Category 8 - MISCELLANEOUS SERVICES
Psychological Therapy Services Attracting Medicare Rebates
Eligible psychological therapy services
There are eight MBS items for the provision of psychological therapy services to eligible patients by a clinical psychologist, including five items for face-to-face consultations and three items for video conference consultations. Clinical psychologists must meet the provider eligibility requirements set out below and be registered with the Department of Human Services.
In these notes, 'GP' means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.
Referrals and Referral Validity
Services provided under the Psychological Therapy 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 (GP items 2700, 2701, 2715, 2717 or medical practitioner items 272, 276, 281, 282);
- 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 (item 291);
- a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals); or
- a referral has been made by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a Health Care Home shared care plan.
Health Care Home shared care plan
A Health Care Home shared care plan means a written plan that is prepared for a patient enrolled at a Health Care Home trial site; is prepared by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) who is leading the patient's care at the Health Care Home trial site; and includes: an outline of the patient's agreed current and long-term goals; the person or people responsible for each activity; arrangements to review the plan by a day mentioned in the plan; and if authorised by the patient, arrangements for the transfer of information between the medical practitioner and other health care providers supporting patient care about the patient's condition or conditions and treatment.
Number of services per year
Medicare rebates are available for up to 10 (temporarily increased to 20 until 31 December 2022) individual mental health services in a calendar year. The services may consist of: GP/medical practitioner focussed psychological strategies services (GP items 2721 to 2727 or medical practitioner items 283 to 287); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies - allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165).
The referring practitioner can decide how many sessions the patient will receive in a course of treatment, within the maximum session limit for the course of treatment. The maximum session limit for each course of treatment is set out below:
- 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).
- Additional COVID-19 sessions (only available until 31 December 2022) – a maximum of ten sessions.
The written report provided by the clinical psychologist following a course of treatment will be considered by the referring practitioner in assessing the patient's clinical need for further sessions after each course of treatment.
Patients will also be eligible to claim up to 10 separate services within a calendar year for group therapy services involving 6-10 patients to which items 80020 (psychological therapy - clinical psychologist), 80021 (psychological therapy by video conference - clinical psychologist), 80120 (focussed psychological strategies - psychologist), 80121 (focussed psychological strategies by video conference - psychologist), 80145 (focussed psychological strategies - occupational therapist) , 80146 (focussed psychological strategies by video conference - occupational therapist), 80170 (focussed psychological strategies - social worker) and 80171 (focussed psychological strategies by video conference - social worker) apply. 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.
Please note if a referral does not specify whether the referral is for individual or group therapy, the patient can use a referral to access either individual or group therapy treatment options. The patient should speak to their GP about their treatment needs and the type of treatment that might be suitable in their particular circumstances.
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 providers 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. The clinical psychologist must personally attend the patient face-to-face, or by video conference for items 80001, 80011, 80021, 80101, 80111, 80121, 80126, 80136, 80146, 80151, 80161 and 80171.
It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.
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.
Course of treatment and reporting back to the referring medical practitioner
Eligible patients can claim Medicare subsidies for up to 10 (temporarily increased to 20 until 31 December 2022) individual and 10 group mental health services per calendar year.
Within this maximum service allocation, the clinical psychologist can provide one or more courses of treatment (additional information on course of treatment session limits is above). This enables the referring medical practitioner to consider a report from the clinical psychologist on the services provided to the patient, and the need for further treatment.
On completion of the initial course of treatment, the clinical psychologist must provide a written report to the referring GP or medical practitioner, which includes information on:
- assessments carried out on the patient;
- treatment provided; and
- recommendations on future management of the patient's disorder.
A written report must also be provided to the referring GP or medical practitioner at the completion of any subsequent course(s) of treatment provided to the patient.
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, if a service was provided out-of-hospital, 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.
Items 80000 to 80021 (inclusive) 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 (GP items 2700, 2701, 2715, 2717 or medical practitioner items 272, 276, 281, 282), under a Health Care Home shared care plan, under a referred psychiatrist assessment and management plan (item 291), or on referral 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.
Checking patient eligibility for psychological therapy services
Patients seeking Medicare rebates for psychological therapy services will need to have a referral from a GP, medical practitioner, psychiatrist or paediatrician. If there is any doubt about a patient's eligibility, the Department of Human Services will be able to confirm whether a GP Mental Health Treatment Plan; shared care 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 allied mental health services already claimed by the patient during the calendar year.
Clinical psychologists can call the Department of Human Services 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, the Department of Human Services 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.
Publicly funded services
Psychological therapy items 80000 to 80021 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 items apply for services that are provided by eligible clinical psychologists salaried by, or contracted to, the service as long as all requirements of the items 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.
- 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