Medicare Benefits Schedule - Item 80010

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.

These therapies are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 283 to 287; 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

(Professional attendance at consulting rooms)

Fee: $161.20 Benefit: 85% = $137.05

(See para MN.6.2, MN.6.3, MN.6.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $483.60

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Eligible psychological therapy services

There are eight MBS items for the provision of individual psychological therapy services to eligible patients by a clinical psychologist (80000, 80005, 80010, 80015, 91166, 91167, 91181 and 91182). 

Clinical psychologists must meet the provider eligibility requirements set out below and be registered with Services Australia.

In these notes, 'GP' means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.

Referrals and Referral Validity

Services provided under the Psychological Therapy items will not attract a Medicare rebate unless:

• a referral has been made by a GP or medical practitioner who is managing the patient under a GP Mental Health Treatment Plan;
• 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; or
• a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals).

Number of services per year

Medicare rebates are available for up to 10 individual mental health services in a calendar year. The services may consist of: GP/medical practitioner focussed psychological strategies services; and/or psychological therapy services delivered by clinical psychologists; and/or focussed psychological strategies - allied mental health services.

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 six sessions.
• Subsequent course of treatment – a maximum of six sessions up to the patient’s cap of ten sessions (for example, if the patient received six sessions in their initial course of treatment, they can only receive four sessions in a subsequent course of treatment).

The written report provided by the clinical psychologist following a course of treatment will be considered by the referring practitioner in assessing the patient's clinical need for further sessions after each course of treatment.

Patients will also be eligible to claim up to 10 separate services within a calendar year for group therapy services, see MN.6.7.  These group services are separate from the individual services and do not count towards the individual services per calendar year maximum associated with those items.

Please note if a referral does not specify whether the referral is for individual or group therapy, the patient can use a referral to access either individual or group therapy treatment options. The patient should speak to their GP about their treatment needs and the type of treatment that might be suitable in their particular circumstances.

In the instance where a patient has received the maximum services available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year and is considered to clinically benefit from some additional services, the patient may be eligible for Primary Health Networks (PHNs) funded psychological therapies if they meet relevant eligibility criteria for the PHN commissioned services. It is recommended that providers refer to their PHN for further guidance.

Referrals for the Additional 10 Sessions (available until 31 December 2022)

In response to the COVID-19 pandemic, the number of Medicare rebateable individual mental health services was temporarily increased from 10 to 20 per calendar year until 31 December 2022.

A patient does not need a new referral to access Better Access sessions from 1 January 2023. If the patient has a current referral (either for the initial 10 sessions or the additional 10 sessions) and has not used all of the sessions, they can use that referral to access sessions in 2023. However, they cannot receive more than 10 individual sessions in 2023.

Service length and type

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

It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes. 

In addition to psycho-education, it is recommended that cognitive-behaviour therapy be provided.  However, other evidence-based therapies ─ such as interpersonal therapy ─ may be used if considered clinically relevant.

Course of treatment and reporting back to the referring medical practitioner

Eligible patients can claim Medicare subsidies for up to 10 individual mental health services per calendar year.

Within this maximum service allocation, the clinical psychologist can provide one or more courses of treatment (additional information on course of treatment session limits is above). This enables the referring medical practitioner to consider a report from the clinical psychologist on the services provided to the patient, and the need for further treatment.

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.

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, if a service was provided out-of-hospital, 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.

Eligible patients

Individual psychological therapy service items apply to people with an assessed mental disorder and where the patient is referred 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.

The conditions classified as mental disorders for the purposes of these services are 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 these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder.

Checking patient eligibility for psychological therapy 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 allied mental health services already claimed by the patient during the calendar year.

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

The patient will not be eligible 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 clinical psychologist should, with the patient's permission, contact the referring practitioner to ensure the relevant service has been provided to the patient.

Publicly funded services

Psychological therapy 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.  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, the items apply for services that are provided by eligible clinical psychologists salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Services Australia.  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: 80010

Referrals

Patients must be referred for psychological therapy services by a GP or medical practitioner managing the patient under a GP Mental Health Treatment Plan or a referred psychiatrist assessment and management plan; or on referral from a psychiatrist or a paediatrician.

