Medicare Rebates

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Some clients may be eligible for a Medicare rebate if your child’s GP or paediatrician has deemed then eligible and provided a referral. See below for more information about the different kinds of rebates that are available.

Chronic Disease Management Plan

Chronic Disease Management Plans (CDM) can allow clients to receive a Medicare rebate for up to 5 allied health sessions in total per calendar year. The rebate for these sessions is typically $52.95 per session.

Chronic Disease Management Plans are intended for people who have conditions that last 6 months or more and who require a structured approach to their treatment that often involves more than one health professional. Speak to your GP to find out whether your child is eligible for a rebate under this plan.

You might sometimes hear your GP referring to this plan as an Enhanced Primary Care Plan (EPC) or Team Care Arrangements Plan (TCA). The rebates and number of allocated sessions are the same for all of these.

If your child is of Aboriginal or Torres Strait Islander descent and they have already used a CDM this calendar year, they may be eligible for a rebate on an additional 5 allied health sessions. Speak to your child’s GP for further information about the Follow Up Allied Health Services for People of Aboriginal or Torres Strait Islander Descent.

Medicare Helping Children with Autism and Better Start for Children with Disability Initiative

Children with a diagnosis of an Autism Spectrum Disorder or eligible disability are often eligible for rebates under this program. Please note that despite having the same name as the Department of Social Service’s ‘Helping Children with Autism’ and ‘Better Start’ programs, these Medicare rebates are in addition to that funding and function in an entirely different way.

This program can allow your child to access a rebate on up to 20 therapy sessions in total throughout their lifetime, provided that their doctor makes the referral before they turn 13 and the sessions are used before they turn 15. The rebate for speech pathology and occupational therapy sessions is usually around $74.80

If your child has a diagnosis of an Autism Spectrum Disorder, the referral will need to be made to us by their paediatrician or consultant psychiatrist.

If your child has a diagnosed eligible disability, the referral can be made to us by their specialist, GP or consultant physician.

We suggest that when asking your child’s doctor about this program, you let them know that you’d like to find out if your child can receive a referral under item M10.1 of the Medicare Benefits Schedule – Provision of Autism, Pervasive Developmental Disorder or Disability Services by Allied Health Professionals – (Items 82000 to 82035). With this information, your doctor will easily be able to look up the eligibility requirements and referral guidelines if they are not already familiar with this program.

How do I claim my Medicare rebate?

We require you to pay the full session fee to us then claim the rebate back from Medicare. Our fee schedule is available here.

We recommend using the Medicare Express Plus app on your mobile device to claim your rebate. You’ll need to register for a myGov account online first and connect your Medicare account.

Alternatively, you could claim your rebate through myGov on your computer or take your receipt into your nearest Medicare office.

If you still have more questions about Medicare or private health rebates, get in touch with us and we’ll be happy to provide you with information specific to your situation.

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