Fees & Rebates

Beyond diagnosis, Medicare’s Better Access to Mental Health Care and Chronic Disease Management plans provide rebates for ongoing therapy and treatment. These plans help individuals with autism access necessary mental health support and manage chronic conditions effectively, ensuring comprehensive care and support. The first step to access these schemes is to see your GP who will assess whether the plans are appropriate for you.

The Medicare rebate for 2024 to 20225  is $96.65. This means you would be out of pocket a gap fee of $126.34.

If you are insured with a Private Health Fund and have Extras, you may be eligible for rebates for psychological therapy. You generally do not require a Mental Health Care Plan or referral to attend and claim privately. To determine your eligibility and rebate, call your fund. They will tell you the specific amounts to which you are entitled.

You can work out your payment total using this calculation:

Gap Fee = Appointment Fee – Rebate

By law you are unable obtain a health fund rebate AND a Medicare rebate for the same session.

Under Medicare, autism diagnosis appointments with health professionals for individuals aged under 25 can be covered under the Complex Neurodevelopmental Disorder Services initiative. This typically covers assessments and diagnoses by professionals such as paediatricians, psychiatrists, and clinical psychologists. Medicare rebates are available for these services, but they generally require a referral from a GP and are subject to specific item numbers. While the rebates reduce out-of-pocket costs, some fees may still apply depending on the practitioner. Your GP should be familiar with this initiative and can guide you through the process. If they are unfamiliar with the specifics, you can share this factsheet with them. It provides detailed information about the eligible services and item numbers that apply under Medicare for autism diagnosis and assessment services.

The Medicare rebate for 2024 to 20225  is $96.65. This means you would be out of pocket a gap fee of $126.34.

If you are supported by the NDIS you may have funding allocated for psychotherapy. Positive Futures is a registered NDIS provider which enables you to utilise your plan even if you are NDIA managed. You can typically access funding under CB Daily Living but on occasion are able to use funds from Improved Relationships (Behaviour Support) or Activities of Daily Living (CORE). If it doubt speak with your LAC or Supports Coordinator. There is no gap fee for NDIS supports.

We also have psychosocial and developmental therapists who are qualified social workers or teachers. The cost of these sessions are $193.99 but typically are not funded by Medicare. NDIS will provide funding for these services and some private health funds.