Medicare Benefit Schemes

Medicare Rebates for Speech Therapy and Occupational Therapy

There are two main Medicare pathways that can help with the cost of speech pathology and occupational therapy for your child. Both require a referral from your GP or a specialist, and both provide a rebate rather than covering the full fee — a gap payment usually applies.

Kids Connect Therapy can provide the paperwork you need. If you're not sure which pathway suits your child, call us on (03) 9807 1114 before you see your GP.

1. GP Chronic Condition Management Plan (GPCCMP)

Previously called a GP Management Plan (GPMP), Team Care Arrangement (TCA) or Chronic Disease Management (CDM) plan. These were replaced by the single GPCCMP on 1 July 2025.

What it is

A plan prepared by your GP for a patient with a chronic condition — one that has been, or is likely to be, present for six months or longer. Developmental conditions including autism can qualify.

What it covers

Up to 5 individual allied health services per calendar year, across all providers combined. That includes speech pathology, occupational therapy, physiotherapy, psychology, dietetics and podiatry.

Speech pathology is Medicare item 10970; occupational therapy is item 10958.

The important limits

  • The 5 services are per calendar year(January to December) and are shared across every allied health provider you see, not 5 per provider.
  • Your child must have a GPCCMP that has been prepared or reviewed within the previous 18 months.
  • A gap payment applies. The Medicare rebate does not cover our full fee.
  • 5 sessions a year is rarely enough for meaningful therapy. Most families use a GPCCMP alongside another funding source, or as a starting point while other funding is arranged.

What changed on 1 July 2025

  • GP Management Plans and Team Care Arrangements no longer exist — there is now one plan.
  • The referral is now a standard referral letter from your GP. The old structured referral form is gone, and the referral no longer has to name a specific provider or a number of sessions.
  • Referrals issued on or after 1 July 2025 are valid for the period stated, or for 18 months from the first service if no period is stated.
  • If your child has an existing GP Management Plan or Team Care Arrangement, you can continue using it until 30 June 2027. After that a GPCCMP is required.

How to access it

  1. Book a longer appointment with your GP and explain what you need.
  2. Your GP assesses your child and prepares the GPCCMP.
  3. Your GP writes a referral letter to an allied health provider.
  4. Book with us and bring the referral.
  5. Claim your rebate from Medicare after the appointment.

2. Medicare M10 — complex neurodevelopmental conditions and eligible disabilities

This is the pathway that replaced what families used to know as the "Helping Children with Autism" Medicare items.

What it is

A separate set of Medicare items for children and young people with a complex neurodevelopmental condition or an eligible disability. It provides substantially more sessions than a GPCCMP, but they are lifetime totals, not annual.

Who is eligible

Patients under 25 years of age with one of the following:

Complex neurodevelopmental conditions

  • Autism Spectrum Disorder
  • Other complex neurodevelopmental conditions as assessed by the referring practitioner

Eligible disabilities

  • Cerebral palsy
  • Down syndrome
  • Fragile X syndrome
  • Sight or hearing impairment as specified in the Medicare rules
  • Prader-Willi, Williams, Angelman, Kabuki, Smith-Magenis, CHARGE, Cornelia de Lange, Cri du Chat and Rett syndromes, and microcephaly, as specified

New from 1 March 2026 — three additional eligible conditions:

  • Stuttering
  • Speech sound disorders — including articulation disorder, phonological disorder, childhood apraxia of speech, and dysarthria
  • Cleft lip, cleft palate, or cleft lip and palate

This March 2026 expansion is significant and many families and GPs are still not aware of it. If your child has a speech sound disorder or stutters, they may now be eligible for a Medicare pathway that did not exist for them a year ago. Talk to your GP, or talk to us and we'll help you frame the conversation.

What it covers

  Lifetime limit
Assessment services Up to 8
Treatment services Up to 20

Speech pathology assessment is item 82005 and treatment is item 82020. Occupational therapy assessment is item 82010 and treatment is item 82025. Telehealth equivalents are available.

Please read this part carefully

The 8 assessment and 20 treatment services are lifetime totals, shared across every allied health profession and every eligible condition.

They are not 20 sessions of speech pathology plus another 20 of occupational therapy. If your child uses 20 treatment services with a speech pathologist, there are none remaining for OT or psychology. If your child is eligible under more than one condition, the totals do not reset.

Because Kids Connect Therapy offers both speech pathology and occupational therapy, we will talk this through with you before you start, so you can decide how to allocate the sessions.

Other things to know:

  • Services must be provided individually and in person(or by telehealth). M10 items cannot be used for group therapy — including our Play and Social Language Group Program or school holiday programs.
  • A separate referral is required for each allied health practitioner your child sees.
  • The referral must state the Medicare item number the referring doctor used.
  • A gap payment applies.

How to access it

  1. See your GP or paediatrician. They can refer your child for up to 4 assessment services if a complex neurodevelopmental condition or eligible disability is suspected.
  2. Assessment. We complete the assessment and report back to the referrer. A further 4 assessment services are available if the referrer agrees after reviewing the first round.
  3. The plan. If a diagnosis is confirmed, the referring practitioner completes a one-off Medicare item to write a treatment and management plan — item 135 for a consultant paediatrician, 137 for a specialist or consultant physician, 139 for a GP, or 289 for a consultant psychiatrist. A patient can only claim one of these in their lifetime.
  4. Treatment referrals. Your referrer then refers for treatment in blocks of up to 10 services, to a maximum of 20 in a lifetime.

The old age limits no longer apply

If you have read elsewhere — including on this website previously — that referrals must be made before a child's 13th birthday and services used before their 15th, that rule was abolished on 1 March 2023. The current limit is under 25 years of age, both at referral and at the time of each service. Assessment services were also increased from 4 to 8 at that time.

Which pathway is right for us?

  GPCCMP Medicare M10
Sessions 5 per calendar year 8 assessment + 20 treatment, lifetime
Renews? Yes, annually No — once used, they're used
Shared across providers? Yes Yes
Needs a diagnosis? Chronic condition, 6+ months Eligible condition, confirmed by referrer
Group therapy? No No
Best for Ongoing low-intensity support, or bridging while other funding is arranged An assessment and treatment block after diagnosis

Many families use M10 for an initial assessment and treatment block, then move to NDIS, Thriving Kids or private funding for ongoing therapy. See all funding options →

Useful links

Last reviewed August 2026. Medicare item numbers, fees and rules change. Confirm current details with Services Australia or your GP.