Private health cover
Speech pathology assessment and therapy sessions can be claimed through private health cover under extras cover. The rebate amount per session and the number of sessions covered is dependent on the individual’s level of cover. The rebate for assessments is usually higher than that for therapy sessions. A typical rebate would be somewhere between $30-$80 per therapy session for 10-16 sessions per calendar year.
Before commencing therapy, please check with your health fund to ensure that speech pathology is included in your cover and the amount you are eligible to claim for each individual assessment and therapy session.
Chronic disease management
Medicare provides a rebate for up to five speech pathology sessions per calendar year for individuals with chronic conditions and complex needs that require a multi-disciplinary approach (treatment from several health professionals). Eligible conditions are those that are likely to be present for six months or longer such as autism, dyspraxia, learning disorders, Down syndrome, ADHD, cerebral palsy, cleft lip and palate, chronic middle ear infections, intellectual disability and severe speech or language impairments. For adults these may also include stroke, traumatic brain injury, progressive neurological diseases (motor neurone disease, Parkinson’s disease), stuttering, vocal cord pathologies and dementia.
The rebate is $52.95 (indexed on 1 November) per session. Please note that clients cannot claim a Medicare rebate and private health care rebate for the same service.
Better Start Medicare (0-13 years)
Children with an eligible disability can be referred by a GP (item number 139), a specialist or consultant physician (item number 137) for the following allied health services.
Up to four diagnostic/assessment services from allied health professionals including speech pathologists to assist the referring practitioner with diagnosis or to contribute to a child’s treatment and management plan (for a child under 13 years of age). (Item number 82005 for speech pathologist.)
Up to twenty treatment services from an allied health professional including a speech pathologist (for a child under 15 years of age, providing a treatment and management plan is in place before their 13th birthday). Note: these are the total number of services available to each child through the Better Start Medicare program – not an annual entitlement. (Item number 82020 for speech pathologist.)
HCWA Medicare (0-13 years)
Children undergoing assessment or treatment for autism can be referred by a consultant paediatrician or psychiatrist for the following allied health services:
Department of Veterans Affairs (DVA)
Clients (and their dependents) who have gold Department of Veterans Affairs cards are eligible for rebates on speech pathology services.
Clients (and their dependents) who have white Department of Veterans Affairs cards are eligible for rebates on speech pathology services in some circumstances.
We are registered to provide Early Intervention Services and Therapeutic Supports under the NDIS.