Information for General Practitioners and other Referrers

Medicare Mental Health Plans

Many GPs and their support staff report a lack of understanding about how Medicare Better Access Mental Health Plans (MHPs) work from their perspective.   The following information is provided as a courtesy to referring doctors, although both Medicare and the Australian Psychological Society provide information on their respective websites about Medicare services and those two sources should be considered the definitive guide for any questions you may have, or in the event any of the information below contradicts those guides.

  • Mental Health Care Plans (MHCP or MHP) are valid for up to two years from the date of issue. After that time, the patient will require a new MHP.
  • Medicare allows for up to 10 individual psychology sessions in a calendar year, starting 1st January each year. This annual 10-session limit applies even if a new MHP is issued.
  • The psychologist will normally provide a Referral Acceptance letter to the referring GP, so that the GP knows the patient has engaged with the psychologist.
  • The initial MHP typically entitles the patient for up to 6 sessions with the psychologist. At this point the psychologist will again write to the GP and, if it is deemed necessary, the GP can then approve access to an additional four sessions.
  • After the first 10 sessions have been used, the GP can approve another two sets of 5 sessions under the previous MHP (but in the following calendar year), for a total of 20 sessions in 24 months.  All that is required is a brief MHP Review letter asking the psychologist to continue treating the patient.
  • Up to 10 group sessions (for 6 – 10 patients) may also be claimed by the patient in a calendar year, in addition to their individual sessions.***
  • MHPs are valid only for the provider/s named in the plan. If a patient chooses to move to a different psychologist (especially when they move to a different psychology business altogether), then they will need a new MHP.
  • Some patients may choose to see one psychologist for individual sessions, and another for group sessions, in which case they would require a MHP that names both providers.
  • Sometimes the psychologist may choose to provide a patient with only a short session (30 minutes), but this is billed at a lower Medicare rate (Code 80100) and still counts as one of the 10 sessions per annum. Given that the patient often has limited access to psychology services, treatment sessions usually last for 50+ minutes and are billed at the higher rate (Code 80110).
  • If you are aware when making a referral that a patient has already seen another psychologist during the current calendar year, please mention this in the referral, as it will reduce the total number of sessions available to them and may influence treatment planning decisions.

*** Hunter Valley Psychology is in the process of organising some group sessions for people with anxiety disorders, particularly social anxiety disorder.

Treatment Reviews

  • Patients are eligible for up to six sessions under the initial MHP.  A further four sessions are available following review by the GP and provision of a letter requesting the patient continue to be seen for the remaining balance of sessions for that calendar year.
  • Under Medicare guidelines, the psychologist is required to provide the referring GP with a letter about progress of treatment following the sixth session, or earlier if required.
  • The psychologist will also provide a Treatment Summary letter after the tenth session with the patient.
  • Medicare claims by GPs for MHP creation may be used to validate psychologist Medicare claims against the data you provide when you create the plan. If you do not claim the Medicare item code related to MHP creation, the psychologist may be unable to successfully process their claims through Medicare.

Enhanced Care Plans (ECPs)

A Medicare ECP can be used by GPs to extend a patient’s access to Medicare-rebated psychological treatments beyond their 10 MHP sessions where they have an identified complex need.   However, ECP rebate amounts are substantially less than MHP rebates, so all patients referred under an ECP will invariably incur an additional out-of-pocket gap payment. As ECP entitlements are very limited (4 or 5 sessions per year) but can be used for other allied health services such as physiotherapy, ECPs are best used only when other entitlements to psychology services have been exhausted and ongoing treatment is required.

Fees and Medicare Bulk Billing

  • The Full Fee for a 50-min session is currently $184.50 ($60.00 gap fee after Medicare rebate).
  • The Low-Gap Fee for a 50-min session is $149.50 ($25.00 gap after Medicare rebate).
  • Bulk-Billing is available for some patients, depending upon their circumstances.
  • An initial deposit of $50 may be requested from bulk-billed clients, and that deposit will be forfeited in the event of late cancellations or non-attendance.  The deposit will be refunded to the client’s nominated bank account at the end of treatment.
  • A No-Show Fee of $124.50 (equivalent to Medicare rebate amount) applies if a patient misses or cancels an appointment with less than 24 hrs notice, regardless of reason. This fee is reduced or waived only in exceptional circumstances.
  • The amount of deposit required may be varied or waived at the psychologist’s discretion, but taking a deposit reduces the overall frequency of no-shows so is necessary in most cases to ensure the ongoing viability of the business.
  • Please note that the Australian Psychological Society’s Recommended Fee is currently $241 per hour.

Other Referral Options

Patients can also be referred via Vietnam Veteran’s Counselling Service (VVCS), where the patient or a member of their family is a former or serving member of the Australian Defence Forces.  Patients should contact VVCS directly on 1800 011 046 to arrange a referral through that service.

I am currently a registered SIRA (Workcover NSW) provider.

Hunter Valley Psychology is no longer providing services under NDIS, except where the patient has self-managed funding for psychology services.

Cognitive Assessments and Reports

I am able and willing to undertake cognitive assessments and reporting for children and adults.  Please note that no Medicare rebates apply to such testing, although a GP Mental Health Plan could cover initial clinical assessment of the patient. Cognitive assessments and reporting are now substantially streamlined thanks to the Pearson Q-Global testing platform, with most of the test administration and scoring conducted using a pair of linked Apple iPads.   The testing and reporting process can now be completed for about $400 per assessment (actual fees may vary depending on the time taken to administer the test).   An initial deposit will be required as test materials are often purchased on a per-use basis.

Legal Reports

I am keen to undertake forensic assessment and reporting for clients with legal issues.  Again, a GP Mental Health Plan could be used to cover initial clinical assessment of the patient in such circumstances (assuming a diagnosable mental health condition is present), but the report and any clinical assessments directly related to the preparation of the report are billed privately.  I have done a few such reports in the last couple of years and the feedback from solicitors has been very positive regarding the quality and detail of these reports.  Please note that preparation of reports for legal purposes does require substantial time and effort and that is reflected in the fees charged (typically $1,500 – $2,000 per report including GST).


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