Medicare Benefits Schedule - Note MN.8.2

There are four MBS items for the provision of non-directive pregnancy support counselling services:

Item 4001 - services provided by an eligible GP;

Item 81000 - services provided by an eligible psychologist;

Item 81005 - services provided by an eligible social worker; and

Item 81010 - services provided by an eligible mental health nurse. 

These notes relate to items 81000-81010.  Each individual allied health professional must meet the provider eligibility requirements set out below and be registered with the Department of Human Services. 

Service length and type

Non-directive pregnancy support counselling services provided by eligible psychologists, social workers and mental health nurses using items 81000-81010 inclusive must be of at least 30 minutes duration and provided to an individual patient.  The allied health professional must personally attend the patient. 

The service involves the psychologist, social worker or mental health nurse undertaking a safe, confidential process that helps the patient explore concerns they have about a current pregnancy or a pregnancy that occurred in the preceding 12 months.  This includes providing, on request, unbiased, evidence-based information about all options and services available to the patient. 

Non-directive counselling is a form of counselling that is based on the understanding that, in many situations, people can resolve their own problems without being provided with a solution by the counsellor.  The counsellor's role is to encourage the person to express their feelings but not suggest what decision the person should make.  By listening and reflecting back what the person reveals to them, the counsellor helps them to explore and understand their feelings. With this understanding, the person is able to make the decision that is best for them. 

Number of services per year

Medicare benefits are available for up to three (3) eligible non-directive pregnancy support counselling services per patient, per pregnancy, provided using items 81000, 81005, 81010 and 4001.  

Partners of eligible patients may attend each or any counselling session, however, only one fee applies to each service. 

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, such out-of-pocket costs will count toward the Medicare safety net for that patient.  Non-directive pregnancy support counselling services in excess of three (3) per pregnancy will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services. 

Publicly funded services

Items 81000, 81005 and 81010 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, items 81000, 81005 and 81010 can be claimed for services provided by an eligible psychologist, social worker or mental health nurse salaried by or contracted to the service, where all requirements of the relevant item 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.

Related Items: 81000 81005 81010

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Provision of a non-directive pregnancy support counselling service to a person who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible psychologist, where the patient is referred to the psychologist by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may be provided by a psychologist who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service.  It may not be provided by a psychologist who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items -81000, 81005, 81010 and 4001

Fee: $77.30 Benefit: 85% = $65.75

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)

Provision of a non-directive pregnancy support counselling service to a person who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible social worker, where the patient is referred to the social worker by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may be provided by a social worker who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service.  It may not be provided by a social worker who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items -81000, 81005, 81010 and 4001

Fee: $77.30 Benefit: 85% = $65.75

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)

Provision of a non-directive pregnancy support counselling service to a person who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible mental health nurse, where the patient is referred to the mental health nurse by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may be provided by a mental health nurse who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service.  It may not be provided by a mental health nurse who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items - 81000, 81005, 81010 and 4001

Fee: $77.30 Benefit: 85% = $65.75

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)