Fee schedule
Medicare occupational therapy items 2026-27
Medicare item 10958 pays an OT $74.55 (rebate $63.40) under a chronic condition plan. Two more pathways exist outside chronic disease care: Better Access focused psychological strategies, from $74.55 for 20 to 50 minutes in rooms (80125) to $135.65 for 50 or more minutes out of rooms (80140), and complex neurodevelopmental items for patients under 25 (82010, 82025), both $105.25.
Last checked 25 Sep 2026 against the sources listed at the end of this page.
- Payer
- Medicare
- Effective from
- 1 Jul 2026
- Official schedule
- Source document
What changed this year
- Occupational therapy is the only discipline in this batch with three unrelated Medicare item groups: chronic condition management (10958, MBS Group M3), Better Access focused psychological strategies (80125 to 80145, Group M7) and complex neurodevelopmental disorder services for under-25s (82010, 82025, Group M10).
- Every OT Better Access item pays about $10 less than the matching registered psychologist item and the same as the matching social worker item: for example 80125 ($74.55) versus the psychologist's 80100 ($84.65) for the identical 20 to 50 minute in-rooms service.
- The complex neurodevelopmental items were extended from a fixed age ceiling to "aged under 25 years" under the current description, and both the assessment item (82010) and the treatment item (82025) pay the identical $105.25 schedule fee, effective 1 July 2026.
All 8 occupational therapy items
| Item | Description | Fee |
|---|---|---|
| 10958 | Occupational therapy service, individual, by an eligible OT, at least 20 minutes, under a GP chronic condition management plan (rebate 85% = $63.40) | $74.55 |
| 80125 | Focused psychological strategies, individual, in consulting rooms, 20 to less than 50 minutes, by an eligible OT, referred under Better Access (rebate 85% = $63.40) | $74.55 |
| 80130 | Focused psychological strategies, individual, out of consulting rooms, 20 to less than 50 minutes, by an eligible OT (rebate 85% = $89.25) | $105.00 |
| 80135 | Focused psychological strategies, individual, in consulting rooms, 50 minutes or more, by an eligible OT (rebate 85% = $89.50) | $105.25 |
| 80140 | Focused psychological strategies, individual, out of consulting rooms, 50 minutes or more, by an eligible OT (rebate 85% = $115.35) | $135.65 |
| 80145 | Focused psychological strategies, group of 4 to 10 patients, at least 60 minutes, by an eligible OT (rebate 85% = $22.70) | $26.70 |
| 82010 | Complex neurodevelopmental disorder or disability assessment/diagnostic contribution, patient under 25, by an eligible OT, at least 50 minutes (rebate 85% = $89.50) | $105.25 |
| 82025 | Complex neurodevelopmental disorder or disability treatment, patient under 25, diagnosed condition such as autism spectrum disorder, by an eligible OT, at least 30 minutes (rebate 85% = $89.50) | $105.25 |
OT sits at the intersection of three Medicare item groups
Occupational therapy has more overlapping Medicare pathways than any other discipline in this batch. Item 10958 covers chronic physical and complex care needs the same way it does for a physiotherapist or podiatrist. Items 80125 to 80145 cover focused psychological strategies under the Better Access to Mental Health Care initiative, where OTs sit alongside registered psychologists and social workers as eligible providers. Items 82010 and 82025 cover assessment and treatment of complex neurodevelopmental disorders and disabilities in patients under 25, a group where OT commonly works alongside psychology and speech pathology.
Each pathway has its own referral type, its own annual limits and its own report-back rule, and a clinic that only sets up 10958 because "that's the OT item" is missing two genuinely separate funding streams that many paediatric and mental health focused OT practices rely on more heavily than chronic disease work.
Better Access pays OTs the same as social workers, less than psychologists
Focused psychological strategies items price by location (in rooms versus out of rooms) and duration (20 to 50 minutes versus 50 or more), the same structure Medicare uses for registered psychologists and social workers. An OT's 20 to 50 minute in-rooms session (80125, $74.55) pays about $10 less than a registered psychologist's equivalent item (80100, $84.65), and exactly the same as a social worker's equivalent item (80150, $74.55). The pattern holds across every duration and location combination: OT and social work share one fee scale, psychology sits above it, and clinical psychology sits above that again.
A course of FPS treatment under Better Access needs a formal review with the referring GP at completion, plus a written report on what was assessed, treated and recommended, the same completion obligation that applies across all providers on the Better Access scale regardless of profession.
Under-25 neurodevelopmental items are a distinct clinical pathway
Items 82010 and 82025 exist for a narrower purpose than either of OT's other two item groups: contributing to diagnosis or a treatment and management plan for a patient under 25 with a suspected or confirmed complex neurodevelopmental disorder such as autism spectrum disorder, or an eligible disability. 82010 is the assessment or diagnostic contribution item, at least 50 minutes; 82025 is the treatment item delivered against an existing plan, at least 30 minutes. Both pay $105.25, noticeably more than the standard chronic condition item.
