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Medicare Rebates

From the 1st November 2006, the Better Access to Mental Health Care initiative has allowed people with a diagnosed mental disorder to access psychology services through Medicare. For information, download the Australian Psychological Society Medicare factsheet.

Patients will need to be referred by a GP in the context of a GP Mental Health Care Plan, or by a psychiatrist or paediatrician. When making an appointment with your GP for the Mental Health Care Plan assessment, it is recommended that patients ask for a longer consultation.

For patients to be eligible for rebates from Medicare, they must have a clinically diagnosable disorder that significantly affects their cognitive, emotional or social abilities. These can include:

Chronic and acute psychotic disorders

Schizophrenia

Bipolar disorder

Phobic disorders

Generalised anxiety disorder

Adjustment disorder

Unexplained somatic complaints

Depression

Sexual disorders

Conduct disorder

Bereavement disorders

Post-traumatic stress disorder

Eating disorders

Panic disorder

Alcohol use disorders

Drug use disorders

Mixed anxiety and depression

Dissociative (conversion) disorder

Neurasthenia

Sleep problems

Hyperkinetic (attention deficit) disorder

Enuresis (non-organic)

Obsessive-Compulsive Disorder

Mental disorder, not otherwise specified (sourced from www.health.gov.au)

Medicare will rebate up to 10 sessions per calendar year (from 1 January to 31 December). After six sessions, clients are required to obtain a GP Mental Health Care Review from their GP to access the additional four sessions. The GP Mental Health Care Plan expires after 12 months from the date of referral.

For clinical psychologists, clients will receive a Medicare rebate of $124.50 for a one hour session. Clients seeing an approved registered psychologist will receive $84.80 from the Medicare rebate for a one hour session.

Clients are required to pay our full fee on the day of consultation. Clients can then either claim the Medicare rebate electronically on the spot using Medicare easyclaim, or take their invoice to Medicare to claim the rebate.

About Better Access

(the following information has been taken from https://www.humanservices.gov.au/organisations/health-professionals/enablers/education-guide-better-access-mental-health-care-general-practitioners-and-allied-health)

We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available on the website.

The purpose of the Better Access initiative is to improve treatment and management of mental illness within the community by providing patients with access to mental health professionals and team-based mental health care.  Under this initiative, Medicare benefits are available to patients for selected mental health services provided by:

  • general practitioners (GPs)
  • psychiatrists
  • clinical psychologists
  • registered psychologists, and
  • appropriately trained social workers and occupational therapists

Information for General Practitioners

GP services under Better Access

GPs can provide the following services under Better Access:

Service

MBS item

Frequency it can be used

Prepare a GP mental health treatment plan (GPMHTP)

2700, 2701, 2715 or 2717

Once every 12 months however not within 3 months of a review under item 2712

Review a mental health treatment plan

2712

Once every 3 months however not within 4 weeks of claiming item 2700, 2701, 2715 or 2717

Manage a patient’s mental health condition

2713 or a general consultation item

As often as necessary – no restrictions

*GP focused psychological strategies (FPS) services

2721 – 2727

Up to 10 services every 12 months

*You should register with us if you have completed the mental health skills training accredited by the General Practice Mental Health Standards Collaboration. Once you have registered, you can provide GP FPS services.

Eligible patients for GP mental health treatment

GP mental health treatment plan and review services are available to:

  • patients in the community
  • private in-patients including residents of aged care facilities being discharged from hospital

To determine if a patient is eligible, they must:

  • have a mental disorder, and
  • be likely to benefit from a structured approach to the management of their care needs

Referred mental health services

Once you have completed a GP mental health treatment plan for a patient you can refer them for a range of mental health services:

Services

Performed by

Psychological therapy services

Clinical psychologists

Allied health FPS services

  • registered psychologists
  • occupational therapists
  • social workers

GP FPS services

GPs with appropriate mental health skills training

You can also refer your patient for these services if you’re managing them under a referred psychiatrist assessment and management plan – MBS item 291 or under a shared care plan.

