital benefits for:

  • private patient hospital costs (for example, theatre fees or accommodation)
  • dental examinations and treatment (except specified items introduced for allied health services as part of the Chronic Disease Management (CDM) program
  • ambulance services
  • home nursing
  • physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic health services, podiatry or psychology (except specified items introduced for allied health services as part of the Chronic Disease Management (CDM) program
  • acupuncture (unless part of a doctor’s consultation)
  • glasses and contact lenses
  • hearing aids and other appliances
  • the cost of prostheses (except External Breast Prostheses covered by the External Breast Prostheses Reimbursement Program)
  • medicines (except for the subsidy on medicines covered by the Pharmaceutical Benefits Scheme)
  • medical and hospital costs incurred overseas
  • medical costs for which someone else is responsible (for example a compensation insurer, an employer, a government or government authority)
  • medical services which are not clinically necessary
  • surgery solely for cosmetic reasons
  • examinations for life insurance, superannuation or membership of a friendly society
  • eye therapy

 Private health insurance is needed if you require to cover these services.

The following link to the Medicare Benefits Schedule web site gives access to details:

Website:  http://www.medicareaustralia.gov.au/public/claims/what-cover.jsp

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