Medicare and Autism Assessment: The Complex Neurodevelopmental Conditions Items Explained

Beyond the Better Access scheme most people know about, Medicare has a separate set of items that can help fund assessment and treatment for autism and some eligible disabilities. Here is a plain-language guide to how they work.

When people think about Medicare and psychology, they usually think of the Better Access scheme, the Mental Health Treatment Plan from a GP that subsidises therapy sessions. Fewer people know that Medicare also has a separate, distinct set of items designed specifically to help with the assessment, diagnosis, and treatment of autism and certain other eligible disabilities. These are often referred to as the Complex Neurodevelopmental Conditions and Eligible Disabilities items.

Because the two schemes are easy to confuse, this post sets out what these items are, who can refer, what they cover, and how they differ from both Better Access and a privately funded assessment. As with anything Medicare-related, the specifics can change, so this is a general guide rather than financial advice.

Two Different Medicare Pathways

It helps to hold the two schemes apart. Better Access, accessed through a Mental Health Treatment Plan, is for therapy sessions for a mental health condition. The Complex Neurodevelopmental Conditions and Eligible Disabilities items are a separate pathway aimed at the assessment, diagnosis, and treatment of autism and certain eligible disabilities. You cannot mix and match the two for the same service, and the referral pathways are different.

Confused about which pathway applies?It is genuinely confusing, and it is one of the most common things people ask us. A short conversation usually makes it clear. Speak with our team

What These Items Are For

These Medicare items exist to support the work involved in assessing, diagnosing, and treating a complex neurodevelopmental condition such as autism, or an eligible disability. They recognise that this work often involves several professionals and more than one appointment, and they provide a way to subsidise part of that cost where a person is eligible.

Who Refers

A medical practitioner needs to be involved to start the process. Depending on the pathway, that may be a consultant paediatrician, a consultant psychiatrist, or a specialist, with general practitioners also playing a role for some eligible disabilities. The referring practitioner provides a referral, and allied health professionals, including psychologists, then deliver the assessment or treatment services under that referral.

Assessment Services

On a valid referral, a set number of allied health assessment services can be subsidised, with a current cap of up to four assessment services attached to a referral. Each assessment service has a minimum duration (currently at least 50 minutes), and the psychologist provides a written report back to the referring practitioner after the assessment. This report often feeds into the diagnosis and the plan for what comes next.

Considering an autism assessment?We can talk through the process and what funding may apply to your situation before you commit to anything. Start a referral

Treatment Services

Where treatment is recommended, a medical practitioner can prepare a treatment and management plan. Only one such plan is generally payable per person across their lifetime, and it can allocate a course of allied health treatment services, with current limits of up to ten services per course and up to twenty treatment services per person over their lifetime. Each treatment service has a minimum duration (currently at least 30 minutes), and the treating professional reports back to the referrer.

Important Things to Know

• Allied health services under this scheme only attract a Medicare benefit once the prerequisite medical practitioner item has been paid.
• There is a daily limit on how many allied health services can be claimed for the same person (currently up to four per day).
• These services can often be delivered via telehealth as well as in person.
• The rebate amounts and item rules are set by the government and can change over time.
• This pathway is separate from Better Access, and eligibility criteria apply, so not everyone will qualify.

How This Differs From a Privately Funded Assessment

Where a person is eligible, these items can subsidise part of the cost of assessment or treatment. In practice, many assessments still involve an out-of-pocket component, because the rebate covers only part of the fee. The right way to understand what you would actually pay is to ask the practice directly, with your specific referral and circumstances in mind.

Want to understand the costs?Our fees and funding page sets out what our services cost and the funding pathways that may apply. See fees & funding

Check Your Eligibility

Because eligibility, item numbers, and rules can and do change, the most reliable approach is to confirm the current details with your GP or paediatrician and with Medicare directly. We are also happy to help you understand what is likely to apply for an assessment with us, and to point you in the right direction.

If you would like to talk through an assessment and the funding options around it, you are welcome to get in touch.

Have questions?Tell us what you are looking for and we will help you work out the right next step. Get in touch