Medicare Benefits Schedule - Item 92139

Phone attendance of at least 20 minutes in duration by a medical practitioner (not including a general practitioner, specialist or consultant physician) who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non-directive pregnancy support counselling to a person who:
(a) is currently pregnant; or
(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 792 or 4001 of the general medical services table, or item 81000, 81005 or 81010 of the Allied Health Determination or item 92136, 92137, 92138, 93026 or 93029 applies in relation to that pregnancy

Fee: $69.80 Benefit: 100% = $69.80

(See para AN.0.66, MN.8.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $209.40

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Publication date: 1 March 2025

SUMMARY

This note relates to MBS items for non-directive pregnancy support counselling for GPs (see GN.4.13) and prescribed medical practitioners (PMPs see AN.7.1).

For MBS items for non-directive pregnancy counselling for eligible psychologists, social workers and mental health nurses see MN.8.1 to MN.8.4.

USE OF THE ITEMS

These items are for the provision of non-directive pregnancy support counselling in a general practice setting for a person who is pregnant or was pregnant in the previous 12 months.

The requirements of the items are set out in the Health Insurance (General Medical Service Table) Regulations 2021 (the Regulations) and, for telehealth, the Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 (the Telehealth Determination).

Clause 2.22.1 of the Regulations defines non-directive pregnancy support counselling as counselling “to a patient in which:

(a) information and issues relating to pregnancy are discussed; and

(b) the medical practitioner does not impose the medical practitioner’s views or values about what the patient should or should not do in relation to the pregnancy.”

The non-directive pregnancy support counselling items are professional attendances. For more information on the meaning of professional attendance see AN.0.3.

Are these time-tiered items?

Yes. The Regulations specify that the provider’s attendance on each patient must be at least 20 minutes duration.

What is non-directive counselling?

Non-directive counselling is a form of counselling 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 to explore and understand their feelings. With this understanding, the person is able to make the decision which is best for them.

When should these items be used?

The service involves the GP or PMP 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.

The service may be used to address any pregnancy-related issues for which non-directive counselling is appropriate.

Is there a limit on the number of non-directive pregnancy support counselling services available?

Yes. A patient is eligible for up to three MBS non-directive pregnancy counselling services per pregnancy.

There are MBS item numbers for non-directive pregnancy counselling for eligible psychologists, social workers and mental health nurses, as well as GPs and PMPs. The cap of three services applies to the total number of services provided for the pregnancy, regardless of which provider (or combinations of providers) provide the services. A patient cannot access additional services by seeing multiple types of providers.

How do I know how many non-directive pregnancy support counselling services a patient has already used for a pregnancy?

Health professionals can check a patient's eligibility via Health Professional Online Services (HPOS). HPOS is a fast and secure way for health professionals and administrators to check if a patient is eligible for a Medicare benefit for a specific item on the date of the proposed service. However, this system will only return advice that the service/item is payable or not payable. Patients can also access their own claiming history with a My Health Record or by establishing a Medicare online account through myGov or the Express Plus Medicare mobile app. Alternatively, health professionals can call Services Australia on 132 150 to check this information, while patients can seek clarification by calling 132 011.

Can a partner attend the session?

Yes, with the patient’s consent. However, these items are not family or group counselling items, they are personal attendance items meaning that only the time spent counselling the person who is pregnant or was pregnant in the previous 12 months can contribute to the 20 minute minimum time. Only one MBS benefit is payable (for the patient) regardless of whether their partner and/or another support person(s) attends the session.

ELIGIBLE PATIENTS

These services are for people who:

• are pregnant, or
• were pregnant in the 12 months before the first of these services was provided in relation to the same pregnancy.

For telehealth services (video and phone), the existing clinical relationship criteria must be satisfied for the patient to be eligible for a telehealth service. See AN.1.1 for information on the existing clinical relationship criteria.

There is a combined limit of three services per pregnancy that applies across all provider types and modes.

ELIGIBLE PRACTITIONERS

GPs and PMPs must be registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service to claim these items.

Clause 2.22.1 of the Regulations prohibits a medical practitioner that has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination from providing a service using the non-directive pregnancy support counselling items.

RECORD KEEPING AND REPORTING REQUIREMENTS

All Medicare claiming is subject to compliance checks and providers may be required to submit evidence about the services they bill. More information about the Department’s compliance program can be found on its website at Medicare compliance. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. Non-directive pregnancy support counselling service items are set out in the following regulatory instruments:

• Health Insurance (General Medical Service Table) Regulations 2021 – MBS items 792, 4001
• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 – MBS items 92136, 92137, 92138, 92139

Related Items: 792 4001 92136 92137 92138 92139

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 (video and phone) MBS items for the provision of non-directive pregnancy support counselling services:

• Item 92136 - services provided by an eligible GP by video 
• Item 92138 - services provided by an eligible GP by phone
• Item 92137 - services provided by an eligible medical practitioner by video 
• Item 92139 - services provided by an eligible medical practitioner by phone
• Item 93026 - services provided by an eligible psychologist, social worker or mental health nurse by video
• Item 93029 - services provided by an eligible psychologist, social worker or mental health nurse by phone

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