Medicare Benefits Schedule - Item 286

Professional attendance at consulting rooms by a prescribed 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 mental disorders that have been assessed by a medical practitioner; and
(b) lasting at least 40 minutes

Fee: $123.90 Benefit: 100% = $123.90

(See para AN.0.78, AN.7.1, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $371.70

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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

Last reviewed: 1 November 2023

A prescribed medical practitioner is a medical practitioner:

(a) who is not a general practitioner (see GN.4.13), specialist or consultant physician, and

(b) who:

a. is registered under section 3GA of the Act and is practising during the period, and in the location in respect of which the medical practitioner is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or

b. is covered by an exemption under subsection 19AB(3) of the Act; or

c. first became a medical practitioner before 1 November 1996.

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 228 231 232 235 236 237 238 239 240 243 244 245 249 272 276 281 282 283 285 286 287 301 303 733 737 741 745 761 763 766 769 772 776 788 789 792 2197 2198 2200 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215

Eating Disorders Treatment and Management Plans Explanatory Notes (items 90250-90257, 92146-92153, 90260-90261, and 92162-92163)

This note provides information on Eating Disorders Treatment and Management Plan (EDTMP) items and should be read in conjunction with the Eating Disorders General Explanatory Notes

Eating Disorder Treatment and Management Plan (EDTMP) items overview

The EDTMP items define services for which Medicare benefits are payable where practitioners undertake the development of a treatment and management plan for patients with a diagnosis of anorexia nervosa, bulimia nervosa, binge-eating disorder and other specified feeding or eating disorder diagnoses who meet the eligibility criteria.

The EDTMP items trigger eligibility for items which provide delivery of eating disorders psychological treatment services (up to a total of 40 psychological services in a 12-month period) and dietetic services (up to a total of 20 in a 12-month period).

For any particular patient, an eating disorder treatment and management plan expires at the end of a 12-month period following provision of that service. Eating Disorders treatment services are not available to the patient if the EDTMP has expired.

Preparation of the EDTMP must include:

• discussing the patient’s medical and psychological health status with the patient and if appropriate their family/carer;
• identifying and discussing referral and treatment options with the patient and their family/carer where appropriate, including identification of appropriate support services;
• agreeing goals with the patient and their family/carer where appropriate - what should be achieved by the treatment - and any actions the patient will take;
• planning for the provision of appropriate patient and family/carer education;
• a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
• making arrangements for required referrals, treatment, appropriate support services, review and follow-up;
• documenting the results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date in the patient's plan;
• discussing and organising the appropriate reviews throughout the patient’s treatment; and
• discussing the need for the patient to be reviewed to access a higher intensity of eating disorder psychological treatment services in a 12-month period.
   

Preparing a Medical practitioner in general practice Eating Disorder Treatment & Management Plan (items 90250-90257 and 92146-92153)

Who can provide the service

Items in subgroup 1 of Group A36 can be rendered by a medical practitioner in general practice. This includes:

• Medical practitioners who can render a general practitioner service in Group A1 of the MBS (see note AN.0.9 for the types of medical practitioners). These medical practitioners can render a ‘general practitioner’ service for items in subgroup 1 of Group A36.
• Medical practitioners who are not general practitioners, specialists or consultant physicians. These medical practitioners can render a ‘medical practitioner’ service for items in subgroup 1 of Group A36.

What is Involved - Assess and Plan

It is expected that the practitioner developing the EDTMP has either performed or reviewed the assessments and examinations required to make a judgement that the patient meets the eligibility criteria for accessing these items.

Items 90250-90257 and their equivalent telehealth items (92146-92153) provide services for development of the eating disorder treatment and management plan. Where a comprehensive physical examination is performed, either on the same occasion or different occasion, the appropriate item could be claimed provided the time taken performing the assessment is not included in the time for producing the plan, or time producing the EDTMP is not included in the time for assessment.

