Medicare Benefits Schedule - Item 81000

Provision of a non-directive pregnancy support counselling service to a person who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible psychologist, where the patient is referred to the psychologist by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may be provided by a psychologist who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service.  It may not be provided by a psychologist who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items -81000, 81005, 81010 and 4001

Fee: $77.30 Benefit: 85% = $65.75

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $231.90

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Medicare benefits are available for non-directive pregnancy support counselling services provided to a person who is pregnant or who has been pregnant in the 12 months preceding the first service to which item 81000, 81005 or 81010 applies in relation to that pregnancy.  Services can be provided either by an eligible GP or by an eligible psychologist, social worker or mental health nurse on referral from a GP. 

The term 'GP' is used hereafter as a generic reference to medical practitioners (including a general practitioner, but not including a specialist or consultant physician).  

The items may be used to address any pregnancy related issues for which non-directive counselling is appropriate. 

Related Items: 81000 81005 81010

There are four MBS items for the provision of non-directive pregnancy support counselling services:

Item 4001 - services provided by an eligible GP;

Item 81000 - services provided by an eligible psychologist;

Item 81005 - services provided by an eligible social worker; and

Item 81010 - services provided by an eligible mental health nurse. 

These notes relate to items 81000-81010.  Each individual allied health professional must meet the provider eligibility requirements set out below and be registered with the Department of Human Services. 

Service length and type

Non-directive pregnancy support counselling services provided by eligible psychologists, social workers and mental health nurses using items 81000-81010 inclusive must be of at least 30 minutes duration and provided to an individual patient.  The allied health professional must personally attend the patient. 

The service involves the psychologist, social worker or mental health nurse undertaking a safe, confidential process that helps the patient explore concerns they have about a current pregnancy or a pregnancy that occurred in the preceding 12 months.  This includes providing, on request, unbiased, evidence-based information about all options and services available to the patient. 

Non-directive counselling is a form of counselling that is based on the understanding that, in many situations, people can resolve their own problems without being provided with a solution by the counsellor.  The counsellor's role is to encourage the person to express their feelings but not suggest what decision the person should make.  By listening and reflecting back what the person reveals to them, the counsellor helps them to explore and understand their feelings. With this understanding, the person is able to make the decision that is best for them. 

Number of services per year

Medicare benefits are available for up to three (3) eligible non-directive pregnancy support counselling services per patient, per pregnancy, provided using items 81000, 81005, 81010 and 4001.  

Partners of eligible patients may attend each or any counselling session, however, only one fee applies to each service. 

Out-of-pocket expenses and Medicare Safety Net

Charges in excess of the Medicare benefit for these items are the responsibility of the patient.  However, such out-of-pocket costs will count toward the Medicare safety net for that patient.  Non-directive pregnancy support counselling services in excess of three (3) per pregnancy will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services. 

Publicly funded services

Items 81000, 81005 and 81010 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital. 

However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory clinic, items 81000, 81005 and 81010 can be claimed for services provided by an eligible psychologist, social worker or mental health nurse salaried by or contracted to the service, where all requirements of the relevant item are met, including registration with the Department of Human Services.  These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services). 

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to 'top up' the Medicare rebate paid for the services.

Related Items: 81000 81005 81010

Patients must be referred for non-directive pregnancy support counselling services by a GP or medical practitioner.  GPs/medical practitioners are not required to use a specific form to refer patients for these services.  The referral may be a letter or note to an eligible allied health professional signed and dated by the referring GP/medical practitioner.

Patients may be referred by a GP or medical practitioner to more than one eligible allied health professional for eligible non-directive pregnancy support counselling services (for example, where a patient does not wish to continue receiving services from the provider they were referred to in the first instance).  However, Medicare benefits are only available for a maximum of three (3) non-directive pregnancy support counselling services to which items 792, 4001, 81000, 81005 and 81010 apply, per patient, per pregnancy.

Where the patient is unsure of the number of Medicare rebated non-directive pregnancy support counselling services they have already accessed, the patient may check with the Department of Human Services on 132 011. Alternatively, the psychologist, social worker or mental health nurse may check with the Department of Human Services.

The relevant allied health professional must be in receipt of the referral at the first non-directive pregnancy support counselling service and must retain the referral for 2 years from the date the service was rendered, for the Department of Human Services auditing purposes. 

A copy of the referral is not required to accompany Medicare claims.  However, referral details are required to be included on patients' itemised accounts/receipts or Medicare assignment of benefit forms.

Referral validity

The referral is valid for up to three (3) non-directive pregnancy support counselling services, per patient, per pregnancy.

Subsequent Referrals

A new referral is required where the patient seeks to access non-directive pregnancy support counselling in relation to a different pregnancy or where the patient wishes to be referred to a different allied health professional than the one they were referred to in the first instance.

Related Items: 81000 81005 81010

Eligible allied health professionals

Items 81000, 81005 and 81010 can only be claimed for services provided by psychologists, social workers and mental health nurses who meet the following specific eligibility requirements, and are registered with the Department of Human Services.

To be eligible to provide services using MBS Item 81000, a psychologist must hold general registration in the health profession of psychology under the applicable law in force in the State or Territory in which the service is provided and be certified by the Australian Psychological Society as appropriately trained in non-directive pregnancy counselling.

To be eligible to provide services using MBS Item 81005, a social worker must be a 'Member' of the Australian Association of Social Workers (AASW), be certified by AASW either as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers 2014’ as in force on 25 September 2014 or as an Accredited Social Worker, and have completed appropriate non-directive pregnancy counselling training;

To be eligible to provide services using MBS Item 81010, a mental health nurse must be a 'Credentialled Mental Health Nurse' as certified by the Australian College of Mental Health Nurses, and have completed appropriate non-directive pregnancy counselling training.

Registering with the Department of Human Services

Advice about registering with the Department of Human Services to provide non-directive pregnancy support counselling services using items 81000-81010 inclusive is available from the Department of Human Services provider inquiry line on 132 150.

Further information

A copy of the Medicare Allied Health Supplement can be accessed from www.health.gov.au/mbsonline.  The Supplement includes more information about Medicare, including how to make a claim from Medicare.

Further information is also available for providers from the Department of Human Services provider inquiry line on 132 150.

Related Items: 81000 81005 81010