Medicare rebates
Medicare rebate eligibility
If you get a Medicare referral from your GP, you may be able to claim a rebate from Medicare to reduce the cost of your appointment. The most common type of referral we receive is called a mental health care plan. There are also several other types of referrals.
If you’re eligible for Medicare’s mental health care plan, you can get a rebate of either $98.85 or $145.25 to reduce the cost of therapy for your first 10 sessions per calendar year. The initial referral will cover you for six appointments, and you can go back to your GP and request four more when your first six have been used.
You will pay us the full amount upfront and Medicare will send you the rebate by bank transfer.
See your GP to enquire about mental health care plans.
Other referral types
The other referrals we frequently receive are eating disorder treatment and management plans (EDP) and chronic disease management plans (CDM)
Eating disorder management plan
An eating disorder management plan is a referral written by a doctor to help treat an eating disorder. Under an EDP, you will commonly be referred to both a psychologist and a dietitian.. You can see a psychologist up to 40 times per calendar year. The referral must be reviewed by the referring doctor after every 10 appointments. Additionally, after 20 appointments, the plan must be reviewed by either a paediatrician or a psychiatrist. The rebate amount is usually between $96.65 and $141.85.
Chronic disease management plan
Chronic disease management plans, also called enhanced primary care plans (EPC) are written by a doctor when several health care professionals are needed to treat a chronic disease. You can have up to five appointments under a CDM per calendar year.
The rebate for an appointment with this type of referral is $60.35. Your doctor may refer you to our dietitian as part of a CDM. The number of sessions and rebate amount is the same whether seeing a psychologist or dietitian.
Testing referral types
Development of Assessment, Treatment and Management Plan for Complex Neurodevelopmental Disorder
New changes have been implemented in the Medicare Benefits Schedule for complex neurodevelopmental disorders (which includes autism) and eligible disabilities for patient's aged under 25 years by an eligible psychologist.
If you are below 25, you can receive a medicare rebate for a diagnostic assessment and treatment of neurodevelopmental disorders/eligible disabilities. It is designed for use in 3 stages:
Assessment and diagnosis
Treatment and management plan
Treatment services
To receive these medicare rebates for suspected autism, it will require that you first visit your GP. Your GP will need to generate a referral to a paediatrician or psychiatrist/psychologist for a diagnosis. After your initial consultation with the paediatrician or psychiatrist, you may be referred to a psychologist for assessment.
The outcome of your consultation and assessment will determine what happens next. You may need to have treatment sessions with a psychologist, speech therapist, occupational therapist and a host of other allied health professionals, depending on your individual circumstances.
The Medicare rebate is $93.35 for each eligible appointment up to a maximum of 8 in a lifetime. The Extended Medicare Safety Net Cap is $329.40.
Frequently asked questions
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No. A referral entitles you to receive a rebate from Medicare, but you can still see a psychologist without a referral.
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It depends. Depending on the details of your referral, the rebate will be either $87.45 or $136.35. Please contact us if you’d like to clarify what level of rebate you’ll receive.
If you have reached the Medicare Safety Net threshold for the year, your rebate will be higher.
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A referral can be written by certain kinds of a doctor: a general practitioner (GP), a paediatrician or a psychiatrist.
Your first step in seeking help should be talking to your doctor. If they feel it is appropriate, they will write you a referral to a psychologist.
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Your referring doctor specifies a number of appointments for the referral to cover, up to a maximum of six.
Most doctors will write an initial referral for six appointments, and then a second referral (if needed) for a further four appointments. This is because only 10 appointments can be claimed per calendar year.
There is no time limit on using a referral.
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When you have reached the number of appointments specified in the referral, the referral ends. Medicare will not pay a rebate for any further appointments.
Your psychologist will write a letter to your referring doctor, updating them on your circumstances.
Your doctor can, at their discretion, write another referral, letting you claim future appointments with Medicare – up to the maximum of 10 per calendar year.
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We can lodge a claim with Medicare on your behalf, or you can do it yourself.
To lodge a claim, we need:
Your referral letter
Your name as it appears on your Medicare card
Your date of birth
Your Medicare card number, including the individual digit next to your name
To lodge a claim for a minor under 18 years old, we need to list a parent or carer as the claimant. In this case, we also need:
The name of the parent/carer, as it appears on your Medicare card
The parent/carer’s date of birth
The parent/carer’s Medicare card number, including the individual digit next to their name
If you would prefer to lodge the claim yourself, you can do this by:
Using the my.gov.au website.
Using the Medicare phone app.
Visiting a Medicare service centre.
To lodge a claim yourself, you will need your Medicare card and an invoice from us confirming your referral details and the details of your appointment. Medicare requires that the invoice is marked ‘Paid’. We will email you this invoice after receiving payment.
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Medicare will pay you the rebate via bank transfer, usually within 1-2 days.
Medicare will use the bank account they have on record for you. You can update your bank account details with Medicare by:
Using the my.gov.au website.
Using the Medicare phone app.
Visiting a Medicare service centre.
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We recommend that you keep track of how many appointments you have had on your referral. It is your responsibility to ensure your referral is valid.
As a courtesy, we will endeavour to inform you by email when the end of your referral is approaching, and when it has ended, however this may not always be possible.
If you would like to check how many appointments you have left, please call or email us.
You can also check your history of Medicare claims on my.gov.au. This is the most accurate source of information, as Medicare has access to information we do not.
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Only 10 appointments can be claimed per calendar year.
The best way to check how many claims you’ve lodged this year is to contact Medicare. The most convenient way to do this is via the my.gov.au website.
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Yes. Your ‘review’ referral does not need to be written by the same doctor that wrote your original referral.
If you were originally referred by a paediatrician or psychiatrist, a review can be completed by your GP, which you may find to be more convenient and less expensive.
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No. Some of our psychologists prefer to have separate appointments with parents. These appointments cannot be claimed under a child’s referral – only appointments that the child attends can be claimed under their referral.
Depending on your circumstances, you may wish to discuss with your GP whether it is appropriate to receive your own mental health care plan.
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No. Medicare rules state that you cannot claim a private health rebate for a service where Medicare has paid a rebate.
However, you can use one or the other for different appointments. For example, people will often claim the Medicare rebate for the maximum 10 sessions per calendar year, and then use their private health insurance for any further appointments.
Depending on your level of private health cover, it is possible that your private insurer may pay a higher rebate than Medicare. We cannot advise what rebate your private insurer will pay – you will need to contact them.
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Yes. Medicare allows for referrals written to one psychologist to be used for another, as long as they are unused.
However, if you have already partially used a referral letter (i.e. you have attended appointments and lodged Medicare claims with a different psychologist), you must get a new referral to see a new psychologist.