It is emphasised that it is best practice for the practitioner to perform a comprehensive physical assessment to facilitate ongoing patient management and monitoring of medical and nutritional status.

Patient Assessment

An assessment of a patient with an eating disorders includes:

• taking relevant history (biological, psychological, social, including family/carer support);
• eating disorder diagnostic assessment;
• medical review including physical examination and relevant tests;
• conducting an assessment of mental state, including identification of comorbid psychiatric conditions;
• an assessment of eating disorder behaviours;
• an assessment of associated risk and any medical co-morbidity, including as assessment on how this impacts on the patients functioning and activities of daily living;
• an assessment of family and/or carer support; and
• administering an outcome measurement tool, except where it is considered clinically inappropriate.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.

It should be noted that the patient's EDTMP should be treated as a living document for updating as required. In particular, the plan can be updated at any time to incorporate relevant information, such as feedback or advice from other health professionals on the diagnosis or treatment of the patient.

Preparing a Consultant Psychiatrist Eating Disorder Treatment & Management Plan (90260-90261 and 92162-92163)

Who can provide the service

Items in subgroup 2 of Group 36 can be rendered by consultant psychiatrists (items 90260 and 90261, and their respective telehealth items 92162 and 92163).

What is Involved – Assess and Plan

Items 90260-90261 and their equivalent telehealth items (92162 and 92163) provide access to specialist assessment and treatment planning. It is expected that items will be a single attendance. However, there may be particular circumstances where a patient has been referred by a GP for an assessment and management plan, but it is not possible for the consultant to determine in the initial consultation whether the patient is suitable for management under such a plan. In these cases, where clinically appropriate, other appropriate consultation items may be used. In those circumstances where the consultant undertakes a consultation (in accordance with the item requirements) prior to the consultation for providing the referring practitioner with an assessment and management plan. It is expected that such occurrences would be unusual for the purpose of diagnosis under item 90260.

Patient Assessment

In order to facilitate ongoing patient focussed management, an assessment of the patient must include:

• administering an outcome measurement tool during the assessment and review stages of treatment, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner;
• conducting a mental state examination;
• taking relevant history (biological, psychological, behavioural, nutritional, social);
• assessing associated risk and any co-morbidity; and
• making a psychiatric diagnosis for conditions meeting the eligibility criteria.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.
   

Where a consultant psychiatrist provides an EDTMP service, the service must also include:

• administering an outcome measurement tool, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner. Practitioners using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training; and
• conducting a mental state examination.

Consultation with the patient’s managing practitioner

A written copy of the EDTMP should be provided to the patient’s managing practitioner, within a maximum of two weeks of the assessment. It should be noted that two weeks is the outer limit and in more serious cases more prompt provision of the plan and verbal communication with the managing practitioner may be appropriate.

Additional Claiming Information (general conditions and limitations)

Patients seeking benefits for items 90250-90257 and 90260-90261 will not be eligible if the patient has had a claim within the last 12-months.

Items 90250-90257 cannot be claimed with Items 2713, 279, 735, 758, 235 and 244. Items 90261 cannot be claimed with Items 110, 116, 119, 132, 133.

Consultant psychiatrist and paediatrician EDTMP items 90260-90261 do not apply if the patient does not have a referral within the period of validity.

Before proceeding with the EDTMP the medical practitioner must ensure that:

(a) the steps involved in providing the service are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and

(b) the patient's agreement to proceed is recorded.

The medical practitioner must offer the patient a copy of the EDTMP and add the document to the patient's records. This should include, subject to the patient's agreement, offering a copy to their carer, where appropriate. The medical practitioner may, with the permission of the patient, provide a copy of the EDTMP, or relevant parts of the plan, to other providers involved in the patient's treatment.

The medical practitioner EDTMP cover the service of developing an EDTMP. A separate consultation item can be performed with the EDTMP if the patient is treated for an unrelated condition to their eating disorder. Where a separate consultation is performed, it should be annotated separately on the patient’s account that a separate consultation was clinically required/indicated.

