Key takeaways
- Yes, you can often get money back on speech therapy and OT, through Medicare, private health extras or an NDIS plan. None of them covers the full fee, so expect a gap.
- Most families start with a GP Chronic Condition Management Plan: up to 5 allied health sessions a year, shared across all therapists.
- Since 1 March 2026, a GP can refer children with stuttering, speech sound disorders or cleft lip and/or palate to a larger Medicare pathway: up to 8 assessment and 20 treatment sessions before age 25.
- You can’t claim Medicare and private health (or Medicare and NDIS) for the same session, but you can use different options for different sessions across the year.
- Medicare referrals must be in place before the session. A rebate can’t be applied afterwards.
Therapy is an investment, and one of the first questions families ask us in Northmead is “Can I claim any of this back?” The answer is often yes, but the rules are spread across Medicare, private health funds and the NDIS, and they changed in 2025 and again in 2026.
This guide pulls it together in plain English for speech therapy and occupational therapy.
Can I claim speech therapy or OT? The short answer
You can usually claim some of the cost of speech therapy or occupational therapy through:
- Medicare, with a referral from your GP or specialist
- private health insurance, if your extras cover includes speech pathology or occupational therapy
- the NDIS, if your child has a plan that’s self-managed or plan-managed
Each option pays part of the fee, not all of it. Many families combine them across the year.
What are my options at a glance?
| Option | Who it’s for | Sessions | What you need first | Speech therapy | OT |
|---|---|---|---|---|---|
| GP Chronic Condition Management Plan | A child with a condition lasting (or expected to last) 6+ months | Up to 5 a calendar year, shared across all allied health | GP plan and referral | Yes | Yes |
| M10 (also called Item 135): complex neurodevelopmental disorder or eligible disability | Under 25, for example autism or another eligible disability | Up to 8 assessment + 20 treatment, lifetime | Referral from a paediatrician, psychiatrist or other eligible specialist | Yes | Yes |
| M10 speech expansion (from 1 March 2026) | Under 25 with stuttering, a speech sound disorder or cleft lip and/or palate | Same lifetime limits as M10 | Referral from a GP, consultant physician or specialist | Yes | No |
| Better Access mental health | A child with a GP Mental Health Treatment Plan | Up to 10 individual + 10 group a calendar year | GP plan; an OT registered for Better Access | No | Yes |
| Aboriginal and Torres Strait Islander pathway | First Nations children after a health assessment | Up to 10 a calendar year | Referral from a medical practitioner | Yes | Yes |
| Private health extras | Anyone whose policy includes speech pathology or OT | Set by your fund’s annual limit | Nothing (no referral usually needed) | If covered | If covered |
| NDIS | Children with a self-managed or plan-managed NDIS plan | Set by your plan budget | An NDIS plan | Yes | Yes |
Our Medicare rebates page has more detail on each pathway. For Better Access, The Bridge Effect has an occupational therapist registered with Medicare, so you can use it here.
What changed in 2025 and 2026?
From 1 July 2025: one GP plan instead of two. GP Management Plans and Team Care Arrangements (often called “CDM” or “EPC” plans) were replaced by a single GP Chronic Condition Management Plan. Your GP can now refer straight to allied health from that plan. Families with an older plan made before 1 July 2025 can keep using it until 30 June 2027.
From 1 March 2026: more children can access the larger M10 pathway for speech therapy. Children under 25 with stuttering, a speech sound disorder (such as articulation or phonological disorder, childhood apraxia of speech or dysarthria) or cleft lip and/or palate can now be referred by their GP, not just a specialist. It’s the same pathway, with up to 8 assessment and 20 treatment sessions in total before age 25. Developmental language disorder is not included in this expansion.
Which option should I use first?
Every family’s situation is different, but this order works for many:
- Does your child have an NDIS plan that’s self-managed or plan-managed? Therapy is usually funded from the plan’s Capacity Building budget. Medicare can’t be claimed for the same session.
- Could your child be eligible for the M10 pathway? For example autism, another eligible disability, stuttering, a speech sound disorder or cleft lip and/or palate. It offers far more sessions than a GP plan, so ask your GP or paediatrician.
- Otherwise, ask your GP about a Chronic Condition Management Plan. Remember the 5 sessions are shared: if your child also sees a physio or psychologist, they come from the same 5.
