Medicare Benefits Schedule - Item 80025

Psychological therapy health service provided to a patient as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

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

(b)  the attendance is by video conference; and

(c)  the patient is located within a telehealth eligible area; and

(d)  the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)  the service is at least 120 minutes duration

Fee: $78.40 Benefit: 85% = $66.65

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $235.20

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Summary

This explanatory note provides an overview of The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule Initiative (Better Access), which commenced on 1 November 2006. Under this initiative, Medicare benefits are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, prescribed medical practitioners (PMPs), psychologists (clinical and registered) and eligible social workers and occupational therapists.

Better Access Initiative Explanatory Notes

All Medicare Benefits Schedule (MBS) explanatory notes that are associated with the Better Access initiative are listed below:

Services provided under Better Access

Through Better Access, eligible patients can claim a Medicare benefit for up to 10 individual and 10 group mental health treatment services per calendar year. These services consist of:

• psychological therapy provided by eligible clinical psychologists (refer to explanatory note MN.6.2 - Provision of Psychological Therapy); and
• focussed psychological strategies provided by GPs, PMPs and eligible psychologists, occupational therapists, and social workers (refer to explanatory note MN.7.4 – Provision of Focussed Psychological Strategies).

A Medicare benefit is also available for a patient to involve another person, such as a family member or carer, in their treatment. Medicare benefits are available to a patient for up to 2 services provided to another person per calendar year. Any services delivered using these MBS items count towards the patient's course of treatment and calendar year allocations under Better Access. For further information on involving another person in a patient’s treatment, refer to explanatory note MN.7.5 – Family and Carer Participation.

There are also MBS items for the provision of mental health case conferencing services to establish and coordinate the management of the care needs of a patient. For further information refer to explanatory note AN.15.1– Mental Health Case Conferences.

Patient eligibility for Better Access services

Better Access services apply to people with an assessed mental disorder. For the purposes of Better Access services, a mental disorder is defined as a significant impairment of an individual's cognitive, affective and/or relational abilities which may require intervention and may be a recognised, medically diagnosable illness or disorder. This definition is 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 Better Access services, dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders. 

Additionally, Better Access MBS treatment items will not attract a Medicare benefit unless the patient has been referred for Better Access services by a referring practitioner. For the purposes of these services, referring practitioner means:

• a medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan (refer to explanatory note AN.0.56 – GP Mental Health Treatment Plans and Consultation) or a Psychiatrist Assessment and Management Plan (refer to explanatory note AN.0.30 - Consultant Psychiatrist – Referred Patient Assessment and Management Plan); or
• a specialist or consultant physician specialising in the practice of their field of psychiatry; or
• a specialist or consultant physician specialising in the practice of their field of paediatrics.

For more information on referral requirements for Better Access services, refer to explanatory note MN.6.3 - Referral requirements for Better Access Treatment Services.

If there is any doubt about a patient's eligibility, Services Australia will be able to confirm whether a GP Mental Health Treatment 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 Better Access services already claimed by the patient during the calendar year.

Allied health providers can call Services Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011.

A patient will not be eligible to receive a Medicare benefit if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Services Australia will not be aware of the patient's eligibility. In this case the treating practitioner should, with the patient's permission, contact the referring practitioner to ensure a relevant referring service has been provided to the patient.

Better Access redesign from 1 November 2025

As announced through the 2024-25 Budget, the Australian Government is making changes to the Better Access initiative from 1 November 2025 (subject to the passage of legislation) to respond to the Better Access evaluation, better meet the needs of individuals, and improve equity of access.

As part of this, GP Mental Health Treatment Plan review and mental health consultation MBS items will be removed, and GPs will be able to use general attendance items to review and provide mental health care recognising the time spent with patients to provide quality care. GP Mental Health Treatment Plan MBS items will be retained.

Out-of-pocket expenses and Medicare safety net

Charges in excess of the Medicare benefit for Better Access MBS items are the responsibility of the patient. However, 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.

Publicly funded services

Better Access MBS items 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. Unless an exemption under subsection 19(2) of the Health Insurance Act 1973 applies for a Medicare benefit to be payable, all requirements of the service must be met, including registration with Services Australia.

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 benefit paid for the services.

