Medicare Care Plans:
Complex Neurodevelopmental Disorders
This is a summary of the Medicare-funded Complex Neurodevelopmental Disorders (NDD) care plan. It includes general information about the plan, as well as useful resources and links for further information.
What is it?
The Complex NDD plan is designed to support patients with significant cognitive and functional impairments across multiple domains, ensuring that they receive a comprehensive treatment plan coordinated by a paediatrician/psychiatrist (for a complex NDD) or a GP/paediatrician/psychiatrist (for an eligible disability). If you do not have National Disability Insurance Scheme (NDIS) funding, or have limited funding in your child’s NDIS plan, this Complex NDD plan may be helpful .
Who is eligible?
This Medicare plan that is either for:
Complex neurodevelopment disorders (NDD) such as Autism Spectrum Disorder (ASD), ADHD, intellectual disability and learning disabilities. A complex NDD is defined as a condition that affect multiple areas of development, including cognitive function, language, social-emotional skills, motor abilities, and adaptive behaviours like practical or social communication skills. To be eligible, a diagnosis of a complex NDD requires evidence of impairment in at least two or more of these domains, leading to significant challenges in daily functioning.
Eligible disabilities:
There is a list of eligible disabilities for this care plan, inlcuding deafblindness,chromosomal disorders (such as Fragile X, Down Syndrome) and more.
For the full list of eligible disabilities, click here
Eligibility:
Less than 25 years old
For complex neurodevelopmental disorders: a referral from a consultant paediatrician or a psychiatrist (please note that you will need a referral from your GP for a paediatrician/psychiatrist)
For eligible disabilities: a referral from a GP, Consultant Paediatrician, Psychiatrist or eligible Specialist
What services are covered?
Assessments
Your paediatrician/psychiatrist can refer to an allied health professional for further assessment.
Up to 4 assessment sessions through an allied health professional per block of management, with a total of up to 8 assessment sessions in a person’s lifetime.
These should be at least 50 minutes long.
Allied health professionals can include: Psychologist, speech pathologist, occupational therapist, audiologist, optometrist, orthoptists, and physiotherapists.
Therapy Sessions
Once the treatment and management plan is in place, a paediatrician/psychiatrist can refer the patient for further therapy to support them.
Up to 10 sessions per block of therapy may be used, with a total of 20 therapy sessions in a person’s lifetime.
Therapy sessions must be for a minimum of 30 minutes, and your therapist must send a final report to your paediatrician/psychiatrist
Therapy sessions can be provided by any of the allied health professionals previously mentioned.
What is the Medicare rebate?
The Medicare rebates below are accurate as of January 2025. This is the amount that Medicare will cover, however if a service does not bulkbill, you will need to cover the cost of the gap. You will need to check with potential therapy clinics if they are able to process Medicare items.
For psychology services= $96.65 per session
For all other allied health therapists = $85.20 per session
For referring specialist = $259.40
Other useful links:
Disclaimer: While we strive to provide accurate and up-to-date information and resources, the information on this website is intended as a general reference only. We encourage all readers to conduct their own research to ensure that any information or links provided are accurate and relevant to their specific circumstances and needs.