Medicare Benefits Schedule - Item 91197

Video 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: $102.60 Benefit: 85% = $87.25

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

Extended Medicare Safety Net Cap: $307.80

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Family and Carer Participation

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 a clinically diagnosed mental disorder, 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 individual 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 (PMPs):

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

General Practitioners (GPs):

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

Psychologists (registered):

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

Occupational therapists:

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

Social workers:

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

and;

Psychological Therapy provided by eligible Clinical psychologists:

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

To provide and claim these services under the MBS, the eligible GP or eligible PMP or eligible allied health professional providing treatment services to the patient 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 service 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 family member or carer supporting the patient. Should the family member or carer require mental health treatment themselves, they should be advised to see their GP or PMP for an assessment to be made on their mental health. For information on Better Access patient requirements, refer to explanatory note AN.0.78 – Better Access Initiative.

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

For more information on referral requirements for Better Access services, refer to explanatory note MN.6.3 - Referral Requirements for Better Access Treatment Services.

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 referring practitioner, or eligible practice 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 during the provision of the service.

When utilising family and carer items, the patient must not be in attendance during the provision of the service. In addition, the eligible GP or eligible PMP or eligible allied health professional must also 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 eligible GP or eligible PMP or eligible 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 treating eligible GP or eligible PMP or eligible 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 eligible GPs or eligible PMPs or eligible 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 91864 91865 91866 91867