Record keeping and reporting requirements

The Department of Health and Aged Care undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. All practitioners providing Better Access services should ensure they keep adequate and contemporaneous records, including documenting the date, time and people who attended. Only clinical details recorded at the time of attendance count towards the time of the consultation. Other notes or reports added at a later time are not included. For information on what constitutes adequate and contemporaneous records, refer to explanatory note GN.15.39 - Practitioners should maintain adequate and contemporaneous records.

Relevant Legislation

Details about the legislative requirements of the Better Access Initiative MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au.

Attendance items are set out in three regulatory instruments:

Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 - Clinical psychologist, psychologist, social worker, and occupational therapist items.

Health Insurance (General Medical Services Table) Regulations 2021 – General practitioner, prescribed medical practitioner and psychiatrist items.

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 – telehealth (video) and telephone attendance items – General practitioner, prescribed medical practitioner, clinical psychologist, psychologist, social worker, and occupational therapist items.

Further information

For further information about Medicare Benefits Schedule items, please visit the MBS Online website at www.health.gov.au/mbsonline.

For providers, further information is also available from the Services Australia provider enquiry line on 132 150.

If you are a patient seeking advice about Medicare services, patient benefits, or your Medicare claims, please contact Services Australia on the Medicare General enquiry line on 132 011.
 

Related Items: 272 276 277 279 281 282 283 285 286 287 309 311 313 315 930 933 935 937 943 945 946 948 959 961 962 964 969 971 972 973 975 986 2700 2701 2712 2713 2715 2717 2721 2723 2725 2727 2739 2741 2743 2745 80000 80002 80005 80006 80010 80012 80015 80016 80020 80021 80022 80023 80024 80025 80100 80102 80105 80106 80110 80112 80115 80116 80120 80121 80122 80123 80125 80127 80128 80129 80130 80131 80135 80137 80140 80141 80145 80146 80147 80148 80150 80152 80153 80154 80155 80156 80160 80162 80165 80166 80170 80171 80172 80173 80174 80175 80176 80177 80178 91166 91167 91168 91169 91170 91171 91172 91173 91174 91175 91176 91177 91181 91182 91183 91184 91185 91186 91187 91188 91194 91195 91196 91197 91198 91199 91200 91201 91202 91203 91204 91205 91818 91819 91820 91821 91842 91843 91844 91845 91859 91861 91862 91863 91864 91865 91866 91867 92112 92113 92114 92116 92117 92118 92119 92120 92121 92122 92123 92126 92127 92132 92133

Associated Items: 80000, 80005, 80010, 80015, 80020, 80021, 80022, 80023, 80024, 80025, 91166, 91167, 91181, 91182.

Services attracting Medicare benefits

There are 14 Medicare Benefits Schedule (MBS) items for the provision of psychological therapy services to eligible patients by an eligible clinical psychologist. These consist of:

Individual Psychological Therapy Services:

• Face-to-Face items:  80000, 80005, 80010 and 80015
• Telehealth items: 91166, 91167, 91181 and 91182

Group Psychological Therapy Services:

• Face-to-Face items: 80020, 80022, and 80024
• Telehealth items: 80021, 80023 and 80025 

To provide these services, clinical psychologists must meet the provider eligibility requirements set out below and be registered with Services Australia.

To receive these services, patients must meet the eligibility requirements outlined in explanatory note AN.0.78 - Better Access Initiative.

For Group Psychological Therapy Services provided via Telehealth, additional restrictions apply. Please see the Group psychological therapy services - Telehealth Requirements section below for further information.

Service length and type

Services provided by eligible clinical psychologists under these items must be within the specified time period within the item descriptor.

In addition to psychoeducation, it is recommended that cognitive-behaviour therapy be provided. However, other evidence-based therapies may be used if considered clinically relevant. 

Number of services per year

Medicare benefits are available for up to 10 individual and 10 group mental health services in a calendar year. The services may consist of:

• psychological therapy services delivered by clinical psychologists; and/or
• focussed psychological strategies services delivered by eligible GPs, PMPs, psychologists, social workers and occupational therapists (refer to explanatory note MN.7.4 – Provision of Focussed Psychological Strategies) 

Course of treatment and reporting back to the referring medical practitioner

Eligible patients must be referred to psychological therapy services by a GP or medical practitioner who is managing the patient under a GP Mental Health Treatment Plan, under a referred psychiatrist assessment and management plan, or on referral from an eligible psychiatrist or paediatrician. For additional information on Better Access referral requirements, please see explanatory note MN.6.3 - Referral requirements for Better Access Treatment Services.

