Medicare rebates for Speech Therapy and Occupational Therapy
Medicare does not fund therapy in full, but several pathways provide a rebate towards the cost of speech pathology and occupational therapy for children. Which one applies depends on your child’s needs and who refers you.
Below are the four pathways families most often use at The Bridge Effect, what each covers for speech therapy and OT, and the referral you will need before your first eligible session.
The referral has to be in place before the eligible service is provided — a rebate cannot be applied afterwards. Ask your GP, paediatrician or psychiatrist which pathway is most appropriate for your child.
Session limits are shared across allied health professions, not counted separately for each therapist. If your child already sees a psychologist, physiotherapist or dietitian, check how many services have already been used.
Your GP assesses whether your child is eligible. This pathway applies to 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 is sometimes still referred to by its older name, a Chronic Disease Management (CDM) plan.
What it covers: up to 5 allied health services per calendar year. Those five services are shared across eligible allied health disciplines — occupational therapy, speech pathology, psychology, physiotherapy and dietetics — not five per profession.
Item numbers: occupational therapy is claimed under MBS item 10958. Speech pathology is claimed under its own MBS item; your GP’s referral will name the profession being referred to.
Referral: from your GP, as part of preparing the plan, and in place before the session.
Rebate: Medicare pays a set rebate per service, which is indexed periodically. The balance is payable by you. Services Australia publishes the current amount.
Often called the M10 pathway or simply “item 135”, this is for a person under 25 with a suspected or diagnosed complex neurodevelopmental disorder — such as autism — or another eligible disability. A paediatrician, psychiatrist or other eligible medical practitioner determines eligibility and establishes the pathway.
What it covers: up to 8 allied health assessment services and 20 treatment services per lifetime — 28 in total, and they must be used before the person turns 25. These limits are shared across eligible allied health professions, not counted separately for each therapist.
Speech pathology: assessment is claimed under MBS item 82005. Following diagnosis and completion of a treatment and management plan, treatment is claimed under item 82020.
Occupational therapy: assessment is generally claimed under item 82010, and treatment under item 82025.
Important: item 135 is the paediatrician’s own medical item for developing the treatment and management plan. It is not the speech pathology or occupational therapy item. A separate written referral is generally required for each allied health profession.
Your child’s GP assesses their needs and determines whether they are eligible for a Mental Health Treatment Plan.
What it covers: up to 10 individual and 10 group mental health services per calendar year. The first referral is usually for up to six individual sessions; a GP review and a new referral are needed to access the remaining sessions.
Important: this pathway can only be used with an occupational therapist who is registered with Medicare to provide Better Access focused psychological strategies, and the treatment itself must involve those approved strategies. For a clinic appointment of at least 50 minutes, the OT item is 80135.
This pathway does not cover speech pathology.
For Aboriginal and Torres Strait Islander children who have completed an appropriate health assessment, or who meet the chronic-condition pathway requirements.
What it covers: up to 10 individual allied health and First Nations health services per calendar year. The ten services can all be used for one discipline or shared across eligible disciplines.
Item numbers: speech pathology is claimed under MBS item 81340, and occupational therapy under item 81330.
Referral: a medical practitioner must identify the need for follow-up services and provide a referral. These services count towards the overall annual limit across the relevant First Nations and chronic-condition items.
A few rules apply across every Medicare pathway:
That is a decision for your GP, paediatrician or psychiatrist. They will 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.
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.
No. Where a Medicare rebate is claimed for an appointment, you cannot also claim the gap from your private health fund for that same appointment. Our private health insurance page explains how extras cover works.
Not for the same appointment. Medicare and NDIS cannot 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.
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.
Related pages: Funding Options · NDIS funding · Private health insurance · Speech therapy · Occupational therapy · Areas we serve
Last reviewed: 10 September 2026. Medicare item numbers, session limits and rebate amounts are set by the Australian Government and are reviewed periodically. Confirm your child’s eligibility and remaining services with Medicare or your referring practitioner.
Send through your referral and plan details before the first appointment and we will confirm what is claimable and what the gap will be, so there are no surprises on the day.
Call 9037 1163 or visit us at 7/185 Briens Road, Northmead NSW 2152.
