Bulk Billing Exercise Physiology: How Funding Works

People searching for a bulk billing exercise physiologist are usually asking one thing: what will this cost me out of pocket? The honest answer depends on which funding pathway you come through, because exercise physiology is paid for in four or five quite different ways in Australia, and only some of them involve Medicare at all. Here is how each one works so you can work out where you sit before you pick up the phone.

What bulk billing actually means

Bulk billing is a Medicare arrangement. The provider accepts the Medicare rebate as full payment for the service and bills Medicare directly, so you pay nothing on the day and claim nothing back afterwards. If a provider does not bulk bill, you pay the full fee, Medicare pays you a set rebate, and the difference is the gap.

Bulk billing only applies to Medicare-funded sessions. NDIS, DVA and private health extras are separate systems with their own rules, and none of them use the term bulk billing even though some of them also leave you with no out-of-pocket cost.

The Medicare chronic condition management pathway

Medicare funds allied health, including accredited exercise physiology, for people managing a chronic condition. From 1 July 2025, GP Management Plans and Team Care Arrangements were replaced by GP Chronic Condition Management plans. Plans written under the old system are still valid, and referrals issued under them still work.

The key points to understand:

• Your GP decides whether you are eligible. The condition needs to be chronic, meaning it has been present or is likely to be present for six months or longer. Type 2 diabetes, osteoarthritis, cardiovascular disease, COPD and persistent musculoskeletal pain are common examples.
• The plan allows up to five allied health services per calendar year in total. That five is shared across every allied health provider you see, so if you use three with a dietitian, two remain.
• Your GP writes a referral form naming the provider type. You bring that form to your first appointment.
• Medicare pays a set rebate for allied health item 10953. The figure is indexed and changes, so check the current amount on the Services Australia website rather than relying on a number you read somewhere last year.

Whether a clinic bulk bills that item is a decision each practice makes. Some bulk bill everyone, some bulk bill concession card holders only, some charge a gap. Ask directly when you book and ask for the gap figure in dollars, not a percentage.

Five sessions a year is not a lot for a condition you will manage for decades. A reasonable way to use them is a full assessment, a program build, and reviews spaced across the year, with the training itself done at home or at a gym between visits.

NDIS funding

NDIS participants usually access exercise physiology through Capacity Building, Improved Daily Living supports, and sometimes through Improved Health and Wellbeing. There is no bulk billing and no gap. The service is billed against your plan at the price listed in the NDIS Pricing Arrangements and Price Limits.

How the invoice gets paid depends on how your plan is managed. Agency-managed plans are claimed through the NDIS portal by the provider. Plan-managed participants have invoices sent to their plan manager. Self-managed participants pay the provider and claim it back themselves.

NDIS sessions are typically longer and more frequent than the Medicare pathway allows, because the funding is built around working toward functional goals over months rather than a handful of appointments.

DVA

Veterans holding a Gold Card, or a White Card where the accepted condition is relevant, can be referred by their GP for exercise physiology using a D904 referral. DVA pays the provider directly at the DVA fee schedule rate and there is no out-of-pocket cost. Referrals cover a set number of sessions before a new referral is needed.

Private health extras

Most extras policies include exercise physiology, usually under a general allied health or natural therapies category. No GP referral is required. Cover is a fixed amount per visit or an annual limit, and it varies enormously between funds and tiers, so check your policy details with your fund. Terminals in the clinic let you claim on the spot and pay only the gap.

Workers compensation and CTP

If your injury sits under a workers compensation or motor accident claim, sessions are billed to the insurer with prior approval from the case manager. You should not pay anything directly. Bring your claim number to the first appointment.

What to ask before you book

Call and ask four questions. Do you bulk bill Medicare CDM referrals, and if not, what is the gap? What does an initial assessment cost privately? Are you registered with NDIS, and do you take plan-managed and self-managed participants? Are home visits charged differently to clinic appointments?

Any clinic should answer those without hesitation.

What a first session involves

An initial exercise physiology appointment usually runs 45 to 60 minutes. It covers your medical history, current medications, what your condition stops you doing, and what you want to get back to. Then objective testing, which might include blood pressure, sit-to-stand repetitions, walking speed, grip strength, balance tests and range of motion, depending on why you are there. You leave with a written program built around the equipment you actually have access to.

If you are unsure which funding pathway fits your situation, get in touch and we can talk it through, or book an assessment at the Five Dock clinic.