Medicare rebate paediatric therapy: a parent guide

If your child has just been referred for psychology, speech pathology, or occupational therapy, you are probably trying to work out what Medicare actually pays for, and what the gap will cost. This page lays out the three Medicare pathways for kids in plain English, with current rebate amounts and the rule changes that took effect in late 2025 and early 2026.

Three Medicare pathways your child might use

There is no single Medicare programme called "paediatric therapy". There are three separate pathways, each with its own rules, session limits, and rebate amounts. Most families only ever use one. A small number of children with co-occurring conditions will legitimately use two.

The right pathway depends on what is going on for your child, not on what is most convenient for the clinic. Your GP decides which one applies and signs the referral.

Sources: Services Australia (mental health care and Medicare); Services Australia (allied health referrals for GP chronic condition management plans); Speech Pathology Australia (Medicare expansion for speech pathology, March 2026).

Better Access for diagnosed mental disorders

The Better Access initiative is the Medicare pathway most families use when a child sees a psychologist for anxiety, ADHD, depression, OCD, eating disorders, sleep problems, or another diagnosable mental disorder. It has been running since 2006 and is described by the Department of Health as supporting people with "mild to moderate" mental health conditions.

What you actually get

Eligible patients can claim a Medicare benefit for up to 10 individual and 10 group therapy sessions per calendar year (1 January to 31 December). The condition has to be a clinically diagnosed mental disorder — a concern is not enough.

There is one detail that catches many families out: a single referral covers a maximum of 6 sessions, not the full 10. After those 6, your child returns to the referring practitioner for a review, who decides whether to refer for the remaining 4. The Australian Psychological Society puts it plainly: "Referrals cannot be provided for the full 10 sessions. A referral is for a maximum of six sessions."

Who can refer

A GP can prepare a Mental Health Treatment Plan (MHTP) and refer your child. A paediatrician or psychiatrist can also issue a direct referral without an MHTP being in place — useful if your child is already under specialist care.

Since 1 November 2025, Medicare benefits are only payable when the MHTP, review, and referral are done by your child's usual medical practitioner — defined as the GP who has provided most of your child's care over the previous 12 months — or by a GP at the practice where your child is enrolled in MyMedicare. If your family changed GP practices recently, check enrolment before booking.

Who can treat your child

Under Better Access, a child can see:

• A clinical psychologist — providing Psychological Therapy services (the higher-rebate item group: MBS 80000–80015).
• A registered psychologist, an eligible occupational therapist, or an eligible social worker — providing Focussed Psychological Strategies (MBS 80100–80175).

Speech pathologists are not eligible providers under Better Access. If speech is the issue, the GPCCMP or M10 pathways apply instead.

Family and carer sessions

A parent or carer can attend up to 2 sessions per calendar year without the child present, as part of the child's treatment. Those sessions count against the child's 10-session allocation, not as extras.

If anxiety is what brought you to this page, the anxiety and mood concerns hub covers what is typical at different ages and the supports that help. The psychology services hub explains what paediatric psychologists actually do.

Sources: Department of Health (Better Access initiative); Services Australia (eligibility for a Mental Health Treatment Plan); Services Australia (MBS billing rules for mental health services); Australian Psychological Society (Better Access FAQs).

The GP Chronic Condition Management Plan

If your child has a chronic condition — a speech or language disorder, developmental delay, or autism with ongoing allied-health needs — the GP Chronic Condition Management Plan is usually the pathway. Many parents will know it by older names: GP Management Plan and Team Care Arrangements (GPMP+TCA), Chronic Disease Management plan (CDM), Enhanced Primary Care plan (EPC). All of those terms refer to the same idea, but the official name from 1 July 2025 is the GP Chronic Condition Management Plan (GPCCMP).

Who qualifies

Services Australia defines a chronic condition as one that is "present or likely to be present for 6 months or longer" — or terminal. There is no fixed list. It is the GP's clinical judgement, based on what they observe and the reports they have. In practice, paediatric conditions that frequently qualify include:

• Speech sound disorders, language disorders, and stuttering
• Developmental delay (cognitive, motor, or social)
• Autism spectrum disorder where allied-health input is part of ongoing care
• Other long-term conditions requiring multidisciplinary support

What you get

Once the GPCCMP is in place, your child can access 5 individual allied-health services per calendar year, across all professions combined. Five services can be used with one practitioner — for example, five speech pathology sessions — or split across disciplines, like three speech and two occupational therapy.

Eligible allied-health professions are: audiologists, chiropractors, diabetes educators, dietitians, exercise physiologists, mental health workers, occupational therapists, osteopaths, physiotherapists, podiatrists, psychologists, and speech pathologists.

Each service has to be delivered face-to-face for at least 20 minutes, individually (group treatment is not claimable). The referral letter is valid for 18 months from the first service date unless your GP states a shorter period.

What changed in 2025, and what is still changing

If your family had a GPMP+TCA in place before 1 July 2025, those plans continue to operate until 30 June 2027. From 1 July 2027 a GPCCMP will be required for ongoing access. Practices generally roll patients onto the new format at the next routine review rather than rewriting plans en masse.

Sources: Services Australia (GP chronic condition management plan); Services Australia (requirements for a chronic condition management plan); Services Australia (allied health referrals for GP chronic condition management plans); Speech Pathology Australia (fees, rebates and funded programs).

