Medicare Facts & Rebates

Medicare Facts & Rebates 2017-09-18T20:25:01+00:00

Referral Requirements

  • Medicare – Psychology consultation: If you wish to claim a rebate through Medicare, under a Mental Health Care Plan, you will need to consult your GP, psychiatrist or paediatrician for a referral to a psychologist.
  • Medicare – Allied Health Professional: If you wish to claim an allied health professional service under a Medicare rebated GP Team Management Plan for Chronic Disease Management, you will need to consult your GP.
  • Medicare will not accept your claim without the relevant referral information from a medical practitioner.

  • You cannot claim both a private health and Medicare rebate for the same session.

  • In all cases, rebates from Medicare and private health funds do not apply to any services provided by an intern psychologist. We will tell you if a service is to be provided by an intern.

To review Medicare’s Better Access to Mental Health Care: Fact Sheet for Patients

Psychology Conditions Covered by Medicare Rebates

Many, but not all, conditions are eligible for Medicare rebates. If you want to ascertain your eligibility for rebates for psychological services under Medicare’s Better Access to Mental Health it is advisable that you book a long session with your treating doctor. Your doctor will conduct an assessment to determine if you have a diagnosed mental disorder that will allow you to access psychology services through Medicare.

Conditions that are covered by Medicare include:

  • Mood disorders

  • Depression

  • Bipolar disorder

  • Anxiety disorders
  • Phobias

  • Generalised anxiety disorder

  • Post-traumatic stress disorder

  • Panic disorder

  • Obsessive Compulsive disorder

  • Mixed anxiety and depression

  • Psychotic disorders including schizophrenia and drug-induced psychosis

  • Adjustment disorders
  • Unexplained somatic complaints

  • Conduct disorder

  • Attention deficit disorder

  • Bereavement disorder

  • Eating disorders

  • Alcohol use disorders

  • Sleep problems

  • Sexual disorders

  • Enuresis (non-organic)

Conditions that are not covered by Medicare include:

  • Dementia

  • Delerium

  • Tobacco-use Disorder Mental Retardation

How many sessions per year does Medicare offer rebates for?

a. Mental Health Care Plans: 10 sessions in a calendar year (1 January to 31 December).
b. GP Team Management Plans: 5 sessions in a calendar year (1 January to 31 December).

Amounts available under Medicare rebates

a. Mental Health Care Plan Rebates:
General Psychologist: Services provided by a general registered psychologist attract a rebate of $84.80 (hour session) or $60.10 (30 minute session)
Clinical Psychologist: Services provided by a clinical psychologist attract a rebate of $124.50 (hour session) or $84.80 (30 min session)

b. GP Team Management Plan Rebates (Chronic Disease Management Plan or EPC)

$52.95 per session (for up to five sessions in a year). Sessions must be at least 20 minutes.

To review the complete Medicare Benefits Schedule list of fees and rebates for psychology items click here

Medicare Safety Net and Higher Rebates

The Medicare Safety Net provides a higher Medicare benefit (85% of the fee) once you reach a certain threshold. If you are single Medicare will automatically pay you the higher benefit when you reach your threshold. However, if you are a family, or a couple, you must register as a Medicare Safety Net Family. This includes those on the same Medicare card. If you are registered as a family or couple, Medicare combines your medical costs so you are more likely to reach the thresholds sooner.

A family is:
– A married couple – not separated, with or without dependent children
– A couple in a de facto relationship, with or without children
– A single person with dependent children

The Safety Net is calculated on a calendar year, 1 January to 31 December.

To register for the Medicare Safety Net as a couple or family use the form at this link: https://www.humanservices.gov.au/customer/forms/ms016

For further information you can download the Australian Psychological Society Table of Medicare Benefits Schedule fees and rebates for psychology items available here.