Can Medicare Help Pay For My Speech Or Occupational Therapy Sessions?
The quick answer is… yes, for some children.
There are some rebates available from Medicare for speech pathology and occupational therapy services, but there are criteria surrounding who may be eligible.
Typically your GP or Paediatrician will go through these rebates with you if they believe your child is eligible. Each rebate is associated with a different kind of referral, which needs to be set up prior to use. These referrals can often be used across different allied health professionals, so the same processes typically apply to both Speech Pathology and Occupational Therapy services.
What type of Medicare funding is available?
- CDM (Chronic Disease Management Plan) under a Team Care Arrangement
This plan can be set up by your GP usually in an extended appointment. Eligibility for this plan is based upon whether your child has a complex, or chronic condition, requiring ongoing care by a multidisciplinary team. Your doctor will determine if your child is eligible and if so, will allocate up to 5 sessions towards speech and/or occupational therapy per calendar year.
Does an EPC or CDM cover the full fee for therapy?
An EPC or CDM will entitle you to a rebate from Medicare of approx $61 per session from the total fee and does not cover the full amount for a session. All sessions must be paid for in full prior to processing the plan as we do not bulk bill. The rebate for an EPC or CDM is the same regardless of the price of the session, and can only be claimed on face-to-face or telehealth appointments.
- Complex Neurodevelopmental Conditions such as Autism Spectrum Disorder (click here for more info)
This plan requires a diagnosis, which can be referred from your GP to a Psychiatrist or Paediatrician. Eligibility for this plan if you are under 25 years and have a confirmed diagnosis of a complex neurodevelopmental condition. Your Paediatrician or Psychiatrist will need to develop a treatment and management plan, and can allocate up to 20 sessions towards speech and/or occupational therapy across the patient’s lifetime.
Does a Complex Neurodevelopmental Conditions rebate cover the full fee for therapy?
An CNC plan will entitle you to a rebate from Medicare of approx $87 per session from the total fee and does not cover the full amount for a session. All sessions must be paid for in full prior to processing the plan as we do not bulk bill. The rebate for CNC is the same regardless of the price of the session, and can only be claimed on face-to-face or telehealth appointments.
Do you have to wait in line at Medicare – No!
After attending a session at Cooee, parents pay the regular treatment fee, and then if a plan is in place, we will make a patient claim for you online, based on the referral provided. The rebate will then be deposited directly in to the bank account you have nominated with Medicare.
We are happy to accept Medicare referrals for families here at Cooee. GP’s no longer need to provide a referral to a specific practice or therapist, once you have a referral you are able to choose the practice or therapist that best suits you.
Please do not hesitate to contact a member of our friendly client care team at reception with any questions, as it can get fairly confusing! You can contact us via email at [email protected] or call us on (07) 3265 4495. We would be happy to help!
Want more information?
Check out our Funding and Rebates page by clicking here!
We are also a registered NDIS provider and for more information you can contact us here.