Do I need a referral for physio?

One of the most common questions from people considering physiotherapy is whether they need a referral from their GP before booking an appointment. The short answer is: no — not for a private physiotherapy appointment. However, there are several situations where a referral is required to access a rebate or subsidy. Understanding the distinction may help you plan your appointment and manage your costs.

The short answer: no referral required for private physio

Physiotherapists are primary contact practitioners in Australia. This means you can book and attend a physiotherapy appointment without first seeing a GP or obtaining a referral. You can contact the clinic directly, make an appointment, and attend as a private patient. No letter or referral document is needed.

This applies regardless of the condition you want to have assessed — whether it is a new injury, a chronic issue, a post-surgical question, or a general musculoskeletal concern.

Physiotherapists are primary contact practitioners — you can book directly without first seeing a GP.

When you do need a referral

A referral is required when you want to access physiotherapy through a subsidised or funded pathway. Each pathway has its own requirements.

Medicare Chronic Disease Management (EPC) plan

If you have a chronic condition — one that has been present for six months or longer — your GP may be able to prepare a Chronic Disease Management (CDM) plan, sometimes called an Enhanced Primary Care (EPC) plan. Under this plan, Medicare may contribute towards up to five allied health visits per calendar year, including physiotherapy. Your GP must provide the referral as part of the plan, and the plan must specify physiotherapy as one of the referred services.

DVA (Department of Veterans’ Affairs)

Eligible veterans and war widows/widowers covered by DVA are entitled to physiotherapy services. A GP referral is typically required to initiate DVA-funded physiotherapy, and the referral must specify the condition being treated. The treating physiotherapist will then claim directly against DVA on your behalf, so there is generally no out-of-pocket cost to eligible DVA patients.

WorkCover Queensland

If you have sustained a work-related injury and have an active WorkCover claim, physiotherapy may be funded as part of your injury management plan. A GP or treating medical officer’s referral is required to access WorkCover-funded physiotherapy. Your employer or insurer may also need to be notified, depending on your claim status.

NDIS

NDIS participants with physiotherapy funded under their plan can access physiotherapy without a GP referral — the funding is approved at plan level. However, the physiotherapy must align with your NDIS plan goals, and your physio will need to document how the sessions relate to those goals. Some participants use self-managed or plan-managed funding; others use agency-managed funding with specific registered providers.

What to do if you do not have a referral

If you do not have a referral and are not accessing a subsidised scheme, you can simply book as a private patient. You will pay the private fee for your appointment, and your health fund may contribute a rebate.

If you think you may be eligible for a Medicare CDM plan but do not yet have one, consider seeing your GP before booking physiotherapy. Your GP can assess whether a CDM plan is appropriate and prepare the referral at the same visit.

Private health fund requirements

Most private health funds that include physiotherapy in their extras cover do not require a GP referral. You can attend physiotherapy as a private patient and claim your health fund rebate directly, usually via a HICAPS terminal at the clinic at the time of payment. The amount you can claim depends on your level of cover and your fund’s set benefit for physiotherapy.

It is worth checking your extras cover before booking if out-of-pocket cost is a concern. Your fund’s app or website will show your current annual limit and how much you have already used for physiotherapy in the calendar year.

Summary: when you need a referral

To summarise: a referral is not required for private physiotherapy in Australia. A referral is required for Medicare CDM/EPC, DVA, and WorkCover pathways. NDIS participants generally do not need a separate referral. Private health fund claims do not require a referral. If you are unsure about your funding options, the reception team at Alpha Physio can assist you in clarifying what pathway applies to your situation before you attend.