These items require a referring eligible medical practitioner (or an eligible allied health practitioner following that referral) and, for 82025, a written report at the end of the course of treatment. Up to 4 same-day services combining several items in this group can be billed, which matters for clinics running combined assessment days with several allied health professions.
Claiming notes
- 10958 follows the standard individual chronic condition management rules: a GP chronic condition management plan (or transitional GP Management Plan and Team Care Arrangement), referral, at least 20 minutes, sharing the 5-service annual cap with every other discipline the patient sees.
- Focused psychological strategies (80125 to 80145) need a referral from a GP under a GP Mental Health Treatment Plan, or from a psychiatrist or paediatrician. The OT must review the need for further treatment with the referring practitioner at the end of a course, and give a written report on assessments, treatment and future management at completion.
- The 60 minute group item (80145) needs 4 to 10 patients and is delivered in person; it cannot substitute for individual sessions and is billed at a lower fee reflecting the shared delivery.
- Complex neurodevelopmental items (82010, 82025) are for patients under 25 with a suspected or diagnosed complex neurodevelopmental disorder, such as autism spectrum disorder, or an eligible disability. 82010 supports diagnosis or contributes to the treatment and management plan; 82025 delivers a course of treatment consistent with that plan and needs a written report to the referring practitioner at completion.
- Up to 4 services combining 82010 with items 82000, 82005, 82030 and the equivalent telehealth items can be billed on the same day; the same day limit of 4 applies separately to 82025 combined with 82015, 82020, 82035 and their telehealth equivalents.
- All three item groups are entirely separate for claiming purposes. A patient's 5-service chronic condition cap, their Better Access mental health item entitlement and their complex neurodevelopmental service access do not draw down against each other.
Load these fees into your practice software
- Set up three distinct billable item groups in Cliniko for OT: chronic condition management (10958), Better Access mental health (80125 to 80145), and complex neurodevelopmental (82010, 82025), since each has its own referral type, cap and clinical record requirement.
- With eight items across three referral pathways, load the full list through Cliniko's Billable items CSV import (Settings, Data & docs, Data imports), naming each row by its referral pathway, for example "Medicare 80125 FPS Rooms 20-50min" rather than just the code, so reception does not mix up chronic disease and mental health referrals.
- For the group item (80145), use Cliniko's group appointment or class pricing set to $26.70 per attendee, matching the per-client Medicare fee, not a flat class rate.
- Flag 82010 and 82025 as under-25 items with an age check note in Cliniko, since the schedule specifically restricts them to patients under 25, unlike the other item groups on this page which have no age limit.
- Every item across the three groups bulk bills through the same Cliniko Tyro Health connection, regardless of which referral pathway it belongs to. Cliniko's help centre treats this Medicare workflow as the baseline it uses to explain DVA claiming.
- Keep a completion checklist for the Better Access and complex neurodevelopmental items, since both need a written report back to the referring practitioner before or at the end of the course of treatment, a requirement the plain chronic condition management item (10958) also has but is easier to miss across three different referral types.
Sources
- Effective 1 July 2026, MBS item 10958 (occupational therapy, individual chronic condition management service) has a schedule fee of $74.55 with an 85 per cent benefit of $63.40, for a service of at least 20 minutes under a GP chronic condition management plan. Department of Health and Aged Care, MBS Online, checked 25 Sep 2026.
- MBS item 80125 (occupational therapist focused psychological strategies, individual, in rooms, 20 to less than 50 minutes) has a schedule fee of $74.55; item 80140 (out of rooms, 50 minutes or more) has a schedule fee of $135.65; item 80145 (group of 4 to 10 patients, 60 minutes) has a schedule fee of $26.70. Department of Health and Aged Care, MBS Online, checked 25 Sep 2026.
- The equivalent registered psychologist item 80100 (in rooms, 20 to less than 50 minutes) has a schedule fee of $84.65, higher than the occupational therapist and social worker items for the same service. Department of Health and Aged Care, MBS Online, checked 25 Sep 2026.
- MBS item 82010 (occupational therapy complex neurodevelopmental disorder or disability assessment, patient under 25, at least 50 minutes) and item 82025 (treatment, at least 30 minutes) each have a schedule fee of $105.25, effective 1 July 2026, and both are capped at up to 4 same-day services combined with related items in their subgroup. Department of Health and Aged Care, MBS Online, checked 25 Sep 2026.
- Cliniko's data import tool can create billable items from a CSV with the fields Item code, Name, Price (ex. tax), Taxable and Item type. Cliniko, checked 25 Sep 2026.
- Cliniko's help centre confirms Medicare bulk bills are processed through the Tyro Health (formerly Medipass) integration, and uses that as the comparison point for how DVA claiming works in Cliniko. Cliniko, checked 25 Sep 2026.