Under the Medicare Benefit Scheme “Diagnosis & Treatment for Eligible Disabilities”, the following conditions will be added to the eligible disabilities list:
- Stuttering
- Speech sound disorders, including:
- Articulation disorder
- Phonological disorder
- Childhood apraxia of speech (also known as dyspraxia, developmental verbal dyspraxia, or speech apraxia)
- Dysarthria
- Cleft lip and/or palate
We break down the jargon for parents and give you a practical guide on how to access this Medicare rebate, with your frequently asked questions answered and a step-by-step process to take to your GP.
Summary of Updated Medicare Funding for Speech Pathology
Name
Diagnosis & Treatment for Eligible Disabilities
Eligibility
You are eligible if you:
- have a Medicare card
- are not admitted to a hospital.
- are under 25 years of age.
- have a valid referral from a GP, specialist or consultant physician (doctor).
- are suspected of having or has been diagnosed with one or more of the eligible disabilities
Additions to eligible conditions from 1 March 2026:
- Stuttering
- Speech sound disorders, including:
- Articulation disorder
- Phonological disorder
- Childhood apraxia of speech (also known as dyspraxia, developmental verbal dyspraxia, or speech apraxia)
- Dysarthria
- Cleft lip and/or palate
| Diagnosis | Treatment | |
|---|---|---|
| Number of Rebated Sessions | 8 assessment sessions over an individual’s lifetime | 20 treatment sessions over an individual’s lifetime |
| Details | Maximum 4 per allied health discipline | GP’s will need to provide 2x referrals of 10 session blocks |
| Frequency of Rebate Access | You can redeem this rebate once during your lifetime | You can redeem this rebate once during your lifetime |
| MBS Number For Video Telehealth Speech Therapy | 93033 | 93036 *Note: GP's must bill the GP appointment as a long appointment and MBS code 139 for the treatment plan to be accepted by Medicare |
Medicare's Diagnosis for Eligible Disabilities
What: The assessment and diagnosis for eligible disabilities, including stuttering, speech sound disorder or cleft lip and/or palate.
How long are sessions: at least 50 minutes duration
Rebate amount: $87.25
MBS number for video telehealth speech pathology services: 93033
Process to Receive Medicare Rebate for Diagnosis of Stuttering, Diagnosis of Speech Sound Disorder, or Diagnosis of Cleft Palate
Step 1: Book an appointment with your GP.
Step 2: Discuss your concerns about your child’s condition and ask for a diagnosis for eligible disabilities under suspicion of:
- Stuttering;
- Speech sound disorder; or
- Cleft lip and/or palate.
If the GP suspects your child has an eligible disability, they can make a diagnosis of the eligible disability themselves or write a referral to a speech pathologist or other relevant specialist.
Make sure your letter(s) include:
- A separate referral letter for each allied health practitioner
- Name of referring practitioner
- The address of practice or the referring practitioners provider number at that practice
- The date on which the referring practitioner made the referral
- Be in writing
- Signed (electronic is accepted)
- Explain the reasons for referring / the intent of the assessment
- If appropriate, specify the number of services to be provided. Where the number of sessions is not specified, each allied health practitioner can provide up to 4 assessment services
Your referral will be valid for 18 months (from date of first service not the date of the referral)
A Pop speech pathologist can support your GP visit by providing a letter to bring to your GP outlining:
- Recommendation for diagnosis of suspected eligible disability (stuttering or speech sound disorder)
- Medicare Benefits Schedule (MBS) number for the GP to use for rebates via video telehealth speech pathology services: 93033
Step 3: Book in with your allied health professional for the assessment sessions.
Step 4: After assessments, allied health professionals will report back to the GP.
Note: If needed, your GP or specialist may refer your child to multiple allied health professionals for assessments to assist with the diagnosis. These may be under different Medicare Benefits Schedule (MBS) numbers.
Number of Sessions Over an Individual’s Lifetime
Maximum of 8 assessment sessions. This can be broken into a maximum of 4 per discipline from same allied health provider.
Example:
Speech pathologist for 4 assessment sessions
Occupational therapist for 4 assessment sessions
= full diagnosis rebate
OR
Occupational therapist for 2 assessment sessions
Audiologist for 2 assessment sessions
Speech pathologist for 4 assessment sessions
= full diagnosis rebate
Medicare's Treatment for Eligible Disabilities
What: The intervention and treatment for eligible disabilities, including stuttering, speech sound disorder or cleft lip and/or palate.
