Chronic Disease Management (CDM) Plan – via your GP
previously known as an Enhanced Primary Care (EPC) plan

Up to 5 sessions per calendar year, shared across allied health services.
You must have a chronic condition requiring support from at least two health professionals.
The below codes must be reflected on your GP's form.

Eligible item numbers:
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Occupational Therapy | 10958
Speech Pathology | 10970
Psychology | 10968

Steps to Obtain a Chronic Disease Management (CDM) Plan – via your GP

A Chronic Disease Management (CDM) Plan, also known as a GP Management Plan, is an Australian government initiative that provides Medicare rebates for allied health services. It is designed to help people with a chronic medical condition that has been, or is likely to be, present for six months or longer.

Step 1: Book a Long Consultation with Your GP
Adults: Book a long appointment with your GP. Tell the receptionist you would like to discuss a Chronic Disease Management Plan.
Parents/Carers: Book a long appointment with your child's GP or paediatrician.

‍Step 2: Discuss Your Condition
Discuss the chronic medical condition with the GP. The GP will assess if it is chronic and complex enough to require a structured plan and multiple health professionals.

‍Step 3: Develop the Plan and Receive Referrals
If eligible, the GP will create a GP Management Plan outlining health goals and required services. They will then provide referrals for up to five subsidised allied health services per calendar year.

‍Step 4: Attend Appointments and Review
Use the referral to complete our intake form. After a period, you may need to book a review appointment with your GP to monitor progress and update the plan if necessary.

Important Note: The Medicare rebate covers a portion of the fee for up to five allied health services per calendar year. There may be an out-of-pocket cost for each appointment. It is recommended to discuss fees with the allied health professional before the first session.

Better Access Mental Health Plan – via GP or Psychiatrist

This referral type supports individuals with diagnosed mental health conditions such as anxiety, depression, PTSD, and more.
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‍You may be eligible for:
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‍Up to 10 Medicare-rebated psychology sessions per calendar year
‍A GP or psychiatrist review after the first 6 sessions to obtain the remaining 4 sessions

From 1 July 2025 – Medicare Referral & Billing Information
Psychology | 10968 For standard sessions ≥ 50 min

‍Important Update (Effective 1 July 2025):

‍Item 80110 is no longer used for new referrals.
New referrals must list 10968.
Referrals issued before 1 July 2025 using 80110 will still be accepted.

Steps to Obtain a Better Access Mental Health Plan

The Better Access Mental Health Plan is an Australian government initiative that provides Medicare rebates for mental health services. The process is similar for both adults and children.

‍Step 1: Book a Long Consultation with Your GP
Adults: Book a long appointment with your GP. Tell the receptionist you are seeking a Mental Health Treatment Plan.
‍Parents/Carers: Book a long appointment with your child's GP or a paediatrician.
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‍Step 2: Discuss Mental Health Concerns
Adults: Be open and honest with your GP about your symptoms and concerns.
‍Parents/Carers: Discuss your child's behaviour and emotional well-being with the doctor.The doctor will assess your or your child's eligibility for the plan, which requires a diagnosed mental health disorder.
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‍Step 3: Receive the Plan and Referral
‍If eligible, the doctor will create a Mental Health Treatment Plan that outlines treatment goals and includes a referral to a mental health professional (e.g., a psychologist). This plan and referral are essential for claiming Medicare rebates.
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‍Step 4: Start Sessions
‍Use the referral to complete our intake form. The initial referral is typically for up to six sessions.
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‍Step 5: Review and Re-Refer
‍After the initial sessions, book a review appointment with the referring doctor. If they agree more sessions are needed, they can provide a new referral for additional sessions, up to the yearly maximum.
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‍Important Note: The Medicare rebate covers a portion of the fee, but there may be an out-of-pocket cost. It is recommended to discuss fees with the mental health professional before the first session.

Autism and Complex Neurodevelopmental Disorders Plan – via Paediatrician or Psychiatrist

For individuals aged under 25 with a diagnosis of autism or a complex neurodevelopmental disorder.
Allows up to 20 lifetime rebated sessions across allied health professionals.

Eligible item numbers:
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Occupational Therapy | 82025
Speech Pathology | 82030
Psychology | 82020

Steps to Access Support for Individuals with Autism:

The type of support available in Australia for individuals with autism depends on their age. While children and young people can access a dedicated plan, adults use different government-subsidised schemes to manage their health and well-being.

