1 Name
This instrument is the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020.
3 Authority
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
4 Cessation
(a) Schedule 2 of this instrument ceases as if revoked on 31 March 2021.
(b) this instrument ceases as if revoked on 30 June 2022.
5 Definitions
(1) In this Determination:
Act means the Health Insurance Act 1973.
admitted patient means a patient who is receiving a service that is provided:
(a) as part of an episode of hospital treatment; or
(b) as part of an episode of hospital‑substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer.
Allied Health Services Determination means the Health Insurance (Allied Health Services) Determination 2014.
better access subsequent treatment service means a service to which an item in Schedule 1 or 2 (excluding Group A42) of this instrument applies.
care recipient has the meaning given by the general medical services table.
course of treatment, for items 93375, 93376, 93381, 93382, 93383, 93384, 93385 and 93386, has the meaning giving by paragraph 4(1)(a) of the definition in the Allied Health Services Determination.
COVID‑19 Determination means the
eligible clinical psychologist has the meaning given by section 4 of the Allied Health Services Determination.
eligible occupational therapist has the meaning given by section 4 of the Allied Health Services Determination.
eligible psychologist has the meaning given by section 4 of the Allied Health Services Determination.
focussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑based psychological therapies:
(a) psycho‑education;
(b) cognitive‑behavioural therapy which involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy;
(f) eye movement desensitisation and reprocessing;
(g) narrative therapy (for Aboriginal and Torres Strait Islander people).
GP mental health treatment plan means a service to which any of the following applies:
(a) items 2700, 2701, 2715 or 2717 of the general medical services table;
(b) items 272, 276, 281 or 282 of the Other Medical Practitioner Determination;
(c) items 92112, 92113, 92116, 92117, 92118, 92119, 92122, 92123, 92124, 92125, 92128, 92129, 92130, 92131, 92134 or 92135 of the COVID 19 Determination;
(d) items 93400 to 93411 and 93431 to 93442 of this Determination.
Other Medical Practitioner Determination means the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018.
mental disorder means a significant impairment of any or all of an individual’s cognitive, affective and relational abilities that:
(a) may require medical intervention; and
(b) may be a recognised, medically diagnosable illness or disorder; and
(c) is not dementia, delirium, tobacco use disorder or mental retardation.
patient’s usual medical practitioner has the meaning given by section 8 of the COVID‑19 Determination.
person who is experiencing homelessness has the meaning given by section 5 of the COVID‑19 Determination.
person who is in a COVID‑19 impacted area has the meaning given by section 5 of the COVID‑19 Determination.
preparation of a GP mental health treatment plan has the meaning given by the general medical services table.
phone attendance means a professional attendance by telephone where the health practitioner:
(a) has the capacity to provide the full service through this means safely and in accordance with professional standards; and
(b) is satisfied that it is clinically appropriate to provide the service to the patient; and
(c) maintains an audio link with the patient.
psychiatrist assessment and management plan means a psychiatrist assessment and management plan made under item 92435 or 92475 in this instrument or item 291 of the general medical services table.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.
shared care plan has the meaning given by section 9B of the Allied Health Services Determination.
telehealth attendance means a professional attendance by video conference where the rendering health practitioner:
(a) has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
(b) is satisfied that it is clinically appropriate to provide the service to the patient; and
(c) maintains a visual and audio link with the patient; and
(d) is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.
Note: The following terms are defined in subsection 3(1) of the Act:
general medical services table
item
medical practitioner
Chief Executive Medicare
professional service
6 Treatment of relevant services
For subsection 3C(1) of the Act, a relevant health service, provided in accordance with this instrument and as a clinically relevant health service, is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the health service; and
(ii) specified in respect of the health service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
7 Application of items in this instrument
An item in Group A41, M25 or M26 of this instrument does not apply if a person has received 10 better access subsequent treatment services for that calendar year.
8 Applications of items in Group A41
(2) Items 93300 to 93311 and 93287, 93288, 93291 and 93292 apply to a service which is provided by a medical practitioner:
(a) whose name is entered in the register maintained by the Chief Executive Medicare under section 33 of the Human Services (Medicare) Regulations 2017; and
(b) who is identified in the register as a medical practitioner who can provide services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination applies; and
(c) who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration for providing services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination applies.
