Medicare Benefits Schedule - Note MN.6.8

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Category 8 - MISCELLANEOUS SERVICES

MN.6.8

Provision of Psychological Therapy Services by Clinical Psychologists to a Person other than the Patient (80002, 80006, 80012, 80016, 91168, 91171, 91198 and 91199)

OVERVIEW

The purpose of these MBS items is to enable clinical psychologists to involve another person in a patient’s treatment, under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative, where:

  • the patient has been referred for Better Access services,
  • the clinical psychologist providing the service, or the referring practitioner, 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.

These MBS items recognise the important role another person, such as a family member or carer, can play in supporting patients with mental illness, and the benefits that can result from involving them in treatment.

Under these MBS items, Medicare rebates are available to a patient for up to two services provided to another person per calendar year. Any services delivered using these items count towards the patient’s course of treatment and calendar year allocations under Better Access. For further information on patient allocations, please see explanatory note MN.6.2.

For Medicare benefit purposes, charges 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 REBATES 

MBS items

There are eight MBS items for the provision of psychological therapy health services to a person other than the patient by clinical psychologists:

  • 80002, 80006, 80012, 80016 for provision of in person psychological therapy health services;
  • 91168 and 91171 for provision of telehealth psychological therapy health services; and
  • 91198 and 91199 for provision of phone psychological therapy health services.

Telehealth services are the preferred approach for substituting a face-to-face consultation. However, clinical psychologists will also be able to offer phone (audio-only) services if video is not available or appropriate. As outlined above, there are separate items available for phone services.

To claim these MBS items the clinical psychologist must meet the provider eligibility requirements for the delivery of psychological therapy health services. For further information, please see explanatory note MN.6.4.

Eligible psychological therapy health services

Clinical psychologists must use their professional judgement to determine what would be an appropriate psychological therapy health service to deliver to another person as part of the patient’s treatment.

Publicly funded services

These MBS items do not apply for services provided by any other Commonwealth or state funded services, or provided to an admitted patient of a hospital, unless there is an exemption under subsection 19(2) of the Health Insurance Act 1973.

SERVICE LIMITATIONS      

Medicare rebates are available to a patient for up to two services provided to another person per calendar year. The two services may consist of:

  • Clinical psychologist items: 80002, 80006, 80012, 80016, 91168, 91171, 91198 and 91199
  • GP items: 2739, 2741, 2743, 2745, 91859, 91861, 91864 and 91865
  • Other medical practitioner items: 309, 311, 313, 315, 91862, 91863, 91866 and 91867 
  • Psychologist items: 80102, 80106, 80112, 80116, 91174, 91177, 91200 and 91201
  • Occupational therapist items: 80129, 80131, 80137, 80141, 91194, 91195, 91202 and 91203
  • Social worker items: 80154, 80156, 80162, 80166, 91196, 91197, 91204 and 91205

Any services delivered using these MBS items count towards:

  • the maximum session limit for each course of treatment under Better Access, and
  • the patient’s calendar year allocation for individual services under Better Access.

For further information on the maximum session limits for each course of treatment and maximum calendar year allocation, please see explanatory note MN.6.2.

CLAIMING REQUIREMENTS

Referrals 

Services provided under these MBS items will not attract a Medicare rebate unless the patient has been referred for Better Access services by a referring practitioner. Referring practitioner means:

  • a medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan or psychiatrist assessment and management plan; or
  • a specialist or consultant physician specialising in the practice of their field of psychiatry; or
  • a specialist or consultant physician specialising in the practice of their field of paediatrics.

The referring practitioner can indicate in the patient’s mental health treatment plan, psychiatrist assessment and management plan or the referral if they consider it would be clinically appropriate for sessions to be delivered to another person as part of the patient’s treatment.

Regardless, clinical psychologists can use their clinical judgment to provide services to another person under the patient’s referral. For further information on patient referrals for Better Access services, please see explanatory note MN.6.3.

Determining service is clinically appropriate

The clinical psychologist providing the service, or the referring practitioner, must use their professional judgment to determine it is clinically appropriate, and would form part of the patient’s treatment, to provide a psychological therapy health service to another person.

This determination must be recorded in writing in the patient’s records.

