Medicare and Physio in 2026: What You Can Claim, What You Can’t, and How the Referral Path Works

If you live in Sydney, you already know the vibe. You’ll do a “quick” walk at Barangaroo that turns into ten kilometres, you’ll carry a laptop like it’s a newborn, and you’ll tell yourself that the tight hip and stiff neck will sort itself out. Then it doesn’t. So you start Googling physiotherapy techniques at 11pm like it’s a side project, and you wonder whether seeing a physiotherapist based in Sydney can be partly covered by Medicare.

Here’s the thing. Medicare can help with physio in very specific situations, but it’s not a blanket “yep, we’ll cover that” kind of deal. It’s more like a set of rules, pathways, and timeframes that make sense once someone explains them in plain language.

You can book a physio without a GP… and still need a GP

In Australia, you don’t have to see a doctor to get a referral before you see a physiotherapist. You can book directly. Healthdirect says it plainly: you don’t need a referral to see a physio, though seeing a doctor can still be helpful depending on your situation.

Now the contradiction. If you want Medicare to chip in for physio under chronic condition arrangements, you’ll usually need your GP involved, because Medicare isn’t paying for “physio in general”, it’s paying for a specific type of allied health service under a specific plan and referral pathway.

So yes, you can walk into a clinic in Newtown or Chatswood and start treatment tomorrow. But if you’re aiming for a Medicare rebate, you’ll want to slow down for a second and get the right paper trail in place first.

What Medicare is actually supporting

Most people who say “Medicare covers physio” are talking about chronic condition management allied health items. For physio, the core item is MBS item 10960, which covers an individual physiotherapy service by an eligible physiotherapist, for a patient with a chronic condition and complex care needs managed by a GP (or similar) under the relevant plan. The service has to run at least 20 minutes, and Medicare supports a maximum of five services in a calendar year across eligible allied health items.

That’s the big frame. The smaller frame is where the confusion lives.

Medicare is not paying for every sore knee, every post-gym tweak, or every “I slept funny and now my neck is doing interpretive dance” moment. If it’s acute and short-term, you may still absolutely need physio, but Medicare chronic condition rebates may not apply.

And even when Medicare does apply, it often won’t cover the whole consult fee. It covers a set benefit against the schedule fee, and many clinics charge above the schedule. That gap is where out-of-pocket costs appear, and where people feel caught off guard.

What physiotherapist sessions you can claim without the fine print headache

In 2026, if you’re eligible under chronic condition arrangements, you can generally claim a Medicare benefit for a physio service when the service meets the MBS rules. For item 10960, that includes the chronic condition plan requirements, and the service being at least 20 minutes, delivered by an eligible physiotherapist, as an individual service.

As of the MBS schedule fee update shown for item 10960, the fee listed is $72.65 and the Medicare benefit is 85% of that, which is $61.80. (These figures can change with indexation, so treat them as “check the current number” rather than tattooing them on your brain.)

So, broadly, Medicare is contributing a set rebate amount per eligible session, up to the annual cap, through a GP-led plan and referral pathway.

What physio sessions you typically can’t claim

This is the part people don’t like reading, but it’s the part that saves you time, money, and awkward phone calls.

If you don’t have the right plan and referral in place, Medicare chronic condition rebates for physio generally won’t apply, even if the treatment is medically sensible.

If the consult doesn’t meet the minimum duration, it won’t line up with the item descriptor requirements.

If you’ve already used your five eligible services for the calendar year across allied health, that’s it for that year under this pathway.

And if you’re in hospital as an inpatient, you’re not eligible for these services under the community chronic condition arrangements. (A lot of people assume “hospital” means “more cover”, but these particular items are framed around community care.)

Also, the referral itself has rules. It needs to be written, signed, dated, and include the required particulars and reasons for referral. If it’s missing the essentials, it can become messy fast.

The simplest way to think about it in 2026

If your situation fits chronic condition management, Medicare can help fund a limited number of physio sessions, under a GP-led plan and a written referral, with services meeting the item requirements.

If your situation doesn’t fit that pathway, that doesn’t mean physio isn’t worth doing. It just means Medicare isn’t the right funding lane for it, and you may look at other options like private health extras (if you have it), workplace claims where relevant, or simply paying privately for the care you want, on the timeline you want.

And that last bit matters. People sometimes treat Medicare approval like it’s a stamp of legitimacy. It’s not. It’s a funding system with rules. Your body doesn’t care about the rules; it cares about what helps.

General info only, not personal medical advice. For your specific eligibility and rebates, check MBS Online and Services Australia, and confirm details with your GP and clinic before you start.

• Next