Medicare Benefits Schedule - Item 80020

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View Associated Notes

Category 8 - MISCELLANEOUS SERVICES

80020

80020 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Group
M6 - Psychological Therapy Services

Psychological therapy health service provided to a person as part of a group of 4 to 10 patients (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:

(a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)  the service is provided in person; and

(c)  the service is at least 60 minutes duration

Further information on the requirements for this item are available in the explanatory notes to this Category.

Fee: $39.30 Benefit: 85% = $33.45

(See para MN.6.7 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $117.90


Associated Notes

Category 8 - MISCELLANEOUS SERVICES

MN.6.7

Provision of Group Psychological Therapy Services by Clinical Psychologists

This note provides information on Group Psychological Therapy services delivered by clinical psychologists. It includes an overview of the items, patient and provider eligibility, what activities are involved in providing services rebated by these items, and additional claiming information.

For information on Individual Psychological Therapy services see MN.6.1 to MN.6.5.

OVERVIEW

The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative commenced on 1 November 2006. Under the Better Access initiative MBS items provide Medicare benefits for the following allied mental health services:

  • psychological therapy - provided by eligible clinical psychologists; and
  • focussed psychological strategies – allied mental health - provided by eligible psychologists, occupational therapists and social workers.

GROUP PSYCHOLOGICAL THERAPY SERVICES

There are 6 MBS items for the provision of group psychological therapy services to eligible patients by clinical psychologists:

  • 80020, 80022, 80024 for provision of psychological therapy services by a clinical psychologist; and
  • 80021, 80023, 80025 for provision of video conference services to patients in telehealth eligible areas by a clinical psychologist.

Note, the clinical psychologist must be satisfied that it is clinically appropriate to provide a video consultation to a patient, and the patient must be in a telehealth eligible area (see ‘Telehealth eligible areas’ below).

In these notes, ‘GP’ means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.

Referrals 

Services provided under the group psychological therapy service items will not attract a Medicare rebate unless:

  • a referral has been made by a GP or medical practitioner who is managing the patient under a GP Mental Health Treatment Plan;
  • a referral has been made by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or
  • a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service.

The clinical psychologist must be in receipt of the referral at the first mental health consultation. The clinical psychologist must also retain the referral for 2 years (24 months) from the date the service was rendered.

Referrals from psychiatrists and paediatricians must be made from eligible Medicare services. For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109. For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133. 

Referring practitioners are not required to use a specific form to refer patients for these services. A referral for mental health services should be in writing (signed and dated by the referring practitioner) and include:

  • the patient’s name, date of birth and address;
  • the patient’s symptoms or diagnosis and a statement on whether a mental health treatment plan has been prepared;
  • a list of any current medications;
  • the number of sessions the patient is being referred for;
  • a statement about whether the patient has a mental health treatment plan or a psychiatrist assessment and management plan.

It may be useful for a referral to include a statement indicating whether group sessions could be considered. If a referral does not specify whether the referral is for individual or group therapy, the patient can use a referral to access either or both individual and group therapy treatment options. However, the patient should speak to their referring practitioner about their treatment needs and the type of treatment that might be suitable in their particular circumstances.

A referral should include all of the above details, to assist with any auditing undertaken by the Department of Health and Aged Care. Where appropriate, and with the patient’s agreement, the GP can also attach a copy of the mental health treatment plan to the referral.

Minimum number of patients

Group psychological therapy service MBS items can be claimed for groups of four to 10 patients. However, clinical psychologists can claim these MBS items if four patients were due to attend and one patient is unable to attend, regardless of the reason.

Number of services per year

Medicare rebates are available for up to 10 group therapy services per calendar year. The services may consist of psychological therapy services delivered by clinical psychologists and/or focussed psychological strategies - allied mental health services. These group services are separate from the individual services and do not count towards the individual services per calendar year maximum associated with those items, see MN.6.1 to MN.6.5.

The referring practitioner can decide how many sessions the patient will receive, within the maximum session limit for the calendar year. If the referring practitioner does not specify the number of sessions on the referral, or specifies a number of sessions above the maximum allowed for the calendar year (including any sessions the patient has already received that year), the clinical psychologist can use their clinical judgement to provide services under the referral up to the maximum.

In the instance where a patient has received the maximum services available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year and is considered to clinically benefit from some additional services, the patient may be eligible for Primary Health Networks (PHNs) funded psychological therapies if they meet relevant eligibility criteria for the PHN commissioned services. It is recommended that clinical psychologists refer to their PHN for further guidance.