Obtaining and recording patient consent to deliver the service

The patient must consent to the other person receiving a psychological therapy health service using these MBS items. The eligible clinical psychologist 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.
  • 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 clinical psychologist should be aware of the requirements in the relevant state or territory.

Service must be part of the patient’s treatment 

Any service delivered using these MBS items must be part of the patient’s treatment. These MBS items are not for the purposes of providing mental health treatment to the person receiving the service. Should that person also require mental health treatment, they will need to speak with a referring practitioner.

Patient is not in attendance

These MBS items are for clinical psychologists to provide services to another person when the patient is not in attendance. If the patient is in attendance, clinical psychologists can consider whether the requirements of the patient MBS items for delivering Better Access services have been met. For further information, please see explanatory note MN.6.2.

Course of treatment and reporting back to the referring practitioner

These services may be accessed at any stage of a patient’s course of treatment and do not need to be accessed consecutively, provided no more than two services are delivered to another person and delivering these services does not exceed the maximum allowed for the patient in a course of treatment or calendar year under Better Access.

On completion of a course of treatment by the patient, the eligible clinical psychologist must provide a written report to the referring medical practitioner on assessments carried out on the patient, treatment provided, and recommendations on future management of the patient's disorder. This report should also include relevant information on any services delivered using these MBS items to another person where relevant.

ADDITIONAL INFORMATION

Out-of-pocket expenses and Medicare safety net

For Medicare benefit purposes, charges relating to services covered by these MBS items should be raised against the patient rather than against the person receiving the service.

Charges in excess of the Medicare benefit for these items are the responsibility of the patient. However, if a service was provided out of hospital, 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. 

Checking patient eligibility for Better Access services

As outlined above, patients seeking Medicare rebates for services delivered to another person will need to have a referral from a GP, medical practitioner, psychiatrist or paediatrician. If there is any doubt about a patient’s eligibility, Services Australia will be able to confirm whether an eligible service has been claimed, as well as the number of mental health services already claimed by the patient during the calendar year. Clinical psychologists can call Services Australia on 132 150 to check this information, while patients can call on 132 011. 

The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service 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 eligible clinical psychologist should, with the patient’s permission, contact the referring practitioner to ensure the relevant service has been provided to the patient. 

Further information

For further information about Medicare Benefits Schedule items, please go to the Department of Health and Aged Care's website at www.health.gov.au/mbsonline.

For providers, further information is also available from the Services Australia Medicare Provider Enquiry Line on 132 150.

Related Items: 80002 80006 80012 80016 91168 91171 91198 91199


Related Items

Category 8 - MISCELLANEOUS SERVICES

80002

80002 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychological therapy health service provided in consulting rooms by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)   the service lasts at least 30 minutes but less than 50 minutes

Fee: $109.80 Benefit: 85% = $93.35

(See para MN.6.8 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

80006

80006 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychological therapy health service provided at a place other than consulting rooms by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)   the service lasts at least 30 minutes but less than 50 minutes

Fee: $137.25 Benefit: 85% = $116.70

(See para MN.6.8 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

80012

80012 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychological therapy health service provided in consulting rooms by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)   the service lasts at least 50 minutes

Fee: $161.20 Benefit: 85% = $137.05

(See para MN.6.8 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

80016

80016 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychological therapy health service provided at a place other than consulting rooms by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)   the service lasts at least 50 minutes

Fee: $188.60 Benefit: 85% = $160.35

(See para MN.6.8 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91168

91168 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance for a psychological therapy health service provided by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)    the service lasts at least 30 minutes but less than 50 minutes

Fee: $109.80 Benefit: 85% = $93.35

(See para MN.6.8 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91171

91171 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance for a psychological therapy health service provided by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

Fee: $161.20 Benefit: 85% = $137.05

(See para MN.6.8 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91198

91198 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Phone attendance for a psychological therapy health service provided by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)     the service lasts at least 30 minutes but less than 50 minutes

Fee: $109.80 Benefit: 85% = $93.35

(See para MN.6.8 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91199

91199 - Additional Information

Item Start Date:
01-Mar-2023
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Phone attendance for a psychological therapy health service provided by an eligible clinical psychologist 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 clinical psychologist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

Fee: $161.20 Benefit: 85% = $137.05

(See para MN.6.8 of explanatory notes to this Category)


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change