Autism — Helping Children with Autism program

Medicare items supporting early diagnosis and treatment.

Page last updated: 03 April 2014

Printable version of Autism Fact Sheet (PDF 369 KB)
The Helping Children with Autism program commenced on 1 July 2008, and created items in the Medicare Benefits Schedule (MBS) for the early diagnosis and treatment of children with autism or any other pervasive developmental disorder (PDD).

Eligibility

The Medicare items available through the Helping Children with Autism program are early intervention services for children undergoing diagnosis/assessment or treatment for autism or any other PDD.
Children can access the autism Medicare services providing they have not already accessed services under the Better Start for Children with a Disability initiative and providing they meet the requirements of each service.

Medicare items for consultant paediatricians or psychiatrists

Medicare items are available for assessment, diagnosis and the creation of a treatment and management plan by a consultant paediatrician (MBS item 135) or a psychiatrist (MBS item 289) for a child aged under 13 years.

A consultant paediatrician or psychiatrist can refer a child to an eligible allied health provider to assist with diagnosis of the child or for the purpose of contributing to the child’s treatment plan. Referrals for these allied health assessment services can be made by a consultant paediatrician as an outcome of the service provided under one of the MBS items 110-131, or as an outcome of a service provided by a psychiatrist under one of the MBS items 296-370.

When a treatment and management plan is in place, the medical practitioner who develops the plan can refer a child for allied health treatment services, providing the child is aged under 15 years and had a treatment and management plan prepared for them before their 13th birthday.

Only one autism treatment and management plan can be prepared for a child in their lifetime. However, if a child sees a different medical practitioner to the one who prepared the treatment and management plan, the consultant paediatrician or psychiatrist who is seen subsequently can refer the child for any remaining allied health treatment services that are available to the child.

Children with an existing treatment and management plan created under MBS items 135 or 289 can be reviewed under attendance items for a consultant paediatrician or psychiatrist..

Referring medical practitioners are not required to use a specific form to refer patients for the allied health services that are available through the Autism — Helping Children with Autism program. The referral may be a letter or note to an eligible allied health professional, signed and dated by the referring practitioner.

Medicare items for allied health providers

Under the Helping Children with Autism program, a child can be referred by a consultant paediatrician or psychiatrist for the following allied health services:
  • up to four diagnostic / assessment services from psychologists, speech pathologists, occupational therapists, audiologists, optometrists, orthoptists or physiotherapists to assist the referring practitioner with diagnosis or to contribute to a child’s treatment and management plan (for a child under 13 years of age).
  • up to twenty treatment services from psychologists, speech pathologists, occupational therapists, audiologists, optometrists, orthoptists or physiotherapists (for a child under 15 years of age, providing a treatment and management plan is in place before their 13th birthday).
These are the total number of services available to each child through the Helping Children with Autism program – not an annual entitlement.

Assistance with diagnosis/contribution to a treatment plan*

MBS items for allied health assessment and treatment of autism/PDD
  • 82000 Psychologist
  • 82005 Speech pathologist
  • 82010 Occupational therapist
  • 82030 Audiologist, optometrist, orthoptist, physiotherapist
* Prerequisite MBS items: 110-131 (paediatrician) or 296-370 (psychiatrist).

Treatment services**

MBS items for allied health treatment of children with autism/PDD
  • 82015 Psychologist
  • 82020 Speech pathologist
  • 82025 Occupational therapist
  • 82035 Audiologist, optometrist, orthoptist, physiotherapist
** Prerequisite MBS items: 135 (paediatrician) or 289 (psychiatrist).

A course of treatment for the allied health treatment services consists of the number of allied health services stated on the child’s referral, up to a maximum of 10 services. This enables the referring practitioner to consider a report from the allied health provider(s) about the services provided to the child, and the need for further treatment.

Patients will require a separate referral for each allied health provider they are referred to and they will also need new referrals for each new course of treatment.

More Information

The explanatory notes and item descriptors for these items are in the Medicare Benefits Schedule (MBS) available online.

For inquiries about eligibility, claiming, fees and rebates, call the Department of Human Services (Medicare): patient inquiries 132 011; provider inquiries 132 150

For information on early intervention funding for children with Autism Spectrum Disorder (ASD) see the Department of Social Services website.

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