All consultations conducted as part of the EDTMP must be rendered by the medical practitioner and include a personal attendance with the patient. A specialist mental health nurse, other allied health practitioner, Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker with appropriate mental health qualifications and training may provide general assistance to the medical practitioner in provision of this care.

Additional Claiming Information (interaction with Chronic Condition Management and Better Access)

It is preferable that wherever possible patients have only one plan for primary care management of their disorder. As a general principle the creation of multiple plans should be avoided, unless the patient clearly requires an additional plan for the management of a separate medical condition.

The Chronic Condition Management (CCM) items (items 231, 232, 392, 393, 729, 731, 965, 967, 92026, 92027, 92029, 92030, 92057, 92058, 92060 and 92061) continue to be available for patients with chronic medical conditions, including patients with complex needs. 

Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a CCM Plan, and to manage their eating disorder through an EDTMP. In this case, both items can be used. Where the patient receives dietetic services under the CCM arrangements (item 10954), these services will count towards the patients maximum of 20 dietetic services in a 12-month period. 

Where a patient has other psychiatric comorbidities, these conditions should be managed under the EDTMP. Once a patient has a claim for an EDTMP, the patient should not be able to have a claim for the development or review of a Mental Health Treatment plan by a GP (items 2700, 2701, 2715 and 2717) or medical practitioner in general practice (items 272, 276, 281 and 282) within 12-months of their EDTMP unless there are exceptional circumstances.

For the purpose of the 40 eating disorder psychological treatment count; eating disorder psychological treatment service includes a service provided under the following items: 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 2721, 2723, 2725, 2727, 283, 285, 286, 287 and items in Groups M6, M7 and M16 (excluding item 82350). 

Related Items: 110 116 119 132 133 231 232 235 244 272 276 281 282 283 285 286 287 392 393 729 731 735 758 965 967 2700 2701 2715 2717 2721 2723 2725 2727 82350 90250 90251 90252 90253 90254 90255 90256 90257 90260 90261 90271 90272 90273 90274 90275 90276 90277 90278 92026 92027 92029 92030 92057 92058 92060 92061 92146 92147 92148 92149 92150 92151 92152 92153 92162 92163 92182 92184 92186 92188 92194 92196 92198 92200

Referral Requirements for Better Access Treatment Services

Associated items: 2721, 2723, 2725, 2727, 91818, 91819, 91842, 91843, 283, 285, 286, 287, 91820, 91821, 91844, 91845, 80100, 80105, 80110, 80115, 91169, 91170, 91183, 91184, 80125, 80130, 80135, 80140, 91172, 91173, 91185, 91186, 80150, 80155, 80160, 80165, 91175, 91176, 91187, 91188, 80120, 80122, 80127, 80121, 80123, 80128, 80145, 80147, 80152, 80146, 80148, 80153, 80170, 80172, 80174, 80171, 80173, 80175, 80000, 80010, 80005, 80015, 91166, 91167, 91181, 91182, 80020, 80021, 80022, 80023, 80024, 80025, 80002, 80006, 80012, 80016, 91171, 91199, 91168, 91198

Services requiring referral

Medicare Benefits Schedule (MBS) mental health treatment services under the Better Access initiative (refer to explanatory note AN.0.78 – Better Access Initiative) require an eligible referral for a Medicare benefit to be claimed. Medicare benefits are available for up to 10 individual and 10 group therapy mental health treatment services in a calendar year. These services may consist of:

• psychological therapy services (refer to explanatory note MN.6.2 - Provision of Psychological Therapy) and/or
• focussed psychological strategies (refer to explanatory note MN.7.4 - Provision of Focussed Psychological Strategies). 

Up to 2 of a patient’s individual services may be used for family and carer participation items per calendar year. For additional information, refer to explanatory note MN.7.5 – Family and Carer Participation.  