How long are sessions:at least 30 minutes duration
Rebate amount: $87.25
MBS number for video telehealth speech pathology services: 930336
Process to Receive Medicare Rebate for Treatment of Stuttering, Treatment of Speech Sound Disorder, or Treatment of Cleft Palate
Step 1: Book a long GP appointment with your GP. The length of the appointment is crucial for Medicare to accept your treatment plan.
Step 2: Discuss your concerns about your child’s assessment and diagnosis of:
- Stuttering;
- Speech sound disorder; or
- Cleft lip and/or palate.
Your speech pathologist will support your GP visit by providing a written summary outlining the results, diagnosis and recommendations.
Step 3: Ask your GP to create a treatment and management plan under the Medicare Benefit Scheme “Treatment for Eligible Disabilities” and bills your GP appointment under MBS code 139.
Make sure your letter(s) include:
- A separate referral letter for each allied health practitioner
- Name of referring practitioner
- The address of practice or the referring practitioners provider number at that practice
- The date on which the referring practitioner made the referral
- Be in writing
- Signed (electronic is accepted)
- Explain the reasons for referring / the goals of the treatment
- If appropriate, specify the number of services to be provided
Your referral will be valid for 18 months (from date of first service not the date of the referral)
Medicare Benefits Schedule (MBS) number for the GP to use for rebates via video telehealth speech pathology services: 93036
Step 4: Return to your allied health service provider for up to 10 telehealth rebated speech therapy treatment sessions.
Step 5: After your 10 rebated video telehealth speech therapy treatment sessions, return to your GP to request for another 10 treatment sessions if needed.
- This GP appointment must be a long appointment billed under MBS code 139 for Medicare to accept the treatment plan.
- The referral for more speech therapy sessions is under the same MBS number – 93036.
- Your speech pathologist will provide a written report to the referring GP, with information on the treatment provided, recommendations on future management of the individual’s disorder and any advice to caregivers (such as parents, carers, schoolteachers).
- This written report will inform the referring GPs decision to refer for further treatment services.
Step 6: Return to your allied health service provider for the remaining 10 videocall rebated speech therapy treatment sessions.
Note: If needed, your GP or specialist may refer your child to multiple allied health professionals for treatment. These may be under different Medicare Benefits Schedule (MBS) numbers.
Number of Sessions Over an Individual’s Lifetime
Maximum of 20 treatment sessions. This is broken into 2x 10 treatment session blocks, requiring you to visit your GP in between your session blocks to receive another rebate referral.
Example:
Speech pathologist for 10 speech therapy treatment sessions
Visit GP
Speech pathologist for 10 speech therapy treatment sessions
= full 20 treatment sessions rebate
OR
Speech pathologist for 5 speech therapy treatment sessions
Occupational therapist for 5 occupational therapy treatment sessions
Visit GP
Speech pathologist for 5 speech therapy treatment sessions
Occupational therapist for 5 occupational therapy treatment sessions
= full 20 treatment sessions rebate
Looking For Resources to Support Your GP Visit?
Book a free discovery call to ask a speech pathologist for their advice.
We can explain how the Medicare Rebates for Eligible Disabilities might apply to your child’s unique situation. We listen to your concerns, and if our experience suggests that you may be eligible, we can provide a free GP Recommendation Letter to support you to receive funding.
Fill out our Discovery Call Form, tick “I am specifically enquiring to receive a GP Recommendation Letter” on the last page and select the best time for you to chat!
FAQ for Parents: Medicare Rebates for Eligible Disabilities
How can I get my child diagnosed with an eligible disability under Medicare?
To start the diagnosis process, book an appointment with your GP. If your GP suspects an eligible disability, they can either make the diagnosis themselves or refer your child to a specialist or Medicare-eligible allied health professionals for further assessments.
Medicare covers up to 8 allied health assessments per lifetime (maximum 4 per allied health discipline) to assist with diagnosis.
What disabilities are eligible for Medicare support?
Medicare provides support for various disabilities, including Angelman syndrome, Down syndrome, cerebral palsy, hearing impairment, sight impairment, autism (via a separate factsheet), and more. From March 2026, conditions like stuttering, speech sound disorders, and cleft lip/palate will also be eligible.