Certain allied health services require that the patient’s care is being managed under one of various types of care plans:

  • GP Management Plan and Team Care Arrangements, or
  • GP Mental Health Treatment Plan, or 
  • shared care plan

A shared care plan may be developed for a patient enrolled under the Health Care Home trial.

Calendar year claiming limits for allied mental health services

In a calendar year patients can receive psychological therapy and or FPS services up to the limit of:

  • 10 individual services, up to 7 of which can be provided by video conference, and
  • 10 group services, up to 7 of which can be provided by video conference

A calendar year is from 1 January to 31 December, not the 12 month period from the date of the referral.

Determine what item applies if a GPMHTP is claimed

Firstly you can:

  • ask the patient if they have a copy of the previous mental health treatment plan, or
  • if the patient agrees, ask their previous GP for a copy

If you get a copy of the previous plan, and it was in place for more than 4 weeks, you can review it by billing MBS item 2712.

Only prepare a mental health treatment plan if you are the patient’s usual GP and expect to continue to manage their condition.

Confirming mental health items and limits

Call us to check:

  • if a GP mental health treatment plan has previously been claimed and paid
  • how many allied mental health services the patient has already received in the calendar year
  • which MBS item you can bill a patient if their clinical condition or care circumstances have changed significantly

Information for allied health professionals

Allied mental health services and MBS items

Eligible allied health professionals can provide the following services under Better Access.

You must meet the eligibility criteria and have a Medicare provider number.

Allied health professionals

Mental health services

Individual items

Group items

Clinical psychologists

Psychological therapy services

80000-80015

80020

Registered psychologists

Focussed psychological strategies (FPS) services

80100-80115

80120-80121

Occupational therapists

FPS services

80125-80140

80145-80146

Social workers

FPS services

80150-80165

80170-80171

Patient eligibility for allied mental health services

A patient must be assessed as having a mental disorder and referred by a:

  • GP who is managing the patient under a
    • GP Mental Health Treatment Plan, or
    • referred psychiatrist assessment and management plan, or
    • shared care plan
  • psychiatrist, or
  • paediatrician

If you’re not sure if your patient is eligible you can contact the referring medical practitioner.

You can continue to see patients who aren’t eligible but they can’t access Medicare benefits for the services you provide.

Referral items for claiming allied mental health services

The relevant GP, psychiatrist or paediatrician referral item must be claimed, and a Medicare benefit paid by us before Medicare benefits are available for psychological therapy and FPS services.

Referring medical practitioner service

Medicare items

Preparation of a GP Mental Health Treatment Plan

2700, 2701, 2715 or 2717

Referred psychiatrist assessment and management plan

291

Specialist psychiatrist and paediatrician consultation

104-109

Consultant physician paediatrician consultation

110-133

Consultant physician psychiatrist consultation

293-370

Confirming patient eligibility for allied mental health services

Call us to check if the referral item has been paid or if the patient has reached the calendar year limit of their allied mental health services.

Where a patient has already reached the allied mental health service limit for the calendar year, you can choose to continue to see the patient but they can’t access Medicare benefits for your services.

Telehealth focused psychological strategies services

New MBS items numbers have been introduced from 1 November 2017 to provide Medicare rebates for attendances provided via videoconferencing by a psychologist, occupational therapist or social worker to a patient.  Unlike other telehealth (video-conferencing) items, these items are stand-alone and do not have a derived fee structure.

These FPS services are time limited, being deliverable in up to 7 planned video-conferencing sessions in a calendar year, with at least one face-to-face consultation to be conducted within the first 4 sessions.

Patients will also be eligible to claim up to 7 separate services within a calendar year for group therapy services involving 6-10 patients to which the following items apply:

  • item 80021—psychological therapy via video conference – clinical psychologist
  • item 80121—FPS via video conference – psychologist
  • item 80146—FPS via video conference – occupational therapist, and
  • Item 80171—FPS via video conference – social worker apply

These group services are separate from the individual services and do not count towards the 7 individual services per calendar year maximum associated with those items.

