Allied health referrals for mental health care plans

Allied health professional eligibility

Under Better Access, these health professionals can provide services:

clinical psychologists
registered psychologists
occupational therapists
social workers.

If you’re an allied health professional, you can check your eligibility for Medicare benefits through the Medicare Benefits Schedule (MBS) items online checker in HPOS. You can also call Medicare.

Patient eligibility

An eligible health professional must assess your patient as having a mental disorder. These health professionals can refer patients for allied mental health services:

health professionals who are managing the patient under a General Practitioner Mental Health Treatment Plan (GPMHTP), referred psychiatrist assessment and management plan or shared care plan
psychiatrists
paediatricians.

If you’re an allied health professional and you’re not sure if your patient is eligible, you can contact the referring medical practitioner. You can continue to treat patients who aren’t eligible, but they can’t access Medicare benefits for the services you provide.

Referral course of treatment

The number of services stated in the referral is a ‘course of treatment’.

The maximum number of sessions you can include on a referral for the initial course of treatment is 6.

A patient can have 2 or more courses of treatment within a calendar year with a limit of 10 services.

Patients need a new referral for each course of treatment.

If you provide focused psychological strategies (FPS) services to your patient, they count towards the calendar year claiming limits.

Referral format and content

There’s no standard form for mental health referrals. You can refer your patient for services with a signed and dated letter.

The referral should include:

your patient’s name
date of birth
address
their symptoms or diagnosis
the number of treatment services required
a statement about whether the patient has a GPMHTP, shared care plan or a psychiatrist assessment and management plan.

Referral validity

Referrals are valid for the number of services shown on the referral letter or note. Mental health referrals don’t expire at the end of the year.

If your patient has unused services on their referral at the end of the calendar year, they can use them the next year.

Calendar year claiming limits

In a calendar year, your patient can get psychological therapy and FPS services up to the combined limit of:

10 individual services
10 group services.

A calendar year is from 1 January to 31 December. We calculate the yearly claiming limit on the date of service, not when the treatment was referred. Once a patient has reached their service limit, you can keep treating them, but they can’t access Medicare benefits for your services.

Better Access services for family and carer participation

Additional MBS items allow eligible GPs, medical practitioners working in general practice, clinical psychologists, psychologists, occupational therapists and social workers to deliver up to 2 Better Access services per calendar year. These Better Access services can be provided to a person other than the patient, where the:

patient has been referred for Better Access services (for allied health professionals delivering these services)
treating or referring practitioner determines it is clinically appropriate
patient consents for the service to be provided to the person as part of their treatment
service is part of the patient’s treatment
patient isn’t in attendance.

Any services delivered using these MBS items count towards the patient’s calendar year allocation for individual services under Better Access. There’s a maximum of 2 services per calendar year.

These changes recognise the important role family members and carers play in supporting patients with mental illness. Involving family members and carers in treatment benefits patient outcomes.

You can check patient eligibility and claiming conditions in the MBS items online checker in HPOS.

Reporting requirements

Allied health professionals must provide a written report to the referring medical practitioner after completing each course of treatment.

It must include all of the following:

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

You don’t need to use an approved form to write a report.

If your patient doesn’t complete treatment, you need to write your report after the last service. If they return later and complete the course of treatment, you’ll need to write another report.

Telehealth for allied health

Telehealth MBS items provide Medicare benefits for allied health services delivered via video conferencing.

Telehealth services are the preferred alternative to face-to-face consultations. However, you can provide some services via phone if telehealth is not available.

Allied health professionals can deliver all 10 services by telehealth.

Group therapy services involving 4 to 10 patients can be delivered by telehealth for:

psychological therapy with a clinical psychologist
FPS with a psychologist, occupational therapist or social worker.

Your patients must:

have both a visual and audio link with you
be located in an area within regions 4-7 of the Modified Monash Model
be located at least 15 km by road from you at the time of consultation.

You can read about telehealth item numbers.

You can use the Medicare Benefits Schedule (MBS) items online checker in HPOS to confirm patient and claim eligibility.

Read about the relevant MBS item descriptions, fact sheets and explanatory notes on the MBS Online website.

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