- Use private health extras for the rest of the year, once Medicare sessions are used, and keep an eye on your fund’s annual limit.
Your GP, paediatrician or psychiatrist decides which Medicare pathway applies. Bringing this list to the appointment can help the conversation.
How do I claim Medicare, step by step?
- See your GP (or specialist) first. Ask whether your child is eligible for a Chronic Condition Management Plan or the M10 pathway.
- Get a written referral for each therapist. Speech pathology and occupational therapy each need their own referral.
- Send the referral to us before the first Medicare session. We’ll confirm what’s claimable and the likely gap.
- Pay for the session and claim your rebate from Medicare. Our client care team will explain how claiming works when you book.
- Track how many sessions you’ve used, especially if your child sees more than one allied health professional.
- Check in with your GP as needed. Session limits for calendar-year pathways reset on 1 January, and your GP can tell you whether your plan or referral needs a review.
How do private health extras work?
Speech pathology and occupational therapy usually sit under extras (ancillary) cover, not hospital cover. Before you book, call your fund and ask:
- Is speech pathology covered? Is occupational therapy? (Some policies cover one and not the other.)
- How much will I get back for an initial assessment, and for a regular session?
- What’s my annual limit, and is it shared with other extras?
- Do any waiting periods apply?
Give your fund our fee and the service name and they can quote the exact benefit. We issue an itemised receipt for every session, which you can submit to your fund through its app, website or a branch. More on our private health insurance page.
What are the common mistakes to avoid?
- Booking before the referral. A Medicare rebate can’t be applied to a session that happened before the referral was in place.
- Assuming 5 sessions per therapist. The Chronic Condition Management Plan’s 5 sessions are shared across all allied health professionals.
- Double-claiming. You can’t claim Medicare and private health, or Medicare and NDIS, for the same appointment.
- Forgetting the reset. Calendar-year Medicare limits and many fund limits reset on 1 January, so plan December sessions with that in mind.
- Missing the M10 option. If your child stutters, has a speech sound disorder or has cleft lip and/or palate, ask your GP about M10 before using up GP plan sessions.
Getting help at The Bridge Effect
Our client care team is happy to talk through funding before you book. The Bridge Effect supports NDIS self-managed and plan-managed families. We also accept Medicare referrals and issue itemised receipts for private health claims.
See all our funding options, read our NDIS self-managed vs. plan-managed guide, or contact our Northmead team.
Frequently asked questions
Can I claim speech therapy on Medicare?
Often, yes. With a GP Chronic Condition Management Plan, Medicare pays a rebate for up to 5 allied health sessions a year, shared across professions. Children under 25 with autism, another eligible disability, stuttering, a speech sound disorder or cleft lip and/or palate may be eligible for the M10 pathway, with up to 8 assessment and 20 treatment sessions. A referral is needed before the session.
Can I claim occupational therapy on Medicare?
Yes, through a GP Chronic Condition Management Plan, the M10 pathway for children with complex neurodevelopmental disorders or eligible disability, or Better Access with an OT registered to provide mental health services. Each needs the right plan and referral before the session.
Is speech therapy covered by private health insurance?
On many extras policies, yes, but not all. Speech pathology and occupational therapy are often listed separately, so check both. Your fund sets the benefit per session and the annual limit.
Can I use Medicare and private health for the same session?
No. You can’t claim a Medicare rebate and a private health benefit for the same appointment. You can use Medicare for some sessions and private health for others across the year.
Do I need a referral to see a speech pathologist or OT?
Not to book. You only need a referral if you want to claim a Medicare rebate, and it must be in place before the session.
What happened to Chronic Disease Management (CDM) plans?
From 1 July 2025, GP Management Plans and Team Care Arrangements were replaced by the GP Chronic Condition Management Plan. Plans made before 1 July 2025 can still be used until 30 June 2027.
References
- Speech Pathology Australia. Medicare expansion for speech pathology starts 1 March 2026.
- Department of Health, Disability and Ageing. More speech pathology sessions for young people now available through Medicare.
- Services Australia. Services available under a GP chronic condition management plan.
- Department of Health, Disability and Ageing. Upcoming changes to chronic condition management MBS items.