Medicare Benefits Schedule - Note MN.6.3

Referrals

Patients must be referred for psychological therapy services by a GP or medical practitioner managing the patient under a GP Mental Health Treatment Plan or a referred psychiatrist assessment and management plan; 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. 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 (the ‘course of treatment’);
• a statement about whether the patient has a mental health treatment plan, a shared care plan (prepared on or before 30 June 2021), 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.

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.

Number of Sessions

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).

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.

Specifying the Number of Sessions on a Referral

If the referring practitioner:

• Does not specify the number of sessions
• Specifies a number of sessions above the maximum allowed for the course of treatment
• Specifies a number of sessions above the maximum allowed for the calendar year (including any sessions the patient has already received that year)

Then the clinical psychologist can use their clinical judgment to provide services under the referral, noting the patient cannot receive more than:

• the maximum number of sessions allowed for that particular course of treatment (as set out above), and
• the maximum number of sessions allowed in a calendar year.

In these circumstances, a clinical psychologist must provide a report at the end of a course of treatment in line with standard practice for these services. This enables the referring medical practitioner to consider the treating practitioner’s report on the services provided to the patient, and the need for further treatment.

Verbal Referral

A referring practitioner can verbally refer a patient for Better Access services only if:

• in their clinical judgement they consider it is necessary for the patient to have immediate access to support from a clinical psychologist, and
• it is not practicable in the circumstances to provide a written referral – for example, to do so would cause delays in treatment to the patient’s detriment, and
• the clinical psychologist documents in writing that they are treating the patient based on the referring practitioner’s verbal referral, and
• the referring practitioner provides a written referral to the clinical psychologist as soon as possible afterwards.

While waiting for the referring practitioner to provide a written referral, the treating practitioner can provide treatment according to the verbal referral until the referred number of sessions have been completed. If there is any doubt about the number of sessions the patient was verbally referred for, the treating practitioner should follow the guidance provided above under the heading ‘Specifying the number of sessions on a referral’. 

A verbal referral does not replace any requirement for the GP to review the patient’s progress (taking into account the written report from their treating allied health professional) after each course of treatment.

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

Use of Referrals across Different Calendar Years

Eligible patients can claim Medicare subsidies for up to 10 individual and 10 group mental health services per calendar year.

If a patient has not used all their psychological therapy services and/or focussed psychological strategies services in course of treatment 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.  Where the patient's care is being managed by a GP or medical practitioner, the GP/medical practitioner 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.

Referrals for the Additional 10 Sessions (available until 31 December 2022)

In response to the COVID-19 pandemic, the number of Medicare rebateable individual mental health services was temporarily increased from 10 to 20 per calendar year until 31 December 2022.

A patient does not need a new referral to access Better Access sessions from 1 January 2023. If the patient has a current referral (either for the initial 10 sessions or the additional 10 sessions) and has not used all of the sessions, they can use that referral to access sessions in 2023. However, they cannot receive more than 10 individual sessions in 2023.

Related Items: 80010

• Previous - Note MN.6.2
• Next - Note MN.6.4

Psychological therapy health service provided to a patient in consulting rooms by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the service is provided to the patient individually and in person; and

(c)  at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d)  on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e)  the service is at least 50 minutes duration

Fee: $161.20 Benefit: 85% = $137.05

(See para MN.6.2, MN.6.3, MN.6.4 of explanatory notes to this Category)