Medicare Rebates for ADHD Assessment in Australia

Yes. Medicare provides rebates for ADHD assessments and ongoing treatment when you see a psychiatrist, psychologist, or paediatrician with a valid GP referral. The rebate amount depends on the provider type and whether you have a referral.

There is no dedicated Medicare item number for ADHD assessment — assessments are billed under general psychiatry or psychology consultation items. This means the rebate is the same regardless of the complexity or duration of an ADHD-specific assessment, which is a structural limitation of the current system.

This guide explains every relevant MBS item number, rebate amount, and strategy to maximise your Medicare coverage for ADHD.

Psychiatrist consultations:

Psychology consultations (Better Access):

The critical difference: Item 291 (referred psychiatrist) provides $467.45 in rebates vs $268.90 for Item 296 (unreferred) — a difference of $198.55 per appointment. A GP referral costs nothing if your GP bulk bills, making it the most impactful single step you can take to reduce costs.

The Better Access initiative provides Medicare-subsidised psychology sessions for people with a diagnosed mental health condition, including ADHD. It underwent significant reform effective 1 November 2025.

• Session allocation:**
• 10 individual sessions per calendar year
• 10 group therapy sessions per calendar year
• Up to 2 family/carer participation sessions (counted within the individual allocation)

• November 2025 changes:**
• MHTP referrals are now restricted to your MyMedicare-registered GP practice or your "usual medical practitioner" — you can't just see any GP
• Several GP review items were removed from the MBS (items 2712, 92114, 92126, 277, 92120, 92132)
• GPs now use general attendance items for mental health reviews and care

• How to access:**
• Book with your regular GP (or MyMedicare-registered GP)
• GP creates a Mental Health Treatment Plan
• GP provides referral to psychologist or clinical psychologist
• Attend sessions and claim Medicare rebate at each visit
• GP reviews the plan after 6 sessions

The MHTP itself is usually bulk-billed by your GP, so there's no upfront cost to get started.

• Book a standard GP appointment — this can be bulk-billed
• Tell your GP you'd like to be assessed for ADHD — you don't need to prove you have ADHD, just that you'd like an assessment
• Ask for a referral to a psychiatrist (for diagnosis + medication) or a Mental Health Treatment Plan (for psychology)
• Your GP will write a referral letter — this is valid for 12 months for a psychiatrist, or until the MHTP is reviewed
• Get a copy — keep a copy of your referral for your records

If your GP is dismissive about ADHD, you're entitled to seek a second opinion. Many GPs are unfamiliar with adult ADHD presentation — this is a well-documented issue that the Senate inquiry specifically identified as a barrier to care.

If your out-of-pocket medical costs are high, the Medicare Safety Net provides additional support once you hit the annual threshold:

How it works: Once your total gap expenses (the difference between the schedule fee and the rebate) reach the threshold in a calendar year, Medicare reimburses you 100% of the schedule fee for all further out-of-hospital services for the rest of the year.

Family pooling: Families and couples registered together can combine their Medicare gap expenses toward the threshold. If multiple family members are accessing health services, you may reach the threshold faster.

Practical tip: Register for Medicare Safety Net tracking at your pharmacy or through MyGov. Many people don't realise they've hit the threshold because they haven't registered.

Your out-of-pocket cost (the "gap") is the difference between what the provider charges and the Medicare rebate. Based on current provider data:

• Psychologist: Average fee $714 (based on 238 providers). 4% offer bulk billing.
• Psychiatrist: Average fee $438 (based on 214 providers). 4% offer bulk billing.
• GP: Average fee $384 (based on 287 providers). 16% offer bulk billing.
• Paediatrician: Average fee $355 (based on 261 providers). 2% offer bulk billing.

Gap fees vary enormously between providers — it's worth asking for the exact fee and the expected rebate before booking, and asking whether the practice bulk bills any part of the assessment.

Private health insurance can help with some ADHD-related costs, but coverage is limited:

• Hospital cover: Gold-tier policies cover inpatient psychiatric treatment. This is relevant for severe comorbidities but not for standard ADHD assessment.
• Extras cover (psychology): Many mid-to-top-tier Extras policies include $200-$1,000+ per year toward psychology sessions. The waiting period is typically 2 months.
• Important limitation: You cannot claim both Medicare and private health insurance for the same service. Private health extras are used for sessions that aren't covered by Medicare, or for the gap on partially covered services.
• Outpatient psychiatrist fees are NOT covered by private health insurance — only Medicare applies.

Check your policy details — the amount covered per session and annual limits vary enormously between funds and tiers.