Update on MBS changes in Australia

Following the introduction of new and updated psychiatry Medicare Benefits Schedule (MBS) item numbers from 1 March 2024, we are aware that psychiatrists are facing claiming issues when providing new patient consultations via telehealth where patients have been seen previously by a different psychiatrist in the preceding 24 months. 

The College, involving the Section of Private Practice Psychiatry (SPPP) Committee, is continuing to liaise with the Australian Department of Health and Aged Care (DoHAC) on this matter, along with other concerns raised by members. A summary of issued raised and discussed is as follows. 

Use of item 296 and telehealth equivalent 92437 

We have expressed concern about the item descriptor wording differences between face-to-face items 296 and 297, 299, compared to telehealth item 92437, when patients have been seen by any psychiatrist using the psychiatry MBS item numbers in the preceding 24 months. Our view is that these should align with the explanatory note (AN0.75) which states that items are identical other than their location and have requested changes be made to align the item descriptors. 

We are aware that the current restriction imposed on item 92437 is limiting access to psychiatry for patients who may need to see a new psychiatrist within 24 months of a preceding appointment for a multitude of reasons. We have advised that telehealth is a vital part of improving access to patients who may otherwise be unable to access a psychiatrist, and new patient assessment is an important part of commencing the therapeutic relationship. 

Item 294 and removal of non-patient consultations (341, 343, 345, 347 and 349)

DoHAC has advised that the reason for these consultations not being billable alongside item 294 is that they do not meet the legislative definition of a consultation. We have urged reconsideration of this, which is devaluing family and carers’ consultations that have a vital role in understanding the patients’ mental health problems and assisting with their recovery. This is particularly important for people who are eligible for item 294. We have we proposed that a solution be implemented to reinstate this via an alternative method if legislation is a barrier. 

Cap of 50 consultations at the higher schedule fee incorporating telehealth consultations

The cap of 50 consultations at a higher rate now aligns telehealth with face-to-face although will limit access to affordable services for people who require more regular check ins or monitoring via telehealth.  We have agreed to monitor usage data on these items in collaboration with DoHAC to determine impact on service access and affordability. 

Item number use when item 319 (and telehealth equivalent) exceeds 160 consultations 

DoHAC has confirmed that, in line with explanatory note AN.0.31, if the patient requires more than 160 services in a calendar year for intensive psychotherapy, then such attendances would be covered by items 310, 312, 314, 316, 318, 91868 to 91872 or 91879 to 91881. DoHAC has confirmed that, although item descriptors for these items do not include reference to item 319 and 91873, they are still eligible for inclusion in line with the explanatory note.  

For more information, please contact policy@ranzcp.org


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