Can I bill Medicare and the NDIS for physio?

The short answer

Yes, but never for the same service. A physiotherapist can be a Medicare provider and an NDIS provider, and NDIS participants keep their Medicare entitlements. Each session is billed once, to the funder responsible for it. Medicare funds treatment of a health condition under a GP chronic condition management plan, and the NDIS funds therapy related to the functional impact of a person's disability.

Sources
National Disability Insurance Scheme Act 2013 (Cth), section 34
Health Insurance Act 1973 (Cth), section 19(2)
Medicare Benefits Schedule, item 10960 and allied health explanatory notes (MBS Online)
Applied Principles and Tables of Support to determine the responsibilities of the NDIS and other service systems

Where the line sits

Section 34 of the National Disability Insurance Scheme Act 2013 says the NDIS funds a support only if it is not more appropriately funded through another system such as health. The Applied Principles and Tables of Support agreed by governments set out the split. The health system, including Medicare, is responsible for diagnosis, treatment of acute and chronic health conditions and time-limited rehabilitation after illness or injury. The NDIS is responsible for ongoing therapy that maintains or builds functional capacity where the need arises from the participant's disability. Since 3 October 2024 the NDIS supports lists also spell out mainstream health items that the scheme will not fund.

Billing Medicare

Medicare rebates for physiotherapy are mainly available through item 10960, which needs a GP chronic condition management plan prepared or reviewed in the last 18 months. The patient can claim up to 5 allied health services per calendar year across all professions, and the rebate is 85 percent of the schedule fee. Section 19(2) of the Health Insurance Act 1973 means a Medicare benefit is generally not payable for a service that is funded by another Commonwealth or state arrangement, so a session paid from an NDIS plan cannot also be claimed from Medicare. You also cannot bill the NDIS for the gap on a Medicare service.

Billing the NDIS

To bill the NDIS, the therapy must be in the participant's plan, usually under improved daily living, and covered by a service agreement. You claim against the therapy items in the NDIS Pricing Schedule 2026-27, up to the price limit for physiotherapy, and follow its rules on travel, cancellations, reports and non-face-to-face time. The NDIS will not fund treatment of a health condition that Medicare should cover, such as acute rehabilitation after surgery, even for a participant. Plan managers and the NDIA may query claims that look like health treatment, so record the disability-related goal each session addresses.

Practical steps

Decide the purpose of each episode of care at the start and document it. A participant with an NDIS goal of walking safely at home is having NDIS therapy. The same person recovering from a fractured wrist is having health treatment that Medicare or the hospital should fund. Keep separate invoices and item numbers for each funder, and never claim both for one appointment. If the participant asks you to use Medicare to stretch their plan, explain the rule. The framework is national, but hospital outpatient physiotherapy is run by the states, so local arrangements for post-acute care vary.

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