For Children and Young People (Under 25 Years)

Step 1: Get a Referral from a GP
Parents/carers must first book an appointment with a GP for a referral to a paediatrician or a psychiatrist.

Step 2: Diagnosis and Plan Development
The specialist will conduct a comprehensive assessment to confirm a diagnosis of a complex neurodevelopmental disorder. Once confirmed, they will develop a plan that includes referrals to allied health professionals.

Step 3: Access Services and Review
With the referral(s), you can complete our intake form. The patient is eligible for up to 20 subsidised sessions in their lifetime, with a maximum of 10 per course of treatment. The specialist can provide a new referral for further sessions after a review.

For Adults (25 Years and Over)

Adults with autism can access support through other government-subsidised schemes.

Step 1: Book a Consultation with a GP or Psychiatrist
Book a long appointment with a GP or psychiatrist to discuss health concerns related to autism.

Step 2: Receive an Appropriate Plan
The doctor will determine which plan is most suitable based on the individual's needs:
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Better Access Mental Health Plan: For a diagnosable mental health condition, the doctor creates a plan for subsidised sessions with a psychologist.

Chronic Disease Management (CDM) Plan: For a chronic physical condition, the doctor may create a CDM Plan for up to five subsidised allied health services per year.

Step 3: Start Sessions and Review
Use the referral to complete our intake form. A review with the referring doctor may be required to continue treatment.

Important Note: The Medicare rebates reduce the cost of services, but there is often an out-of-pocket gap fee. Individuals with a permanent disability, including adults with autism, may also be eligible for support through the National Disability Insurance Scheme (NDIS).

Are these sessions covered by Medicare?
Not fully. These sessions are not “covered” in full by Medicare, but if you're eligible, you can claim a partial rebate for each session after you’ve paid the full session fee. Your rebate amount depends on the referral type and item number.

We strongly recommend contacting Medicare directly before starting sessions to confirm how much you are entitled to claim.

What is a Medicare rebate?
A rebate is a partial refund from Medicare. After paying your invoice in full, you can submit your paid invoice to Medicare, and they will reimburse you a portion of the session cost directly into your bank account.

Do you process the Medicare rebate for me?
No, we do not process Medicare claims on your behalf. However, our invoices include all the required information (including your practitioner’s details and the item number) so you can easily submit the claim yourself via:

myGov/Medicare online
The Medicare app
Paper form (available from Medicare)

What happens after I pay the invoice?
Once your payment is received in full (which can take 1–3 business days to process), your invoice status will automatically update. You can use the same email link to view and download your paid tax invoice (PDF), which you can then submit to Medicare.

How much is the rebate?
Rebate amounts depend on the Medicare item number listed on your referral. As a general guide:

Psychology - $93.35–$96.65
Occupational Therapy - $58.30–$75.10
Speech Pathology -  $58.30–$75.10

Rebate amounts can change and vary. The above prices are mentioned as a guide only. We will not be held liable for any differences in rebates. We recommend confirming current rates with Medicare directly.

Can I use more than one type of referral?
Yes — some clients may be eligible for more than one plan (e.g. a Chronic Disease Management Plan and an Autism Assessment referral). Each referral type has specific limits and item numbers, and a GP or paediatrician can guide you on what’s most appropriate.

Can I split my 5 CDM sessions across different therapists?
Yes. Under the Chronic Disease Management (CDM) Plan, you can divide the 5 annual sessions across different allied health providers (e.g. 2 with a psychologist, 2 with an OT, 1 with a speech therapist). Your GP will need to indicate this on the referral.

Do I need a new referral each year?
It depends on the referral type:

Better Access Plan: Renewed annually, with a review required after the first 6 sessions.
CDM Plan: Renewed annually (calendar year).
Autism/Developmental Assessment Plan: This is a once-off referral for up to 4 sessions and does not renew yearly.

What if my referral uses an old item number (like 80110)?
If your referral was issued before 1 July 2025, and lists an older item number like 80110, we will honour that referral and bill accordingly, provided it is still within its valid timeframe.

New referrals after 1 July 2025 must use updated item numbers such as 10968 for psychology.

Where can I get help with my Medicare claim?
Please contact Medicare directly for help with claims, rebate amounts, or any issues. Due to privacy laws, Medicare will not speak to us about your individual claim or rebate status.

Medicare general enquiries: 132 011
Or visit: www.servicesaustralia.gov.au/medicare