Funding pathway 2 of 3 · Medicare

Medicare rebates for speech & OT

Medicare doesn’t fund therapy in full, but several pathways give a rebate towards speech pathology and occupational therapy for children. Here’s what each one covers, and the referral you’ll need before your first eligible session.

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At a glance

Medicare pathways at a glance

Session limits are shared across allied health professions, not counted separately for each therapist.

GP Chronic Condition Management PlanUp to 5 per yearShared across allied health. Covers speech therapy and OT.
Complex neurodevelopmental (Item 135)8 + 20 per lifetimeAssessment and treatment services, used before age 25. Speech therapy and OT. Since March 2026, also stuttering, speech sound disorders and cleft for speech.
Better Access10 + 10 per yearIndividual and group services. Occupational therapy only, and we have an OT registered.
Aboriginal and Torres Strait IslanderUp to 10 per yearFollowing a health assessment. Speech therapy and OT.
Therapist reacting with delight as a toddler smiles during a session
How it works

Before you book a Medicare-funded session

The referral has to be in place before the eligible service is provided. A rebate can’t be applied afterwards. Ask your GP, paediatrician or psychiatrist which pathway is most appropriate for your child.

If your child already sees a psychologist, physiotherapist or dietitian, check how many services have already been used, because the limits are shared.

Referral firstIn place before the first eligible session.
Shared limitsCounted across all allied health, not per therapist.
Expect a gapThe rebate covers part of the fee, not all of it.
One referral per professionUsually a separate referral for speech and for OT.
Pathway by pathway

How each Medicare pathway works

Your referring doctor decides which pathway fits. Bringing this list to the appointment can help the conversation.

GP Chronic Condition Management Plan

Speech therapyOTPer calendar year

For a child with at least one condition that has lasted, or is expected to last, at least six months and who would benefit from coordinated care. It’s sometimes still called by its older name, a Chronic Disease Management (CDM) plan. It replaced GP Management Plans (GPMPs) and Team Care Arrangements (TCAs) on 1 July 2025.

Covers
Up to 5 allied health services per calendar year, shared across occupational therapy, speech pathology, psychology, physiotherapy and dietetics. Not five per profession.
Item numbers
Speech pathology 10970 · Occupational therapy 10958
Referral
A standard referral letter from your GP, in place before the session. The old allied health referral form is no longer used. Your child’s plan needs to have been prepared or reviewed by the GP in the last 18 months.
Older plans
A GPMP or TCA made before 1 July 2025 can still be used for allied health services until 30 June 2027, and referrals written before 1 July 2025 stay valid until their services are used. From 1 July 2027, a GP Chronic Condition Management Plan is needed.
Rebate
A set rebate per service, indexed periodically, with the balance payable by you. Services Australia publishes the current amount.

Complex neurodevelopmental disorder and disability pathway (Item 135)

Speech therapyOTLifetime, under 25

Often called the M10 pathway or simply “item 135”. It’s for a person under 25 with a suspected or diagnosed complex neurodevelopmental disorder, such as autism, or another eligible disability. Since 1 March 2026 it also covers speech pathology for stuttering, cleft lip and/or palate, and speech sound disorders (articulation and phonological disorders, childhood apraxia of speech and dysarthria). These added conditions are for speech pathology only, and developmental language disorder (DLD) on its own isn’t included.

Covers
Up to 8 assessment and 20 treatment services per lifetime, used before age 25 and shared across eligible allied health professions.
Speech pathology
Assessment 82005 · Treatment 82020 (after a treatment and management plan is in place)
Occupational therapy
Assessment 82010 · Treatment 82025
Referral
From a paediatrician, psychiatrist or other eligible medical practitioner. For stuttering, cleft lip and/or palate and speech sound disorders, a GP, consultant physician or specialist can refer. A separate written referral is generally needed for each profession.
Good to know
Item 135 is the paediatrician’s own item for the treatment and management plan. It isn’t the speech pathology or OT item. Services on this pathway are in addition to any GP Chronic Condition Management Plan services, but the two can’t be claimed for the same session.

Better Access Mental Health Treatment Plan

OT onlyPer calendar year

Your child’s GP assesses their needs and decides whether they’re eligible for a Mental Health Treatment Plan. This pathway doesn’t cover speech pathology.

Covers
Up to 10 individual and 10 group mental health services per calendar year. The first referral is usually for up to six sessions, with a GP review needed for the rest.
Item number
Occupational therapy 80135 (clinic appointment of at least 50 minutes)
Referral
From your GP, with a review before the remaining sessions.
Good to know
Only available with an OT who is registered with Medicare to provide Better Access focused psychological strategies, and the session must use those strategies. The Bridge Effect has an occupational therapist registered for Better Access.

Aboriginal and Torres Strait Islander health pathway

Speech therapyOTPer calendar year

For Aboriginal and Torres Strait Islander children who have completed an appropriate health assessment, or who meet the chronic-condition pathway requirements.

