How Medicare helps with autism, in brief
Medicare has two separate ways to lower the cost of therapy for an autistic child. A GP Chronic Condition Management Plan gives a small number of rebated allied health visits each calendar year. The complex neurodevelopmental items, known as the M10 group, cover assessment, a treatment and management plan and a set number of therapy sessions for people under 25.
Services Australia, Services available under a GP chronic condition management plan ↗Services Australia, MBS billing for complex neurodevelopmental conditions and eligible disabilities ↗
The GP Chronic Condition Management Plan
What it is
Your usual GP can prepare a GP Chronic Condition Management Plan for a medical condition that has lasted, or is likely to last, six months or longer. Your GP decides whether your child is eligible. If your child is registered with a practice through MyMedicare, the plan must be done through that practice.
Services Australia, Requirements for a chronic condition management plan ↗
How many visits
With the plan, your child can get up to 5 rebated individual allied health visits each calendar year. These can all be with one therapist or shared between different types, for example some occupational therapy and some speech pathology. Aboriginal and Torres Strait Islander children can get up to 10.
Services Australia, Services available under a GP chronic condition management plan ↗Services Australia, Allied health referrals for GP chronic condition management plans ↗
Which therapists
Therapists who can provide visits under the plan include speech pathologists, occupational therapists, psychologists, physiotherapists, dietitians, exercise physiologists and audiologists, among others. Each visit must be one on one and in person for at least 20 minutes.
Services Australia, Allied health referrals for GP chronic condition management plans ↗
You don't need a diagnosis first
The plan is based on your child having an ongoing condition and care needs, not on a confirmed autism diagnosis, so it can help while you wait for an assessment. Plans made before 1 July 2025 under the old names can still be used until 30 June 2027.
Services Australia, Requirements for a chronic condition management plan ↗Services Australia, Services available under a GP chronic condition management plan ↗
The complex neurodevelopmental (M10) items for under 25s
Who they are for
These items are for people under 25 who have, or may have, a complex neurodevelopmental disorder such as autism. Complex means your child needs support and shows difficulty in two or more areas of development, such as language, social and emotional development, motor skills, thinking skills or everyday adaptive skills. The doctor decides, using their clinical judgement, whether your child meets this.
Services Australia, Requirements of services for complex neurodevelopmental disorders and eligible disabilities ↗MBS Online, Note AN.0.24 (paediatrician item 135) ↗
Who confirms the diagnosis and writes the plan
A consultant paediatrician (item 135) or a consultant psychiatrist (item 289) confirms the diagnosis and writes a treatment and management plan. Each of these plan items can be claimed once in a person's lifetime. Your GP's role is usually to refer your child to the paediatrician or psychiatrist.
MBS Online, Note AN.0.24 (paediatrician item 135) ↗MBS Online, Note AN.0.72 (psychiatrist item 289) ↗MBS Online, Complex neurodevelopmental disorder and eligible disability FAQs ↗Department of Health, Disability and Ageing, Referral pathway flowchart for complex neurodevelopmental conditions ↗
Allied health assessment before diagnosis
While the doctor is working out a diagnosis, or putting the plan together, they can refer your child to allied health professionals for assessment. Medicare covers up to 8 of these assessment services in a person's lifetime. A therapist can do up to 4 before the referring doctor needs to review and agree to more.
MBS Online, Note MN.10.1 (allied health assessment services) ↗MBS Online, Item 82005 (speech pathology assessment) ↗
Telehealth
These services can be provided and billed by telehealth when the item rules allow.
Treatment sessions cover many kinds of therapy, not speech only
Which therapists
Once the plan is in place, Medicare treatment sessions can be with psychologists, speech pathologists, occupational therapists, audiologists, dietitians, exercise physiologists, optometrists, orthoptists and physiotherapists. The treatment must match the plan your paediatrician or psychiatrist wrote.
MBS Online, Item 82015 (psychology treatment) ↗MBS Online, Item 82020 (speech pathology treatment) ↗MBS Online, Item 82025 (occupational therapy treatment) ↗MBS Online, Item 82035 (other allied health treatment) ↗MBS Online, Complex neurodevelopmental disorder and eligible disability FAQs ↗
What each session involves
Each session is one on one and in person, and lasts at least 30 minutes. At the end of a course of treatment, the therapist sends a written report back to the referring doctor.
MBS Online, Item 82020 (speech pathology treatment) ↗MBS Online, Item 82035 (other allied health treatment) ↗
Referrals
Your child needs a current referral from an eligible doctor, and a separate referral for each therapist they see. The referring doctor decides how the sessions are shared between therapists based on your child's needs.
MBS Online, Note MN.10.2 (allied health treatment services) ↗
Session limits: lifetime totals and per referral
Two kinds of limits apply at the same time. They are easy to mix up.
Lifetime totals
Across your child's whole life, Medicare covers up to 8 allied health assessment services and up to 20 allied health treatment services under these items. These are totals for all therapists combined, not per therapist and not per year.
