Complex Neurodevelopmental Disorders: 
Medicare Benefits Schedule (MBS) Eligibility

MBS items are available for assessing, diagnosing and treating patients under 25 years old with a Complex Neurodevelopmental Disorder, such as autism spectrum disorder.

If you are concerned that you or your child is struggling with an underlying neurodevelopmental disorder which is affecting many domains of your/their life, including:

• cognition,

• language,

• social-emotional development,

• motor skills,

• adaptive behaviour: conceptual skills, practical skills, social skills, or social communication skills,

you may be eligible for subsidized support through Medicare.

If your treating psychiatrist suspects a complex neurodevelopmental disorder, they can send a referral to eligible allied health practitioners for conduct up to 8 assessment services.

• The allied health disciplines include psychology, speech pathology, occupational therapy, audiology, optometry, orthoptists and physiotherapy.

After the assessments are completed, the allied health practitioner needs to provide a report to your psychiatrist. This will determine if a diagnosis of a complex neurodevelopmental disorder is confirmed.
 

If the diagnosis is confirmed, your psychiatrist will be able to recommend access to 20 treatment and management services by the same allied health disciplines.

Step 1: You need a GP referral to access our psychiatry services.

Step 2: Discuss with your treating psychiatrist about this pathway. Your psychiatrist will also be able provide recommendations of the appropriate allied health providers to conduct the relevant assessments.

Step 3: Once you have the referral, you can seek the relevant allied health supports.

Step 4: After the assessments are completed, arrange a follow-up review with your psychiatrist to determine the next step. If the diagnosis is confirmed, your psychiatrist may recommend access of up to 20 treatment and management services.

• This is a separate benefit to the Mental Health Treatment Plan or Chronic Disease Management Plan. These can be accessed simultaneously if your GP considers this to be appropriate.

• Please note these services can be claimed per patient per lifetime.

• After the assessments are completed, you may not be eligible for the treatment and management services. This could occur for a few reasons:

  • The assessment is incomplete or inconclusive.

  • The impairment is present in fewer than two domains.

  • The impairment is present in two or more domains, but you may not require sufficient support to meet criteria.

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For more detailed information, please visit the Medicare website.