M10: a new pathway for stuttering, speech sound disorders, and cleft

From 1 March 2026, a meaningful change took effect for paediatric speech pathology. The Medicare M10 item group — previously available for autism and a defined list of eligible disabilities — was expanded to cover three additional conditions for children and young people under 25 years of age:

• Stuttering
• Speech sound disorders (articulation disorder, phonological disorder, childhood apraxia of speech, dysarthria)
• Cleft lip and/or palate

Eligible children can claim up to 8 assessment sessions and 20 treatment sessions under M10. This is a lifetime cap — the count runs from the first session to the 25th birthday, not per calendar year. The current Medicare benefit is $87.25 per face-to-face session (item 82005 for assessment, 82020 for treatment), as listed by Speech Pathology Australia and the MBS in February 2026.

A referral is required from a GP, consultant physician, or specialist. The referrer must suspect or have diagnosed an eligible condition.

This is separate from both Better Access and the GPCCMP. If your child also has a chronic condition, the GPCCMP's 5 sessions per year and the M10 lifetime cap can be used together — but not for the same session on the same day.

One important caveat

Developmental Language Disorder (DLD) is not included in the 1 March 2026 expansion, despite the language-disorder framing of the announcement. Speech Pathology Australia continues to advocate for DLD inclusion. If your child has DLD without one of the eligible conditions above, the GPCCMP is currently the Medicare pathway available.

Sources: Speech Pathology Australia (Medicare expansion for speech pathology, March 2026); Speech Pathology Australia (fees, rebates and funded programs); MBS Online (allied health services for eligible disabilities — addition of stuttering, speech sound disorders and cleft lip and/or palate).

Eligible practitioners and current rebate amounts

Not every clinician with the right qualification can bill Medicare. Two things have to be true. The practitioner must hold current AHPRA registration in their profession (or, for social workers, accreditation with the Australian Association of Social Workers). And they must hold an active Medicare provider number at the practice location where they see your child.

Always check with the receptionist before booking — it is a routine question and good practices answer it without hesitation.

The current Medicare schedule fees and benefits (effective from 1 July 2025) for the most common paediatric items are:

The Medicare benefit is 85% of the schedule fee for out-of-hospital allied-health services. There are also longer-consultation items at higher rebates — your practitioner will choose the right item based on session length and content.

Sources: Services Australia (MBS billing rules for mental health services); Australian Psychological Society (Better Access FAQs); MBS Online item descriptors.

Bulk billing, gap fees, and the Medicare Safety Net

Few paediatric clinicians bulk-bill — accepting the Medicare benefit as full payment — under any of these three pathways. It happens, particularly for concession-card holders or in specific access programmes, but it is the exception. Most families pay the full session fee and claim the rebate back.

A worked example for a Better Access psychology session with a clinical psychologist:

• Practice fee: $260
• Medicare benefit (item 80000): $98.95
• Out-of-pocket gap: $161.05

Practitioners set their own fees and are not bound to charge the schedule fee. Out-of-pocket costs vary considerably by location, seniority, and practice model. Always ring the practice and ask the full session fee, the rebated amount, and any concession arrangement before booking — this is a normal question.

A few things worth knowing about the Medicare Safety Net: every dollar your family pays out of pocket for out-of-hospital Medicare services counts toward an annual threshold. Once the threshold is reached, Medicare pays a higher proportion of remaining out-of-pocket costs for the rest of the year. The Australian Psychological Society notes the extended Medicare Safety Net pays "80 per cent of your total out-of-pocket expenses for out-of-hospital services" once the threshold is met. Current thresholds change each calendar year — check Services Australia for the figure that applies to your family.

You cannot combine Medicare and private health insurance for the same session. You choose one or the other. You also cannot claim a Medicare rebate for a session that is funded by the NDIS.

Sources: Australian Psychological Society (Better Access FAQs); Speech Pathology Australia (fees, rebates and funded programs).

How to claim the rebate

Before anything else, your child needs to be enrolled in Medicare — most are, via a parent's card. You can enrol a child through myGov or at a Services Australia service centre.

Once you have had a session, there are four ways to claim:

• At the practice (most common). Pay the full fee, then ask the receptionist to lodge an electronic claim. The rebate lands in your bank account, usually within 24–48 hours.
• Bulk billing. If the practitioner bulk-bills, they lodge the claim directly. You pay nothing.
• Through Medicare online or the Express Plus Medicare app. Log in via myGov, choose "Make a claim", and enter the receipt details. Benefit usually arrives within 7 days.
• By post or in person. Download form MS014 from the Services Australia website, complete it, and post it. Allow up to 21 days.

Make sure your bank account details are registered with Medicare so the benefit can be paid electronically. The receipt from the clinic must show the practitioner's provider number, the MBS item number, the referring doctor's name and provider number, the date of the referral, and the amount charged — all of which a competent practice provides without being asked.

Sources: Services Australia (mental health care and Medicare); Speech Pathology Australia (fees, rebates and funded programs).

What to do next

Medicare funding is one piece of finding the right support for your child. Choosing a clinician who actually has the experience your child needs — and who can bill the relevant Medicare item — is another.

If you have not yet had the GP conversation, that is the right first step. Bring written notes about what you have observed at home and at childcare or school. Ask which Medicare pathway applies. Ask for the referral letter and a copy of any plan that is prepared.

When you are ready to look for a clinician:

Find Medicare-eligible paediatric psychologists, speech pathologists, and OTs near you

If you are not sure which type of support your child needs, the GP is still the right first call. They can assess eligibility, prepare the relevant plan, and issue a referral that opens up the funding.

Information on this page is general in nature and current as of April 2026. Medicare rules change. Always confirm details at servicesaustralia.gov.au or with your GP.