From 1 March 2026, Medicare speech pathology services were expanded for children and young people under 25 with certain eligible disabilities.
It’s good news for families, but the process can be confusing. Who needs to make the diagnosis? Does your child have to see a paediatrician first? What does the GP actually need to do, and when does a Medicare rebate apply?
This guide explains how the pathway can work, in plain language.
Quick answer
In most cases, you don’t need to see a paediatrician first. A GP can establish your child’s Treatment and Management Plan and write the referral to an eligible speech pathologist. The GP can use their own assessment, a speech pathologist’s report, or information from a specialist when deciding whether your child meets the Medicare requirements.
Can my GP make the referral?
Yes.
For eligible disabilities and conditions, a GP can complete the Treatment and Management Plan under the complex neurodevelopmental disorder or disability (CND) and refer the patient to a speech pathologist for 20 speech pathology sessions and/or 8 speech pathology assessment sessions.
The GP does not necessarily need to be a paediatrician or other specialist.
For the speech pathology treatment items, including MBS item 82020, the legislation specifically provides for a GP referral where the referral is for diagnosed complex neurodevelopmental disorder.
Does my child need to see a paediatrician first?
Not necessarily. A paediatrician or other specialist may be involved where it’s clinically appropriate, but seeing one is not automatically required before a GP can establish the Medicare Treatment and Management Plan.
Your GP can consider your child’s clinical presentation and any relevant information available, such as:
- the GP’s own assessment
- a speech pathologist’s assessment and report
- an assessment or diagnosis from a paediatrician or other specialist
- other relevant clinical information.
The GP then decides whether the Medicare requirements are met and, if appropriate, completes the Treatment and Management Plan.
Can a speech pathologist provide the assessment?
Yes, in appropriate circumstances. Speech pathologists play a key role in assessing communication and speech difficulties.
Where an assessment is needed to help establish your child’s eligible disability, Medicare provides a pathway for assessment services by an eligible allied health professional, including a speech pathologist. The speech pathologist sends their findings and report to the GP, who uses that information alongside their own clinical assessment when completing the plan.
How the process works: a step-by-step example
Imagine a child has significant difficulty producing speech sounds.
Step 1 – GP appointment
The family sees their GP to talk about the child’s speech difficulties. The GP considers the child’s history and presentation.
Step 2 – Speech pathology assessment
If further assessment is needed, a speech pathologist assesses the child’s speech and sends a report to the GP.
Step 3 – GP Treatment and Management Plan
The GP considers the available information and, where the Medicare requirements are met, completes the Treatment and Management Plan for CND. For the relevant telehealth pathway, options may apply.
Step 4 – Referral to speech pathology
The GP provides a written referral to the speech pathologist. The referral is for treatment under the relevant Medicare speech pathology item, such as item 82020, where the patient and service meet the eligibility requirements.
Step 5 – Speech pathology treatment
The speech pathologist provides the eligible treatment services in accordance with the Medicare requirements and the Treatment and Management Plan.
What if Medicare says the GP needs a special provider number?
This has been a source of confusion for some families and practices.
The legislation specifically says that, for speech pathology items including 82020, a GP referral must be a referral for a service for CND.
The legislation does not state that a GP needs a separate “M10 provider number” simply to make the referral.
If a Medicare claim is rejected because of a provider-number issue, the GP practice may need to clarify with Medicare whether the issue relates to the GP’s ability to claim the relevant prerequisite MBS item or to the details on the referral.
Where can I find the legislation?
The requirements are contained in the:
Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.
The specific provision relevant to GP referrals for speech pathology items 82015, 82020, 82025 and 82035.
View the legislation on the Federal Register of Legislation
You can also read Services Australia’s overview of the changes to Medicare speech pathology services.
In summary:
- You do not necessarily need to see a paediatrician first.
- Your GP can assess the situation and, where appropriate, use information from a speech pathologist or specialist to establish the relevant disability.
- The GP completes the Treatment and Management Plan for CND.
- The GP then provides the referral to the speech pathologist.
- The speech pathologist can then provide eligible Medicare-funded treatment where all MBS requirements are met.
Because Medicare eligibility depends on the individual child’s circumstances and the specific MBS requirements, families should discuss their individual situation with their GP and speech pathologist.
Talk to our speech pathology team
If you’re unsure whether your child may be eligible, or you’d like a speech pathology assessment to share with your GP, our team at Moi Clinic Rowville can help you understand the next steps.
Call (03) 9768 2900 or email info@moiclinic.com to make a booking.
Related reading: What to expect in your first speech session
This article is general information only and isn’t a substitute for advice about your child’s individual circumstances. Medicare requirements can change; information is current as at October 2026.
