Understanding health fund claiming of pilates informed exercise with our physios in 2019

Dec 20, 2018 | Physiotherapy

Understanding health fund claiming of pilates informed exercise with our physios in 2019


The Australian Physiotherapy Association have won a battle with many health funds ensuring Pilates-informed exercises prescribed by physiotherapists as part of an individualised program will continue to receive rebates in one-on-one, group and class settings.

As previously advised and in keeping with the intention of the natural therapy reforms, Pilates-only sessions will no longer be funded as of 1 April next year.

The reform of natural therapies was designed to eliminate rebates for non evidence-based therapies, and not intended to impact physiotherapy.

However, the review into natural therapies conducted by the government and announced last year did not differentiate between Pilates-informed exercises prescribed by physiotherapists as part of a treatment program and Pilates offered by fitness instructors and in other contexts.

We at the living well studio have worked very hard to make sure we are in alignment with this reform as we are passionate about evidence based preventative and rehabilitative health care. 

As part of these standards we as physios working with the service we provide at The Living Well Studio must provide:

1. Individualised assessment of patients in one-on-one, group sessions and classes.

2. A program of exercise-based interventions specific to the patient. In group sessions, this includes adjusting the group program for individuals as required. In both groups and classes, the exercises should address a current health problem.

3. High quality clinical notes that reflect physiotherapy practice.

4. Continuing to monitor patient and therapist goals and ensure reassessments when appropriate.

Service descriptors have not been impacted by the PHI reforms. You can continue to claim item code 560 and 561 where the insurance company allows it.

HCF – The APA have stated that members with HCF have had a harder time getting clear on what they can claim if you are a member of HCF and you want to claim group physiotherapy sessions please let our reception know and our practice managed will liaise with them to work it out.

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As per the government health guidelines on the 22nd of March 2020 non essential services will be closed. This does not include us. While we are still open for our usual services we will be practicing strict and heightened hygiene measures during this time to prevent further spread of COVID-19.

From the PM’s address today, we want to be clear we are not a gym. We are a health care practice, that provides services to optimise health and reduce pain from musculoskeletal injuries and conditions. Our studio team are ensuring complete high grade sanitisation of props and equipment that will only be single person use for each session, and ensuring social distancing. The staff and studio have had no connection to the COVID-19 at this time.

As per the government health guidelines we will not allow access to our services if you answer “yes” to any of the below:

Have you been overseas in the last 14 days?
Have you been in contact with anyone who tested positive for COVID-19 in the last 14 days?
Do you have a dry cough, shortness of breath, fever or sore throat?
If answered yes to any of the above, please call the COVID-19 hotline on 1800 020 080.

We ask patients who are at risk to please let us know before your appointment so we can discuss your position. This includes immune-suppressed, the elderly and those who have been in high-risk areas. We also ask that you call the clinic if you do develop COVID-19 or have come in contact with someone who has so we can act according to the government recommendations.

For all treatments, our linen is being changed for every client and a wipe down of all equipment used. We ask that you remain in your car until your treatment time to minimise patient to patient contact in the waiting area. We also ask that you use ‘tap and go’ for your payment method rather than cash. Also we will not require you to sign your health fund slip to minimise cross use of pens between staff and patients. All our door handles and surfaces are regularly being cleaned during the day.

We ask everyone who comes in for group therapy sessions.

Bring a large towel and socks.
Keep 1.5m distance between yourself and others.
Wash your hands before and after the class.
If you need to cough or sneeze, cover your face and wash or sanitise hands immediately.
If you wish to wear gloves we have them available for you.
Online and Telehealth will be an option in the very near future….watch this space.

We are understanding of each and everyone’s individual position and we deeply care for your health and encourage everyone to take steps to keep strong and healthy at this time. Please feel free to call or email our staff to voice your concern and receive guidance. We are dedicated to informing you of our position and future movements in relation to Covid-19.

Thank you for your cooperation and support.

TLWS Management team.