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 and referral requirements outlined in explanatory note AN.0.78 | Better Access Initiative.

Referrals from psychiatrists and paediatricians must be made from eligible Medicare services. 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.

Course of treatment and specifying the number of services in a referral

Under the Better Access initiative, a patient may be referred for up to 10 individual and 10 group therapy mental health treatment services within a calendar year. Eligible patients must be referred to mental health treatment services by either a general practitioner (GP) or a prescribed medical practitioner (PMP) at the general practice in which the patient is enrolled in MyMedicare, or regardless of whether the patient is enrolled in MyMedicare, by the patient’s usual medical practitioner who is managing the patient under a Mental Health Treatment Plan. This also includes a GP or PMP who is located at a medical practice that has provided the majority of their care over the previous 12 months or will be providing the majority of their care over the next 12 months. In addition, eligible patients can be referred under a Psychiatrist Assessment and Management Plan, or on direct referral from an psychiatrist or paediatrician.  

The referring practitioner can decide how many services the patient will receive in a course of treatment, within the maximum service limit for the course of treatment. The maximum service limit for each course of treatment is set out below: 

• Initial course of treatment - a maximum of 6 individual services.
• Subsequent course of treatment - remaining individual services up to the patient's cap of 10 services per calendar year (for example, if the patient received 6 services in their initial course of treatment, they could only receive 4 services in a subsequent course of treatment provided within the same calendar year).
• Up to a maximum of 10 group therapy mental health treatment services per calendar year.

On completion of the initial course of treatment, the eligible allied health professional providing the service must provide a written report to the referring practitioner, which includes information on:

• assessments carried out on the patient;
• treatment provided; and
• recommendations on future management of the patient's disorder (e.g. if they require a subsequent course of treatment as the initial course of individual services is only up to 6 services, with the subsequent being no more than the maximum of 10 services per calendar year), noting further treatment under the Better Access initiative should be utilised for patients who require at least a moderate level of support. 

This report will aid the referring practitioner in determining whether another course of treatment is appropriate for the management of the patient’s mental disorder.

If, in their referral, the referring practitioner:

• Does not specify the number of services
• Specifies a number of services above the maximum allowed for the course of treatment
• Specifies a number of services above the maximum allowed for the calendar year (including any services the patient has already received that year),

The eligible allied health professional must contact the referring practitioner to determine the required number of services required.

Referral requirements

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

Referring practitioners are not required to use a specific Medicare form to refer patients for these services, however, AN.15.6 – Referral requirements for allied health and Aboriginal and Torres Strait Islander Health and Wellbeing Services sets out the requirements when referring patients to MBS supported allied health services.

In addition to the referral requirements outlined in AN.15.6, it must be noted that a Mental Health Treatment Plan is not considered a referral, and a referral for mental health services under Better Access should be in writing (signed and dated by the referring practitioner [which can be by an electronic signature]) and include:

• the patient's name, date of birth and address;
• the patient's symptoms or diagnosis;
• a list of any current medications;
• the number of services the patient is being referred for; and
• a statement about whether the patient has had a Mental Health Treatment Plan or a Psychiatrist Assessment and Management Plan prepared. 

A referral should include all the above details, and any additional information outlined in AN.15.6 to assist with any auditing undertaken by the Department of Health, Disability and Ageing. Eligible GPs and eligible PMPs who provide focussed psychological strategies services do so as part of an arrangement for the treatment of an assessed mental health disorder under a Mental Health Treatment Plan. Where appropriate, and with the patient's agreement, a copy of the Mental Health Treatment Plan can be attached to the referral.

Use of referrals across different calendar years

If a patient has not used all their psychological therapy services and/or focussed psychological strategies services covered by a referral within the calendar year, it is not necessary to obtain a new referral for the "unused" services. However, any "unused" services received from 1 January in the following year under that referral will count as part of the total services for which the patient is eligible in that calendar year.

