Medicare Benefits Schedule - Note MN.6.5

These notes provide information on the telehealth psychological therapy MBS video consultation items by clinical psychologists. A video consultation involves a single clinical psychologist attending a patient, or a group of 6 to 10 patients.

MBS item numbers 80001 and 80011 provide for attendance via videoconferencing by a clinical psychologist to an individual patient.  MBS item number 80021 provide for attendance via videoconferencing by a clinical psychologist to a group of 6 to 10 patients. The items are stand-alone items and do not have a derived fee.

These therapies are time limited, being deliverable in up to 10 planned sessions in a calendar year (including services to which items 80001, 80011, 80101, 80111, 80126, 80136, 80151 and 80161 apply).

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 80021 (psychological therapy via video conference – clinical psychologist), 80121 (focussed psychological strategies via video conference – psychologist), 80146 (focussed psychological strategies via video conference – occupational therapist) and 80171 (focussed psychological strategies via video conference – social worker) apply. These group services are separate from the individual services and do not count towards the 10 individual services per calendar year maximum associated with those items.

Clinical indications

The clinical psychologist must be satisfied that it is clinically appropriate to provide a video consultation to a patient, or a group of 6 to 10 patients.

Restrictions

The MBS telehealth attendance items are not payable for services to an admitted hospital patient (this includes hospital in the home patients). Benefits are not payable for telephone or email consultations. In order to fulfil the item descriptor there must be a visual and audio link between the patient and the remote clinical psychologist. If the remote clinical psychologist is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth attendance is not payable.

Billing Requirements

All video consultations provided by clinical psychologists must be separately billed. That is, only the relevant telehealth MBS consultation item is to be itemised on the account/bill/voucher. Any other service/item billed should be itemised on a separate account/bill/voucher. This will ensure the claim is accurately assessed as being a video consultation and paid accordingly.

Clinical psychologists should not use the notation ‘telehealth’, ‘verbal consent’ or ‘Patient unable to sign’ to overcome administrative difficulties to obtaining a patient signature for bulk-billed claims (for further information see mbsonline.gov.au/telehealth).

Eligible Geographical Areas

Geographic eligibility for psychological 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 providers are able to check their eligibility using the Modified Monash Model locator on the Department of Health’s website (http://www.health.gov.au/internet/otd/publishing.nsf/Content/MMM_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 are measured by the most direct (ie least distance) route by road. The patient or the clinical psychologist is not permitted to travel to an area outside the minimum 15 kilometres distance in order to claim a video consultation.

Record Keeping

Participating telehealth clinical psychologists must keep contemporaneous notes of the consultation including documenting that the service was performed by video conference, the date, time and the people who participated.

Only clinical details recorded at the time of the attendance count towards the time of the consultation. It does not include information added at a later time, such as reports of investigations.

Extended Medicare Safety Net (EMSN)

All telehealth consultations (with the exception of the participating optometrist telehealth items) are subject to EMSN caps. The EMSN caps for telehealth consultation items in Groups M6 and M7 are equal to 300% of the schedule fee (to a maximum of $500).

Aftercare Rule

Video consultations are subject to the same aftercare rules as clinical psychologists providing face-to-face consultations.

Multiple attendances on the same day

In some situations a patient may receive a consultation via video conference and a face-to-face consultation by the same or different clinical psychologist on the same day.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same clinical psychologist, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations. Clinical psychologists will need to provide the times of each consultation on the patient’s account or bulk-billing voucher.

Referrals

The referral procedure for a video consultation is the same as for conventional face-to-face consultations.

Technical requirements

In order to fulfil the item descriptor there must be a visual and audio link between the patient and the remote clinical psychologist. If the remote clinical psychologist is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth attendance is not payable.

Individual clinicians must be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy.

Related Items: 80001 80011 80021

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Professional attendance for the purpose of providing psychological assessment and therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting more than 30 minutes but less than 50 minutes, where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan or as part of a shared care plan; or referred 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 referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics if:

• the attendance is by video conference; and
• the patient is not an admitted patient; and
• the patient is located within a telehealth eligible area; and
• the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist.

Psychological therapy services delivered by video conference are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 80001, 80011, 80101, 80111, 80126, 80136, 80151 and 80161 apply).

Psychological therapy services delivered by video conference time limits include the maximum ten planned sessions in a calendar year services to which items 283 to 287; 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply.

Fee: $103.80 Benefit: 85% = $88.25

(See para MN.6.5 of explanatory notes to this Category)

Professional attendance for the purpose of providing psychological assessment and therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting at least 50 minutes, where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan or as part of a shared care plan; or referred 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 referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics if:

• the attendance is by video conference; and
• the patient is not an admitted patient; and
• the patient is located within a telehealth eligible area; and
• the patient is, at the time of the attendance , at least 15 kilometres by road from the clinical psychologist.

Psychological therapy services delivered by video conference are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 80001, 80011, 80101, 80111, 80126, 80136, 80151 and 80161 apply).

Psychological therapy services delivered by video conference time limits include the maximum ten planned sessions in a calendar year services to which items 283 to 287; 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply.

Fee: $152.40 Benefit: 85% = $129.55

(See para MN.6.5 of explanatory notes to this Category)

Professional attendance for the purpose of providing psychological therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP Mental Health Treatment Plan or as part of a shared care plan; or referred 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 referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics if:

• the attendance is by video conference; and
• the patient is not an admitted patient; and
• the patient is located within a telehealth eligible area; and
• the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist.

Group psychological therapy services delivered by video conference are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 80021, 80121, 80146 and 80171 apply).

Group psychological therapy services delivered by video conference time limits include the maximum ten planned sessions in a calendar year services to which items 80020, 80120, 80145 and 80170 apply.

- GROUP THERAPY with a group of 6 to 10 patients, EACH PATIENT

Fee: $38.70 Benefit: 85% = $32.90

(See para MN.6.5 of explanatory notes to this Category)