MBS Online, Note MN.10.1 (allied health assessment services) ↗MBS Online, Note MN.10.2 (allied health treatment services) ↗MBS Online, Note AN.0.24 (paediatrician item 135) ↗
Per referral
Sessions are given in courses. A course of assessment is up to 4 services, and a course of treatment is up to 10 services. So the 20 lifetime treatment sessions are usually used as two or more referrals, for example 10 with one therapist and 10 with another, or two courses with the same therapist.
MBS Online, Note MN.10.1 (allied health assessment services) ↗MBS Online, Note MN.10.2 (allied health treatment services) ↗
Same day limit
Up to 4 assessment or treatment services can be provided on the same day.
MBS Online, Note MN.10.1 (allied health assessment services) ↗MBS Online, Note MN.10.2 (allied health treatment services) ↗
Separate from the GP plan
The GP plan visits (up to 5 each calendar year) are a separate set of items with their own rules. Ask your doctor and therapist which items each session is billed under.
Services Australia, Services available under a GP chronic condition management plan ↗MBS Online, Note MN.10.2 (allied health treatment services) ↗
The speech pathology change from 1 March 2026
From 1 March 2026, the list of eligible disabilities for these Medicare items was expanded to include stuttering, speech sound disorders (including childhood apraxia of speech) and cleft lip or palate. People under 25 with one of these may now get up to 8 assessment and 20 treatment sessions. This change is about those speech conditions, not about autism itself: autism was already covered as a complex neurodevelopmental disorder. It may matter if your autistic child also has one of these speech conditions, so ask your doctor.
MBS Online, Allied health services for eligible disabilities: changes from 1 March 2026 ↗Services Australia, Changes to Medicare speech pathology services ↗MBS Online, Note AR.29.1 (list of eligible disabilities) ↗
Gap fees and out of pocket costs
Rebates are not always the full fee
Therapists and doctors can either bulk bill, so you pay nothing for that service, or charge their own fee. If they charge more than Medicare pays back, you pay the difference. This is called your out of pocket cost.
Services Australia, Medicare billing and claiming basics ↗Department of Health, Disability and Ageing, Medicare safety nets ↗
The Medicare Safety Net
If your family's out of pocket costs for out of hospital Medicare services reach a set amount in a calendar year, Medicare pays back more for the rest of that year. Services Australia keeps a running tally for you.
Department of Health, Disability and Ageing, Medicare safety nets ↗
Ask before you book
Ask each provider what they charge, whether they bulk bill, and which Medicare item they will use, so you know your cost before the first session.
How Medicare differs from the NDIS
Medicare and the NDIS are separate systems. These Medicare items were kept so people under 25 can get rebates for assessment and therapy, including those who may not be eligible for the NDIS, and those waiting for an NDIS decision. Medicare gives a rebate for each eligible session; the NDIS funds supports through a plan. Each needs its own referral or application, so ask your therapist how each session is being paid for.
MBS Online, Complex neurodevelopmental disorder and eligible disability FAQs ↗
Current fees and rebates
We don't list dollar amounts because Medicare fees and rebates change each year, and each provider sets their own fee. Check current amounts on the official pages:
Questions parents ask
Does Medicare cover autism therapy?
Partly. Medicare gives rebates for therapy sessions, not the full cost unless the provider bulk bills. After a paediatrician or psychiatrist confirms the diagnosis and writes a treatment plan, your child can get rebates for up to 20 allied health treatment sessions with therapists such as speech pathologists, occupational therapists and psychologists. A GP plan can also give up to 5 rebated visits a calendar year.
MBS Online, Note AN.0.24 (paediatrician item 135) ↗MBS Online, Complex neurodevelopmental disorder and eligible disability FAQs ↗Services Australia, Services available under a GP chronic condition management plan ↗
How many sessions does Medicare cover for autism?
Under the complex neurodevelopmental items: up to 8 allied health assessment services and up to 20 treatment services in your child's lifetime, given in courses of up to 4 assessment or up to 10 treatment services per referral. Separately, a GP Chronic Condition Management Plan can give up to 5 visits each calendar year.
MBS Online, Note MN.10.1 (allied health assessment services) ↗MBS Online, Note MN.10.2 (allied health treatment services) ↗Services Australia, Services available under a GP chronic condition management plan ↗
Can a psychologist's diagnosis unlock Medicare rebates?
Not on its own. For the complex neurodevelopmental items, the diagnosis is confirmed by a consultant paediatrician or psychiatrist, who may use a psychologist's assessment to help decide. If your child was diagnosed by a psychologist, ask your GP for a referral to a paediatrician or psychiatrist.
MBS Online, Complex neurodevelopmental disorder and eligible disability FAQs ↗
Does my child need to be diagnosed before a certain age?
No. The old rule that a child had to be diagnosed before 13 was removed on 1 March 2023. The treatment items are for people under 25 who have a diagnosis and a treatment and management plan.
MBS Online, Complex neurodevelopmental disorder and eligible disability FAQs ↗
Can we use Medicare while waiting for the NDIS?
Yes. These Medicare items can give rebates before an NDIS decision, and also for people who aren't eligible for the NDIS.
MBS Online, Complex neurodevelopmental disorder and eligible disability FAQs ↗
This is general information, not medical or financial advice. Check with your doctor, your therapist and Services Australia about your child's situation.
Details checked October 2026