(3) Items 93302, 93305, 93308, 93311, 93332, 93335, 93352, 93355, 93358, 93361, 93364 or 93367 do not apply to a service if:
(a) the patient elects to be treated in person, and it is safe and appropriate for the service to be performed in person at consulting rooms; or
(b) the rendering health provider and the patient have the capacity to undertake an attendance by telehealth.
(4) Items 93301, 93302, 93304, 93305, 93307, 93308, 93310, 93311, 93404 to 93411 and 93435 to 93442 do not apply to a service unless the service is performed by the patient’s usual medical practitioner.
(5) Subsection 8(4) does not apply to a service provided to:
(a) a person who is under the age of 12 months; or
(b) a person who is experiencing homelessness; or
(c) a person who is in a COVID‑19 impacted area; or
(d) a person who receives the service from a medical practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.
9 Effect of election to claim private health insurance for an allied health service
An item in Group M25, M26, M27 and M28 in a Schedule to this instrument do not apply to a service if a private health insurance benefit has been claimed for the service.
10 Application of items in Group A42
General application of items
(1) Items 93400, 93401, 93402, 93403, 93421, 93431, 93432, 93433, 93434 and 93451 apply only in the course of personal attendance by a single medical practitioner on a single patient.
(2) Items in Subgroup 1, 2, 3 and 4 of Group A42 apply only to a patient with a mental disorder.
Claiming restrictions for treatment plan and review items
(3) Items 93400 to 93411 and 93431 to 93442 do not apply to a service to which items 80020, 80021, 80120, 80121, 80145, 80146, 80170 and 80171 of the allied health services determination apply.
Practitioner training
(4) Items 93402, 93403, 93406, 93407, 93410, 93411, 93433, 93434, 93437, 93438, 93441 and 93442 apply only if the medical practitioner providing the service has successfully completed mental health skills training accredited by the General Practice Mental Health Standards Collaboration.
Note: The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.
Definition
(5) In review items 93421, 93422 and 93423:
associated general practitioner means a general practitioner (not including a specialist or consultant physician) who, if not engaged in the same general practice as the general practitioner mentioned in that item, performs the service described in the item at the request of the patient (or the patient’s guardian).
(6) In review items 93451, 93452 and 93453:
associated medical practitioner means a medical practitioner who, if not engaged in the same general practice as the medical practitioner mentioned in the item, performs the service mentioned in the item at the request of the patient (or the patient or the patient’s guardian).
11 Fee in relation to the first patient during each attendance at a residential aged care facility
(1) For the first patient attended during one attendance by a general practitioner at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 2733, 2735, 93400, 93401, 93402, 93403, 93421, 93287 and 93288 applies is the amount listed in the item plus $66.75.
(2) For the first patient attended during one attendance by a medical practitioner at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 941, 942, 93431, 93432, 93433, 93434, 93451, 93291 and 93292 applies is the amount listed in the item plus $48.55.