Covers
Up to 10 individual allied health services per calendar year, used for one discipline or shared across several.
Item numbers
Speech pathology 81360 · Occupational therapy 81330
Referral
A medical practitioner identifies the need for follow-up services and provides a referral.
Good to know
These services count towards the overall annual limit across the First Nations and chronic-condition items.
Important points

Rules that apply to every pathway

  • Expect a gap paymentMedicare rebates generally don’t cover the entire fee.
  • Referral before the sessionIt must be in place before the eligible service is provided.
  • Limits may be sharedCheck how many services other allied health professionals have already used.
  • One referral per professionA separate written referral is generally needed for speech and for OT.
  • Not with NDIS for one sessionMedicare and NDIS can’t both be claimed for the same appointment.
  • Rules can changeConfirm remaining services with Medicare or your referring practitioner.
Using your referral

How to use a Medicare pathway with us

A referral has to be in place before the first eligible session. Here’s how it usually works.

  1. See your doctor

    Ask your GP, paediatrician or psychiatrist which pathway fits your child.

  2. Get the right referral

    A written referral for each profession, in place before the first eligible session.

  3. Send it to us

    Share the referral before the first appointment and we’ll confirm what’s claimable and the likely gap.

  4. Receive your rebate

    Medicare pays a set rebate per eligible session, with the balance payable by you.

FAQs

Questions about Medicare rebates

Answers to common questions about Medicare and therapy for children. Can’t see yours? Call us on (02) 9037 1163.

All FAQs
Which Medicare pathway is right for my child?

That’s a decision for your GP, paediatrician or psychiatrist. They’ll consider your child’s diagnosis or suspected diagnosis, how long the condition has lasted, and what other supports are in place. Bringing the list of pathways from this page to the appointment can help the conversation.

How many sessions do we actually get?

Often fewer than families expect, because the limits are shared across professions. Five services on a Chronic Condition Management Plan means five across speech pathology, occupational therapy, psychology, physiotherapy and dietetics combined, not five of each. The Item 135 pathway’s 8 assessment and 20 treatment services are lifetime limits, shared the same way.

Can I claim Medicare and private health insurance for the same session?

No. Where a Medicare rebate is claimed for an appointment, you can’t also claim the gap from your private health fund for that same appointment. Our private health insurance page explains how extras cover works.

We have an NDIS plan. Can we use Medicare as well?

Not for the same appointment. Medicare and NDIS can’t both be claimed for one session. Some families use each for different services across the year. See our NDIS page for how we work with self-managed and plan-managed participants.

Can my child get Medicare rebates for stuttering or a speech sound disorder?

Since 1 March 2026, yes, if your child is under 25. Stuttering, speech sound disorders (such as articulation or phonological disorders, childhood apraxia of speech or dysarthria) and cleft lip and/or palate are now eligible for speech pathology on the Item 135 pathway, with up to 8 assessment and 20 treatment services per lifetime. Your GP, a consultant physician or a specialist can refer. Developmental language disorder on its own isn’t included.

We have an older GP Management Plan and Team Care Arrangement. Is it still valid?

Yes, for now. Plans made before 1 July 2025 can still be used for allied health services until 30 June 2027, and referrals written before then stay valid until their services are used. When your GP next reviews the plan, they’ll usually move your child to a GP Chronic Condition Management Plan.

Do we need a new referral each year?

For the calendar-year pathways, generally yes. A review and a fresh referral are usually needed for each new year’s services. The Item 135 pathway has lifetime rather than annual limits, but a written referral is still required for each allied health profession. Your referring practitioner will confirm exactly what you need.

Explore more

Other ways to fund therapy

Many families use more than one pathway across the year, one funding source per session.

NDIS funding

For self-managed and plan-managed participants using Capacity Building – Improved Daily Living funding.

Private health insurance

How extras cover works for speech pathology and OT, and what to ask your fund before you book.

All funding options

Compare NDIS, Medicare and private health side by side, and find the pathway that fits your family.

Bringing a referral for speech therapy or occupational therapy? Both services are under one roof at our Northmead clinic. See the areas we serve.

Last reviewed: 29 October 2026. Medicare item numbers, session limits and rebate amounts are set by the Australian Government and reviewed periodically. Confirm your child’s eligibility and remaining services with Medicare or your referring practitioner.

Get started

Bringing a Medicare referral to us?

Send through your referral before the first appointment and we’ll confirm what’s claimable and what the gap will be, so there are no surprises on the day.

  1. Get your referral first

    See your GP, paediatrician or psychiatrist about the pathway that fits your child.

  2. Send it to us

    Share the referral before the first appointment and we’ll confirm what’s claimable and the likely gap.

  3. Meet, assess and plan

    We get to know your child, assess their strengths and needs, and set goals together with you.

Start your booking Call (02) 9037 1163