Does Medicare Cover Physio for Children?

Medicare does not cover routine private physiotherapy the way it covers a GP visit. It can, however, subsidise a limited number of sessions each year for children with an ongoing health condition, through a plan written by your GP. Understanding the difference saves a lot of disappointment at the front desk.

The main pathway: a GP chronic condition management plan

From 1 July 2025 the older GP Management Plan and Team Care Arrangement combination was replaced by a single GP Chronic Condition Management Plan. Families who already had the older plan in place can generally continue under transition arrangements until 30 June 2027.

• Your GP must assess that your child has a chronic condition, meaning one that has lasted or is likely to last at least six months, with complex care needs.
• The GP prepares the plan and refers your child to the physiotherapist, using a specific referral form.
• Up to five individual allied health services are subsidised per calendar year. Ten are available for Aboriginal and Torres Strait Islander patients.
• Those five sessions are shared across all allied health providers, not five per profession. If your child also sees a speech pathologist or occupational therapist under the plan, they draw from the same five.
• Each session must run at least twenty minutes.

What you get back, and what you pay

The Medicare benefit for an individual physiotherapy service under these items is 85 per cent of the schedule fee. As at the 2025-26 year that was approximately \$63.40 per session. Most private practices charge more than the schedule fee, so you pay the difference, known as the gap. Some practices bulk bill these items; many do not. Always ask what the out-of-pocket cost will be when you book.

Medicare fees are indexed, usually on 1 July, so confirm the current amount with Services Australia or your practice rather than relying on a figure you read online.

The Medicare Safety Net

Out-of-pocket costs on these out-of-hospital items count towards the Medicare Safety Net thresholds. Once your family reaches a threshold in a calendar year, Medicare pays a higher benefit for the rest of that year. Families should register as a family with Services Australia so that everyone's costs are counted together. Thresholds are indexed each January.

Children with a diagnosed neurodevelopmental condition

The former Helping Children with Autism and Better Start programmes closed in 2021, and the NDIS now carries most ongoing therapy funding for eligible children. Separate Medicare items exist for assessment and treatment services relating to complex neurodevelopmental disorders and eligible disabilities for people under 25, accessed through a paediatrician, psychiatrist or GP. Your GP or paediatrician can tell you whether your child qualifies.

Other ways families manage cost

• Private health insurance extras cover, which can be used for sessions outside the Medicare-subsidised five. You cannot claim Medicare and private health for the same visit.
• NDIS funding, where a child is eligible under the early childhood approach or as a participant.
• Public hospital outpatient or community child development services, which are free but referral-based and often have waiting periods.
• Asking your practice about session spacing, group programmes, or a home programme with fewer reviews.

A reassuring takeaway

Five subsidised sessions will not cover a long therapy journey, but they can cover an assessment, a clear plan and a couple of reviews, which is often exactly what a family needs. Ask your GP whether your child is eligible, and ask your physiotherapist for a written cost estimate before you start.

Funding rules and rebate amounts change. Confirm current figures with Services Australia, your GP and your practice before making decisions.

Sources and further reading

Services Australia --- Services available under a GP chronic condition management plan

MBS Online --- Physiotherapy allied health item 10954

MBS Online --- Medicare Safety Net arrangements

Services Australia --- Complex neurodevelopmental disorders and eligible disabilities

Suggested closing call to action

Still unsure about something you have noticed? A GP, child health nurse or paediatric physiotherapist can help you decide whether your child would benefit from an individual assessment. Contact PHYSITEK to ask about a paediatric physiotherapy visit.