ADHD assessment cost and Medicare rebates

Summary

• Psychiatry is a private fee. You pay the full amount at the time of booking.
• Where you are eligible and validly referred, Medicare may return part of it as a rebate.
• Updoc does not lodge Medicare claims on your behalf. You claim it yourself through myGov or the Express Plus Medicare app.
• Item 92435 and item 92437 cover different things, and which applies depends on the consultation.

What you pay

Current fees for assessment and follow-up are listed on the psychiatry pricing page. The fee is payable when you book, and it is the full amount, not a gap.

What Medicare may return

Medicare rebates for psychiatry depend on three things: that you hold a valid Medicare card, that you have a valid referral, and that the item claimed matches what was actually done. Rebate amounts are set by the Department of Health, not by Updoc, and the current schedule fees are published on MBS Online.

Two items commonly come up:

• 92435 — assessment of a patient referred by their GP, including preparation of a management plan sent back to that GP. Claimable once in a course of treatment.
• 92437 — an initial psychiatry consultation by video where a management plan is not prepared.

The differences, and the conditions attached to the 92435 pathway, are set out on the psychiatry Medicare rebates page.

How you claim

Because Updoc does not process Medicare claims, you lodge the claim yourself using the invoice you receive. The step-by-step version, for both myGov and the Express Plus Medicare app, is in the Medicare self-claim guide. Rebates are paid into the bank account Medicare holds for you, so it is worth checking that account is current before you claim.

Referral first

No valid referral, no rebate. If you have not sorted that yet, start with getting a psychiatry referral from your GP.

Frequently asked questions

Is bulk billing available?

No. Psychiatry consultations through Updoc are privately billed.

How long does the rebate take?

Medicare generally pays into your nominated account within a few business days of a successful claim. Timing is set by Services Australia.

Can I claim without a referral?

No. A valid referral is a condition of the rebate.

What if my claim is rejected?

Contact Medicare on 132 011. Most rejections come down to referral details or bank account information.

Important: This is general information, not personal medical or financial advice. Eligibility for a rebate is determined by Services Australia, and no rebate is guaranteed. If you are in crisis, call Lifeline 13 11 14, or 000 in an emergency.