Medicare Benefits Schedule - Item 971

Attendance by a prescribed medical practitioner, as a member of a multidisciplinary case conference team, to organise and coordinate a mental health case conference if the conference lasts for at least 20 minutes, but for less than 40 minutes

Fee: $110.25 Benefit: 75% = $82.70 100% = $110.25

(See para AN.0.78, AN.15.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $330.75

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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: 930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 80176, 80177, 80178

Mental Health Case Conference service requirements

The purpose of a case conference is to establish and coordinate the management of the care needs of a patient.

A case conference is a process by which a multidisciplinary team carries out the following activities:

• discusses a patient's history;
• identifies the patient's multidisciplinary care needs;
• identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;
• identifies tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and
• assesses whether previously identified outcomes (if any) have been achieved.

A Medicare benefit may not be claimed until all of these activities have been completed. 

Services attracting Medicare benefits

There are 21 Medicare Benefits Schedule (MBS) items for the provision of mental health case conferencing services. These services consist of:

Organisation and coordination of a mental health case conference:

• GP items: 930, 933 and 935
• Psychiatrist and paediatrician items: 946, 948 and 959
• Prescribed medical practitioner items: 969, 971 and 972.

Participation in a mental health case conference:

• GP items: 937, 943 and 945
• Psychiatrist and paediatrician items: 961, 962 and 964
• Prescribed medical practitioner items: 973, 975 and 986
• Eligible allied health professionals: 80176, 80177 and 80178.  

The requirements of case conference organisation, coordination and participation are set out below. It is expected that a patient would not normally require more than 4 case conferences in a 12-month period unless there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of additional services.

Patient Eligibility

Mental Health Case conferences using these MBS items can be held for patients who have been referred for treatment under the Better Access Initiative or have an active eating disorder treatment and management plan. For further information on the Better Access Initiative, refer to explanatory note AN.0.78 - Better Access Initiative.

Organising and Coordinating a Mental Health Case Conference

To organise and coordinate a mental health case conference, a provider must:

• explain to the patient the nature of a mental health case conference and ask for their agreement to the conference taking place;
• record the patient's agreement to the conference;
• record the day on which the conference was held, and the times at which the conference started and ended;
• record the names of the participants;
• offer the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) a summary of the conference;
• provide this summary to other team members;
• discuss the outcomes of the conference with the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
• record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records.

The organising of a mental health case conference should generally be undertaken by the patient's usual medical practitioner. A patient’s usual medical practitioner is a prescribed medical practitioner, or a medical practitioner working in the same medical practice, that has provided the majority of services to the patient over the previous 12 months and/or will be providing the majority of services to the patient over the coming 12 months.

Participating in a Mental Health Case Conference

To participate in a mental health case conference, a provider must:

• explain to the patient the nature of a mental health case conference, and ask for their agreement to the prescribed medical practitioner's participation in the conference;
• record the patient's agreement to the prescribed medical practitioner's participation;
• record the day on which the conference was held, and the times at which the conference started and ended;
• record the names of the participants; and
• record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records.

Mental Health Case Conference members

A mental health case conference must be organised by a medical practitioner (GP, prescribed medical practitioner or consultant physician in their specialty of paediatrics or psychiatry) and involve at least two other members of the multidisciplinary case conference team providing different kinds of treatment to the patient. In some instances, two providers from the same profession may both participate in the case conference if they each provide different aspects of care to the patient – for example, if the providers have different specialisations which are both clinically relevant to the patient.

Other members of the case conference team may include allied health professionals, home and community service providers, and care organisers. Participating providers must be invited to attend by the organising practitioner.

During the provision of a mental health case conference service, a maximum of one other medical practitioner may be present, and they must be providing a different kind of service to the organising practitioner.

The case conference must be arranged in advance, within a time frame that allows for all the participants to attend. The minimum of three case conference members as outlined above must be present for the whole of the case conference. All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.

Patient, Family and Carer participation

The patient should be given the option to attend the case conference, however, may choose not to do so. A family member or unpaid carer, as well as other individuals providing support to the patient (such as a close friend, counsellor, teacher, or peer worker) may also be invited to attend the case conference with the patient’s consent. However, these individuals do not count towards the minimum number of providers required to meet the regulatory requirements of these items (refer to section on mental health case conference members). 

Allied Health Practitioner Eligibility

Only eligible allied health practitioners can claim participation in mental health conference services under these MBS items.

For the purpose of a mental health case conference, an eligible allied health practitioner means an allied health professional who meets the qualification requirements for providing the following types of treatment:

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

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: 930 933 935 937 943 945 946 948 959 961 962 964 969 971 972 973 975 986 80176 80177 80178