The clinical psychologist must be in receipt of the referral at the first mental health consultation. The clinical psychologist must also retain the referral for 2 years (24 months) from the date the service was rendered.

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 6 sessions.
• Subsequent course of treatment - a maximum of 6 sessions up to the patient's cap of 10 sessions per calendar year (for example, if the patient received 6 sessions in their initial course of treatment, they could only receive 4 sessions in a subsequent course of treatment provided within the same calendar year).

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.

Group psychological therapy services

In addition to individual psychological therapy services, eligible patients may also claim up to 10 separate group psychological therapy service MBS items within a calendar year for group therapy services. Group psychological therapy service MBS items can be claimed for groups of 4 to 10 patients. However, clinical psychologists can claim these MBS items if 4 patients were due to attend and one patient is unable to attend, regardless of the reason.

Group psychological therapy services - Telehealth Requirements

Group therapy may only be delivered via telehealth in certain circumstances. To be eligible for group therapy services via telehealth, the patient must be located in a Modified Monash Model area 4-7 at the time of the consultation, and at least 15 kilometres apart by road from the allied health professional delivering the session. The patient or clinical psychologist is not permitted to travel to an area outside the minimum 15 kilometres distance in order to claim a telehealth consultation item.

More information about the Modified Monash Model, including a search tool to identify the classification of a specific location, is available at:

https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm

Record Keeping

Clinical psychologists providing psychological therapy services must keep contemporaneous notes of the consultation including documenting the date, time and people who attended. Only clinical details recorded at the time of attendance count towards the time of the consultation. For information on what constitutes adequate and contemporaneous records, refer to explanatory note GN.15.39 - Practitioners should maintain adequate and contemporaneous records.

Allied health professional eligibility for the provision of psychological therapy services

Focussed psychological strategy services under the MBS may only be provided by eligible allied health professionals.  

A person is an eligible allied health professional in relation to the provision of a psychological therapy health service if the person:

1. holds general registration in the health profession of psychology with the Psychology Board of Australia; and
2. is endorsed by the Psychology Board of Australia to practice in clinical psychology.

Registering with the Services Australia

Advice about registering with the Services Australia to provide Better Access services is available from the Services Australia provider enquiry line on 132 150.

Further information

For further information on the Better Access Initiative, refer to explanatory note AN.0.78 – Better Access Initiative.

For further information about Medicare Benefits Schedule items, please visit the MBS online website at www.health.gov.au/mbsonline

Further information is available for providers from the Services Australia provider enquiry line on 132 150.

If you are a patient seeking advice about Medicare services, patient benefits, or your Medicare claims, please contact Services Australia on the Medicare General enquiry line on 132 011.

Related Items: 80000 80005 80010 80015 80020 80021 80022 80023 80024 80025 91166 91167 91181 91182

Associated items: 2721, 2723, 2725, 2727, 91818, 91819, 91842, 91843, 283, 285, 286, 287, 91820, 91821, 91844, 91845, 80100, 80105, 80110, 80115, 91169, 91170, 91183, 91184, 80125, 80130, 80135, 80140, 91172, 91173, 91185, 91186, 80150, 80155, 80160, 80165, 91175, 91176, 91187, 91188, 80120, 80122, 80127, 80121, 80123, 80128, 80145, 80147, 80152, 80146, 80148, 80153, 80170, 80172, 80174, 80171, 80173, 80175, 80000, 80010, 80005, 80015, 91166, 91167, 91181, 91182, 80020, 80021, 80022, 80023, 80024, 80025, 80002, 80006, 80012, 80016, 91171, 91199, 91168, 91198

Services requiring referral

Medicare Benefits Schedule (MBS) treatment services under the Better Access initiative (refer to explanatory note AN.0.78 – Better Access Initiative) require an eligible referral for a Medicare benefit to be claimed. Medicare benefits are available for up to 10 individual and 10 group mental health services in a calendar year. These services may consist of:

• psychological therapy services (refer to explanatory note MN.6.2 - Provision of Psychological Therapy) and/or
• focussed psychological strategies (refer to explanatory note MN.7.4 - Provision of Focussed Psychological Strategies) 

Up to 2 of a patient’s individual mental health services may be used for family and carer participation items per calendar year. For additional information, refer to explanatory note MN.7.5 – Family and Carer Participation.  