When a patient has used all of their referred services, they will need to obtain a new referral from either their GP or PMP at their MyMedicare registered practice or by their usual medical practitioner if they are eligible for further services.

It is not necessary to have a new Mental Health Treatment Plan and/or Psychiatrist Assessment and Management Plan prepared each calendar year in order to access a new referral(s) for psychological therapy services and/or focussed psychological strategies services. A Mental Health Treatment Plan or a Psychiatrist Assessment and Management Plan does not expire. A new Mental Health Treatment Plan or a Psychiatrist Assessment and Management 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 is unable to obtain a copy of their Mental Health Treatment Plan or Psychiatrist Assessment and Management Plan.

Patients continue to be eligible for benefits for psychological therapy services and/or focussed psychological strategies services while they are being managed under a Mental Health Treatment Plan and/or a Psychiatrist Assessment and Management Plan as long as the need for eligible services continues to be recommended. However, patients will only receive a Medicare benefit for psychological therapy services and/or focussed psychological strategies services by eligible allied health professionals if they obtained a referral from a GP or PMP at their MyMedicare registered practice or by their usual medical practitioner.

Receipt of referral

The treating eligible allied health professional providing the relevant treatment service (refer to explanatory notes MN.6.2 – Provision of Psychological Therapy and MN.7.4 – Provision of Focussed Psychological Strategies) must be in receipt of the referral at the first consultation. The treating eligible allied health professional must also retain the referral for a period of 2 years (24 months) from the date the first treatment service was rendered. For more information on record keeping and reporting requirements, refer to explanatory note AN.0.78 – Better Access Initiative.

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: 283 285 286 287 2721 2723 2725 2727 80000 80002 80005 80006 80010 80012 80015 80016 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 91166 91167 91168 91169 91170 91171 91181 91182 91183 91184 91185 91186 91187 91188 91198 91199 91842 91843 91844 91845

Provision of Focussed Psychological Strategies

Associated Items: 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 , 91188

Services attracting Medicare benefits

There are 58 Medicare Benefits Schedule (MBS) items for the provision of focussed psychological strategy services to eligible patients by an eligible general practitioner (GP), eligible prescribed medical practitioner (PMP), eligible psychologist (registered), eligible occupational therapist, or eligible social worker. These consist of:

Individual focussed psychological strategies:

GP services:

• face-to-face items: 2721, 2723, 2725 and 2727
• video and phone items: 91818, 91819, 91842 and 91843

PMP services:  

• face-to-face items: 283, 285, 286 and 287
• video and phone items: 91820, 91821, 91844 and 91845

Psychologist (registered) services:

• face-to-face items: 80100, 80105, 80110 and 80115
• video and phone items: 91169, 91170, 91183 and 91184

Occupational therapist services:

• face-to-face items: 80125, 80130, 80135 and 80140
• video and phone items: 91172, 91173, 91185 and 91186

Social worker services:

• face-to-face items: 80150, 80155, 80160 and 80165
• video and phone items: 91175, 91176, 91187, and 91188

Group focussed psychological strategies:

Psychologist (registered) services:

• face-to-face items: 80120, 80122 and 80127
• video items: 80121, 80123 and 80128

Occupational therapist services:

• face-to-face items: 80145, 80147, 80152
• video items: 80146, 80148, 80153

Social worker services:

• face-to-face items: 80170, 80172, 80174
• video items: 80171, 80173, 80175

To provide these services, eligible health professionals must meet the provider eligibility requirements set out below and be registered with Services Australia.

For group focussed psychological strategies services provided via video, additional restrictions apply. Please see the group focussed psychological strategies services - telehealth (video) requirements section below for further information.

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 and referral requirements outlined in explanatory note AN.0.78 | Medicare Benefits Schedule.

Service length and type

Services provided by eligible health professionals under these items must meet the time period requirements specified within the item descriptor.

It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.

