Pilates & Private Health Insurance rebate – how do the changes effect you?

18.Mar.19 | Pilates

Reform of the Private Health Insurance rebate scheme for Pilates

From 1stApril 2019, the Australian Government and Private Health Insurers have changed their policy relating to rebates available for a range of previously covered therapies, including Pilates.

While the majority of these changes relate to Natural Therapies (i.e. Bowen Therapy, Reflexology, Kinesiology etc…), exercise classes including yoga and Pilates have been included in these changes.

The classes targeted by the reform are non-physiotherapist run group classes that have no individual program or aim for each participant. The new policy states exercise classes where the participants are supervised by a physiotherapist and performing an individualised program will remain eligible for Private Health rebate. Physiosports Pilates classes have always been run in this was and will continue to be covered.

To remain eligible for rebates under the new policy, a review appointment to assess your progress and ensure you are meeting your goals are now mandatory. These appointments must occur at the end of each term or at a maximum time of 12 weeks from the start of your program.

The new policy does require us to make some small changes. We are no longer permitted to call the program Pilates and will now refer to these sessions as “Physio Exercise Class”. Further, the billing code for the insurer will be a 560 (Group consultation). In some instances, this will lead to a smaller amount rebated per session, but will also result in more sessions being covered for the year. Ultimately you will receive the same amount back over the year.

To avoid any issues, we have made the appropriate changes in our billing system effective immediately.

In summary:

  • As of 1stApril 2019 the Private Health Insurance rebate scheme regarding Pilates classes has been changes.
  • Pilates classes at Physiosports will remain eligible for rebates but will be known as Physiotherapy Exercise Classes.
  • You will still have an individualised program that is goal oriented for each of these classes and will be required to have a review assessment with your physiotherapist every term or 12 weeks.
  • Classes will be billed under the Private Health Insurance billing code of 560 Group Consultation.

If you would like to read the outline from the new policy please read on below.

We believe that these changes will have very little impact on your experience in classes and hope they are not a significant inconvenience. If you have any queries please do not hesitate to ask reception or your treating physiotherapist.

The Department considers that an insurer may lawfully pay benefits if a physiotherapist, providing services to a patient within the accepted scope of clinical practice, uses exercises or techniques drawn from Pilates as part of that patient’s treatment as long as the exercises or techniques are within the accepted scope of clinical practice.

As long as your practice is performed within the scope of physiotherapy, it does not need to change. It should be underpinned by individualised assessment, treatment and follow-up, and backed by thorough notes. The Department and private health insurers agree that physiotherapy is physiotherapy, and therefore fundable through private health insurance.