Medicare Benefits Schedule - Item 4001

Professional attendance of at least 20 minutes in duration at consulting rooms by a general practitioner who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non-directive pregnancy support counselling to a patient who:

(a) is currently pregnant; or

(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 81000, 81005 or 81010 applies in relation to that pregnancy

Note:    For items 81000, 81005 and 81010, see the determination about allied health services under subsection 3C(1) of the Act.

Fee: $87.25 Benefit: 100% = $87.25

(See para AN.0.66, MN.8.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $261.75

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Overview

The Pregnancy Support Counselling initiative provides for Medicare benefits to be paid for non-directive pregnancy support counselling services provided to a person who is:

·         pregnant; or

·         who has been pregnant in the 12 months preceding the first service to which this item, item 792 or item 81000, 81005 or 81010 applies in relation to that pregnancy. 

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

Item 4001 - services provided by an eligible GP. The term 'GP' is used hereafter as a generic reference to general practitioners;

Item 792 – services provided by an eligible medical practitioner (not including a specialist or consultant physician)

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. 

This notes relate to provision of a non-directive pregnancy support counselling service by an eligible GP. 

Non-directive counselling is a form of counselling 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 which is best for them. 

The service involves the GP 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.

 The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

 Patient eligibility

Medicare rebates for non-directive pregnancy support counselling services provided using item 4001 are available to a person who is:

• pregnant; or
• who has been pregnant in the 12 months preceding the first service to which this item, item 792 or item 81000, 81005 or 81010 applies in relation to that pregnancy. 

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

 Medicare benefits

Medicare benefits are payable for up to three non-directive pregnancy support counselling services per patient, per pregnancy, from any of the following items - 792, 4001, 81000, 81005 and 81010. 

Where the patient is unsure of the number of Medicare rebated non-directive pregnancy support counselling services they have already accessed, the patient may check with Services Australia on 132 011.  Alternatively, the GP may check with Services Australia (although the patient must be present to give permission). 

Item 10990 or item 10991 can also be claimed in conjunction with item 4001 provided the conditions of the relevant item, 10990 or 10991, are satisfied. 

Minimum Requirements

This service may only be provided by a GP who has completed appropriate non-directive pregnancy counselling training.

Related Items: 4001

There are 5 in person MBS items for the provision of non-directive pregnancy support counselling services:

• Item 4001 - services provided by an eligible GP;
• Item 792 - services provided by an eligible medical practitioner;
• 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. 

There are 6 telehealth MBS items for the provision of non-directive pregnancy support counselling services:

• Item 92136 - services provided by an eligible GP by telehealth via videoconference
• Item 92138 - services provided by an eligible GP by telephone
• Item 92137 - services provided by an eligible medical practitioner by telehealth via videoconference
• Item 92139 - services provided by an eligible medical practitioner by telephone
• Item 93026 - services provided by an eligible psychologist, social worker or mental health nurse by telehealth via videoconference
• Item 93029 - services provided by an eligible psychologist, social worker or mental health nurse by telephone

These notes relate to items 81000, 81005, 81010, 93026 and 93029. Each individual allied health professional must meet the provider eligibility requirements set out below and be registered with Services Australia. 

Service length and type

Non-directive pregnancy support counselling services provided by eligible psychologists, social workers and mental health nurses using items 81000, 81005, 81010, 93026 and 93029 must be of at least 30 minutes duration and provided to an individual patient. For items 81000, 81005 and 81010, 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 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 a maximum of 3 services (including services to which items 792, 4001, 81000, 81005, and 81010 in the general medical services table, or items 92136, 92137, 92138, 92139, 93026, or 93029 in the Telehealth and Telephone Determination apply) for each pregnancy.

Where the patient is unsure of the number of Medicare rebated non-directive pregnancy support counselling services they have already accessed, the patient may check with Services Australia on 132 011. Alternatively, the psychologist, social worker or mental health nurse may check with Services Australia.

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 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, 81010, 93026 and 93029 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, these items 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 Services Australia. These services must be bulk billed (that is, the Medicare benefit is accepted as full payment for services). 

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance general treatment cover (also known as ancillary or extras cover) cover to pay for these services. Patients cannot use their general treatment cover to 'top up' the Medicare benefit paid for the services.

Related Items: 792 4001 81000 81005 81010 92136 92137 92138 92139 93026 93029