Medicare Benefits Schedule - Note MN.8.3

Patients must be referred for non-directive pregnancy support counselling services by a GP or medical practitioner. GPs/medical practitioners are not required to use a specific form to refer patients for these services. The referral may be a letter or note to an eligible allied health professional signed and dated by the referring GP/medical practitioner.

Patients may be referred by a GP or medical practitioner to more than one eligible allied health professional for eligible non-directive pregnancy support counselling services (for example, where a patient does not wish to continue receiving services from the provider they were referred to in the first instance). 

The relevant allied health professional must be in receipt of the referral at the first non-directive pregnancy support counselling service and must retain the referral for 2 years from the date the service was rendered, for Services Australia auditing purposes. 

A copy of the referral is not required to accompany Medicare claims. However, referral details are required to be included on patients' itemised accounts/receipts or Medicare assignment of benefit forms.

Referral validity

The referral is valid for up to 3 non-directive pregnancy support counselling services, per patient, per pregnancy.

Subsequent Referrals

A new referral is required where the patient seeks to access non-directive pregnancy support counselling in relation to a different pregnancy or where the patient wishes to be referred to a different allied health professional than the one they were referred to in the first instance.

Related Items: 81000 81005 81010 93026 93029

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Non directive pregnancy support counselling health service provided to a person, who is currently pregnant or who has been pregnant in the preceding 12 months by an eligible psychologist, eligible social worker or eligible mental health nurse as a phone attendance if:

(a)    the person is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

(b)    the person is referred by a medical practitioner who is not a specialist or consultant physician; and

(c)     the service is provided to the person individually; and

(d)    the eligible psychologist, eligible social worker or eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(e)     the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005, 81010 in the Allied Health Determination, item 4001 of the general medical services table and item 93026, 92136 and 92138 apply) for each pregnancy.

The service may be used to address any pregnancy related issues for which non directive counselling is appropriate

Fee: $83.30 Benefit: 85% = $70.85

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)

Non‑directive pregnancy support counselling health service provided to a patient who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible psychologist if:

(a)   the patient is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

(b)  the patient is referred by a medical practitioner who is not a specialist or consultant physician; and

(c)   the eligible psychologist does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(d)  the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005 or 81010, items 792 or 4001 in the general medical services table, or items 92136, 92138, 93026, 93029, 92137 or 92139 in the Telehealth and Telephone Determination apply) for each pregnancy

Fee: $83.30 Benefit: 85% = $70.85

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)

Non‑directive pregnancy support counselling health service provided to a patient, who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible social worker if:

(a)   the patient is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

(b)  the patient is referred by a medical practitioner who is not a specialist or consultant physician; and

(c)   the eligible social worker does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(d)  the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005 or 81010, items 792 or 4001 in the general medical services table, or items 92136, 92138, 93026, 93029, 92137 or 92139 in the Telehealth and Telephone Determination apply) for each pregnancy

Fee: $83.30 Benefit: 85% = $70.85

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)

Non‑directive pregnancy support counselling health service provided to a patient, who is currently pregnant or who has been pregnant in the preceding 12 months, by an eligible mental health nurse if:

(a)   the patient is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

(b)  the patient is referred by a medical practitioner who is not a specialist or consultant physician; and

(c)   the eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(d)  the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005 or 81010, items 792 or 4001 in the general medical services table, or items 92136, 92138, 93026, 93029, 92137 or 92139 in the Telehealth and Telephone Determination apply) for each pregnancy

Fee: $83.30 Benefit: 85% = $70.85

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)

Non directive pregnancy support counselling health service provided to a person who is currently pregnant or who has been pregnant in the preceding 12 months by an eligible psychologist, eligible social worker or eligible mental health nurse as a telehealth attendance if:

(a) the person is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

(b) the person is referred by a medical practitioner who is not a specialist or consultant physician; and

(c) the service is provided to the person individually; and

(d) the eligible psychologist, eligible social worker or eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(e) the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005, 81010 in the Allied Health Determination, item 4001 of the general medical services table and item 93029, 92136 and 92138 apply) for each pregnancy.

The service may be used to address any pregnancy related issues for which non directive counselling is appropriate

Fee: $83.30 Benefit: 85% = $70.85

(See para MN.8.1, MN.8.2, MN.8.3, MN.8.4 of explanatory notes to this Category)