Medicare Benefits Schedule - Item 91862

Telehealth attendance by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)    lasting at least 30 minutes but less than 40 minutes

Fee: $81.25 Benefit: 100% = $81.25

(See para AN.7.31 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $243.75

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OVERVIEW

The purpose of these MBS items is to enable eligible other medical practitioners (OMPs) to involve another person in a patient’s treatment, under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative, where:

• the eligible OMP 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.

These 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 rebates are available to a patient for up to two 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 Better Access. For further information on patient allocations, please see explanatory note AN.7.22.

For Medicare benefit purposes, charges 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 REBATES 

MBS items

There are eight MBS items for the provision of focussed psychological strategies (FPS) health services to a person other than the patient by eligible OMPs:

• 309, 311, 313 and 315 for provision of in person FPS services by an OMP;
• 91862 and 91863 for provision of telehealth FPS services by an OMP; and
• 91866 and 91867 for provision of phone FPS services by an OMP.

Telehealth services are the preferred approach for substituting a face-to-face consultation. However, eligible OMPs will also be able to offer phone (audio-only) services if video is not available or appropriate. As outlined above, there are separate items available for phone services.

To claim these MBS items the eligible OMP must meet the provider eligibility requirements for the delivery of FPS services. For further information, please see explanatory note AN.7.23.

Eligible focussed psychological strategies services

A range of acceptable strategies have been approved for use by eligible OMPs utilising FPS items. For further information, please see explanatory note AN.7.23.

Eligible OMPs must use their professional judgement to determine what would be an appropriate FPS service to deliver to another person as part of the patient’s treatment within the approved list of FPS.

Publicly funded services

These MBS items do not apply for services provided by any other Commonwealth or state funded services, or provided to an admitted patient of a hospital, unless there is an exemption under subsection 19(2) of the Health Insurance Act 1973.

SERVICE LIMITATIONS      

Medicare rebates are available to a patient for up to two services provided to another person per calendar year. The two services may consist of:

• OMP items: 309, 311, 313, 315, 91862, 91863, 91866 and 91867 
• GP items: 2739, 2741, 2743, 2745, 91859, 91861, 91864 and 91865
• Clinical psychologist items: 80002, 80006, 80012, 80016, 91168, 91171, 91198 and 91199
• Psychologist items: 80102, 80106, 80112, 80116, 91174, 91177, 91200 and 91201
• Occupational therapist items: 80129, 80131, 80137, 80141, 91194, 91195, 91202 and 91203
• Social worker items: 80154, 80156, 80162, 80166, 91196, 91197, 91204 and 91205

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.

For further information on the maximum session limits for each course of treatment and maximum calendar year allocation, please see explanatory note AN.7.22.

CLAIMING REQUIREMENTS

Determining service is clinically appropriate

The eligible OMP providing the service must use their professional judgment to determine it is clinically appropriate, and would form part of the patient’s treatment, to provide a FPS service to another person.

This determination must be recorded in writing in the patient’s records.

Obtaining and recording patient consent to deliver the service

The patient must consent to the other person receiving a FPS service using these MBS items. The eligible OMP 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.
• 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 OMP should be aware of the requirements in the relevant state or territory.

Service must be part of the patient’s treatment 

Any service delivered using these MBS items must be part of the patient’s treatment. These MBS items are not for the purposes of providing mental health treatment to the person receiving the service. Should that person also require mental health treatment the patient MBS items should be claimed (where all the requirements for the relevant item descriptor have been met).

Patient is not in attendance

These MBS items are for eligible OMPs to provide services to another person when the patient is not in attendance. If the patient is in attendance, the OMP can consider whether the requirements of the patient MBS items for delivering Better Access services have been met. For further information, please see explanatory note AN.7.23.

Course of treatment

These services may be accessed at any stage of a patient’s course of treatment and do not need to be accessed consecutively, provided no more than two services are delivered to another person and delivering these services does not exceed the maximum allowed for the patient in a course of treatment or calendar year under Better Access.

ADDITIONAL INFORMATION

Out-of-pocket expenses and Medicare safety net

For Medicare benefit purposes, charges relating to services covered by these MBS items should be raised against the patient rather than against the person receiving the service.

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. 

Checking the number of services

If there is any doubt about a patient’s eligibility, Services Australia will be able to confirm the number of mental health services already claimed by the patient during the calendar year. Eligible OMPs can call Services Australia on 132 150 to check this information, while patients can call on 132 011. 

Further information

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

For providers, further information is also available from the Services Australia Medicare Provider Enquiry Line on 132 150.

Related Items: 309 311 313 315 91862 91863 91866 91867