Referrals for
Department of Veterans Affairs (DVA) clients
Allied health treatment cycle and referrals
GPs can refer DVA clients to an allied health provider if there is a clinical need. To make this referral, your GP will need to follow the treatment cycle which reinforces your GPs role as your care coordinator.
The treatment cycle lasts for 12 sessions or 12 months (whichever comes first) and aims to improve the quality of care for DVA clients by supporting better coordination and communication between you, your GP and your allied health service provider(s). You can have as many treatment cycles as your GP decides is clinically necessary to optimise your healthcare.
GP DVA referrals
You can access this referral if you are an eligible DVA client who holds a specific DVA card. The referral you receive will be based on the type of DVA card you hold (i.e. DVA gold card, DVA white card, DVA TPI Gold Card). Regardless of card type or condition, a referral is required.
The referral must also contain the correct profession for allied health treatment, for example, physiotherapy, exercise physiology, etc.
DVA Gold Card Holders
- The client will discuss their condition and goals with their GP. Gold card holders are covered for any condition which does not need to be specific on the referral form.
- The GP will prepare a referral, which must include the DVA client’s file number on it, which the client will bring to the practice for their initial consultation.
- The clinician will complete a ‘DVA Patient Care Plan’ at the start of the treatment cycle and share this with the GP following the session.
- Towards the end of the 12 sessions or 12-month period, the clinician will prepare an ‘End of Cycle Report’ to be sent to the GP containing the proposed future treatment plan.
- Following each treatment cycle or 12-month period, a new referral is required to renew the treatment cycle.
Totally and Permanently Incapacitated (TPI) pension Gold Card Holders
Referrals last one year from the date of referral for each injury and the treatment cycle of 12 sessions does not apply.
DVA White Card Holders
- The client will bring in a referral letter from DVA for a specific condition(s) or injury that has been approved by DVA.
- The client will discuss their condition and goals with their GP. Accepted conditions or injuries covered by DVA under a white card need to be specified on the referral and must match the terminology of their condition on their DVA treatment acceptance letter.
- The GP will prepare a referral containing the specific condition(s) in the referral and the client’s DVA file number. The client will bring the referral form to the practice for their initial consultation.
- The clinician will complete a ‘DVA Patient Care Plan’ at the start of the treatment cycle and share this with the GP following the session.
- Towards the end of the 12 sessions or 12-month period, the clinician will prepare an ‘End of Cycle Report’ to be sent to the GP containing the proposed future treatment plan.
- Following each treatment cycle or 12-month period, a new referral is required to renew the treatment cycle.
Note: Unlike gold-card holders, the condition must be specified in each new D904 referral form to be accepted by DVA.
Referrals for
Private Healthcare Claims
SportsCare Canberra processes private healthcare claims via HICAPS. HICAPS partners with all Australian health insurers.
To make a claim, simply present your private health insurance card following your appointment and our reception team will process your rebate on the spot using our HICAPS terminal.
If for whatever reason you need to claim the rebate yourself, the SportsCare reception team will either print or email a copy of your invoice which includes the HICAPS codes for you to claim this back via your health funds website/app.
Referrals for
Third-party insurance claims
SportsCare Canberra provides allied health treatment to clients who have workers’ compensation or motor vehicle claims.
Third-party insurance clients must provide the insurance companies’ details, claim number and if possible, their claims managers’ details prior to their first appointment.
Our reception team will then contact the insurance company to collect written approval for your treatment. Following your initial consult, the treating therapist will fill out an allied health treatment plan and send this to the insurance company for further approvals. Our team of allied health professionals will work with your GP and claims team to assist in your recovery and return to work.
If you do not have an approved claim/written approval, we will charge you privately upfront and provide you with a copy of your invoice to claim back through your insurance company once the claim has been approved.
Referrals for
Chronic disease allied health (individual) services under Medicare
Medicare provides financial assistance to patients who have chronic medical conditions.
Your GP can refer you for up to five sessions per calendar year under a Chronic Disease Management (CDM) Plan so that you can claim a Medicare rebate on allied health services for relevant chronic conditions. This treatment plan was formally referred to as an Enhanced Primary Care (EPC) Plan. The EPC was replaced by the CDM Plan in 2005, however, some GPs may still use the term EPC in their referral processes.
To be eligible for a CDM referral you must have a chronic (or terminal) medical condition and have the following Chronic Disease Management (CDM) services provided by your GP:
- A GP Management Plan (GPMP) – (item 721) and
- Team Care Arrangements (TCAs) – (item 723)
A CDM referral provides access to the following allied health professionals:
- Aboriginal Health Worker/Aboriginal and Torres Strait Islander Health Practitioner
- Exercise Physiologist
- Podiatrist
- Audiologist
- Mental Health Worker
- Psychologist
- Chiropractor
- Occupational Therapist
- Speech Pathologist
- Diabetes EducatorOsteopath
- Physiotherapist
- Dietitian
Your GP may choose to split the five rebated sessions between different allied health services specific to your care plan and needs, for example, your GP may refer you for two sessions of exercise physiology and three sessions of physiotherapy.
Visit the Department of Health and Aged Care website to downoad the referral form
Frequently asked questions (FAQs) about Medicare referrals
What is a chronic medical condition?
The Australian Government defines a chronic medical condition as “one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke” (Department of Health and Aged Care, 2022).
There is no list of eligible conditions. However, the CDM items are designed for patients who require a structured approach and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary team.
If your GP determines that your chronic medical condition would benefit from allied health services, you are eligible for services under a Chronic disease GP Management Plan / Team Care Arrangement. The need for allied health services must be directly related to your chronic condition and identified in the care plan prepared by your GP.
Is this referral the same as an EPC?
A previous Medicare referral scheme was known as an Enhanced Primary Care (EPC) referral. Some GPs still use this terminology. The EPC Medicare program was removed in 2005 and replaced by the new Chronic Disease Management (CDM) program.
What is the Medicare benefit/rebate?
Under a CDM/TCA you can receive a rebate of $56.00 from the upfront fee for our services.
Once the SportsCare session has been paid in full, your invoice will be sent directly to Medicare to process the rebate. This rebate will take 1-2 business days to process and be transferred into the bank account you have linked to your Medicare card.
Booking Medicare referral appointments
If you have a CDM referral, you can book an appointment with one of our allied health clinicians depending on what treatment is required.
You must bring a copy of your referral to your initial consultation. You are also required to present your Medicare card to process the rebate. Our reception team will enter the details from the referral and use your Medicare card details to process the rebate following the consultation and payment of the session.