Schedule 1—Services and fees—face‑to‑face psychological therapy and focussed psychological strategies
Group A41 – Additional focussed psychological strategies | |
Item | Service | Fee($) |
Subgroup 1—GP additional focussed psychological strategies |
93300 | Professional attendance at consulting rooms by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 112.50 |
93303 | Professional attendance at consulting rooms by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 161.00 |
93287 | Professional attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 112.50 |
93288 | Professional attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 161.00 |
Subgroup 2—Non specialist practitioner additional focussed psychological strategies |
93306 | Professional attendance at consulting rooms by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 90.00 |
93309 | Professional attendance at consulting rooms by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 128.80 |
93291 | Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 90.00 |
93292 | Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 128.80 |
Group A42 – Mental health planning for care recipients of an residential aged care facility |
Item | Service | Fee($) |
Subgroup 1—GP mental health treatment plans for care recipients of an residential aged care facility |
93400 | Professional attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes, but less than 40 minutes | 87.00 |
93401 | Professional attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 128.05 |
93402 | Professional attendance, by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes, but less than 40 minutes | 110.45 |
93403 | Professional attendance, by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 162.70 |
Subgroup 2—GP mental health treatment plan review for care recipients of an residential aged care facility |
93421 | Professional attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) one of the following services has been provided to the patient: (i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or (ii) a psychiatrist assessment and management plan; and (c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services | 87.00 |
Subgroup 3—Non specialist practitioner mental health treatment plans for care recipients of an residential aged care facility |
93431 | Professional attendance by a medical practitioner who has not undertaken mental health skills training (not including a general practitioner, specialist or a consultant physician), for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes, but less than 40 minutes | 69.55 |
93432 | Professional attendance by a medical practitioner who has not undertaken mental health skills training (not including a general practitioner, specialist or a consultant physician), for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 102.45 |
93433 | Professional attendance, by a medical practitioner who has undertaken mental health skills training (but not including a general practitioner, specialist or consultant physician), for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes, but less than 40 minutes | 88.35 |
93434 | Professional attendance, by a medical practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 130.15 |
Subgroup 4— Non specialist practitioner mental health treatment plan review for care recipients of an residential aged care facility |
93451 | Professional attendance by a medical practitioner to review a GP mental health treatment plan which the medical practitioner, or an associated medical practitioner has prepared, or to review a Psychiatrist Assessment and Management Plan (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) one of the following services has been provided to the patient: (i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or (ii) a psychiatrist assessment and management plan; and (c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services | 69.55 |
Group M25 – Additional psychological therapy services |
Item | Service | Fee($) |
93330 | Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital), by an eligible clinical psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 30 minutes but less than 50 minutes duration | 102.85 |
93333 | Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital), by an eligible clinical psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 151.05 |
93312 | Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 30 minutes but less than 50 minutes duration | 102.85 |
93313 | Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 151.05 |
Group M26 – Additional focussed psychological strategies (allied mental health) | |
Item | Service | Fee($) |
Subgroup 1— Additional focussed psychological strategies (eligible psychologist, attendance 20 to 50 minutes) |
93350 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 72.90 |
93316 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 72.90 |
Subgroup 2— Additional focussed psychological strategies (eligible psychologist, attendance at least 50 minutes) |
93353 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital), by an eligible psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 102.85 |
93319 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital), by an eligible psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 102.85 |
Subgroup 3— Additional focussed psychological strategies (eligible occupational therapist) |
93356 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 |
93359 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 |
93322 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 |
93323 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 |
Subgroup 4— Additional focussed psychological strategies (eligible social worker) |
93362 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 |
93365 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 |
93326 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 |
93327 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 |
Schedule 2—Services and fees—telehealth and phone psychological therapy and focussed psychological strategies
Group A41 – Additional focussed psychological strategies | |
Item | Service | Fee | |
Subgroup 1—GP additional focussed psychological strategies | |
93301 | Telehealth attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 112.50 | |
93302 | Phone attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 112.50 | |
93304 | Telehealth attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 161.00 | |
93305 | Phone attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 161.00 | |
Subgroup 2—Non specialist practitioner additional focussed psychological strategies | |
93307 | Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 90.00 | |
93308 | Phone attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 90.00 | |
93310 | Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 128.80 | |
93311 | Phone attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 128.80 | |
| | | |
Group A42 – Mental health planning for care recipients of an residential aged care facility |
Item | Service | Fee($) |
Subgroup 1— GP mental health treatment plans for care recipients of an residential aged care facility |
93404 | Telehealth attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes but less than 40 minutes | 87.00 |
93405 | Telehealth attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 128.05 |
