How to Get a Medicare Rebate for Autism & ADHD Assessment & How The 80% Rebate Works

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Learn how to access Autism Assessment Medicare Rebates, navigate barriers, and maximize your 80% rebate savings. Explore Autism Assessment Medicare Rebates now! Here's how to get the most out of Medicare for your assessment. Download the Free Guide here: https://www.lizsmalley.com/freeeguide.

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Unfotunately, there are many barries to accessing the Medicare rebate put in place by the government. Barriers such as needing a referral from a paediatrician or a psychiatrist is a huge barrier for many people because it's very difficult to get an appointment and it adds to the cost. Sometimes the gap to see a specialist is greater than the rebate e.g. the gap might be $400 to see a specialist, and the rebate, without the safety net is about $400, so it might not be worth the effort or the expense. However, if you live in WA you will need a paediatrician as well as a clinical psychologist to be able to access funding for support at school. Sadly, another barrier due to the expense and difficulty in getting an appointment. The WA DEpt of Ed does not follow the national guideliness for assessment, where a clinical psychologist like myself, can be a lead practitioner and do a single clinician or one person diagnosis.

1. Overview

Medicare rebates are available in Australia to help cover the costs of private assessments for autism and ADHD, especially for individuals under the age of 25. These rebates can significantly reduce out-of-pocket expenses, and the Medicare Safety Net provides additional support once you reach certain annual thresholds, offering up to an 80% rebate on further eligible costs.

2. Steps to Access a Medicare Rebate for Autism Assessment

Step 1: Initial Consultation and Referral

• See your GP to discuss your concerns and request an assessment referral.

• The GP will refer you to a consultant paediatrician or psychiatrist for assessment under the Medicare Benefits Scheme (MBS), using item numbers such as 135 or 289.

• The paediatrician or psychiatrist can then refer you to eligible allied health professionals (e.g., psychologist, speech pathologist, occupational therapist) for further assessment.

Step 2: Undergoing the Assessment

• You can access up to four allied health assessment sessions per discipline initially, with the possibility of an additional four if needed (maximum of eight in a lifetime).

• Each session must be referred by the paediatrician or psychiatrist engaged in the diagnostic process.

Step 3: Claiming the Rebate

• Pay the provider’s fee upfront and claim the Medicare rebate (e.g., $89.65 per psychology session) through Medicare, usually processed within a few days.

• Ensure all referrals are in place before the assessment date for the rebate to be valid.

  
  

3. Steps to Access a Medicare Rebate for ADHD Assessment

Step 1: GP Referral

• Visit your GP for an initial consultation and screening.

• The GP will refer you to a psychiatrist for a comprehensive ADHD assessment, often under MBS Item 291.

Step 2: Psychiatric Assessment

• The psychiatrist conducts a detailed diagnostic assessment and provides a report to your GP.

• Medicare rebates are available for the psychiatrist’s assessment (Item 291), but out-of-pocket costs will still apply.

Step 3: Follow-Up and Management Plan

• If ADHD is diagnosed, the psychiatrist may develop a management plan and, if appropriate, provide a letter for your GP to prescribe medication.

  
  

4. Medicare Safety Net and the 80% Rebate

What is the Medicare Safety Net?

• The Medicare Safety Net helps lower your out-of-pocket costs for out-of-hospital services once you reach a certain annual threshold.

• For 2025, the Extended Medicare Safety Net (EMSN) threshold is $2,615.50 for general families and $834.50 for concession card holders or families receiving Family Tax Benefit Part A.

How the 80% Rebate Works

• After reaching the EMSN threshold, Medicare will rebate 80% of your out-of-pocket costs for eligible out-of-hospital services, or up to a set cap for certain items.

• Example: If you pay $100 out-of-pocket for an eligible service after reaching the threshold, Medicare will rebate $80 (or the EMSN cap, if lower), reducing your gap to $20.

5. Important Tips

• Register as a family with Medicare to combine expenses and reach the Safety Net threshold faster.

• Keep all receipts and ensure all payments are “verified” (paid in full before claiming) to count towards your Safety Net threshold.

• Some services have capped rebates under the Safety Net, so check with your provider or Medicare for details.

6. Summary Table: Key Steps and Rebates

Step	Autism Assessment	ADHD Assessment	Safety Net/80% Rebate
Initial referral	GP → Paediatrician/Psychiatrist	GP → Psychiatrist	Register as family with Medicare
Allied health sessions	Up to 8 lifetime (referred by paediatrician/psychiatrist)	Psychiatric assessment (MBS Item 291)	Track out-of-pocket costs
Rebate process	Pay upfront, claim rebate via Medicare	Pay upfront, claim rebate via Medicare	After threshold, get 80% rebate
Age eligibility	Under 25 years	No strict age limit, but rebates vary by age and pathway	Applies to all ages