Medicare Information for Psychologists

Medicare Psychologist MBS Items – Rebates Guide

https://psychpoint.com.au/psychology-fee-guide/

The main items that I use are:

– 91170 – Focussed Psychological Strategies for an Individual 50+ minutes

– 91177 – Focussed Psychological Strategies for a person other than the patient, eg. Parent/Carer 50+ minutes

– 93000 – Psychological Treatment under a Chronic Disease Management Plan, 20+ minutes (where it relates to the management of your chronic health condition not a mental health disorder)

What services can I receive under Better Access / with a MHTP referral to a psychologist?

Psychology services provided under the Better Access initiative are for the purpose of providing treatment to eligible clients with an assessed mental disorder. Some assessment activity may, however, form part of the initial consultation with the client, for example, to enable your Psychologist to confirm and refine a differential diagnosis of the client or to identify a baseline for establishing the client’s progress in response to the treatment provided. Better Access Medicare item numbers cannot be used for formal psychological assessment such as cognitive, educational or neuropsychological assessment. It is anticipated that any assessment provided will be appropriate to the client’s presentation and the likely condition to be treated, and will be necessary in informing and directing provision of treatment to the client.

Assessments and the diagnosis of intellectual disability and learning disorders are specifically excluded from Better Access. However, there are some rebates for assessment for individuals under the age of 25 years for neurodevelopmental assessments. Referrals must include, the mental disorder as diagnosed by your referrer, number of treatement sessions in that course of treatment (maximum of 6 per referral), a statement that the MHTP has been completed and submitted to Medicare, the doctors signature and date of the referral.

Is there a difference between a mental health treatment plan and a referral?

Yes. A GP mental health treatment plan (MHTP) is a structured framework for GPs to undertake the management of patients with clinically diagnosed mental disorders. A referral is a separate document. Your referrer, GP, should provide a copy of the MHTP to the Psychologist along with the referral form.

Do MHTPs expire?

No. MHTPs do not expire and there is no fixed time limit on an MHTP. Many clients will not require a new plan after their initial plan has been prepared. A client may still be referred for further mental health services for as long as the referral is consistent with what is in the MHTP and the referring practitioner has determined that further services are required.

At the completion of your 6th session or a minimum of 4 weeks from the date of the initial referral, a Psychologist can request a review for a new course of treatment (ie, up to 4 sessions), there needs to be at least 3 months in between reviews. If a new MHCTP is required, eg for a new diagnosis, then there must be 12 months between the date of the first MHTP (not including the subsequent reviews) and the new MHTP.

What is a valid referral?

Eligible clients must have a diagnosed mental health disorder and must be referred by a GP, psychiatrist or paediatrician. The referral should be in writing (signed and dated by the referring practitioner) and include:

the patient’s name, date of birth and address;
the patient’s symptoms or diagnosis;
a list of any current medications;
the number of sessions the patient is being referred for (the ‘course of treatment’);
a statement about whether the patient has an MHTP or a psychiatrist assessment and management plan; and
a statement about whether the referral can be used for group therapy or individual therapy (if this is not stated, the patient can choose either individual or group).

Why is my referral invalid?

Please note that under Better Access, the Medicare Benefits Schedule (MBS) states that item numbers can only be used for individuals with a mental disorder as defined by the International Statistical Classification of Diseases and Related Health Problems-10. For example, a client may be inappropriately referred under Better Access where the primary concern is relationship issues, learning difficulties or social problems. In all these examples, the MBS items under Better Access cannot be used rendering the referral invalid.

If there is any doubt about a patient’s eligibility, Services Australia can confirm whether an MHTP, and/or a psychiatrist assessment and management plan is in place and claimed, or an eligible psychiatric or paediatric service has been claimed, as well as the number of Better Access services already accessed by the patient during the calendar year. You can contact Services Australia to check this information.

Does a client need a new MHTP every year?

If a client has not used all of those sessions, they can use that referral to access sessions in the next calendar year.

Why do I need to consent to sharing information between my referrer and Psychologist?

The Psychologist who provides psychological therapy health services or FPS services under the Better Access initiative must provide a report back to the referring practitioner after each course of treatment. This report assists the referring practitioner consider the need for further sessions. A report must be written and include:

assessments carried out;
treatment provided; and
recommendations on future management of the patient’s disorder.

Do I have to see the Psychologist named on the referral? Do I need a new MHTP to see a different provider?

No. Where a referral states the name of a specific provider, a client may change to a different provider, either before or during a course of treatment. You should provide a copy of the referral to your new provider, and if possible make an appointment with your referring practitioner to let them know.

Bulk Billing and Gap Fees

I do not bulk bill. So, it is important for clients to know that while some clients may find it difficult to pay the total fee due on the day of their session, and be willing and able to pay a gap fee, it can seem that the obvious solution to resolve this dilemma is for the Psychologist to bulk bill and the client then to only pay the gap directly to t he Psychologist. However, such practices are not permissible under Medicare. According to the Medicare regulations, if a psychologist directly (bulk) bills the client for a service, this must be accepted as the full fee.

What are the treatment strategies approved for use when providing focussed psychological strategies services?

The following are acceptable strategies that have been approved for use in providing Medicare funded psychology services:

Psycho-education (including motivational interviewing)
Cognitive-behavioural therapy including: Behavioural interventions, Behaviour modification, Exposure techniques, Activity scheduling, Cognitive interventions, Cognitive therapy
Relaxation strategies: Progressive muscle relaxation, Controlled breathing
Skills training: Problem solving skills and training, Anger management, Social skills training, Communication training, Stress management, Parent management training
Interpersonal therapy (especially for depression)
Narrative therapy (for Aboriginal and Torres Strait Islander people)
Eye-movement desensitisation reprocessing

Disclaimer: This information was published in November 2024. While I aim to ensure that this information is correct at the time of publishing, changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The first source of information on the usage of Medicare items is MBS Online (www.mbsonline.gov.au) that sets out the requirements for a valid use of an item.

Medicare Safety Net – how to get higher rebates for clients

The official information on Medicare’s Website https://www.servicesaustralia.gov.au/medicare-safety-nets

A prettier version as explained by telehealth allied health business, Very Helpful Chats:

https://www.veryhelpfulchats.com.au/medicaresafetynet