Medicare for Autism & Neurodevelopmental Conditions (M10 Explained)

Medicare provides a specific funding pathway for children and young people being assessed or treated for:

• Autism Spectrum Disorder (ASD)

• Complex neurodevelopmental disorders

• Certain eligible disabilities

This pathway is separate from GP Care Plans (GPCCMP).

It sits under Medicare Group M10.

Understanding how it works helps families make informed decisions.

The M10 Pathway Has Two Parts

There are two separate components under M10:

1. Assessment services

2. Treatment services

They have different item numbers and different limits.

Part 1: Assessment Services

(Up to 8 Services – Lifetime Cap)

Assessment items (e.g., 82005 in-person or 93041 phone attendance) are used to:

• Assist a paediatrician or psychiatrist with diagnostic formulationOR

• Contribute to a specialist-developed treatment and management plan

These services:

• Must be referred by a consultant paediatrician or psychiatrist

• Apply to patients under 25 years

• Must be individual

• Must be at least 50 minutes

• Require a written report back to the referring specialist

Medicare allows:

• Up to 8 assessment services per patient per lifetime

This cap applies across all eligible allied health providers combined (e.g., speech + OT + psychology).

A “course of assessment” equals up to 4 services. If more than 4 services are required from the same provider, the specialist must review and agree before additional services are claimed.

Part 2: Treatment Services

(Up to 20 Services – Lifetime Cap)

Once a complex neurodevelopmental disorder (such as autism) is confirmed by a specialist,

Medicare allows access to:

• Up to 20 treatment services per patient (lifetime cap)

These services:

• Must be referred by an eligible specialist

• Must align with the specialist’s treatment and management plan

• Must be individual

• Apply to patients under 25 years

• Are provided by eligible allied health practitioners

These are therapy sessions — not assessment sessions.

The 20-session cap is separate from the 8 assessment services.

Important: These Are Lifetime Caps

Unlike GP Care Plans, which allow 5 sessions per year, M10 services:

• Do not reset each year

• Are capped across the patient’s lifetime

• Are shared across all eligible allied health providers

For example:If a child uses 12 psychology sessions under M10 treatment items, only 8 therapy sessions remain across speech, OT, etc.

Our Fees & Medicare Rebates

Medicare sets a scheduled fee and rebate, but it does not determine provider fees.

For M10 assessment and treatment items:

• Medicare scheduled fee: $102.60

• Medicare rebate: $87.25

At Each Speech Pear Plum, we charge our standard hourly rate for assessment and therapy services.

If you choose to use M10:

• You pay our standard fee at the time of your appointment.

• Medicare rebates $87.25 to you.

• The remaining amount is your out-of-pocket gap.

These Medicare items contribute toward services. They do not cover the full cost of comprehensive assessment or therapy.

We provide transparent fee information before commencing services.

How Is M10 Different From a GP Care Plan?

Feature	GPCCMP (10970)	M10 Assessment	M10 Treatment
Referral from	GP	Paediatrician / Psychiatrist	Paediatrician / Psychiatrist
Purpose	Ongoing therapy for chronic condition	Diagnostic assessment	Therapy after diagnosis
Session limit	5 per year	8 lifetime	20 lifetime
Age limit	No strict limit	Under 25	Under 25
Reset yearly?	Yes	No	No

Why This Matters

M10 funding is designed to:

• Support multidisciplinary diagnosis

• Provide structured input to specialists

• Contribute toward early intervention

It is not designed to fully fund long-term therapy.

Many families combine:

• M10 services

• GPCCMP

• NDIS (if eligible)

• Private funding

The Bottom Line

If your child is:

• Being assessed for autism → M10 assessment items may apply.

• Diagnosed with autism and commencing therapy → M10 treatment items may apply.

• Needing ongoing therapy under GP management → GPCCMP may apply.

If you are unsure which pathway applies to your child, our team can guide you through the process.

For more information or to book an assessment, visit Each Speech Pear Plum or contact us directly. We’re here to support your child’s journey to better communication, ensuring they have the most fun along the way.