If you've just been told your child needs a psychologist, speech pathologist, or occupational therapist, the cost can feel overwhelming — and the Medicare system can feel even more so. The good news is that Medicare does cover a meaningful share of many allied-health sessions for children, through several distinct pathways. Understanding which pathway applies to your child's situation, and how to use it, can make a real difference to your family's out-of-pocket costs.
This guide explains the three main Medicare funding routes for children's allied-health care in plain English: Better Access (for mental health), the GP Chronic Condition Management Plan (for chronic conditions), and a newer expansion specifically for speech pathology. It also covers who can bill Medicare, why gaps are common, and how to actually submit a claim.
Better Access
The Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative — usually just called Better Access — is the primary Medicare pathway for psychological and allied mental health services. It has been operating since 2006 and it is the route most families use when a child is referred to a psychologist for anxiety, depression, ADHD, PTSD, eating disorders, or a range of other clinically diagnosable mental health conditions.
Under Better Access, eligible patients can claim a Medicare rebate for up to 10 individual therapy sessions and 10 group therapy sessions per calendar year (1 January to 31 December). The rebate amount is set in the Medicare Benefits Schedule (MBS) and is indexed each year on 1 July — check MBS Online for the current figure rather than relying on any amount quoted here.
Better Access covers a wide range of conditions: anxiety disorders, depression, ADHD, conduct disorder, eating disorders, PTSD, OCD, panic disorder, adjustment disorder, sleep problems, enuresis, and others. The condition must be clinically diagnosed — a concern is not enough.
Sessions can be delivered in person or via telehealth (video or phone). Telehealth is a permanent feature of the programme and is available to all eligible Australians where clinically appropriate, regardless of where you live.
From 1 November 2025, the GP mental health treatment plan item numbers were restructured and the programme's rules were tightened around MyMedicare enrolment. This matters practically: the referral must come from your child's usual GP or the GP at your child's MyMedicare-registered practice. If your family recently changed GP practices, it is worth checking with the new practice before booking a specialist.
Mental Health Care Plans
A Mental Health Treatment Plan (MHTP) — also widely called a Mental Health Care Plan or MHCP — is the document your GP prepares before your child can access Better Access sessions. Both names refer to the same thing.
Who qualifies?
To be eligible, your child must:
- Have a clinically diagnosed mental disorder (not just a concern or a risk factor).
- Require at least a moderate level of support.
- Be likely to benefit from a structured approach to care.
A GP, psychiatrist, or paediatrician can initiate the referral. If a psychiatrist refers, they prepare a Psychiatrist Assessment and Management Plan (PAMP) instead; if a paediatrician refers, they can provide a direct referral. Neither requires an MHTP to be in place first.
What the plan covers
The GP prepares the MHTP together with your family. It sets out your child's diagnosis, treatment goals, referral arrangements, and a review schedule. Once the plan is in place, the GP issues a referral letter for the allied health professional.
Importantly, the initial referral covers a maximum of 6 sessions — not the full 10. After those sessions, your child returns to the referring practitioner for a review. That review determines whether to refer for up to 4 remaining sessions (to reach the 10-per-year cap). Reviews cannot happen more often than once every 3 months, or within 4 weeks of the plan being prepared, except in exceptional circumstances.
An MHTP does not expire. You do not need a new plan each year. At the start of a new calendar year, a fresh referral letter is needed to recommence funded sessions, but the underlying plan stays in place.
Who can provide the treatment?
Under Better Access, your child can see:
- A clinical psychologist — providing Psychological Therapy sessions (the higher-rebate item group).
- A registered psychologist (without clinical endorsement), an eligible occupational therapist (OT), or an eligible social worker — all providing Focussed Psychological Strategies (FPS) sessions (a separate item group with a different rebate level).
Sessions with clinical psychologists attract a higher Medicare rebate than sessions with registered psychologists, OTs, or social workers — though both groups provide evidence-based treatment. The current rebate for each item type is listed on MBS Online.
One further point: a carer or family member can attend up to 2 sessions per year as part of the child's treatment (with the child's consent, and without the child present). Those sessions count against the child's annual allocation.
Chronic Condition Management Plans (formerly CDM/GPMP+TCA)
Not every child who needs allied-health support has a mental health condition. Many children with communication disorders, developmental delays, or other chronic health conditions can access a separate Medicare pathway: the GP Chronic Condition Management Plan (GPCCMP).
