Funding Options for Occupational Therapy Services: A Simple Guide for Families
Starting occupational therapy can feel like a big step, and one of the first questions most families ask is how they can pay for sessions. Between Medicare, private health cover, out-of-pocket options and, for many children, NDIS funding, it can feel confusing knowing what applies to you.
This guide breaks everything down into simple, parent-friendly language so you can clearly understand what funding pathways are available for OT services in Australia.
NDIS Funding for Occupational Therapy
The National Disability Insurance Scheme (NDIS) is one of the main funding pathways for children who have developmental concerns, delays or a disability.
Many families use the NDIS to cover some or all of their child’s OT supports.
How OT is funded under the NDIS
OT is typically funded under the following categories:
Capacity Building – Improved Daily Living
This is the most common category for OT. It covers therapy that helps children build daily living skills, regulation, motor development, sensory processing, social participation and overall independence.
Core Supports (Flexible)
Some families may use their Core budget for OT where appropriate. Core funding is flexible and can be used for therapy in some plans if it aligns with the child’s NDIS goals.
Do you need a diagnosis to access NDIS-funded OT?
No. A diagnosis is helpful, but not required. The NDIS focuses on functional impact, not labels. If a child has significant functional difficulties in areas like communication, emotional regulation, social participation, sensory processing, motor skills or daily living, they may be eligible.
How OT fits into your plan
Your child’s OT sessions can be funded if:
- They support the child to work toward their NDIS goals
- They build functional skills and independence
- The therapy is considered “reasonable and necessary”
OTs can also assist families with NDIS reporting, goal setting and functional assessments.
Medicare Rebates for Occupational Therapy
Medicare offers several rebates that can help reduce the cost of OT. These rebates do not usually cover the full session fee, but they can make therapy more affordable. The information below is based on the most recent Medicare guidelines and the documents provided to your service.
Chronic Disease Management Plan (CDM)
This is the most widely used Medicare rebate for OT.
A CDM plan is created by your child’s GP when they have a chronic or complex condition that has lasted, or is expected to last, at least six months. Many children who require OT fall into this category, including children with developmental delays, emotional regulation difficulties, sensory processing challenges, motor delays or autism.
Through a CDM plan, families can receive rebates for up to five allied health sessions per calendar year. These five sessions can be used entirely for OT or shared between other allied health services, depending on your child’s needs.
Your GP must also complete a Team Care Arrangement, which identifies the healthcare professionals involved in your child’s support. A chronic condition must require ongoing care from the GP plus at least two additional providers. Children with ASD typically meet this requirement due to the multidisciplinary nature of their care.
If you do not use all five sessions before the end of the calendar year, unused sessions follow you into the next year but still count as part of that year’s total of five.
Click here for more information >> https://www.servicesaustralia.gov.au/gp-chronic-condition-management-plan?context=20
Autism Assessment Medicare Items
Children who are undergoing an autism assessment may be eligible for up to four Medicare-rebated assessment sessions with allied health professionals such as occupational therapists, speech pathologists or psychologists.
These sessions are designed to support a paediatrician or psychiatrist in the diagnostic process. To be eligible:
- Your child must be under 13
- The assessment must be requested by a paediatrician or psychiatrist
- The sessions must directly support the diagnostic assessment
These assessment items can only be used once in a child’s lifetime.
Autism Treatment Plan Items (20 Lifetime Sessions)
Once a child has a confirmed autism diagnosis, families may be able to access up to 20 Medicare-rebated allied health treatment sessions.
To use these treatment items:
- A paediatrician or psychiatrist must prepare the Autism Treatment Plan before the child turns 13
- The treatment sessions can be used until the child’s 15th birthday
- The 20 sessions are lifetime-limited and cannot be renewed
The 20 sessions can be shared between occupational therapy, speech pathology, psychology, and other eligible allied health professionals, depending on what the paediatrician or psychiatrist specifies in their referral.
Click here for more information >> https://autismqld.com.au/wp-content/uploads/2025/03/Medicare.pdf
Medicare Safety Net
Families who see health professionals regularly throughout the year may reach the Medicare Safety Net threshold. Once this threshold is met, Medicare provides a higher rebate for many out-of-hospital services.
Registering as a family or household can significantly reduce out-of-pocket costs once you reach the threshold, so it’s worth checking whether you are registered.
Private Health Insurance
Many private health funds offer rebates for OT under extras cover. Rebate amounts vary depending on your provider and policy level. Some offer a set amount per session, while others apply an annual limit.
You do not need a referral from a doctor to claim through private health insurance. The best way to check your rebate is to contact your insurer directly and ask about your OT allowance.
Out-of-Pocket (Private Pay)
Some families choose to pay privately for OT because it provides the greatest flexibility. You can start immediately, choose your therapist, and access as many sessions as your child needs without limitations from referral requirements or funding caps.
Which Option Is Right for Your Child?
The best funding pathway depends on your child’s needs, your family’s circumstances and whether you already receive Medicare rebates, private health cover, out-of-pocket therapy, or are considering the NDIS.
If you’re unsure, your GP, paediatrician or occupational therapist can help guide you through which options apply to your child
Final Thoughts
Understanding your funding options can make starting OT much less overwhelming. Whether you are accessing the NDIS, Medicare rebates, private health insurance, private pay or a combination of these, the goal is always the same: ensuring your child receives the support they need to grow, learn and thrive.
