View Associated Notes
Category 8 - MISCELLANEOUS SERVICES
81005 - Additional Information
Non‑directive pregnancy support counselling health service provided to a patient, who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible social worker if:
(a) the patient is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and
(b) the patient is referred by a medical practitioner who is not a specialist or consultant physician; and
(c) the eligible social worker does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and
(d) the service is at least 30 minutes duration;
to a maximum of 3 services (including services to which items 81000, 81005 or 81010, items 792 or 4001 in the general medical services table, or items 92136, 92138, 93026, 93029, 92137 or 92139 in the Telehealth and Telephone Determination apply) for each pregnancy
Fee: $83.30 Benefit: 85% = $70.85
(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)
Associated Notes
Category 8 - MISCELLANEOUS SERVICES
MN.8.1
Pregnancy Support Counselling - Eligible Patients - (Items 81000 - 81010, 93026 and 93029)
Medicare benefits are available 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 item 81000, 81005, 81010, 93026 and 93029 applies in relation to that pregnancy. Services can be provided either by an eligible GP/medical practitioner or by an eligible psychologist, social worker or mental health nurse on referral from a GP or medical practitioner.
The items may be used to address any pregnancy related issues for which non-directive counselling is appropriate.
Category 8 - MISCELLANEOUS SERVICES
MN.8.2
Pregnancy Support Counselling - Eligible Services - (Items 81000, 81005, 81010, 93026 and 93029)
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
Category 8 - MISCELLANEOUS SERVICES
MN.8.3
Pregnancy Support Counselling - Referral Requirements (Items 81000, 81005, 81010, 93026 and 93029)
Patients must be referred for non-directive pregnancy support counselling services by a GP or medical practitioner. GPs/medical practitioners are not required to use a specific form to refer patients for these services. The referral may be a letter or note to an eligible allied health professional signed and dated by the referring GP/medical practitioner.
Patients may be referred by a GP or medical practitioner to more than one eligible allied health professional for eligible non-directive pregnancy support counselling services (for example, where a patient does not wish to continue receiving services from the provider they were referred to in the first instance).
The relevant allied health professional must be in receipt of the referral at the first non-directive pregnancy support counselling service and must retain the referral for 2 years from the date the service was rendered, for Services Australia auditing purposes.
A copy of the referral is not required to accompany Medicare claims. However, referral details are required to be included on patients' itemised accounts/receipts or Medicare assignment of benefit forms.
Referral validity
The referral is valid for up to 3 non-directive pregnancy support counselling services, per patient, per pregnancy.
Subsequent Referrals
A new referral is required where the patient seeks to access non-directive pregnancy support counselling in relation to a different pregnancy or where the patient wishes to be referred to a different allied health professional than the one they were referred to in the first instance.
Category 8 - MISCELLANEOUS SERVICES
MN.8.4
Pregnancy Support Counselling - Allied Health Professional Eligibility (Items 81000, 81005, 81010, 93026 and 93029)
Eligible allied health professionals
Items 81000, 81005, 81010, 93026 and 93029 can only be claimed for services provided by psychologists, social workers and mental health nurses who meet the following specific eligibility requirements, and are registered with Services Australia.
To be eligible to provide services using MBS items 81000, 93026 and 93029, a psychologist must hold 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 be certified by the Australian Psychological Society as appropriately trained in non-directive pregnancy counselling.
To be eligible to provide services using MBS items 81005, 93026 and 93029, a social worker must be a 'Member' of the Australian Association of Social Workers (AASW), be certified by AASW either as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers 2014’ as in force on 25 September 2014 and certified by AASW as appropriately trained in non-directive pregnancy counselling.
To be eligible to provide services using MBS items 81010, 93026 and 93029, a mental health nurse must be a 'Credentialled Mental Health Nurse' as certified by the Australian College of Mental Health Nurses, and be appropriately trained in non-directive pregnancy counselling.
Registering with Services Australia
Advice about registering with Services Australia to provide non-directive pregnancy support counselling services using items 81000 – 81010, 93026 and 93029 is available from Services Australia provider inquiry line on 132 150.
Further information
Additional information can be found on the Department of Health and Aged Care and Services Australia website by searching 'allied health'.
Further information is also available for providers from the Services Australia provider inquiry line on 132 150.
Legend
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change