Medicare Benefits Schedule - Item 80141

Focussed psychological strategies health service provided at a place other than consulting rooms by an eligible occupational therapist to a person other than the patient, if:

(a)   the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)   the service lasts at least 50 minutes

Fee: $132.20 Benefit: 85% = $112.40

(See para AN.0.78, MN.7.5 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $396.60

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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 treatment services provided by eligible general practitioners (GPs), eligible prescribed medical practitioners (PMPs), psychologists (eligible clinical and eligible registered), eligible social workers and eligible occupational therapists.

Further information on the eligibility requirements of a GP can be found at 2.20.7 (Restrictions on items in Subgroup 2 of Group A20 [focussed psychological strategies]) and a PMP can be found at 2.20.7A (Restrictions on items in Subgroup 9 of Group A7 [focussed psychological strategies]). The Health Insurance (General Medical Services Table) Regulations 2021 provides further information on the legislative requirements for eligible GPs and PMPs. For further information on the qualification requirements for Allied Health Professionals who are able to provide mental health services under Medicare, refer to Schedule 1 (Qualification requirements for allied health professionals) in the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.

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

Explanatory Note	Relevant item numbers
AN.0.56 - Mental Health Treatment Plans and Consultation	272, 276, 277, 282, 2700, 2701, 2715, 2717, 92112, 92113, 92116, 92117, 92118, 92119, 92122, and 92123.
MN.6.2 - Provision of Psychological Therapy	80000, 80005, 80010, 80015, 80020, 80021, 80022, 80023, 80024, 80025, 91166, 91167, 91181, and 91182.
MN.7.4 - Provision of Focussed Psychological Strategies	283, 285, 286, 287, 2721, 2723, 2725, 2727, 80100, 80105, 80110, 80115, 80120, 80121, 80122, 80123, 80125, 80127, 80128, 80130, 80135, 80140, 80145, 80146, 80147, 80148, 80150, 80152, 80153, 80155, 80160, 80165, 80170, 80171, 80172, 80173, 80174, 80175, 91818, 91819, 91842, 91843, 91820, 91821, 91844, 91845, 91169, 91170, 91183, 91184, 91172, 91173, 91185, 91186, 91175, 91176, 91187 and 91188.
MN.6.3 - Referral requirements for Better Access Treatment Services	272, 276, 281, 282, 283, 285, 286, 287, 2700, 2701, 2715, 2717, 2721, 2723, 2725, 2727, 80000, 80005, 80010, 80015, 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, 80155, 80160, 80165, 80170, 80171, 80172, 80173, 80174, 80175, 91167, 91169, 91170, 91172, 91173,  91175, 91176, 91181, 91182,91183, 91184, 91185, 91186, 91187, 91188,  91818, 91819, 91820, 91821,  91842, 91843, , 91844, 91845, 92112, 92113, 92116, 92117, 92118 and 92119. Note: 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.
AN.15.1 - Mental Health Case Conferences	930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 80176, 80177 and 80178.
MN.7.5 - Family and Carer Participation	309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91859, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91861, 91862, 91863, 91864, 91865, 91866, and 91867.

Services provided under Better Access

Through Better Access, eligible patients can claim a Medicare benefit for up to 10 individual and 10 group therapy 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 eligible GPs, eligible PMPs, eligible psychologists, eligible occupational therapists, and eligible 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 a clinically diagnosed 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.

When referring for treatment services under the Better Access initiative, services should be utilised for patients who require at least a moderate level of mental health support. Consideration should be given to other treatment interventions and pathways (e.g. digital mental health services, Medicare Mental Health Centres, etc) should the patient’s level of support not require psychological intervention under the Better Access initiative.

Referral requirements

Additionally, Better Access MBS treatment items will only attract a Medicare benefit where a patient has been referred for Better Access services by a GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner, or by a specialist or consultant physician specialising in the practice of their field of psychiatry or paediatrics. For the purposes of these services, referring practitioner means:

• usual medical practitioner, in relation to a patient, means a general practitioner or prescribed medical practitioner:

(a) who has provided the majority of services to the person in the past 12 months; or
(b) who is likely to provide the majority of services to the person in the following 12 months; or
(c) located at a medical practice that:

(i) has provided the majority of services to the person in the past 12 months; or

(ii) is likely to provide the majority of services to the person in the next 12 months.

• A GP or PMP at a MyMedicare registered practice means the registration program by that name administered by the department. A MyMedicare service means a service to which an item is provided:

(a) to a person enrolled in MyMedicare; and
(b) at the general practice at which the person is enrolled.

• 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 directly referring for Better Access services; or

• a specialist or consultant physician specialising in the practice of their field of paediatrics directly referring for Better Access services.

• the patient referral requirements, as part of a Mental Health Treatment Plan (refer to explanatory note AN.0.56 – Mental Health Treatment Plans and Consultation Items) or a Psychiatrist Assessment and Management Plan (refer to explanatory note AN.0.30 - Consultant Psychiatrist – Referred Patient Assessment and Management Plan), have been met.

