Medicare Benefits Schedule - Note M6.3

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Category 8 - MISCELLANEOUS SERVICES

M6.3

Referral Requirements (GPs, Psychiatrists or Paediatricians to Clinical Psychologists for Psychological Therapy)

Referrals

Patients must be referred for psychological therapy services by a GP managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), or a referred psychiatrist assessment and management plan (item 291); or on referral from a psychiatrist or a paediatrician.

 

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.  The referral may be a letter or note to an eligible clinical psychologist signed and dated by the referring practitioner.

 

The clinical psychologist must be in receipt of the referral at the first allied mental health consultation. It is recommended that the clinical psychologist retain the referral for 24 months from the date the service was rendered (for the Department of Human Services auditing purposes).

 

Referral validity

Medicare benefits are available for up to ten individual (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) and/or ten group psychological therapy services and/or focussed psychological strategies services per patient per calendar year.

 

Referrals should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and the patient's clinical need) to a maximum of ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  For the purposes of these services, a course of treatment will consist of the number of services stated in the patient's referral (up to a maximum of six in any one referral).

 

If a patient has not used all of their psychological therapy services and/or focussed psychological strategies services under a referral in a 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 of ten 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.  Where the patient's care is being managed by a GP, the GP may choose to use this visit to undertake a review of the patient's GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan.

 

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 eligible 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.

 


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