Navigating the System, Rebates & Fees

The costs associated with providing the best opportunities for your child can be daunting as can ‘the system’ that supports families. Fortunately, the Commonwealth Government has provided several funding options to ease the financial pressure.

Fees current as of April 2014.


Medicare Funding Options:

Chronic Disease Management (Item Number: 10958)

- Previously known as ‘EPC’ (Enhanced Primary Care Plan)

- Referral: a Doctor (GP) is required to complete the referral for Occupational Therapy

- Entitles your child up to 5 therapy sessions per calendar year

- Rebate/Fees: Medicare rebate $58. Gap $72


Helping Children With Autism Program (Item Numbers: 82010 & 82025)

- Referral: a Paediatrician (as referred to by your GP) is required to make the referral

- Entitles your child to 4 assessment sessions and 20 therapy sessions between the ages of 7-14 years

- Rebate/Fees: Medicare rebate $72.40. Gap $57.60


Mental Health Care Plan (Item Number: 80140)

- Referral: Doctor (GP) or paediatrician is required to complete the referral for Occupational Therapy

- Entitles your child to 10 therapy sessions per calendar year

- Rebate/Fees: billed direct to Medicare – no gap applicable


FaHCSIA (Families, Housing, Community Service & Indigenous Affairs):

Helping Children With Autism Program

- NB: Same name as above under 'Medicare Funding Options', however it is a different program

- Referral: is by a FaHCSIA Advisor once assessed by a Paediatrician and by an approved diagnosing clinician

- Entitles parent/caregivers a budget of $12,000 up to age 7

- Rebate/Fees: billed direct to FaHCSIA – no gap applicable


 Private Health Insurance:

- Please contact your health fund for specific details regarding your entitlements and rebates

- Referral: generally not required

- Rebate/Fees: $500 initial assessment. $130/session 


Self Funded:

- Referral: not required

- Fees: $500 initial assessment. $130/session



General Information:  

- Initial Assessment: $500 - comprises of a minimum of 2 hours with you and your child; a comprehensive written report with recommendations; and communication to your GP, school and other professionals as required

- Therapy sessions: 60 minutes including documentation and communicating follow up recommendations for parents, teachers etc

- Frequency of sessions: usually either weekly or fortnightly

- Late Cancellation: $65 cancellation fee may apply if not advised before 8am on the day of the appointment




Should you have any questions regarding payment schedules or deciding which options best suit your circumstances, please discuss your options with your Autism Advisor; your private health insurer; or contact me for further information.