Under Better Access, Medicare (MBS) rebates can only be used when someone has a diagnosable mental disorder.
In practice, though, referrals don’t always line up with this. Psychologists will sometimes receive referrals for concerns that don’t meet the criteria for a mental disorder under Better Access.
Common examples include:
- Autism
- ADHD
- Dementia or delirium
- Tobacco use or smoking cessation
- Intellectual disability
- Relationship or family issues
- Learning difficulties or general life stress
These are all very real and important concerns—but on their own, they don’t qualify for Better Access Medicare items. When this happens, the referral isn’t valid for Medicare billing under Better Access. This matters because if services are provided and billed anyway, it can become an issue in a Medicare audit. In that situation, psychologists may be asked to repay the funds!!
So, what is eligible under Better Access?
Eligible conditions generally include (non-exhaustive):
- Mood disorders (e.g., depression – F32, F33)
- Anxiety disorders (e.g., GAD F41.1, panic disorder F41.0)
- Trauma-related disorders (e.g., PTSD F43.1)
- Obsessive-compulsive and related disorders (F42)
- Eating disorders (F50 series)
- Personality disorders (F60 series)
- Psychotic disorders (F20–F29)
- Neurodevelopmental disorders where there is a comorbid mental disorder (important nuance)
Clinical nuance is important. Comorbidity (or co-occuring conditions) matters
An Autistic person or ADHDer can access Better Access if:
- There is a co-occurring eligible mental disorder (e.g., major depressive disorder), and
- That disorder is the focus of treatment, clearly documented.
- For example:
- Autism + general anxiety disorder → eligible
- ADHD + depression → eligible
B. Primary vs secondary diagnosis
If the referral says:
- “Anxiety secondary to chronic pain” → may be eligible
- “Chronic pain coping support” → not eligible, but is eligible for Psychology under a GP Chronic Condition Management Plan
So, what is a GPCCMP?
Under a GP Chronic Condition Management Plan (GPCCMP), Medicare isn’t funding treatment of a mental disorder. It’s funding allied health support for a chronic medical condition eg Asthma, Fibromyalgia, Type 1 Diabetes, chronic pain, medical complexity etc. So the rules are broader than Better Access. As a psychologist I am not required to diagnose a mental disorder. What psychologists can bill for under GPCCMP:
- Behavioural support
- Adjustment and coping strategies
- Pain management approaches
- Health behaviour change (e.g. sleep, routine, adherence)
- Emotional support related to the chronic condition
✔ Billable under GPCCMP
- “Supporting adjustment to chronic pain”
- “Behavioural strategies for diabetes management”
- “Emotional coping with dementia diagnosis”
- “Fatigue management and pacing for chronic illness”
✘ Not appropriate framing (for GPCCMP)
- Purely general counselling with no link to a chronic condition
- Vague “support” with no documented functional goal
- Work that isn’t tied back to the GP’s care plan