Service length and type

Services provided by eligible clinical psychologists under these items must be within the specified time period within the item descriptor.

In addition to psycho-education, it is recommended that cognitive-behaviour therapy be provided. However, other evidence-based therapies ─ such as interpersonal therapy ─ may be used if considered clinically relevant.

Record Keeping

Clinical psychologists must keep contemporaneous notes of the consultation including documenting the date, time and people who attended. Only clinical details recorded at the time of attendance count towards the time of the consultation. Other notes or reports added at a later time are not included.

Use of Referrals across Different Calendar Years

If a patient has not used all their psychological therapy services and/or focussed psychological strategies services covered by a referral within the calendar year, it is not necessary to obtain a new referral for the "unused" services. However, any "unused" services received from 1 January in the following year under that referral will count as part of the total services for which the patient is eligible in that calendar year.

When patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services.

It is not necessary to have a new GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan prepared each calendar year in order to access a new referral(s) for group psychological therapy services and/or focussed psychological strategies services.  Patients continue to be eligible for rebates for psychological therapy services and/or focussed psychological strategies services while they are being managed under a GP Mental Health Treatment Plan and/or a psychiatrist assessment and management plan as long as the need for eligible services continues to be recommended in their plan.

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, any out-of-pocket costs will count towards the Medicare safety net for that patient. The out‑of‑pocket costs for mental health services which are not Medicare eligible do not count towards the Medicare safety net. 

Publicly funded services

Psychological therapy services items 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, the psychological therapy service items apply for services that are provided by clinical psychologists salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Services Australia. These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services).

PATIENT ELIGIBILITY

Group psychological therapy service items apply to people with an assessed mental disorder and where the patient is referred by a GP or medical practitioner who is managing the patient under a GP Mental Health Treatment Plan or under a referred psychiatrist assessment and management plan; or from an eligible psychiatrist or paediatrician. 

The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. For the purposes of these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder. 

Telehealth eligible areas

Geographic eligibility for telehealth services funded under Medicare (in Groups M6 and M7) is determined according to the Modified Monash Model (MMM) classifications. Telehealth eligible areas are those areas that are within MMM classifications 4 to 7. Patients and clinical psychologists are able to check their eligibility using the Modified Monash Model locator on the Department of Health and Aged Care’s website (https://www.health.gov.au/resources/apps-and-tools/health-workforce-locator).

There is a requirement for the patient and clinical psychologist to be located a minimum of 15 kilometres apart at the time of the consultation. Minimum distance between clinical psychologist and patient video consultations is measured by the most direct (ie least distance) route by road. The patient or clinical psychologist is not permitted to travel to an area outside the minimum 15 kilometres distance in order to claim a video consultation.

Checking patient eligibility for psychological therapy services

If there is any doubt about a patient’s eligibility, Services Australia will be able to confirm whether a GP Mental Health Treatment Plan and/or a psychiatrist assessment and management plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of group services already claimed by the patient during the calendar year. 

Clinical psychologists can call Services Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011. 

The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Services Australia will not be aware of the patient’s eligibility. In this case the clinical psychologist should, with the patient’s permission, contact the referring practitioner to ensure the relevant service has been provided to the patient. 

CLINICAL PSYCHOLOGIST PROFESSIONAL ELIGIBILITY

A person is an allied health professional in relation to the provision of a psychological therapy health service if the person: 

  • holds 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
  • is endorsed by the Psychology Board of Australia to practice in clinical psychology. 

Until 31 October 2015, a person was also an allied health professional in relation to the provision of a psychological therapy health service if the person:

  • holds 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
  • on 31 October 2015  was an allied health professional in relation to the provision of a psychological therapy health service because the person:

           - was a member of the College of Clinical Psychologists of the Australian Psychological Society; or
           - had been assessed by the College of Clinical Psychologists of the Australian Psychological Society as meeting the requirements for                 membership of that College.

The clinical psychologist must be registered with Services Australia.

Registering with the Services Australia

Advice about registering with the Services Australia to provide psychological therapy services is available from the Services Australia provider enquiry line on 132 150.

Further information

For further information about Medicare Benefits Schedule items, please go to the Department of Health and Aged Care's website at www.health.gov.au/mbsonline.

For providers, further information is also available from the Services Australia provider enquiry line on 132 150.

Related Items: 80020 80021 80022 80023 80024 80025


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change