93406 | Telehealth attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes but less than 40 minutes | 110.45 |
93407 | Telehealth attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 162.70 |
93408 | Phone attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes but less than 40 minutes | 87.00 |
93409 | Phone attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 128.05 |
93410 | Phone attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes but less than 40 minutes | 110.45 |
93411 | Phone attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 162.70 |
Subgroup 2— GP mental health treatment plan review for care recipients of an residential aged care facility |
93422 | Telehealth attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) one of the following services has been provided to the patient: (i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or (ii) a psychiatrist assessment and management plan; and (c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services | 87.00 |
93423 | Phone attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) one of the following services has been provided to the patient: (i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or (ii) a psychiatrist assessment and management plan; and (c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services | 87.00 |
Subgroup 3— Non specialist practitioner mental health treatment plans for care recipients of an residential aged care facility |
93435 | Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes but less than 40 minutes | 69.55 | |
93436 | Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 102.45 | |
93437 | Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes but less than 40 minutes | 88.35 | |
93438 | Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 130.15 | |
93439 | Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 20 minutes but less than 40 minutes | 69.55 | |
93440 | Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 102.45 | |
93441 | Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) of at least 20 minutes but less than 40 minutes | 88.35 | |
93442 | Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) the service lasts at least 40 minutes | 130.15 | |
Subgroup 4— Non specialist practitioner mental health treatment plan review for care recipients of an residential aged care facility | |
93452 | Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review a GP mental health treatment plan which the medical practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) one of the following services has been provided to the patient: (i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or (ii) a psychiatrist assessment and management plan; and (c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services | 69.55 | |
93453 | Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review a GP mental health treatment plan which the medical practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if: (a) the person is a care recipient in a residential aged care facility; and (b) one of the following services has been provided to the patient: (i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or (ii) a psychiatrist assessment and management plan; and (c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services | 69.55 | |
Group M25 – Additional psychological therapy services | |
Item | Service | Fee($) | |
93331 | Psychological therapy health service provided by telehealth attendance by an eligible clinical psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 30 minutes but less than 50 minutes duration | 102.85 | |
93332 | Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 30 minutes but less than 50 minutes duration | 102.85 | |
93334 | Psychological therapy health service provided by telehealth attendance by an eligible clinical psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 151.05 | |
93335 | Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 151.05 | |
| |
Group M26 – Additional focussed psychological strategies (allied mental health) | |
Item | Service | Fee($) | |
Subgroup 1— Additional focussed psychological strategies (eligible psychologist, attendance 20 to 50 minutes) | |
93351 | Focussed psychological strategies health service provided by telehealth attendance by an eligible psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 72.90 | |
93352 | Focussed psychological strategies health service provided by phone attendance by an eligible psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 72.90 | |
Subgroup 2— Additional focussed psychological strategies (eligible psychologist, attendance at least 50 minutes) | |
93354 | Focussed psychological strategies health service provided by telehealth attendance by an eligible psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 102.85 | |
93355 | Focussed psychological strategies health service provided by phone attendance by an eligible psychologist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 102.85 | |
Subgroup 3— Additional focussed psychological strategies (eligible occupational therapist) | |
93357 | Focussed psychological strategies health service provided by telehealth attendance by an eligible occupational therapist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 | |
93358 | Focussed psychological strategies health service provided by phone attendance by an eligible occupational therapist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 | |
93360 | Focussed psychological strategies health service provided by telehealth attendance by an eligible occupational therapist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes in duration | 90.70 | |
93361 | Focussed psychological strategies health service provided by phone attendance by an eligible occupational therapist if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes in duration | 90.70 | |
Subgroup 4— Additional focussed psychological strategies (eligible social worker) | |
93363 | Focussed psychological strategies health service provided by telehealth attendance by an eligible social worker if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 | |
93364 | Focussed psychological strategies health service provided by phone attendance by an eligible social worker if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 | |
93366 | Focussed psychological strategies health service provided by telehealth attendance by an eligible social worker if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 | |
93367 | Focussed psychological strategies health service provided by phone attendance by an eligible social worker if: (b) the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 | |
| | | | | | | |
Schedule 3—Services and fees—initial psychological therapy and focussed psychological strategies
1 Limitation on certain individual items
(1) This section applies to items 93375, 93376, 93381, 93382, 93383, 93384, 93385 and 93386.
(2) For any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient in the calendar year.
(3) In this section relevant service means a service to which any of items 2721 to 2727 of the general medical services table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in the allied health services determination, or items 91166, 91167, 91169, 91170, 91172, 91173, 91175, 91176, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91818, 91819, 91820, 91821, 91842, 91843, 91844 and 91845 of the COVID‑19 Determination, or items 283 and 286 in the Other Medical Practitioner Determination apply.
