A Simple Guide for GPs Managing Eligible Disability Presentations

Medicare M10 Pathway

Children & young people under 25 years may be eligible for Medicare-funded allied health assessment & treatment services under the M10 pathway.

Importantly, for eligible disabilities, a GP can refer directly to allied health without waiting for paediatrician review.

This pathway helps reduce delays to therapy, supports earlier intervention, & allows allied health assessment to assist clinical decision-making & treatment planning.

Patient Eligibility

Your patient must be under 25 years of age to access:

allied health Medicare Benefits Schedule (MBS) items
for assistance in diagnosing the patient or contributing to a treatment plan
a treatment & management plan prepared by a specialist, consultant physician or general practitioner
allied health MBS items for treatment services

Key Point for GPs

You can refer directly for eligible disabilities.

For eligible disability presentations, a GP can:

assess eligibility
refer directly to allied health for assessment services
use allied health assessment to support diagnostic clarification & functional profiling
initiate treatment services once Item 139 & a Treatment & Management Plan are completed

You do not need to wait for paediatrician involvement for eligible disability pathways.

What the M10 Pathway Is NOT

The M10 pathway is:

NOT a GP Management Plan (GPMP)
NOT a Chronic Disease Management Plan
NOT limited to paediatricians
NOT a generic developmental referral pathway

For complex neurodevelopmental conditions such as autism assessment, referral requirements differ & usually require paediatrician or psychiatrist involvement.

Eligible Disabilities Include

Examples of eligible disabilities include:

Cerebral palsy
Down syndrome
Fragile X syndrome
Prader-Willi syndrome
Williams syndrome
Angelman syndrome
Kabuki syndrome
Smith-Magenis syndrome
CHARGE syndrome
Cri du Chat syndrome
Cornelia de Lange syndrome
Rett syndrome
Microcephaly associated with significant functional impairment
Hearing impairment
Deafness
Vision impairment
Blindness
Deafblindness
Fetal alcohol spectrum disorder (FASD) with an IQ of less than 70 on a standardised test of intelligence
Cleft lip and/or palate
Stuttering
Speech sound disorders, including:
- Articulation disorder
- Phonological disorder
- Childhood apraxia of speech (CAS/dyspraxia/developmental verbal dyspraxia/speech apraxia)
- Dysarthria

Patients must experience significant functional impairment related to the eligible disability.

Assessment vs Treatment Services

Assessment Services	Treatment Services
Can occur BEFORE Item 139	Require Item 139
Focus on assessment & functional profiling	Focus on therapy & intervention
Assist diagnostic clarification	Deliver ongoing treatment
Support GP decision making	Support functional improvement

m10 allied health treatment cycle for GPs workflow

Allied Health Services Available

Allied Health Discipline	Assessment Item	Treatment Item
Psychology	82000	82015
Speech Pathology	82005	82020
Occupational Therapy	82010	82025
Physiotherapy, Audiology, Orthoptics, Optometry, Dietetics, Exercise Physiology	82030	82035

Billing Structure

Service	Requirement	Service Limits
Allied Health Assessment Services	GP referral only	Up to 8 services lifetime
Allied Health Treatment Services	GP must bill Item 139 & prepare a Treatment & Management Plan	Up to 20 services lifetime

Important Billing Notes

Prior to Item 139, GPs may use standard GP attendance items while undertaking assessment, developmental review, diagnostic clarification, & care planning.
Assessment services can occur before Item 139. Referral for assessment is a simple request on GP letterhead. No special form is required.
Allied health assessment can assist the GP in confirming diagnosis & informing the Treatment & Management Plan.
Treatment services require the GP to bill Item 139 & prepare a Treatment & Management Plan.
Up to 20 allied health treatment services are available across the patient’s lifetime.
Allied health providers must provide written reporting back to the referring GP after 4 assessment sessions & after 10 treatment sessions.