Medicare Rebates for Autism and Intellectual Disability

The early identification of, and intervention for, individuals with complex neurodevelopmental disorders is important in promoting positive longer-term outcomes as symptoms can cause clinically significant impairment in social, occupational or other important areas of functioning. 

Medicare rebates are available for the assessment and diagnosis of complex neurodevelopmental disorders, specifically Autism and intellectual disability. Access to Medicare rebates for the assessment of Autism or intellectual disability requires a referral from either a paediatrician or psychiatrist under Medicare’s Complex Neurodevelopmental Disorders Scheme.

The scheme encourages a multi-disciplinary approach to assessment and diagnosis by enabling paediatricians and psychiatrists to refer to a psychologist to assist in the completion of a comprehensive and accurate assessment and formulate a diagnosis for someone suspected of having a complex neurodevelopmental disorder.

With the appropriate referral from a paediatrician or psychiatrist under Medicare’s complex neurodevelopmental disorders scheme for the assessment of Autism or intellectual disability it is possible to claim a maximum of eight Medicare rebates for a maximum of eight hours of assessment services with a psychologist (i.e., one rebate per hour).

Please be aware that attending appointments with a paediatrician or psychiatrist incurs a fee. It is therefore important to consider the cost of this fee against the expected rebate amount. It is recommended at the time of booking your appointment you specify the purpose of the appointment in case additional time is required, and also enquire about the fee that will be charged. 

To be able to claim Medicare rebates for an assessment for Autism or intellectual disability your paediatrician or psychiatrist must make a referral using one of the appropriate pre-requisite Medicare item numbers listed below – show this to your referring doctor who will understand which item number to use:

You must be referred for assessment services prior to your paediatrician or psychiatrist developing a Treatment and Management Plan for you. 

As noted previously, you will be able to claim up to eight Medicare rebates for the assessment of Autism or intellectual disability with an appropriate referral. However, your paediatrician or psychiatrist can only refer for up to 4 assessment sessions initially. If further assessment sessions are required, a second referral is necessary, also to a maximum of 4 sessions. 

Please note that the individual being assessed must be under the age of 25 years and that you can only claim these rebates once in a lifetime.

Once we have completed the assessment, we will provide your paediatrician or psychiatrist with a written report. This report will detail our assessment findings including any relevant diagnoses and recommendations for further assessment and treatment to assist your paediatrician or psychiatrist to develop a Treatment and Management Plan for you.

Please feel free to contact us if you or your referring specialist require further assistance of information.

You can also refer to the below websites which contain further information:

Children - Medicare Financial Support | Autism Awareness Australia 

Adults -  Medicare for adults | Autism Awareness Australia