Medicare and Chiropractic — Understanding CDM Plans

One of the most common questions I hear in clinic is whether Medicare covers chiropractic care. The short answer is: not for standard visits. But if you have a chronic condition, there is a pathway that can make chiropractic care more affordable through Medicare. It is called a Chronic Disease Management plan, and it is worth understanding how it works.

What is a CDM plan?

A Chronic Disease Management (CDM) plan is a structured care arrangement set up by your GP. You might also hear it called an EPC plan — that stands for Enhanced Primary Care, which was the old name for the same thing. The two terms are used interchangeably, but CDM is the current official name.

The purpose of a CDM plan is to help people with chronic (ongoing) health conditions access a team of allied health professionals — such as chiropractors, physiotherapists, podiatrists, and dietitians — with a Medicare rebate to help cover the cost.

Under a CDM plan, Medicare provides a rebate for up to 5 allied health visits per calendar year. These visits are Medicare-subsidised, which means Medicare covers part of the cost and you pay a small gap fee. At our clinic, that gap is typically around $10 per visit.

Who qualifies?

To be eligible for a CDM plan, you need to have a chronic medical condition — one that has been present, or is expected to be present, for at least six months. For chiropractic referrals, this usually means musculoskeletal conditions such as:

• Persistent low back pain (lasting three months or more)
• Recurring neck pain or stiffness
• Chronic headaches associated with neck or postural issues
• Ongoing joint pain or stiffness related to conditions like osteoarthritis

It is worth noting that "chronic" in this context does not necessarily mean severe. It simply means the condition is persistent or recurring rather than a one-off episode. If you have had back pain that keeps coming back over the course of a year, that would generally qualify — even if it is manageable most of the time.

Your GP is the one who determines whether a CDM plan is appropriate for your situation. It is their clinical decision.

How it works — step by step

The process is straightforward, though it does require a visit to your GP first. Here is how it typically works:

1. See your GP. Book a longer appointment (sometimes called a care planning appointment) and let them know you would like to discuss a CDM plan for your musculoskeletal condition.
2. Your GP assesses your condition. They will confirm that your condition meets the criteria for a chronic condition and determine which allied health services would be appropriate.
3. Your GP creates the CDM plan. This is a documented care plan that outlines your condition and the allied health services you have been referred to. Your GP may refer you to multiple types of practitioners — for example, chiropractic and exercise physiology — but the total is still 5 visits across all allied health services combined.
4. You receive a referral letter. Your GP will give you a referral form or letter that you bring along to your chiropractic appointment.
5. Bring the letter to your appointment. When you come in, we take a copy of your referral and process everything through Medicare on your behalf.
6. Medicare rebate is applied. We process the claim on the spot using HICAPS. The Medicare rebate is deducted automatically, and you pay only the gap fee — typically around $10.

Important things to know

There are a few details that are worth being clear about, because I find there is sometimes confusion around how CDM plans work:

• This is not "free" chiropractic care. It is Medicare-subsidised, which means Medicare covers a portion of the cost. You will still pay a gap fee at each visit. At our clinic, the gap is typically around $10.
• The 5-visit limit is per calendar year, not per plan. Your allocation resets on 1 January each year. If you use your 5 visits by June, you will need to wait until the new calendar year for the next allocation — or pay the standard fee for any additional visits.
• The 5 visits are shared across all allied health services. If your GP refers you to both a chiropractor and a physiotherapist under the same CDM plan, the 5 visits are split between them — not 5 each.
• You do not need a CDM plan to see a chiropractor. Chiropractors are primary contact practitioners in Australia. You can book directly without any referral at all. A CDM plan is simply one way to access a Medicare rebate if you have an eligible chronic condition.
• Your GP needs to review the plan annually. To continue receiving Medicare-subsidised visits in the following year, your GP will need to review and update the plan.

How it works at Evolve Chiropractic

We make the CDM process as simple as possible. When you arrive with your referral letter, we take care of the paperwork and process your Medicare claim on the spot using our HICAPS terminal. You do not need to submit any claims yourself or wait for reimbursement.

If you are a patient at Gore Street Medical in Hobart, the process is particularly straightforward — we work closely with the GPs there and the referral pathway is well established.

If you are not sure whether you have a CDM plan in place, or whether you might be eligible for one, have a conversation with your GP. They can advise you based on your individual health situation.

What if I do not have a CDM plan?

That is perfectly fine. Most of our patients come in without one. You can book an appointment at any time, and you do not need a referral of any kind. Standard fees apply — you can see our full fee schedule on the pricing page.

If you have private health insurance with extras cover, you can claim on the spot using HICAPS, which usually brings the out-of-pocket cost down significantly. We also offer concession rates for pensioners, students, and children.

Summary

A CDM plan can be a helpful way to access Medicare-subsidised chiropractic care if you have a chronic musculoskeletal condition. The process starts with your GP, who sets up the plan and provides a referral. You are entitled to up to 5 allied health visits per calendar year, with a small gap fee at each visit.

If you have questions about how this works or want to know whether it applies to your situation, your GP is the right starting point. And if you already have a CDM plan and referral in hand, you can book your appointment and bring the paperwork along.