Medicare

Your child will be eligible for a Medicare rebate if they are accessing Occupational Therapy or Speech Pathology services. You need to get a Medicare Plan from your GP or Paediatrician prior to your first session in order to claim the rebate. Please note that we charge a gap fee, so you will have some out of pocket expenses. 

The following is an outline of the Medicare rebates available when receiving either Speech Therapy or Occupational Therapy services:

Occupational Therapy 

  • CDMP – Chronic Disease Management Plan 
    • 5 sessions per calendar year
    • $52.95 rebate, $116.05 out of pocket
  • ASD – Autism Spectrum Disorder Plans
    • 20 sessions (one time use) until 15 years of age
    • $112 rebate, $57 out of pocket
  • MHCP – Mental Health Care Plans
    • 10 individual, 10 group sessions per year
    • Individual clinic: $74.80 rebate, $94.20 out of pocket
    • Individual offsite: $96.35 rebate, $72.65 out of pocket
    • Group sessions: $19/session rebate, out of pocket will vary depending on group cost 

Speech Pathology 

  • ASD – Autism Spectrum Disorder Plans
    • There are two seperate codes for Speech Pathology services under this code:
      • Diagnostic assessment: $112/hour rebate, $171 out of pocket
        (3 hours total service - assessment & report)
      • 20 sessions (one time use) until 15 years of age: $112 rebate, $57 out of pocket
  • CDMP – Chronic Disease Management Plan 
    • 5 sessions per calendar year
    • $52.95 rebate, $116.05 out of pocket

 

Rules: 
You cannot pay the gap with your private health insurance. 

ASD and CDMP plans needs to be shared across allied health providers. i.e. 5 sessions equals 5 in total across OT and Speech Therapy if your child is accessing more than one service at a time.