2 Referrals by psychiatrists for psychological therapy and focussed psychological strategies health services
(1) This section applies to items 93375, 93376, 93381, 93382, 93383, 93384, 93385 and 93386.
(2) The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 293 to 370 of the general medical services table or items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 91840, 91841, 92436, 92437, 92458, 92459, 92460, 92476, 92477, 92498, 92499 and 92500 of the COVID‑19 Determination applies.
(3) The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the general medical services table or items 91822, 91823, 91832 or 91833 of the COVID‑19 Determination applies.
3 Fee in relation to the first patient during each attendance at a residential aged care facility
For the first patient attended during one attendance by an allied health professional at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 93312, 93313, 93316, 93319, 93322, 93323, 93326, 93327, 93375, 93376, 93381 to 93386 applies is the amount listed in the item plus $47.05.
Group M27 – Initial Psychological Therapy Services |
Item | Service | Fee($) |
93375 | Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 30 minutes but less than 50 minutes duration | 102.85 |
93376 | Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 151.05 |
Group M28 – Initial Focussed Psychological Strategies (Allied Mental Health) |
93381 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 72.90 |
93382 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital), by an eligible psychologist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 102.85 |
93383 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 |
93384 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 |
93385 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 20 minutes but less than 50 minutes duration | 64.20 |
93386 | Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if: (a) the person is a care recipient in a residential aged care facility; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and (c) the service is provided to the person individually and in person; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration | 90.70 |
Schedule 4—Services and fees—initial focussed psychological strategies
1 Application of focussed psychological strategies items
(1) Items 941, 942, 2733 and 2735 apply to a service which is provided by a medical practitioner:
(a) whose name is entered in the register maintained by the Chief Executive Medicare under section 33 of the Human Services (Medicare) Regulations 2017; and
(b) who is identified in the register as a medical practitioner who can provide services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination applies; and
(c) who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration for providing services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination applies.
(2) Items 941, 942, 2733 and 2735 do not apply to:
(i) is provided to a patient who, in a calendar year, has already been provided with 6 services to which any of items 941, 942, 2733 and 2735 or any of the items in Subgroup 2 of Group A20 of the general medical services table or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination or items 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845 of the COVID‑19 Determination applies; and
(ii) is provided before the medical practitioner managing the GP mental health treatment plan or the psychiatrist assessment and management plan has conducted a patient review and recorded in the patient’s records a recommendation that the patient have additional sessions of focussed psychological strategies in the same calendar year; or
(b) a service which is provided to a patient who has already been provided, in the calendar year, with 10 other services to which any of items 941, 942, 2733 and 2735 or any of the items in Subgroup 2 of A20 of the general medical services table or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination, or items 80000 to 80015, 80100 to 80115, 80125 to 80140 or 80150 to 80165, or items 91820, 91821, 91844, 91845, 91166, 91167, 91169, 91170, 91172, 91173, 91175, 91176, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91818, 91819, 91842 and 91843 of the COVID‑19 Determination apply.