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.  For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

Referring practitioners are not required to use a specific form to refer patients for these services. 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 (the ‘course of treatment’);
• a statement about whether the patient has a mental health treatment plan, a shared care plan (prepared on or before 30 June 2021), or a psychiatrist assessment and management plan. 

It may be useful for a referral to include a statement indicating whether group sessions could be considered.

A referral should include all of 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.

Number of Sessions

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 six sessions.
• Subsequent course of treatment – a maximum of six sessions up to the patient’s cap of ten sessions (for example, if the patient received six sessions in their initial course of treatment, they can only receive four sessions in a subsequent course of treatment).

The written report provided by the clinical psychologist following a course of treatment will be considered by the referring practitioner in assessing the patient's clinical need for further sessions after each course of treatment.

Specifying the Number of Sessions on a Referral

If 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 clinical psychologist 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.

In these circumstances, a clinical psychologist must provide a report at the end of a course of treatment in line with standard practice for these services. This enables the referring medical practitioner to consider the treating practitioner’s report on the services provided to the patient, and the need for further treatment.

Verbal Referral

A referring practitioner can verbally refer a patient for Better Access services only if:

• in their clinical judgement they consider it is necessary for the patient to have immediate access to support from a clinical psychologist, and
• it is not practicable in the circumstances to provide a written referral – for example, to do so would cause delays in treatment to the patient’s detriment, and
• the clinical psychologist documents in writing that they are treating the patient based on the referring practitioner’s verbal referral, and
• the referring practitioner provides a written referral to the clinical psychologist as soon as possible afterwards.

While waiting for the referring practitioner to provide a written referral, the treating practitioner can provide treatment according to the verbal referral until the referred number of sessions have been completed. If there is any doubt about the number of sessions the patient was verbally referred for, the treating practitioner should follow the guidance provided above under the heading ‘Specifying the number of sessions on a referral’. 

A verbal referral does not replace any requirement for the GP to review the patient’s progress (taking into account the written report from their treating allied health professional) after each course of treatment.

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

Use of Referrals across Different Calendar Years

Eligible patients can claim Medicare subsidies for up to 10 individual and 10 group mental health services per calendar year.

If a patient has not used all their psychological therapy services and/or focussed psychological strategies services in course of treatment 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 patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services.  Where the patient's care is being managed by a GP or medical practitioner, the GP/medical practitioner may choose to use this visit to undertake a review of the patient's GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan.

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

Referrals for the Additional 10 Sessions (available until 31 December 2022)

In response to the COVID-19 pandemic, the number of Medicare rebateable individual mental health services was temporarily increased from 10 to 20 per calendar year until 31 December 2022.

A patient does not need a new referral to access Better Access sessions from 1 January 2023. If the patient has a current referral (either for the initial 10 sessions or the additional 10 sessions) and has not used all of the sessions, they can use that referral to access sessions in 2023. However, they cannot receive more than 10 individual sessions in 2023.

Related Items: 80010

Eligible clinical psychologists

A person is an 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 under the applicable law in force in the state or territory in which the service is provided; and
2. is endorsed by the Psychology Board of Australia to practice in clinical psychology. 

Until 31 October 2015, a person was also an 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 under the applicable law in force in the state or territory in which the service is provided; and
2. on 31 October 2015  was an allied health professional in relation to the provision of a psychological therapy health service because the person:
   1. was a member of the College of Clinical Psychologists of the Australian Psychological Society; or
   2. had been assessed by the College of Clinical Psychologists of the Australian Psychological Society as meeting the requirements for membership of that College.

The clinical psychologist must be registered with the Department of Human Services.

Registering with the Department of Human Services

Advice about registering with the Department of Human Services to provide psychological therapy services using items 80000-80021 inclusive is available from the Department of Human Services provider inquiry line on 132 150.

Further information

For further information about Medicare Benefits Schedule items, please go to the Department of Health's website at www.health.gov.au/mbsonline. 

For providers, further information is also available for providers from the Department of Human Services provider inquiry line on 132 150.

Related Items: 80010