Telehealth restrictions

The MBS telehealth attendance items are not payable for services to an admitted hospital patient. This includes hospital in-the-home patients. Benefits are not payable for telephone or email consultations.

In order to fulfil the item descriptor there must be a visual and audio link between the patient and the remote psychologist, occupational therapist or social worker. If the remote psychologist, occupational therapist or social worker is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth attendance is not payable.

Telehealth billing requirements

All video consultations provided by psychologists, occupational therapists or social workers must be separately billed. That is, only the relevant telehealth MBS consultation item is to be itemised on the account/bill/voucher. Any other service/item billed should be itemised on a separate account/bill/voucher. This will ensure the claim is accurately assessed as being a video consultation and paid accordingly.

Psychologists, occupational therapists or social workers should not use the notation ‘telehealth’, ‘verbal consent’ or ‘Patient unable to sign’ to overcome administrative difficulties to obtaining a patient signature for bulk-billed claims; a patient signature is required for all bulk-billed claims.

Better Access referrals – format and content

There is no standard form for referrals. Medical practitioners can refer patients for allied mental health services with a letter or note that is signed and dated.

The referral should include:

  • the patient’s symptoms
  • the number of treatment services the patient needs to receive, and
  • a statement that a mental health treatment plan, shared care plan or a psychiatrist assessment and management plan is in place, if the referral is from a GP. GPs can also include a copy of the plan if it’s appropriate and the patient agrees

Better Access referrals – course of treatment

Medical practitioners can refer up to 6 services for a course of treatment. The number of services stated in the patient’s referral is a course of treatment.

A patient can have 2 or more courses of treatment within a patient’s entitlement of up to 10 services per calendar year. 

Patients need a new referral for each course of treatment.

Referral validity

Referrals are valid for the number of services shown on the medical practitioner’s referral letter or note. Unused services don’t expire and can be used in the following calendar year.

Allied health professionals must keep copies of all written referrals for 2 years from the date of the patient’s first service.

Allied mental health professional reporting

Allied health professionals must provide a written report back to the referring medical practitioner after completing a course of treatment. Any further completed courses of treatment also require a written report.

The report should allow referring medical practitioners to assess the patient’s need for more treatment services. It must include:

  • assessments carried out on the patient and, where relevant, the progress made
  • treatments provided, and
  • recommendations on future management of the patient’s disorder

Allied health professionals don’t need to use an approved form to write a report.

Reporting when a course of treatment is not completed

If a patient doesn’t complete a course of treatment, the allied mental health professional should write their report after the last service they provided. If the patient returns later and completes the course of treatment, they’ll need to write another report to the medical practitioner.

Case study: Individual services provided in 2 calendar years

Under Better Access, a maximum of 10 allied mental health individual services are payable each calendar year.

Individual services are counted towards a patient’s calendar year limit when 2 courses of treatment are provided over consecutive calendar years. Medical practitioners don’t need to provide a new referral for an existing course of treatment.

For example, a medical practitioner refers a patient for a course of treatment of 5 individual allied health services under the Better Access initiative.

The patient receives 2 services in calendar year 1. In calendar year 2 the patient receives the remaining 3 services. The course of treatment is now complete as 5 individual services have been provided. The allied health professional who treated the patient will write a report back to the medical practitioner.

The medical practitioner decides to refer the patient for a further course of treatment of 4 individual allied mental health services.

The patient receives all 4 services for this course of treatment during calendar year 2. The course of treatment is now complete as 4 individual services have been provided. The allied health professional who treated the patient will write a report back to the medical practitioner.

The patient has now received a total of 7 individual services during calendar year 2.

If the medical practitioner decides that a third course of treatment is necessary, the patient is entitled to 3 more individual services under Better Access in calendar year 2.

 

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