Focussed psychological strategies are available to any patient from any GP or PMP who has the appropriate training recognised by the General Practice Mental Health Standards Collaboration. GPs and PMPs who provide focussed psychological strategies do so as part of an arrangement for the treatment of an assessed mental disorder under a Mental Health Treatment Plan.

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 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. Additionally, providers can also access the Health Professional Online Services (HPOS) to view a patient’s Mental Health Treatment Plan history.

Allied health professionals can call Services Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011 or view their care plan history in their Medicare online account through myGov to help track services that have been claimed.

A patient will not be eligible to receive a Medicare benefit if they have not been appropriately referred or if a relevant Medicare service has not been 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 or allied health professional should, with the patient's permission, contact the referring practitioner to ensure a relevant referring service has been provided to the patient.

Mental Health Treatment Plan review requirements

After a patient has used the allocated number of services in the initial individual course of treatment (a maximum of 6 services on the initial referral), a review of the patient’s Mental Health Treatment Plan and a new referral must be obtained from the referring practitioner for further treatment. The review will assess the patient’s progress and consider further treatment options. A review is not to be undertaken more than once in a 3 month period or within 4 weeks following the preparation of a Mental Health Treatment Plan unless exceptional circumstances exist. It is recommended a Mental Health Treatment Plan be reviewed at least once during a course of treatment, with most patients generally not requiring more than 2 reviews in a calendar year.

GPs and PMPs are to use time tiered professional (general attendance) items for the specific purpose of reviewing a Mental Health Treatment Plan. A Mental Health Treatment Plan does not expire. A new Mental Health Treatment Plan should not be created unless exceptional circumstances exist. An exceptional circumstance may be where the patient has had a significant change to their mental health or the treating practitioner or treating allied health professional is unable to obtain a copy of their Mental Health Treatment Plan.

In addition to the 10 individual services, a patient can be referred up to a maximum of 10 group therapy mental health treatment services each calendar year on any one referral. Patients will be required to have a review of their Mental Health Treatment Plan and obtain a new referral from their referring practitioner after they received the number of group therapy mental health treatment services stated on the referral (if less than 10).

The referring practitioner will use their clinical discretion when undertaking a review to determine the number of allied mental health services their patient will be referred for and if the patient requires additional MBS mental health services. Medicare benefits are only available for a maximum of 10 individual and 10 group therapy mental health treatment services each calendar year. Patients can privately fund or use other funding sources they are eligible for to access further services.

Under MyMedicare and usual medical practitioner requirements, GPs and PMPs will be able to access time-tiered professional (general) attendance items to review and provide mental health care to patients recognising the time spent with patients to provide quality care. There will be no limitation on the number of health-related issues that can be addressed as part of a general attendance consultation, as long as the requirements of the service are met, and adequate and contemporaneous records are maintained. Key principles for using time-tiered professional (general) attendance items and any specific requirements is available at AN.0.9 | Using time-tiered professional (general) attendance items. 

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 (refer to explanatory note GN.10.27 | Medicare Safety Nets.

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. If a patient has exhausted their services for which a Medicare benefit is payable for the calendar year, and if they have appropriate private health insurance which covers psychological services, they may claim from their private health fund. The benefit payable to members of private health funds will vary based on the level of their ancillary cover.

Record keeping and reporting requirements

The Department of Health, Disability and Ageing undertakes regular post payment auditing to ensure 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 3 regulatory instruments:

• Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024 - Eligible psychologist (clinical and registered), eligible social worker, and eligible occupational therapist items.
• Health Insurance (General Medical Services Table) Regulations 2021 – General practitioner, prescribed medical practitioner and psychiatrist items, including items related to Focussed Psychological Strategies for eligible general practitioners and eligible prescribed medical practitioners.
• Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 - telehealth (video and phone) items – General practitioner, prescribed medical practitioner, eligible psychologists (clinical and registered), eligible social worker, and eligible occupational therapist items. In addition, items related to focussed psychological strategies for eligible general practitioners and eligible prescribed medical practitioners are included in this instrument.

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: 272 276 281 282 283 285 286 287 309 311 313 315 930 933 935 937 943 945 946 948 959 961 962 964 969 971 972 973 975 986 2700 2701 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 91174 91181 91182 91183 91184 91185 91186 91187 91188 91198 91199 91200 91201 91202 91203 91204 91205 91842 91843 91844 91845 91864 91865 91866 91867

Family and Carer Participation

Associated Items: 309, 311, 313, 315, 91862, 91863, 91866, 91867, 2739, 2741, 2743, 2745, 91859, 91861, 91864, 91865, 80102, 80106, 80112, 80116, 91174, 91177, 91200, 91201 80129, 80131, 80137, 80141, 91194, 91195, 91202, 91203, 80154, 80156, 80162, 80166, 91196, 91197, 91204, 91205 80002, 80006, 80012, 80016, 91168, 91171, 91198, 91199

Overview

The Family and Carer participation Medicare Benefits Schedule (MBS) items recognise the important role another person, such as a family member or carer, can play in supporting patients with a clinically diagnosed mental disorder, and the benefits that can result from involving them in treatment. Under these MBS items, Medicare benefits are available to a patient for up to 2 services provided to another person per calendar year.

