Medicare

APS Fact Sheet
Better access to psychologists through
the Medicare Benefits Schedule (MBS)

On 1 November 2006, the Australian Government introduced
new Medicare items for psychological treatment by registered
psychologists. This service provides considerable assistance
to people living with mental heath problems, allowing them
greater access to psychologists and providing more affordable
mental healthcare.

Under the new Medicare scheme, all registered psychologists
who are endorsed by Medicare Australia can provide treatment
for mental health problems. Medicare rebates are also available
for consultations with specialist clinical psychologists, who are
experts in the assessment and treatment of mental disorders.

New Medicare services promote a team approach to mental
health care, with general practitioners, psychiatrists and
paediatricians encouraged to work with psychologists, and
other allied mental health professionals as well as mental health
nurses, to increase the availability of care.

Psychologists study the way people feel, think, act and
interact. Through a range of strategies and therapies they aim
to reduce distress and to enhance and promote emotional
wellbeing. Psychologists are experts in human behaviour,
and have studied the brain, memory, learning and human
development. Psychologists can assist people who are having
difficulty controlling their emotions, thinking and behaviour,
including those with mental health problems such as anxiety
and depression, serious and enduring mental illness, addictive
behaviours and childhood behaviour disorders.

All psychologists are legally required to register with the
Psychologist Registration Board in their State or Territory,
in the same way medical practitioners must be registered.
This means that they must be competent and follow a strict
Code of Conduct.

Not all counsellors or therapists are registered psychologists.
Seeing someone who is registered ensures you receive high
quality ethical treatment.

Mental disorder is a term used to describe a range of clinically
diagnosable disorders that significantly impact on a person’s
emotions, thoughts, social skills and decision-making. This
includes patients with mental disorders arising from:

• Psychotic disorders
• Schizophrenia
• Bipolar disorder
• Phobic disorders
• Anxiety disorder
• Adjustment disorder
• Depression
• Sexual disorders
• Conduct disorders
• Bereavement disorders
• Post-traumatic stress disorder
• Eating disorders
• Panic disorder
• Alcohol use disorders
• Drug use disorders
• Sleep problems
• Attention deficit disorder
• Obsessive Compulsive Disorder
• Co-occurring anxiety and depression

Psychologists specialise in providing therapies for mental
health problems. These therapies are effective at treating
common mental health conditions including anxiety and
depression and most childhood problems.

You must be referred by your GP, your psychiatrist or
paediatrician. Your GP will need to complete a detailed
mental health assessment and prepare a Mental Health Care
Plan before referring you to a psychologist. You should book
a longer session with your GP to enable time for this.

Under the Medicare scheme you can only see a registered
psychologist with a Medicare Provider Number who you
have been referred to by your GP, psychiatrist or paediatrician.

Can I request a referral to a specific
psychologist or does my doctor have
to choose?

Your doctor must first assess that you require the services of
a psychologist. Your doctor may allow you to request a specific
psychologist or may refer you to a psychologist that he/she
recommends. The psychologist in question must be registered
and have a Medicare Provider Number for you to
be able to claim the Medicare rebate.

In order to receive a Medicare rebate, you must be referred
to a psychologist by an appropriate medical practitioner (GP,
psychiatrist or paediatrician). The doctor must first make an
assessment that you need the services of a psychologist. If you
are already seeing a psychologist, discuss this with your doctor.

• Up to 12 individual services in a calendar year. Your referring
doctor will assess your progress after the first six sessions.
• Up to 12 group therapy services in a calendar year where
such services are available and seen as appropriate by your
referring doctor and the psychologist.

The cost to you and the rebate available from Medicare will
vary depending on the:

• Length of the session;
• Type of psychologist consulted – general or specialist
clinical; and
• Fee being charged by the psychologist.
If the psychologist decides to bulk bill then you will not have
to pay anything.

However if the psychologist does not use the bulk billing
method (as is the case with Dr Curtis) then you would pay the difference between what the charges you (which may be the schedule fee or a
fee set by the psychologist) and the Medicare rebate. This will
vary and you must check this out with the psychologist before
commencing your treatment.

If the psychologist decides to use the bulk billing method,
you assign your right to a benefit to the psychologist as full
payment for the psychological service. The psychologist cannot
make any additional charge for this service if it has been bulk
billed, and will receive the relevant Medicare rebate or ‘benefit’
from Medicare Australia for the service provided.

As Dr Curtis charges above the scheduled fee, then
the settlement of the account is your responsibility. You may
claim a rebate by lodging a claim through Medicare by the following method:

• Pay the full amount of the consultation($200.00) and use your
detailed receipt to claim a Medicare rebate of $115.05.

