PHI natural therapies reform

In 2018, the Federal Government announced its plans to make certain natural therapies ineligible for private health insurance rebates. Among these was Pilates. The Government’s original position was that Pilates would not be rebatable, regardless of who delivers it or how it is delivered.

Department of Health Private Health Insurance Circular

We have negotiated with the Department of Health and Private Health Insurers for a more reasonable and tenable position on Pilates for physiotherapists. Through our advocacy, we have reached this position:

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.

However, if a physiotherapist (or any other health professional) conducts a Pilates session – either advertised or promoted as such, or a session where the only service provided is Pilates exercises – then benefits cannot lawfully be paid.

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. Be mindful of our guidance on note-taking and the way you promote your treatments, sessions and classes.

Frequently Asked Questions

It’s important to understand that the Department of Health – not private health insurers – introduced the review of natural therapies in its campaign to remove rebates for low-value care. Private Healthcare Australia has been very supportive of physiotherapy.

Physiotherapy is recognised by all parties as high-value, evidence-based care. Therapeutic exercises delivered by physiotherapists are still eligible for rebates.

Service descriptors have not been impacted by the PHI reforms. You can continue to claim item code 560 and 561 where the private health insurance company allows it. You can continue to claim on 593, 595, 596 for pelvic, post and ante natal sessions if you are providing clinically justified treatment reflected in your notes and not called Pilates.

All parties have agreed that physiotherapy is physiotherapy. This presents a great opportunity to market our profession and its evidence-based effectiveness even further. We advise using the term 'group physio'.

The Department of Health does not differentiate between Pilates and clinical Pilates and has removed rebates for sessions that are solely Pilates. Therefore rebates will not be paid for clinical Pilates and clinical Pilates should not be referenced in your clinical notes. All parties have agreed that physiotherapy is physiotherapy, and your physio exercises classes can include exercises drawn from Pilates but must not consist solely of Pilates.

You might tell clients that your Physio sessions are a mixture of clinically appropriate exercises, which may include exercises delivered on Pilates equipment or exercises drawn from Pilates that target their particular needs.

Physios deliver these exercises within an evidenced-based and therapeutic framework, rather than purely for fitness.

The reform does not impact the basis of good physio practice, which includes regular assessments and adjustments to treatment plans based on clinical reasoning and justification. You should continue to assess your patients on a case-by-case basis. Some private health insurers require at least yearly reviews.

Receipting, like all advertising and promotion of sessions, should reflect that they are physio exercise classes and not Pilates. This presents a great opportunity to market our profession and its evidence-based effectiveness even further. All billing and receipting should reflect the correct item codes.

Your clinical notes must reflect the treatment provided. Under the Rules, sessions that are solely Pilates are not eligible for rebates. Therefore, notes should not reference Pilates. Your notes should reflect your physio exercise sessions and the individual exercises prescribed to your patients.

Yes, but you cannot claim for them.

Yes, but you can only claim for Physio sessions, not Pilates.

The reforms take effect on 1 April 2019 and you have until then to adjust your advertised timetables and advise your patients.

Department of Health Private Health Insurance Circular