Group A20—Mental health care |
Subgroup 2—Focussed psychological strategies |
2733 | Professional attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 112.50 |
2735 | Professional attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 161.00 |
| | |
Group A7 – Acupuncture and Non‑Specialist Practitioner Items |
Subgroup 9 – Non Specialist Practitioner mental health care |
941 | Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 30 minutes, but less than 40 minutes | 90.00 |
942 | Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and (b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and (c) the service lasts at least 40 minutes | 128.80 |
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
Endnote 2—Abbreviation key
ad = added or inserted | o = order(s) |
am = amended | Ord = Ordinance |
amdt = amendment | orig = original |
c = clause(s) | par = paragraph(s)/subparagraph(s) |
C[x] = Compilation No. x | /sub‑subparagraph(s) |
Ch = Chapter(s) | pres = present |
def = definition(s) | prev = previous |
Dict = Dictionary | (prev…) = previously |
disallowed = disallowed by Parliament | Pt = Part(s) |
Div = Division(s) | r = regulation(s)/rule(s) |
ed = editorial change | reloc = relocated |
exp = expires/expired or ceases/ceased to have | renum = renumbered |
effect | rep = repealed |
F = Federal Register of Legislation | rs = repealed and substituted |
gaz = gazette | s = section(s)/subsection(s) |
LA = Legislation Act 2003 | Sch = Schedule(s) |
LIA = Legislative Instruments Act 2003 | Sdiv = Subdivision(s) |
(md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
effect | SR = Statutory Rules |
(md not incorp) = misdescribed amendment | Sub‑Ch = Sub‑Chapter(s) |
cannot be given effect | SubPt = Subpart(s) |
mod = modified/modification | underlining = whole or part not |
No. = Number(s) | commenced or to be commenced |
Endnote 3—Legislation history
Name | Registration | Commencement | Application, saving and transitional provisions |
Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020 | 6 Aug 2020 (F2020L00996) | 7 Aug 2020 (s 2(1) item 1) | |
Health Insurance Legislation Amendment (Extend Cessation Date of Temporary COVID‑19 Items) Determination 2020 | 21 Sept 2020 (F2020L01190) | Sch 1 (item 3): 22 Sept 2020 (s 2(1) item 2) | — |
Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Amendment (Expand Eligible Patients) Determination 2020 | 8 Oct 2020 (F2020L01290) | 9 Oct 2020 (s 2(1) item 1) | — |
Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Amendment (Care Recipient in a Residential Aged Care Facility) Determination 2020 | 9 Dec 2020 (F2020L01548) | Sch 1 (items 1–19): 10 Dec 2020 (s 2(1) item 1) | — |
Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services and Chronic Disease Management) Amendment Determination 2020 | 23 Dec 2020 (F2020L01704) | Sch 1 (items 1–6): 10 Dec 2020 (s 2(1) item 2) | — |
Endnote 4—Amendment history
Provision affected | How affected |
s 2..................... | rep LA s 48D |
s 4..................... | am F2020L01190; F2020L01290 |
s 5..................... | am F2020L01290; F2020L01548; F2020L01704 |
| ed C4 |
s 7..................... | am F2020L01290; F2020L01548; F2020L01704 |
| ed C4 |
s 8..................... | am F2020L01548 |
| ed C3 |
s 9..................... | rs F2020L01548 |
s 10.................... | ad F2020L01548 |
s 11.................... | ad F2020L01548 |
| am F2020L01704 |
Schedule 1 | |
Schedule 1................ | am F2020L01290; F2020L01548 |
Schedule 2 | |
Schedule 2................ | am F2020L01290; F2020L01548 |
| exp 31 Mar 2021 (s 4(a)) |
Schedule 3 | |
Schedule 3................ | ad F2020L01548 |
| ed C3 |
Schedule 4 | |
Schedule 4................ | ad F2020L01704 |
c 1..................... | ad F2020L01704 |
Group A20 Table........... | ad F2020L01704 |
Group A7 Table............ | ad F2020L01704 |
Endnote 5—Editorial changes
In preparing this compilation for registration, the following kinds of editorial change(s) were made under the Legislation Act 2003.
Subsection 5(1)
Kind of editorial change
Removal of redundant text
Details of editorial change
Schedule 1 item 2 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services and Chronic Disease Management) Amendment Determination 2020 instructs to repeal and substitute the defintion of better access subsequent treatment service and insert the definitions of care recipient and course of treatment in subsection 5(1).
This amendment results in two occurrences of the definition of care recipient in subsection 5(1).
This compilation was editorially changed to omit the second occurrence of the definition of care recipient in subsection 5(1) to remove the redundant text.
Section 7
Kind of editorial change
Give effect to the misdescribed amendment as intended
Details of editorial change
Schedule 1 item 3 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services and Chronic Disease Management) Amendment Determination 2020 provides as follows:
3 Subsection 7(2)
Repeal the subsection and substitute:
An item in Group A41, M25 or M26 of this instrument does not apply if a person has received 10 better access subsequent treatment services for that calendar year.
Subsection 7(2) does not appear. However, section 7 does appear.
This compilation was editorially changed to repeal the text of section 7 (excluding the heading) and substitute “An item in Group A41, M25 or M26 of this instrument does not apply if a person has received 10 better access subsequent treatment services for that calendar year.” to give effect to the misdescribed amendment as intended.