Parents who have navigated this system before may know it by older names: the GP Management Plan and Team Care Arrangements (GPMP+TCA), the Chronic Disease Management Plan (CDM), or the "EPC referral" or "Care Plan". These all refer to the same pathway. As of 1 July 2025, the official name is the GP Chronic Condition Management Plan (GPCCMP). Families who had a GPMP+TCA in place before 1 July 2025 can continue accessing services under those plans until 30 June 2027, at which point a GPCCMP will be required.
Who qualifies?
Your child must have a medical condition that has been present (or is likely to be present) for at least 6 months, or a terminal condition. There is no fixed list of qualifying conditions — it is the GP's clinical judgement. In practice, this often applies to children with:
- Speech and language disorders.
- Developmental delay.
- Autism spectrum disorder (where ongoing allied-health input is part of chronic care management).
- Other long-term health conditions requiring multidisciplinary support.
What it provides
Under the GPCCMP, eligible patients can access up to 5 allied-health services per calendar year across all referrals combined. Those 5 sessions can be used with a single profession or split across multiple disciplines — for example, 3 speech pathology sessions and 2 occupational therapy sessions.
Eligible allied health professions include: audiologists, chiropractors, diabetes educators, dietitians, exercise physiologists, mental health workers, occupational therapists, osteopaths, physiotherapists, podiatrists, psychologists, and speech pathologists.
Each session must be at least 20 minutes in duration and delivered in person (not group).
The GP decides which allied-health professions are recommended in the plan. A referral under this pathway is typically valid for 18 months from the first service date (unless a shorter timeframe is stated on the referral). The current MBS rebate for each GPCCMP item type is listed on MBS Online — the dollar figure updates each 1 July.
How it differs from Better Access
These two pathways are separate and serve different purposes. Better Access is for diagnosed mental disorders; GPCCMP is for chronic conditions with complex care needs. Some children will legitimately use both — for example, a child with a chronic communication disorder (GPCCMP) who also has a co-occurring anxiety disorder (Better Access). When that happens, the session counts are tracked independently. However, a child cannot use the same practitioner for the same condition under both pathways at the same time.
Speech-pathology M10 group (March 2026)
From 1 March 2026, a significant new Medicare expansion took effect for speech pathology. Children and young people under 25 with any of the following conditions now have access to Medicare-funded speech pathology sessions through the M10 item group (complex neurodevelopmental conditions and eligible disabilities):
- Stuttering
- Speech sound disorders
- Cleft lip and/or palate
Under this pathway, eligible young people can access up to 8 assessment sessions and 20 treatment sessions before they turn 25. This is entirely separate from both Better Access and the GPCCMP — it is not a top-up to the 5-session GPCCMP limit, nor does it affect a Better Access allocation.
As Speech Pathology Australia noted when the expansion was announced, around 385,000 children and young people stand to benefit from better access to the speech pathology support they need, backed by Medicare for the first time.
If your child has a stutter, a speech sound disorder, or a cleft lip or palate, ask your GP or paediatrician whether they are eligible to be referred under the M10 item group. This is a meaningful new entitlement that many families are not yet aware of.
Eligible practitioners
Not every psychologist, speech pathologist, or OT can bill Medicare. To provide Medicare-funded services, a practitioner must:
- Hold current AHPRA registration (for professions regulated under AHPRA — including psychologists and occupational therapists) or the relevant professional accreditation (for social workers, registration with the Australian Association of Social Workers is required).
- Be registered with Services Australia and hold an active Medicare Provider Number.
The provider number is specific to both the practitioner and their practice location. It must appear on the invoice for a rebate to be claimed.
Under Better Access, clinical psychologists must also hold an approved area-of-practice endorsement in clinical psychology — simply being a registered psychologist is not sufficient for the higher-rebate Psychological Therapy items.
The practical implication for parents: always confirm that your chosen provider has a Medicare Provider Number before booking. A practitioner may be highly skilled but not registered for Medicare billing. Ask the receptionist directly — it's a routine question and good practices will answer it readily.
Gap fees vs bulk-billing
Medicare sets a schedule fee for each MBS item. For out-of-hospital services, the Medicare benefit is 85% of the schedule fee (or 100% if the practitioner bulk bills).
Bulk billing means the practitioner accepts the Medicare benefit as full payment. The family pays nothing out of pocket. Bulk billing under Better Access is relatively uncommon — it tends to occur for concession card holders or in areas with specific access initiatives — but it does exist. Always worth asking.
