Medicare OT sessions

Medicare-Funded OT (Occupational therapy) Sessions & How the Rebate Works

What is a Medicare-funded OT session?

Medicare can subsidise occupational therapy through a GP Chronic Disease Management (CDM) Care Plan — sometimes still called an "EPC" or "Care Plan" referral. Your GP assesses whether you (or your child) have a chronic condition that would benefit from allied health support, and writes a referral.

What the Care Plan gives you

A GP Care Plan referral provides access to up to 5 Medicare-subsidised allied health sessions per calendar year. This allocation is shared across all allied health services used under that referral (for example, if you're also seeing a speech pathologist on the same plan, those visits count towards the same 5 sessions) — not 5 sessions with each individual provider.

Step-by-step: getting started

This is the process our Client Care team follows with every new Medicare-referred client.

1. See your GP and request a Chronic Disease Management (Care Plan) referral for OT

Your GP will assess eligibility and prepare a written Care Plan with their provider details.

2. Send us a copy of the referral

Email a copy of the Care Plan to contact@therapyandstuff.com.au so we can add the referring doctor's details to your file before your first Medicare claim is lodged. Your GP practice can EMAIL the Care Plan contact@therapyandstuff.com.au or FAX us on 0730140199  

3. Register as a Medicare claimant

If the referral is for a child, the parent/guardian needs to be added as the claimant with Medicare and provide their own date of birth — we'll guide you through this on your intake form.

4. Attend your parent-only / initial review appointment. 

We'll book an initial review with our Lead OT to understand your goals before ongoing sessions begin.

5. Pay the session fee in full

Medicare requires the full consultation fee to be paid first — there's no direct billing or bulk billing for these sessions.

6. We lodge the Medicare claim on your behalf

Once your invoice is paid, our team processes the rebate claim for you — you don't need to submit anything to Medicare yourself.

7. Your rebate is paid directly to your bank account

The rebate is deposited into the bank account you have registered with Medicare, usually within a few business days.

What it costs

Our fees are the same whether you're funded by Medicare, NDIS or paying privately. You pay the full fee at time of service, then the Medicare rebate is refunded to you separately.

Appointment type - Duration - Fee

Initial review (parent-only or child) at Clinic - 90 mins (60 mins face-to-face + 30 mins non-face-to-face) - $290.99

Standard OT therapy session at Clinic - 70 mins (45 mins face-to-face + 25 mins non-face-to-face) - $226.32

Standard OT therapy session - community (school/home visit) - 75 mins face-to-face & admin, plus travel - $242.49 + travel time ($193.99 / hr, two-way) + travel mileage ($1/km, two-way).

All community (kindy, school, home) visits also incur travel time (practitioner's hourly rate, capped at 30 minutes each way) and mileage ($1/km, two-way). Full pricing details are on our pricing page.

Your Medicare rebate

Once your invoice is paid and your claim is lodged, Medicare's current rebate for Allied Health is around $63.80 per eligible session. This is the Medicare Benefits Schedule (MBS) fee for allied health CDM services, which Medicare indexes from time to time — so the exact amount can change. In practice, this means you pay the gap between our session fee and the Medicare rebate, rather than the full amount out of pocket.

Good to know

Can I use the medicare sessions for Therapy Assistant / Allied Health Assistant sessions?

No. Medicare-funded sessions are to be deleivered by AHPRA-registered, Medicare-enrolled Occupational Therapists only. 

Do I need to do anything with Medicare myself?

No. Once we have a copy of your Care Plan and your invoice is paid, our Client Care team lodges the claim for you. You just need to make sure your bank details are up to date with Medicare. Medicare deposits the rebate to your bank account.

Can I use Medicare and private health insurance together?

You can't claim both Medicare and private health "extras" cover on the same session. If your private health fund covers OT instead of Medicare, pay the invoice as usual and submit the receipt to your fund for reimbursement — this is a separate process to the Medicare rebate we manage for you.

How many sessions can I claim?

Up to 5 Medicare-subsidised allied health sessions per calendar year under a single Care Plan referral, shared across any allied health providers you see on that plan. Your GP can advise if a plan review or new referral is needed after that.

This page is general information only and reflects our current process and fees — it isn't personal Medicare advice. Rebate amounts are set and indexed by Medicare/the Australian Government and may change. For your specific eligibility or claim questions, check with your GP, Medicare (via myGov) or our Client Care team.

Paediatrician referral: ADOS assessment & up to 20 lifetime OT sessions

If your child sees a paediatrician (rather than just a GP) and is diagnosed with a complex neurodevelopmental disorder such as autism spectrum disorder, there's a separate, more substantial Medicare pathway under MBS Item 135. This is different to the standard GP Care Plan referral described above.

What is MBS Item 135?

It's the Medicare item a paediatrician bills once they've completed a comprehensive assessment, confirmed a diagnosis of a complex neurodevelopmental disorder (such as autism), and written a treatment and management plan for a patient under 25. It's claimable once per patient, per lifetime.

Does this cover an ADOS assessment?

It can. While working towards a diagnosis, your paediatrician can refer you to an eligible allied health provider — including our OT — for up to 8 assessment services over your lifetime to help confirm the diagnosis (this is where an ADOS-type assessment fits in). After the first 4 assessment sessions, the paediatrician needs to review and agree before any further assessment sessions are claimed.

How many therapy sessions does the plan unlock?

Once your paediatrician confirms the diagnosis and finalises the treatment and management plan, they can refer you on for OT (and other allied health) treatment — up to 20 treatment services over your lifetime, delivered in blocks of up to 10 sessions at a time. We provide a progress report to your paediatrician at the end of each block before they refer for the next.

Is this the same as the 5-sessions-a-year Care Plan referral?

No — they're two different Medicare pathways. The GP Care Plan referral covers up to 5 sessions per calendar year. The paediatrician's Item 135 pathway is a lifetime allocation (up to 8 assessment sessions plus up to 20 treatment sessions) and requires a paediatrician's diagnosis, not just a GP referral. Let us know which referral you have and we'll bill it under the correct Medicare item.

Official item wording, eligibility criteria and fees: MBS Online – Item 135.

What about NDIS?

If you're an NDIS participant, our session fees follow the current NDIS pricing guide instead of the Medicare/private structure above. Let us know your funding type when you get in touch and we'll set your file up correctly.