From 1 March 2026, Medicare expanded access to rebated speech pathology services for some children and young people under 25 through the eligible disability (M10) pathway.
Key Changes
- The list of eligible disabilities under Note MN.10.3 now includes speech-related conditions for people aged under 25: stuttering, speech sound disorders (articulation and phonological disorders, childhood apraxia of speech, dysarthria), and cleft lip/palate.
- The full list of eligible disabilities is detailed in MBS Note MN.10.3.
Pathway Details
The eligible disability pathway is distinct from the Chronic Condition Management (CCM) pathway with different referral and billing requirements.
- A GP must suspect a patient under 25 has an eligible disability.
- If additional diagnostic information is needed, the GP may refer for up to four Medicare-rebated allied health assessment services (with standard GP consultation items).
- The speech pathologist must report back to the GP after each block of assessment services.
- Up to two blocks of four assessment services are available.
- If the GP diagnoses an eligible disability, they may complete a treatment and management plan using item 139 (or 92142 via video-telehealth), minimum 45 minutes, claimable once per lifetime.
- If treatment is needed, the GP can refer for up to 10 Medicare-rebated allied health treatment services per referral.
- Billing item 139 (or 92142) enables Medicare-rebated allied health treatment services.
Lifetime Limits
- Patients may access up to 20 Medicare-rebated allied health services in total (assessment + treatment) over their lifetime.
- Speech pathology service items must meet MBS minimum time requirements.