Medicare Benefits Schedule - Note MN.6.2

Provision of Psychological Therapy

Associated Items: 80000, 80005, 80010, 80015, 80020, 80021, 80022, 80023, 80024, 80025, 91166, 91167, 91181, 91182.

Services attracting Medicare benefits

There are 14 Medicare Benefits Schedule (MBS) items for the provision of psychological therapy services to eligible patients by an eligible clinical psychologist. These consist of:

Individual Psychological Therapy Services:

• Face-to-Face items:  80000, 80005, 80010 and 80015
• Video and Phone items: 91166, 91167, 91181 and 91182

Group Psychological Therapy Services:

• Face-to-Face items: 80020, 80022, and 80024
• Video items: 80021, 80023 and 80025 

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

For group psychological therapy services provided via video, additional restrictions apply. Please see the Group psychological therapy 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 | Better Access Initiative.

Service length and type

Services provided by eligible clinical psychologists 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.

In addition to psychoeducation, it is recommended that cognitive-behaviour therapy be provided. However, other evidence-based therapies may be used if considered clinically relevant. 

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; and/or
• focussed psychological strategies services delivered by eligible GPs, eligible Prescribed Medical Practitioners (PMPs), eligible psychologists (registered), eligible social workers and eligible occupational therapists (refer to explanatory note MN.7.4 – Provision of Focussed Psychological Strategies). 

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

Eligible patients must be referred to psychological therapy 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 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 a psychiatrist or paediatrician. For additional information on Better Access referral requirements, please see explanatory note MN.6.3 - Referral requirements for Better Access Treatment Services.

The eligible clinical psychologist providing the service must be in receipt of the referral at the first mental health consultation. The eligible clinical psychologist must also retain the referral for 2 years (24 months) from the date the first treatment 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 eligible clinical psychologist 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 psychological therapy services

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

Group psychological therapy 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 clinical psychologist delivering the service. The patient or eligible clinical psychologist 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 clinical psychologists providing psychological therapy 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.

Allied health professional eligibility for the provision of psychological therapy services

Psychological therapy services under the MBS may only be provided by eligible clinical psychologists.

A person is an eligible allied health professional in relation to the provision of a psychological therapy health service if the person:

1. holds general registration in the health profession of psychology with the Psychology Board of Australia; and
2. is endorsed by the Psychology Board of Australia to practice in clinical psychology.

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: 80000 80005 80010 80015 80020 80021 80022 80023 80024 80025 91166 91167 91181 91182

• Previous - Note MN.3.2
• Next - Note MN.6.3

Psychological therapy health service provided by video attendance by an eligible clinical psychologist if:

(a) the patient is referred by a referring practitioner; and

(b) the service is provided to the patient individually; and

(c) at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e) the service is at least 30 minutes but less than 50 minutes duration

Fee: $116.40 Benefit: 85% = $98.95

(See para AN.0.30, AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided by video attendance by an eligible clinical psychologist if:

(a) the patient is referred by a referring practitioner; and

(b) the service is provided to the patient individually; and

(c) at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e) the service is at least 50 minutes duration

Fee: $170.85 Benefit: 85% = $145.25

(See para AN.0.30, AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient in consulting rooms by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the service is provided to the patient individually and in person; and

(c)  at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d)  on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e)  the service is at least 30 minutes but less than 50 minutes duration

Fee: $116.40 Benefit: 85% = $98.95

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient at a place other than consulting rooms by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the service is provided to the patient individually and in person; and

(c)  at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d)  on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e)  the service is at least 30 minutes but less than 50 minutes duration

Fee: $145.45 Benefit: 85% = $123.65

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient in consulting rooms by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the service is provided to the patient individually and in person; and

(c)  at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d)  on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e)  the service is at least 50 minutes duration

Fee: $170.85 Benefit: 85% = $145.25

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient at a place other than consulting rooms by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the service is provided to the patient individually and in person; and

(c)  at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d)  on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e)  the service is at least 50 minutes duration

Fee: $199.90 Benefit: 85% = $169.95

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the service is provided in person; and

(c)  the service is at least 60 minutes duration

Fee: $43.35 Benefit: 85% = $36.85

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the attendance is by video conference; and

(c)  the patient is located within a telehealth eligible area; and

(d)  the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)  the service is at least 60 minutes duration

Fee: $43.35 Benefit: 85% = $36.85

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

(a)  the patient is referred for a course of treatment by a referring practitioner; and

(b)  the service is provided in person; and

(c)  the service is at least 90 minutes duration

Fee: $59.10 Benefit: 85% = $50.25

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the attendance is by video conference; and

(c)  the patient is located within a telehealth eligible area; and

(d)  the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)  the service is at least 90 minutes duration

Fee: $59.10 Benefit: 85% = $50.25

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

(a)  the patient is referred for a course of treatment by a referring practitioner; and

(b)  the service is provided in person; and

(c)  the service is at least 120 minutes duration

Fee: $80.30 Benefit: 85% = $68.30

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided to a patient as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

(a)  the patient is referred by a referring practitioner; and

(b)  the attendance is by video conference; and

(c)  the patient is located within a telehealth eligible area; and

(d)  the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)  the service is at least 120 minutes duration

Fee: $80.30 Benefit: 85% = $68.30

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if:

(a) the patient is referred by a referring practitioner; and

(b) the service is provided to the patient individually; and

(c) at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e) the service is at least 30 minutes but less than 50 minutes duration

Fee: $116.40 Benefit: 85% = $98.95

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)

Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if:

(a) the patient is referred by a referring practitioner; and

(b) the service is provided to the patient individually; and

(c) at the completion of a course of treatment, the referring practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring practitioner on assessments carried out, treatment provided and recommendations on future management of the patient’s condition; and

(e) the service is at least 50 minutes duration

Fee: $170.85 Benefit: 85% = $145.25

(See para AN.0.78, MN.6.2, MN.6.3 of explanatory notes to this Category)