The full list of eligible disabilities include any of the following conditions:
(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;
(b) hearing impairment that results in:
(i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or
(ii) permanent conductive hearing loss and auditory neuropathy;
(c) deafblindness;
(d) cerebral palsy;
(e) Down syndrome;
(f) fragile X syndrome;
(g) Prader-Willi syndrome;
(h) Williams syndrome;
(i) Angelman syndrome;
(j) Kabuki syndrome;
(k) Smith-Magenis syndrome;
(l) CHARGE syndrome;
(m) Cri du Chat syndrome;
(n) Cornelia de Lange syndrome;
(o) microcephaly, if a child has:
(i) a head circumference less than the third percentile for age and sex; and
(ii) a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence;
(p) Rett’s syndrome
(q) fetal alcohol spectrum disorder (FASD);
(r) Lesch-Nyhan syndrome;
(s) 22q deletion syndrome;
(t) Stuttering;
(u) a speech sound disorder, including:
(i) an articulation disorder; and
(ii) a phonological disorder; and
(iii) childhood apraxia of speech (also known as dyspraxia, developmental verbal dyspraxia or speech apraxia); and
(iv) dysarthria;
(v) cleft lip;
(w) cleft palate;
(x) cleft lip and palate.
Source: MBS Online Addition of stuttering, speech sound disorders, cleft lip and/or palate to the eligible disabilities list | Last updated: 13 January 2026
How many treatment sessions can my child access under Medicare?
If your child is diagnosed with an eligible disability, they can access up to 20 allied health treatment sessions per lifetime through the Diagnosis & Treatment for Eligible Disabilities. Each referral covers up to 10 sessions, so you will need two referrals to access the full 20 sessions. These treatments must be part of a GP-prepared treatment and management plan.
What allied health services are covered by Medicare for diagnosis and treatment?
Medicare covers services provided by audiologists, dietitians, exercise physiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists, and speech pathologists.
These professionals can provide both assessments and treatments as part of your child’s care plan.
Are there any out-of-pocket costs for diagnosis and treatment services?
Medicare provides rebates for eligible services, but health professionals can set their own fees. If they do not bulk bill, you may need to pay out-of-pocket costs.
Discuss fees and billing options with your GP and allied health providers to understand the costs involved.
How often can you access the diagnosis & treatment for eligible disabilities rebates?
The maximum number of sessions under the Diagnosis & Treatment for Eligible Disabilities and Complex Neurodevelopmental Conditions can only be redeemed once in an individual’s lifetime. This does not renew annually like a Chronic Condition Management Plan (CCMP).
Are there any requirements around the type of GP appointment made for the Eligible Disabilities Treatment Plan?
Yes. Medicare requires GP’s to bill the GP appointment for issuing the Eligible Disabilities Treatment plan as:
- a long GP appointment
- under MBS billing code 139
I’m not eligible for this Medicare rebate, are there other Medicare rebates I may be eligible for?
Yes, there are a range of Medicare rebates available. These include GP Chronic Condition Management Plans (CCMP), Complex Neurodevelopmental Conditions, and Aboriginal and Torres Strait Islander Health Service Plans (ATSI). Consult with your GP what Medicare rebates are best for your family.
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References
Australian Government Department of Health and Aged Care. (2025, December). Diagnosis and treatment for eligible disabilities [Fact sheet]. Retrieved February 19, 2026, from https://www.health.gov.au/sites/default/files/2025-12/diagnosis-and-treatment-for-eligible-disabilities-fact-sheet.pdf
MBS Online. (2026, January). Addition of stuttering, speech sound disorders, cleft lip and/or palate to the eligible disabilities list [PDF]. Retrieved February 19, 2026, from https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/8D826760369548C6CA258D7E00172FA7/$File/PDF%20Version%20-%20addition%20of%20severe%20speech%20and%20language%20disorders.pdf
MBS Online. (n.d.). Medicare Benefits Schedule – Note MN.10.2. Australian Government Department of Health and Aged Care. Retrieved February 19, 2026, from https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=MN.10.2&qt=noteID
MBS Online. (n.d.). Medicare Benefits Schedule – Note AN.0.25. Australian Government Department of Health and Aged Care. Retrieved February 19, 2026, from https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.0.25&qt=noteID&criteria=93033%20
Speech Pathology Australia. (2025, December). Speech pathology fees, rebates, and funded programs. Retrieved February 19, 2026, from https://www.speechpathologyaustralia.org.au/Public/Public/services/Choose-a-speech-pathologist/fees-rebates-funded-programs.aspx
This info is relevant as at 8 April 2026.
Information provided is specific to the Medicare Benefits Scheme for video telehealth speech pathology services.
All information is general in nature and for informational purposes only. It is not intended to be an official endorsement, diagnosis or recommendation. Please contact the individual programs directly for the most accurate and up-to-date recommendations.
