Medicare Benefits Schedule - Item 322

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration at hospital

Fee: $96.60 Benefit: 75% = $72.45 85% = $82.15

(See para AN.0.32, AN.0.76 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $289.80

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Intention of these items:

Items 341, 343, 345, 347 and 349 and telehealth equivalent items 91874 to 91878 and 91882 to 91884 are for the purpose of interviews with patient relatives or close associates to investigate the particular problem with which the patient presented or the interaction between the patient and the person interviewed. The items also provide for interviews concerned with the continuing management of the patient, focusing on clinically relevant problems rising in the management of the patient.

These items do not cover counselling of family or friends of the patient.

Referral requirements:

The patient who is the subject of the interview needs a referral to attend the psychiatrist in the first place, however the non-patient contacts who are interviewed do not require their own referral.

Claiming of Medicare benefits:

The payment of Medicare benefits under these items is limited to a total of 15 services in a calendar year. 

For Medicare benefit purposes, claims relating to services covered by items 341, 343, 345, 347, 349 and telehealth equivalent items 91874 to 91878 and 91882 to 91884 should be raised against the patient rather than against the person interviewed.

Same day attendance items:

Medicare benefits are payable on the same day for an interview under any of items 341, 343, 345, 347 and 349 or telehealth equivalent items 91874 to 91878 and 91882 to 91884 and for a consultation with a patient (under item 291, 293, 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 320, 322, 324, 326 or 328) provided that separate attendances are involved. This item can only be claimed if the interviewee attends without the patient. 

Related Items: 291 293 296 297 299 300 302 304 306 308 310 312 314 316 318 319 320 322 324 326 328 341 343 345 347 349 91874 91875 91876 91877 91878 91882 91883 91884

To increase the clinical treatment options available to psychiatrists and for which a Medicare benefit is payable, patients with an assessed mental disorder (dementia, delirium, tobacco use disorder and intellectual disability are not regarded as mental disorders for the purposes of these items) a patient is eligible for up to 10 individual allied mental health services per calendar year by:

• clinical psychologists providing psychological therapies; or
• appropriately trained GPs or allied mental health professionals providing focused psychological strategy (FPS) services.

Referrals from psychiatrists to allied mental health professionals must be made under eligible MBS items. While such referrals are likely to occur for new patients seen under item 296, 297, 299 or 92437 or a referred psychiatrist assessment and management plan under item 291 or 92435, they are also available for patients at any point in treatment (under items 104 to 109, 293, 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 320, 322, 324, 326, 328, 330, 332, 334, 336, 338, 341, 342, 343, 344, 345, 346, 347, 349 or telehealth equivalent items, as clinically required, under the same arrangements and limitations as outlined above). 

The ten individual services may consist of:

• psychological therapy services (items 80000 to 80015 or telehealth equivalent items 91166, 91167, 91181 or 91182) - provided by eligible clinical psychologists; and/or
• focused psychological strategies - allied mental health services (items 80100 to 80115 or telehealth equivalent items 91169, 91170, 91183 or 91184; 80125 to 80140 or telehealth equivalent items 91172, 91173, 91185 or 91186; 80150 to 80165 or telehealth equivalent items 91175, 91176, 91187 or 91188) - provided by eligible psychologists, occupational therapists and social workers.

Within the maximum service allocation of ten services, the allied mental health professional can provide one or more courses of treatment.

Group therapy services

In addition to the above services, patients will also be eligible to claim up to ten separate services within a calendar year for group therapy services (involving 6-10 patients) to which items:

• 80020 or 80021 (psychological therapy - clinical psychologist)
• 80120 or 80121 (focused psychological strategies - psychologist)
• 80145 or 80146 (focused psychological strategies - occupational therapist); and
• 80170 or 80171 (focused psychological strategies - social worker) apply.

These group services are separate from the individual services and do not count towards the ten individual services per calendar year maximum associated with those items.

Referral Requirements for Allied Health services

A referral for treatment must be in writing (signed and dated by the psychiatrist) and may include (unless clinically inappropriate):

• the patient’s name, date of birth and address;
• the patient’s symptoms or diagnostic assessment;
• the patient needs and goals of treatment (if clinically appropriate);
• a list of any current medications (if appropriate);
• the number of sessions before a psychiatry review is required; or the allied health practitioner should provide a written report back to the psychiatrist following the completed course of treatment, confirming the patient’s need for a subsequent course of treatment if clinically needed.

Maximum session limit for each course of treatment apply:

Initial course of treatment – a maximum of six sessions. Subsequent course of treatment – a maximum of six sessions up to the patient’s cap of ten sessions (for example, if the patient received six sessions in their initial course of treatment, they can only receive four sessions in a subsequent course of treatment).

Related Items: 104 109 291 293 296 297 299 300 302 304 306 308 310 312 314 316 318 319 320 322 324 326 328 330 332 334 336 338 342 344 346 80000 80015 80020 80021 80100 80115 80120 80121 80125 80140 80145 80146 80150 80165 80170 80171 91166 91167 91169 91170 91172 91173 91175 91176 91181 91182 91183 91184 91185 91186 91187 91188 92435 92437