Eligible Referral Services

For the purposes of Better Access treatment services (refer to explanatory notes MN.6.2 -Provision of Psychological Therapy and MN.7.4 - Provision of Focussed Psychological Strategies), a Medicare benefit will not be payable unless:

• a referral has been made by a GP or medical practitioner who is managing the patient under a GP Mental Health Treatment Plan (refer to explanatory note AN.0.56 – GP Mental Health Treatment Plans and Consultation); 
• 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 (refer to explanatory note AN.0.30 - Consultant Psychiatrist - Referred Patient Assessment and Management Plan); or
• a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service.

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 and items 91822, 91823 and 91833. For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 to 308, 310, 312, 314, 316, 318 or 319 through 349; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

Course of Treatment and Specifying the Number of Sessions in a Referral

Under the Better Access Initiative, a patient may be referred for up to 10 individual and 10 group mental health services within a calendar year.  The referring practitioner can decide how many mental health services a 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 6 sessions.
• Subsequent course of treatment - a maximum of 6 sessions up to the patient's cap of 10 sessions per calendar year (for example, if the patient received 6 sessions in their initial course of treatment, they could only receive 4 sessions in a subsequent course of treatment provided within the same calendar year).

On completion of the initial course of treatment, the treating practitioner or allied health professional providing the service 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. 

This report will aid the referring practitioner in determining whether another course of treatment is appropriate for the management of the patient’s mental disorder.

If, in their referral, 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 treating practitioner or allied health professional 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.

The treating practitioner or allied health professional must still provide a report at the end of a course of treatment in line with standard practice for these services. The referring medical practitioner should therefore consider the treating practitioner or allied health professional’s report on the services provided to the patient, and the need for further treatment.

Referral Requirements

Referring practitioners are not required to use a specific form to refer patients for these services. However, 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; and
• a statement about whether the patient has a mental health treatment plan or a psychiatrist assessment and management plan. 

A referral should include all 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.

Use of Referrals across Different Calendar Years

If a patient has not used all their psychological therapy services and/or focussed psychological strategies services 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 a patient has used all of their referred services, they will need to obtain a new referral from their referring practitioner if they are eligible for further services.

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 group therapy services and/or focussed psychological strategies services.  Patients continue to be eligible for benefits 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.

Receipt of referral

The practitioner or allied health professional providing the relevant treatment service (refer to explanatory notes MN.6.2 – Provision of Psychological Therapy and MN.7.4 – Provision of Focussed Psychological Strategies) must be in receipt of the referral at the first consultation. The allied health provider must also retain the referral for a period of 2 years (24 months) from the date the service was rendered. For more information on record keeping and reporting requirements, refer to explanatory note AN.0.78 – Better Access Initiative.

Further information

For further information on the Better Access Initiative, refer to explanatory note AN.0.78 – Better Access Initiative.

For further information about Medicare Benefits Schedule items, please visit the MBS online website at www.health.gov.au/mbsonline.

Further information is available for providers from the Services Australia provider enquiry line on 132 150.

If you are a patient seeking advice about Medicare services, patient benefits, or your Medicare claims, please contact Services Australia on the Medicare General enquiry line on 132 011.

Related Items: 283 285 286 287 2721 2723 2725 2727 80000 80002 80005 80006 80010 80012 80015 80016 80020 80021 80022 80023 80024 80025 80100 80105 80110 80115 80120 80121 80122 80123 80125 80127 80128 80130 80135 80140 80145 80146 80147 80148 80150 80152 80153 80160 80165 80170 80171 80172 80173 80174 80175 91166 91167 91168 91169 91170 91171 91172 91173 91175 91176 91181 91182 91183 91184 91185 91186 91187 91188 91198 91199 91818 91819 91820 91821 91842 91843 91844 91845