A Mental Health Treatment Plan is not a referral. To claim a Better Access item you need a separate written referral, signed and dated, that names the number of services. Medicare covers up to 10 individual and 10 group sessions per calendar year, with the initial course of treatment capped at six services.
That distinction causes more rejected Better Access claims than any other misunderstanding in Australian private practice. A client arrives with a copy of their plan, the practice files it, and nobody notices that the document on file is not the one Medicare requires.
Is a Mental Health Treatment Plan the same thing as a referral?
No. The explanatory note on referral requirements states plainly that "a Mental Health Treatment Plan is not considered a referral", and that a referral for mental health services under Better Access "should be in writing (signed and dated by the referring practitioner [which can be by an electronic signature])" (MN.6.3).
The two documents do different jobs. The plan is the GP's or prescribed medical practitioner's assessment and management document, prepared under the plan items listed in AN.0.78 (2700, 2701, 2715 and 2717, among others). The referral is what entitles the client to a Medicare benefit for your service. With the client's agreement a copy of the plan can be attached to the referral, but attaching it does not replace it.
So a plan arriving on its own is an incomplete file. Ask the referring practice for the referral letter before the first session, not after the first rejected claim.
What has to be on a Better Access referral?
There is no mandatory Medicare form. MN.6.3 says referring practitioners "are not required to use a specific Medicare form", but sets out what the referral should contain:
- the client's name, date of birth and address
- the client's symptoms or diagnosis
- a list of any current medications
- the number of services the client is being referred for
- a statement about whether a Mental Health Treatment Plan or a Psychiatrist Assessment and Management Plan has been prepared
The general allied health referral requirements in AN.15.6 apply on top of that list.
Two timing rules attach to the document itself. You must be in receipt of the referral at the first mental health consultation, not at the second or at the point of claiming. And you must retain it for two years (24 months) from the date the first treatment service was rendered, a shorter clock than the clinical record retention periods you already work to.
Who can write the referral?
Under AN.0.78, a Better Access referral must come from one of the following:
- a GP or prescribed medical practitioner at the general practice where the client is enrolled in MyMedicare
- the client's usual medical practitioner, meaning the practitioner (or a practitioner at the practice) who has provided the majority of their care over the past 12 months or is likely to over the next 12
- a psychiatrist or paediatrician referring directly from an eligible service, or referring under a Psychiatrist Assessment and Management Plan
How many sessions does the referral actually cover?
Medicare benefits are available for up to 10 individual and 10 group therapy mental health treatment services per calendar year, which runs 1 January to 31 December. Up to two of the 10 individual services may be used for family and carer participation items (MN.6.3, and MN.7.5).
Within that annual cap, treatment is structured in courses:
- Initial course of treatment: a maximum of six individual services.
- Subsequent course of treatment: the remaining individual services, up to the client's cap of 10 in that calendar year. The note gives the worked example directly: a client who used six services in the initial course "could only receive 4 services in a subsequent course of treatment provided within the same calendar year".
Group services sit outside that six-then-four structure. A client can be referred for up to 10 group therapy services per calendar year on any one referral.
What happens at the end of a course of treatment?
Two things, and the first is yours.
On completion of the initial course of treatment you must give the referring practitioner a written report covering the assessments carried out, the treatment provided, and recommendations on future management of the client's disorder. MN.6.2 and MN.7.4 both add that a written report "must also be provided to the referring practitioner at the completion of any subsequent course(s) of treatment". The obligation is once per course, not once per client. Our guide to writing a psychologist letter to a referring GP works through the structure.
The second is the referrer's. Once the services in the initial course are used, AN.0.78 requires a review of the plan and a new referral before further treatment. Reviews are constrained: not more than once in a three month period, and not within four weeks of the plan being prepared, unless exceptional circumstances exist. The note recommends at least one review per course of treatment, and no more than two in a calendar year for most clients. GPs use time-tiered general attendance items for the review itself.
Does a Mental Health Treatment Plan expire at the end of the year?
No, and this is the myth worth correcting with clients directly. AN.0.78 states that "a Mental Health Treatment Plan does not expire" and that a new one "should not be created unless exceptional circumstances exist", such as a significant change in the client's mental health. MN.6.3 adds that a new plan is not needed each calendar year in order to obtain a new referral. What resets on 1 January is the count of subsidised services, not the plan.
