Medicare Benefits Schedule - Item 91205

Phone attendance for a focussed psychological strategies health service provided by an eligible social worker 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 social worker by a referring practitioner; and

(c)     the service lasts at least 50 minutes

Fee: $100.20 Benefit: 85% = $85.20

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

Extended Medicare Safety Net Cap: $300.60

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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 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: 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 mental illness, 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 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:

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

GPs:

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

Psychologists:

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

Occupational therapist items:

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

Social worker items:

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

and;

Psychological Therapy provided by eligible Clinical psychologists:

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

To provide and claim these services under the MBS, the providing practitioner or allied health professional 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 session 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 person receiving the service. Should that person require mental health treatment themselves, the patient MBS items should be claimed (where all the requirements for the relevant item descriptor have been met). For information on Better Access patient requirements, refer to explanatory note AN.0.78– Better Access Initiative.

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 practitioner or allied health professional providing the service, or the referring practitioner, 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.

If the patient is in attendance, the treating practitioner or allied health professional can 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 practitioner or 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 practitioner or 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 practitioners and 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 91859 91861 91862 91863 91864 91865 91866 91867