Any services delivered using these items count towards the patient's individual course of treatment and calendar year allocations under the Better Access Initiative. For further information on patient allocations, please see explanatory note AN.0.78 – Better Access Initiative. For Medicare benefit purposes, claims relating to services covered by these MBS items should be raised against the patient rather than against the person receiving the service.

Services attracting Medicare benefits

Medicare benefits are available to a patient for up to 2 services provided to another person per calendar year. These services may be accessed at any stage of a patient's course of treatment and do not need to be accessed consecutively. The 2 services may consist of:

Focussed Psychological Strategies provided by eligible:

Prescribed medical practitioners (PMPs):

• Face-to-face items: 309, 311, 313 and 315
• Video and phone items: 91862, 91863, 91866 and 91867

General Practitioners (GPs):

• Face-to-face items: 2739, 2741, 2743 and 2745
• Video and phone items: 91859, 91861, 91864 and 91865

Psychologists (registered):

• Face-to-face items: 80102, 80106, 80112 and 80116
• Video and phone items: 91174, 91177, 91200 and 91201

Occupational therapists:

• Face-to-face items: 80129, 80131, 80137 and 80141
• Video and phone items: 91194, 91195, 91202 and 91203

Social workers:

• Face-to-face items: 80154, 80156, 80162 and 80166
• Video and phone items: 91196, 91197, 91204 and 91205

and;

Psychological Therapy provided by eligible Clinical psychologists:

• Face-to-face items: 80002, 80006, 80012 and 80016
• Video and phone items: 91168, 91171, 91198 and 91199.

To provide and claim these services under the MBS, the eligible GP or eligible PMP or eligible allied health professional providing treatment services to the patient must meet the relevant provider eligibility requirements. For further information, please see explanatory notes MN.6.2 -Provision of Psychological Therapy and MN.7.4 - Provision of Focussed Psychological Strategies.

Any services delivered using these MBS items count towards:

• the maximum service limit for each course of treatment under Better Access, and
• the patient's calendar year allocation for individual services under Better Access.

These MBS items are not for the purposes of providing mental health treatment to the family member or carer supporting the patient. Should the family member or carer require mental health treatment themselves, they should be advised to see their GP or PMP for an assessment to be made on their mental health. For information on Better Access patient requirements, refer to explanatory note AN.0.78 – Better Access Initiative.

Eligible referral services

Referrals for treatment services under the Better Access initiative should be utilised for patients who require at least a moderate level of support.

For the purposes of Better Access treatment services, a Medicare benefit will be not payable unless patients meet the eligibility requirements outlined in explanatory note AN.0.78 | Better Access Initiative.

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

Service requirements

A patient can involve another person in their treatment under the Better Access initiative where:

• the patient has been referred for Better Access services;
• the referring practitioner, or eligible practice providing the service determines it is clinically appropriate;
• the patient consents for the service to be provided to the other person as part of their treatment;
• the service is part of the patient's treatment; and
• the patient is not in attendance during the provision of the service.

When utilising family and carer items, the patient must not be in attendance during the provision of the service. In addition, the eligible GP or eligible PMP or eligible allied health professional must also consider whether the requirements of the patient MBS items for delivering Better Access services have been met. For further information, please refer to explanatory note AN.0.78 – Better Access Initiative.

Obtaining and recording patient consent

Before a treating eligible GP or eligible PMP or eligible allied health professional can provide a family and carer participation service, the patient must consent to another person receiving a mental health service as a part of their treatment. The treating eligible GP or eligible PMP or eligible allied health professional providing the service must:

• explain the service to the patient;
• obtain the patient's consent for the service to be provided to the other person as part of the patient's treatment; and
• make a written record of the patient's consent.

The patient may withdraw their consent at any time. In the case of a child, the general laws relating to consent to medical treatment apply. These may differ between states and territories, and the health practitioner should be aware of the requirements in the relevant state or territory.

Eligible mental health treatment services

Treating eligible GPs or eligible PMPs or eligible allied health professionals must use their professional judgement to determine what would be an appropriate mental health treatment service to deliver to another person as part of the patient's treatment. For information on approved treatment services, including provider eligibility requirements to provide these services, please refer to explanatory notes MN.6.2 - Provision of Psychological Therapy and MN.7.4 - Provision of Focussed Psychological Strategies.

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: 309 311 313 315 2739 2741 2743 2745 80002 80006 80012 80016 80102 80106 80112 80116 80129 80131 80137 80141 80154 80156 80162 80166 91168 91171 91174 91177 91194 91195 91196 91197 91198 91199 91200 91201 91202 91203 91204 91205 91864 91865 91866 91867