Unused services carry over, but only once. If a client has not used all the services covered by a referral within the calendar year, no new referral is needed for the leftovers. Any of those services delivered from 1 January onwards, however, count against the new year's allocation of 10. A client who carries four sessions into January has four of their new 10, not 14.
What if the referral does not say how many sessions?
MN.6.3 covers three defective cases: the referral does not specify a number, specifies more than the course allows, or specifies more than the client has left for the calendar year. In all three you must contact the referring practitioner to determine the number required.
If the referrer cannot be reached, you may use clinical judgement, provided the client does not exceed the maximum for that course or for the calendar year. Where the allocation is unknown, Services Australia can confirm what a client has already claimed on the provider enquiry line, 132 150. Providers can also view a client's plan history through Health Professional Online Services (HPOS).
Which items apply to your registration type?
Better Access splits along endorsement, not job title.
- Eligible clinical psychologists claim psychological therapy items: 80000, 80005, 80010 and 80015 face to face, with 91166, 91167, 91181 and 91182 for video and phone. Eligibility requires general registration in psychology plus endorsement in clinical psychology (MN.6.2).
- Eligible registered psychologists, along with eligible social workers and occupational therapists, claim focussed psychological strategies items. For psychologists these are 80100, 80105, 80110 and 80115 face to face, with 91169, 91170, 91183 and 91184 for video and phone (MN.7.4).
Both groups must also be registered with Services Australia to provide Better Access services, a separate step from holding a Medicare provider number.
What are the rules for group and telehealth sessions?
Individual telehealth under Better Access is permanent. The Department of Health, Disability and Ageing confirms that the MBS telehealth services introduced during COVID-19 are now ongoing, so eligible clients can receive individual video and phone services regardless of location where it is safe and clinically appropriate. Our telehealth documentation guide covers what to record for those sessions.
Group therapy by video is far more restricted. The client must be in a Modified Monash Model area 4 to 7 at the time of the consultation and at least 15 kilometres apart by road from the practitioner, and neither party may travel outside that distance in order to claim the video item. Groups run to 4 to 10 clients, though the item is still claimable where four were due to attend and one cannot.
What records does Medicare expect from the session itself?
The record keeping requirement is narrow and specific. You must keep contemporaneous notes documenting the date, time and people who attended, and, in the words of both MN.6.2 and MN.7.4, "only clinical details recorded at the time of attendance count towards the time of the consultation. Other notes or reports added at a later time are not included."
The Department runs regular post-payment auditing on these items, so the referral, the session note and the end-of-course report need to line up.
PractaLuma is AI-native practice management software for Australian mental-health practices, which means the referral, the session count against the calendar year cap and the note itself live in one record rather than three systems. Our clinical notes and AI scribe features capture the note during the session rather than after it, alongside the rest of the feature set and pricing.
Frequently asked questions
Can a client use private health insurance to top up the Medicare rebate? No. AN.0.78 states that clients cannot use ancillary cover to top up the Medicare benefit, so they choose one or the other per service. Once the calendar year allocation is exhausted they may claim from a fund with appropriate cover. Gap fees are covered in our guide to psychologist fees in Australia.
Do out-of-pocket costs count towards the Medicare safety net? Yes. Charges above the Medicare benefit are the client's responsibility, but those out-of-pocket costs count towards the safety net. Costs for services that are not Medicare eligible do not.
Which conditions are excluded from Better Access? Better Access applies to clinically diagnosed mental disorders. For these items AN.0.78 excludes dementia, delirium and tobacco use disorder from that definition, along with intellectual disability, which the note still describes in outdated terminology.
Can I see a client under Better Access if the GP has not yet claimed the plan item? Services Australia will not be aware of the client's eligibility until the referring service is claimed. AN.0.78 says the treating practitioner or allied health professional should, with the client's permission, contact the referring practitioner to confirm a relevant referring service has been provided.
This guide summarises MBS requirements current at the time of writing and is general information, not billing advice. Check the linked explanatory notes on MBS Online for the current wording, or call Services Australia on 132 150.