For the majority of services, practitioners charge more than the MBS schedule fee and the family pays the gap: the difference between the practitioner's charge and what Medicare pays back. Practitioners are entitled to set their own fees and are under no obligation to charge the MBS schedule fee. A meaningful out-of-pocket gap is common, and the gap can vary considerably depending on the practitioner's location, seniority, and practice model.
Do not rely on any dollar amount you see quoted online — including in this article — to predict your actual gap. Fees change, and there is genuine variation across providers. Always call the practice and ask what the full session fee is and whether they offer any concession or bulk-billing arrangements before your first appointment.
A few additional points worth knowing:
- Private health insurance cannot be used to top up the Medicare benefit for the same service. You must choose one or the other — they cannot be combined for a single session.
- Medicare Safety Net: out-of-pocket expenses accumulate toward the Medicare Safety Net threshold each calendar year. Once you reach the threshold, Medicare pays a higher proportion of remaining out-of-pocket costs for the rest of the year. Check Services Australia for current thresholds.
- If Better Access sessions run out and the family cannot afford full fees, Medicare Mental Health Centres offer free walk-in mental health support with no referral, no Medicare card, and no cost. Your GP can advise on the nearest centre.
How to claim
Before anything else, your child must be enrolled in Medicare and appear on a Medicare card (or be linked to one). Parents can enrol a child at a Services Australia service centre or via myGov.
Once you've had a session, there are several ways to claim:
On the spot (fastest and most common): After you pay at the practice, ask the receptionist to submit an electronic claim on your behalf. The Medicare benefit is paid into the bank account registered with Medicare — usually within 24–48 hours.
Bulk billing (no action needed): If the practitioner bulk bills, they lodge the claim directly. You pay nothing and receive nothing — Medicare deals directly with the provider.
Via myGov or the Express Plus Medicare app: Log into your Medicare account, select "Make a claim", and enter the details from your receipt. The benefit typically arrives within 7 days.
By mail or in person at a service centre: Download the Medicare claim form (MS014) from the Services Australia website, complete it, and post it or take it to a service centre. Allow up to 21 days for processing.
Make sure your bank account details are registered with Medicare (via myGov or the app) so benefits can be paid electronically. You can also view your child's care plan history and recent claim status through your Medicare online account.
Full claiming guidance is available at Services Australia — Medicare claims.
Common questions
Does my child need a new Mental Health Treatment Plan every year?
No. An MHTP does not expire, and a new plan should not be created each January without exceptional reason. However, your child does need a fresh referral letter at the start of each calendar year to recommence funded sessions. After the initial 6-session referral is exhausted, a GP review is also required before the final sessions (up to the 10-per-year cap) can be referred.
Can my child see two different practitioners under the same plan?
Yes. The referral letter covers a set number of sessions, and those sessions can be used with a different treating professional — provided the new practitioner is also Medicare-registered. All sessions count toward the child's calendar-year total, regardless of which practitioner delivered them.
What if my child misses a session?
Only attended sessions attract a Medicare rebate. Medicare pays per service rendered, not per referral. If a booked appointment is not attended, no Medicare benefit is paid (though the practice may charge a cancellation fee under its own policy). Unused sessions on a referral at year's end carry over but count toward the following year's limit.
Can my child use both Better Access and the GPCCMP in the same year?
Yes, if they have separate qualifying conditions. Better Access is for diagnosed mental disorders; the GPCCMP is for chronic conditions with complex care needs. The two pathways are counted independently. A child cannot, however, use the same practitioner for the same condition under both pathways simultaneously.
What happens when the 10 Better Access sessions run out?
Once the annual limit is exhausted, the family can: continue seeing the practitioner at full out-of-pocket cost; access private health insurance ancillary cover if applicable (not combined with Medicare for the same service); or seek support through Primary Health Networks (PHNs) or Medicare Mental Health Centres, which are free and require no referral.
Do we need to bring the Medicare card to every appointment?
Practices need your Medicare card details on file to submit claims. Many practices store these details and will only need to see the card once. Digital Medicare cards via the Medicare app or myGov app are accepted.
What to do next
Medicare funding is one piece of the puzzle — finding the right practitioner for your child is another. EarlyBloom's provider directory lets you filter by funding type so you can see practitioners who accept Medicare referrals and narrow by location, specialty, and availability.
- Search for Medicare-eligible providers near you
- Not sure which type of support your child needs? Take the EarlyBloom quiz — it takes about 3 minutes and points you toward the most relevant pathways and provider types for your child's situation.
If you have questions about whether your child qualifies for a particular Medicare pathway, your GP is the right first call. They can assess eligibility, prepare the relevant plan, and issue the referral that makes the funding available.