Note AN.0.66 | Medicare Benefits Schedule

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.66

Non-directive Pregnancy Support Counselling Service (MBS items 792, 4001, 92136, 92137, 92138 and 92139)

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.

	Face to face	Video	Phone
GP item number	4001	92136	92138
Prescribed medical practitioner item number	792	92137	92139

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

Category 1 - PROFESSIONAL ATTENDANCES

792

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, lasting at least 20 minutes, 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 4001, 81000, 81005, 81010, 92136, 92137, 92138, 92139, 93026 or 93029, applies in relation to that pregnancy

Fee: $69.80 Benefit: 100% = $69.80

(See para AN.0.66, AN.7.1, MN.8.2 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

4001

Professional attendance of at least 20 minutes in duration at consulting rooms by a general practitioner 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 patient 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 81000, 81005 or 81010 applies in relation to that pregnancy

Note: For items 81000, 81005 and 81010, see the determination about allied health services under subsection 3C(1) of the Act.

Fee: $87.25 Benefit: 100% = $87.25