Home > Programs & Campaigns > Programs & Initiatives > MBS Primary Care Items

MBS Primary Care Items

Medicare benefits for non-directive pregnancy support counselling services

The non-directive pregnancy support counselling service is available to women who are concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months. These services can be used to address any pregnancy related issues for which non-directive counselling is appropriate.

Printable version of the Fact Sheet (PDF 125 KB)

Overview:

• Rebates are available for up to 3 non-directive pregnancy support counselling services per patient, per pregnancy.
• Women concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months may access the services.
• Services can address all pregnancy-related issues for which non-directive counselling is appropriate.
• Services are provided by eligible GPs, and allied health professionals on referral from a GP.
• Providers may set their own fees.
• Out-of-pocket costs count towards the Medicare Safety Net.

Women who are concerned about a current pregnancy, or a pregnancy that occurred in the preceding 12 months may claim Medicare benefits for up to 3 non-directive pregnancy support counselling services (in total) per pregnancy.

What is non-directive counselling?

This is a form of counselling based on the understanding that, in many situations, people can resolve their own problems without being provided with a solution by the counsellor.

The service involves the counsellor undertaking a safe, confidential process that helps the patient explore concerns they have about a pregnancy. This includes providing unbiased, evidence-based information about all options and services available to the patient, where requested.

The service can address all pregnancy-related issues for which non-directive counselling is appropriate.

A woman’s partner may attend counselling sessions, however, only one fee (for the patient) applies to each service.

Who can provide these services?

Services can be provided by a medical practitioner (including a GP, but not including a specialist or consultant physician) – hereafter referred to as a GP. The GP must be registered with Medicare Australia as having completed non-directive pregnancy counselling training.

Private psychologists, social workers and mental health nurses may also provide services on referral from a GP, where the practitioners are registered with Medicare Australia as meeting the following eligibility criteria and having completed appropriate non-directive pregnancy counselling training:

• psychologists must be registered with the Psychologists Registration Board in the State or Territory in which they are practising (psychologists whose registration includes any limitation, eg, where marked ‘provisional’ are not eligible to register with Medicare Australia to provide these services);
• social workers must be a ‘Member’ of the Australian Association of Social Workers (AASW) and certified by AASW either as meeting the standards for mental health set out in AASW’s ‘Competency Standards for Mental Health Social Workers 1999’ or as an Accredited Social Worker;
• mental health nurses must be a ‘Credentialled Mental Health Nurse’ as certified by the Australian College of Mental Health Nurses (ACMHN).

Exclusions:

GPs, psychologists, social workers and mental health nurses who have a direct pecuniary interest in a health service that has as its primary purpose the provision of pregnancy termination services cannot provide non-directive pregnancy support counselling services under Medicare.

Training and Registration with Medicare Australia

Non-directive pregnancy counselling training is available online from the following organisations:

GPs: Royal Australian College of General Practitioners (RACGP) and Australian College of Rural and Remote Medicine (ACRRM)

Psychologists and Social workers: Australian Psychological Society (APS), with links from Australian Association of Social Workers; and

Mental health nurses: ACMHN.

Referral Process

Any GP may refer patients to eligible psychologists, social workers and mental health nurses for services, via a signed and dated letter or note. GPs do not need to have completed non-directive pregnancy counselling training to make referrals.

Patients may be referred to more than one allied health professional (eg, where the patient does not wish to continue receiving services from the provider they were referred to in the first instance).

A new referral is required for each pregnancy or where the patient wishes to be referred to a different provider.

Patients who are unsure of the number of rebates available to them may check with Medicare Australia on 132 011. Providers may also check prior to providing a service (patient needs to be present).

Which MBS items apply?

There are four MBS items for the provision of non-directive pregnancy support counselling services:
4001 – provided by a GP;
81000 – provided by a psychologist;
81005 – provided by a social worker;
81010 – provided by a mental health nurse.

What conditions must be met before the relevant item can be claimed?

Item 4001:

• the service is provided by a GP registered with Medicare Australia as meeting the credentialling requirements for provision of the service, and lasts at least 20 minutes.

Items 81000, 81005 and 81010:

• the service is provided by a psychologist, social worker or mental health nurse, respectively, registered with Medicare Australia as meeting the credentialling requirements for provision of the service, and lasts at least 30 minutes;

Items 4001, 81000, 81005 and 81010:

• the service is provided to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the service, individually, and in person;
• the person is not an admitted patient of a hospital or day-hospital facility;
• the person has not received more than 3 services to which items 4001, 81000, 81005 and 81010 apply, per pregnancy; and
• the service has not been funded through other State or Commonwealth programs (see section on Other publicly funded programs).

Fees

GPs, psychologists, social workers and mental health nurses may set their own fees for these services. Bulk-billing incentives (item 10990 or 10991) can be claimed in conjunction with item 4001, provided the conditions of the relevant item, 10990 or 10991, are satisfied.

Out-of-pocket costs incurred for eligible services count towards the Medicare safety net.

Medicare claiming/payment processes

After completing the service, providers may:
1. seek payment directly from the patient;
2. invoice the patient who receives a Medicare ‘pay provider’ cheque for the rebate amount to pass to the provider along with any outstanding amount; or
3. seek payment for the service directly from Medicare (bulk-bill the service). In claiming directly from Medicare, providers accept the value of the rebate as full payment for the service and cannot charge patients a co-payment.

Allied health professionals should note that itemised accounts/receipts must include:

• patient’s name and date of service;
• MBS item number;
• name and practice address or name and provider no. of servicing provider;
• name and practice address or name and provider no. of referring GP and date of referral; and
• amount charged, total amount paid, and any amount outstanding for the service.

The MBS Allied Health Services Book contains detailed information about Medicare payment processes. It is available at MBS Online.

Information is also available from Medicare Australia’s provider inquiry line on 132 150.

What about patients with private health insurance cover?

Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for services provided by allied health professionals.

Insured patients can either:
1. access rebates from Medicare by following the claiming processes; or
2. claim on their insurance’s ancillary benefits. No GP referral is required.

Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate for eligible services.

Patients should check with their health fund which ancillary services are covered and how much they may be out of pocket.

Other publicly funded programs

Non-directive pregnancy support counselling services provided by psychologists, social workers or mental health nurses funded under other Commonwealth or State/Territory Government programs are not eligible for Medicare rebates.

However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory clinic, items 81000, 81005 and 81010 can be claimed for services provided by eligible allied health professionals salaried by or contracted to the service, where all requirements of the relevant item are met.

Further information

For more information call Medicare Australia on 132 150 or go to the Medicare Australia website.
Top of page