A range of acceptable strategies has been approved for use by eligible health professionals utilising the focussed psychological strategies items.

These are: 

• psycho-education
• cognitive-behavioural therapy that involves cognitive or behavioural interventions
• relaxation strategies
• skills training
• interpersonal therapy
• eye movement desensitisation and reprocessing; and
• narrative therapy (for Aboriginal and Torres Strait Islander peoples).

Number of services per year

Medicare benefits are available for up to 10 individual and 10 group therapy mental health treatment services in a calendar year. The services may consist of:

• psychological therapy services delivered by eligible clinical psychologists (refer to explanatory note MN.6.2 - Provision of Psychological Therapy); and/or
• focussed psychological strategies services delivered by eligible GPs, eligible PMPs, eligible psychologists (registered), eligible social workers and eligible occupational therapists. 

Course of treatment and reporting back to the referring medical practitioner or practice

Eligible patients must be referred for focussed psychological strategies services by either a GP or PMP at the general practice in which the patient is enrolled in MyMedicare, or regardless of whether the patient is enrolled in MyMedicare, by the patient’s usual medical practitioner who is managing the patient under a Mental Health Treatment Plan. This also includes a GP or PMP who is located at a medical practice that has provided the majority of care over the previous 12 months or will be providing the majority of their care over the next 12 months. In addition, eligible patients can be referred under a Psychiatrist Assessment and Management Plan, or on direct referral from a psychiatrist or paediatrician. For additional information on Better Access referral requirements, refer to explanatory note MN.6.3 - Referral Requirements for Better Access Treatment Services. 

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

The treating eligible allied health professional providing the service must be in receipt of the referral at the first mental health consultation. The treating eligible allied health professional must also retain the referral for 2 years (24 months) from the date the service was rendered.

The referring practitioner can decide how many services the patient will receive in a course of treatment, within the maximum service limit for the course of treatment. The maximum service limit for each course of treatment is set out below:

• Initial course of treatment - a maximum of 6 services.
• Subsequent course of treatment - a maximum of 6 services up to the patient's cap of 10 services per calendar year (for example, if the patient received 6 services in their initial course of treatment, they could only receive 4 services in a subsequent course of treatment provided within the same calendar year).

On completion of the initial course of treatment, the treating eligible health professional providing the service must provide a written report to the referring practitioner, which includes information on:

• assessments carried out on the patient;
• treatment provided; and
• recommendations on future management of the patient's disorder (e.g. if they require a subsequent course of treatment as the initial course of individual services is only up to 6 services, with the subsequent being no more than the maximum of 10 services per calendar year), noting further treatment under the Better Access initiative should be utilised for patients who require at least a moderate level of support.

A written report must also be provided to the referring practitioner at the completion of any subsequent course(s) of treatment provided to the patient.

Group focussed psychological strategies services

In addition to individual focussed psychological strategies services, eligible patients may also claim up to 10 separate group focussed psychological strategies service MBS items within a calendar year for group therapy mental health treatment services provided by eligible allied health professionals. Group focussed psychological strategy services can be claimed for groups of 4 to 10 patients. However, the eligible allied health professional providing the service can claim these MBS items if 4 patients were due to attend and 1 patient is unable to attend, regardless of the reason.

Group focussed psychological strategies services - telehealth (video) requirements

Group therapy mental health treatment services may only be delivered via video in certain circumstances. To be eligible for group therapy mental health treatment services via video, the patient must be located in a Modified Monash Model area 4-7 at the time of the consultation, and at least 15 kilometres apart by road from the eligible allied health professional delivering the service. The patient or eligible allied health professional is not permitted to travel to an area outside the minimum 15 kilometres distance in order to claim a video consultation item.

More information about the Modified Monash Model, including a search tool to identify the classification of a specific location, is available at:

https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm

Record Keeping

Eligible GPs or eligible PMPs or eligible allied health professionals providing focussed psychological strategies services must keep contemporaneous notes of the consultation 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.

