The mental health Medicare items for psychologists

A person with an assessed mental disorder¹ who has been referred by:

• a GP who is managing the client under a GP Mental Health Care Plan² (GP Medicare item 2710);
• a GP who is managing the client under a psychiatrist assessment and management plan (GP item 291); 
• a psychiatrist after seeing the client for an eligible Medicare service (specialist psychiatrist items 104 to 109 or consultant physician psychiatrist items 293 to 370); or
• a paediatrician after seeing the client for an eligible Medicare service (specialist paediatrician items 104 to 109 or consultant physician paediatrician items 110 to 131).

Delivery of approved Focused Psychological Strategies (FPS), which have been specified as:

1. Psycho-education

2. Motivational interviewing  

3. Cognitive behaviour therapy, including:

• Behavioural interventions
  • behaviour modification (especially for children, including behavioural analysis and contingency management)
  • Exposure techniques
  • Activity scheduling 
• Cognitive interventions
  • Cognitive analysis, challenging and restructuring
  • Self-instructional training
  • Attention regulation
• Relaxation strategies
  • Guided imagery, deep muscle and isometric relaxation, controlled breathing
• Skills training
• Problem-solving skills training
  • Anger management
  • Stress management
  • Communication training
  • Social skills training
  • Parent management training

4. Interpersonal therapy (especially for depression)

There is flexibility to include narrative therapy for Aboriginal and Torres Strait Islander people.

Some assessment may form part of the initial consultation with the client in preparation for treatment, but this generally should not extend beyond the initial consultation. ‘Assessment’ refers to clinical interviewing and psychometric testing for the purposes of clarifying and mental health diagnosis (NOT other forms of assessment such as neuropsychological assessment and intelligence testing).

Services provided must be within the specified time period of the Medicare item descriptor and the psychologist must personally attend the client (i.e. provide a face-to-face consultation).

Eligibility is open to all psychologists fully registered with the Psychologists Registration Board in the State or Territory in which they are practising, based on self-assessment of competency to deliver FPS.

Provisionally registered psychologists are not eligible to provide services.

Medicare rebates are available for up to 12 individual psychological services in a calendar year (January to December). After an initial group of six services, the referring medical practitioner managing the client will conduct a review of the need for further services before a further six services may be provided. In addition, the referring medical practitioner may consider that in exceptional circumstances the client may require an additional six services above that already provided (to a maximum total of 18 services per patient per calendar year). In these cases a new referral should be provided, and exceptional circumstances noted in that referral.

Clients are also eligible to claim up to 12 group psychological services within a calendar year for treatment in a group with 6-10 clients. These group services are separate from the individual services and do not count towards the 12 service calendar year maximum associated with those items.

On completion of the first six services, the psychologist must provide a written report to the referring medical practitioner, which includes information on:

• assessments carried out on the client;
• treatment provided; and
• recommendations on future management of the client's disorder

A written report must also be provided to the referring medical practitioner at the completion of the second set of six services provided to the client.

A person with an assessed mental disorder1 who has been referred by:

• a GP who is managing the client under a GP Mental Health Care Plan² (GP Medicare item 2710);
• a GP who is managing the client under a psychiatrist assessment and management plan (GP item 291); 
• a psychiatrist after seeing the client for an eligible Medicare service (specialist psychiatrist items 104 to 109 or consultant physician psychiatrist items 293 to 370); or
• a paediatrician after seeing the client for an eligible Medicare service (specialist paediatrician items 104 to 109 or consultant physician paediatrician items 110 to 131).

In addition to psycho-education, it is recommended that cognitive behaviour therapy be provided. However, other evidence-based therapies, such as interpersonal therapy, may be used if considered clinically relevant.

Some assessment may form part of the initial consultation with the client in preparation for treatment, but this generally should not extend beyond the initial consultation. ‘Assessment’ refers to clinical interviewing and psychometric testing for the purposes of clarifying and mental health diagnosis (NOT other forms of assessment such as neuropsychological assessment and intelligence testing).

Services provided must be within the specified time period of the Medicare item descriptor and the psychologist must personally attend the client (i.e. provide a face-to-face consultation).

Eligibility is only open to fully registered psychologists who are eligible for membership of the APS College of Clinical Psychologists, which is defined as meeting criteria associated with specific training and qualifications, clinical supervision and practice experience. Assessment of eligibility is undertaken by the APS according to set criteria.

Maintenance of eligibility is dependent on completing 30 hours of mental health professional development per year, which should be logged according to APS requirements (see ‘Maintaining eligibility to provide clinical psychology Medicare services’).

Medicare rebates are available for up to 12 individual psychological services in a calendar year (January to December). After an initial group of six services, the referring medical practitioner managing the client will conduct a review of the need for further services before a further six services may be provided. In addition, the referring medical practitioner may consider that in exceptional circumstances the client may require an additional six services above that already provided (to a maximum total of 18 services per patient per calendar year). In these cases a new referral should be provided, and exceptional circumstances noted in that referral.

Clients are also eligible to claim up to 12 group psychological services within a calendar year for treatment in a group with 6-10 clients. These group services are separate from the individual services and do not count towards the 12 service calendar year maximum associated with those items.

On completion of the first six services, the psychologist must provide a written report to the referring medical practitioner, which includes information on:

• assessments carried out on the client;
• treatment provided; and
• recommendations on future management of the client's disorder

A written report must also be provided to the referring medical practitioner at the completion of the second set of six services provided to the client.