Does the Medicare Safety Net apply to my
out-of-pocket expenses under this initiative?

Yes. You are responsible for paying any charges in excess of
the Medicare rebate for items under this initiative. However,
these out-of-pocket expenses will count towards both the
original and the extended Medicare safety nets. Once you or
your family reach the relevant threshold in the calendar year,
Medicare benefits will increase to 100% of the schedule fee
under the original safety net, and 80% of your total out-ofpocket expenses for

out-of-hospital services under the extended Medicare safety net. The Medicare safety net is designed to protect high users of health services from large out-of-pocket expenses.

You cannot use your private health insurance ancillary cover
to top up the Medicare rebates for these services.

You need to decide if you will use Medicare or your private
health insurance ancillary cover to pay for psychological services
you receive. You can either access rebates from Medicare by
following the claiming process or claim where available on
your insurer’s ancillary benefits.

	Threshold	Who it is for?	How it is calculated?	Benefit to you
Concession and Family Tax Benefit (Part A) {FTB(A)}	$529.30*	Commonwealth concession card holders Families eligible for FTB(A)	Out-of-pocket costs	80% of out-of-pocket costs for out-of-hospital services
Gap	$365.70*	All Medicare card holders	Based on gap amount	100% of Schedule fee for out-of-hospital services
General	$1058.70*	All Medicare card holders	Out-of-pocket costs	80% of out-of-pocket costs for out-of-hospital services

Out-of-pocket costs —the difference between the Medicare benefit and what your doctor charges you.

Gap amount —the difference between the Medicare benefit and the Schedule fee.

Remember: You need to give Medicare all of your receipts for doctor's accounts. This way you can make sure you get all the benefits that you're entitled to

Yes—it is possible to reach more than one threshold in a calendar year. Medicare will calculate the benefits you are entitled to and when you reach another threshold, following confirmation of your family make-up (for registered families only), you will be automatically paid the higher benefit for claims made on fully paid accounts for the rest of that calendar year.

This threshold is reached by calculating your out-of-pocket medical costs. Out-of-pocket costs are the difference between the Medicare benefit and what your doctor charges you.

Remember: You need to give Medicare all of your receipts for doctor's accounts. This way you can make sure you get all the benefits that you're entitled to.

Medicare will refund the Medicare benefit plus 80 per cent of the difference between the Medicare benefit and your doctor's charge.

For example, if you reach and qualify for the general threshold and then visit your GP who charges $55, you will receive your Medicare benefit of $31.45. You will also receive 80 per cent of your out-of-pocket costs giving you an extra $18.85 in your pocket. So it will effectively only cost you $4.70 to go to your GP/Psychologist.

This threshold is reached by calculating your gap amounts. Medicare usually pays either 85 or 100 per cent of the Medicare Schedule fee when you visit a doctor other than your GP.

The Schedule fee is the fee for service set by the Australian Government—not the fee charged by the doctor.

Remember: You need to give Medicare all of your receipts for doctor's accounts. This way you can make sure you get all the benefits that you're entitled to.

Eligible concession cards are those issued by either Centrelink or the Department of Veterans’ Affairs, including:

A concessional family is a combination of at least one adult plus another family member who is entitled to a Commonwealth concession card. Only these concession card holders’ out-of-pocket costs count toward the concession Medicare Safety Net threshold.

If one or more children within your family have concession cards but you and your spouse do not, then your child/children are treated as individuals for the purposes of calculations and payments under this safety net.

If you are eligible for an FTB(A) payment you and your family are eligible for the FTB(A) Medicare Safety Net threshold.

There are two ways families can claim an FTB(A) payment as a fortnightly installment or as a lump sum payment.

Please note: Lump sum payments must be received before 31 December to be eligible for the next entire calendar year. If the payment is made after 31 December, eligibility will commence from the date of payment in the eligible calendar year in which it is received.

Disclaimer: How you choose to receive your FTB(A) payment/s determines your eligibility for the FTB(A) safety net threshold. It is your responsibility to understand that your choice of FTB(A) payment can affect your perceived FTB(A) safety net threshold eligibility.

What if I'm only a concession card holder for part of the year or receive only one FTB(A) payment?

If you are a concession card holder or you are eligible for FTB(A) at any time during a calendar year, you are eligible for the concession and FTB(A) Medicare Safety Net threshold for the remainder of that year starting from the concessional eligibility date.

If you claim your FTB(A) through your tax return you would be eligible for the safety net in the following calendar year.

Further information is available from:
The Australian Psychological Society:
www.psychology.org.au

Australian Government
Department of Health and Ageing: www.health.gov.au.
The Australian Psychological Society Ltd. ABN 23 000 543 788