Professional eligibility to provide focussed psychological strategy services

Under the Better Access initiative, focussed psychological strategies services may only be provided by an eligible GP, eligible PMP, eligible psychologist (registered), eligible occupational therapist, or eligible social worker. The eligibility requirements for each profession are set out below.

A person is an eligible GP or eligible PMP in relation to the provision of focussed psychological strategies if the person:

1. is entered in the register maintained by the Chief Executive Medicare under section 33 of the Human Services (Medicare) Regulations 2017;
2. is identified in the register as a medical practitioner who can provide focussed psychological strategies services; and
3. meets the relevant training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration.

A person is an eligible allied health professional in relation to the provision of a focussed psychological strategies health service if the person meets 1 of the following requirements:

1. the person holds general registration in the health profession of psychology with the Psychology Board of Australia; or
2. the person is a member of the Australian Association of Social Workers (AASW) and accredited by AASW as meeting the accreditation criteria set out in the document published by AASW titled ‘AASW Accredited Mental Health Social Worker Application Criteria’ as in force on 1 July 2022; or
3. the person:
   
   1. holds registration in the health profession of occupational therapy with the Occupational Therapy Board of Australia; and
   2. is accredited by Occupational Therapy Australia as meeting the criteria for mental health endorsement as set out in the document published by Occupational Therapy Australia titled ‘Occupational Therapy Australia Mental Health Endorsement Criteria’ as in force on 1 March 2023.

Continuing professional development for occupational therapists and social workers providing focussed psychological strategies services

In addition to meeting the relevant professional eligibility requirements, eligible occupational therapists and eligible social workers are required to have completed 10 one-hour units of focussed psychological strategies continuing professional development per year to provide focussed psychological strategies services.  A year for the purposes of these items is from 1 July to 30 June annually. Part-time allied health professionals are required to complete 10 units of focussed psychological strategies related continual professional development, the same as full-time allied health professionals.

Continual professional development units must relate to the delivery of focussed psychological strategies in any of the following areas:

a. psycho-education;

b. cognitive-behavioural therapy including;

1. behavioural interventions;
2. behaviour modification;
3. exposure techniques;
4. activity scheduling;

c. cognitive interventions including:

1. cognitive therapy;

d. relaxation strategies including;

1. progressive muscle relaxation;
2. controlled breathing;

e. skills training including;

1. problem solving skills and training;
2. anger management;
3. social skills training;
4. communication training;
5. stress management;
6. parent management training;

f. interpersonal therapy;

g. eye movement desensitisation and reprocessing;

h. narrative therapy (for Aboriginal and Torres Strait Islander people);

i. clinical skills to undertake a full assessment of a patient in order to form a diagnosis and commence treatment planning.

Acceptable continual development activities where the content is related to focussed psychological strategies can include formal postgraduate education, workshops, seminars, lectures, journal reading, writing papers, receipt of supervision and peer consultation, and online training. There is flexibility in the continual professional activities that can be undertaken to meet individual professional needs and their practice/client base and client needs. For example, activities could also include assessment and treatment of specific disorders and client types such as youth, or different modalities and delivery such as working with groups.

A person required to complete focussed psychological strategies continuing professional development must keep written records of completion of focussed psychological strategies continuing professional development for a period of 2 years from the end of the continuing professional year to which the focussed psychological strategies continuing professional development relates.

Eligible occupational therapists and eligible social workers who register to provide focussed psychological strategies during the continual professional development year (1 July – 30 June), are obligated to undertake continual professional development on a pro-rata basis. The amount of continual professional development units will be calculated from the 1st of the month immediately succeeding the month they obtained initial registration. 

Registering with Services Australia

Advice about registering with Services Australia to provide Better Access services is available from the Services Australia provider enquiry line on 132 150. 

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: 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 91169 91170 91183 91184 91185 91186 91187 91188 91842 91843 91844 91845