Psychologists claiming private health extras through HICAPS use four item numbers: 100 (individual assessment), 200 (individual treatment), 300 (couple or family treatment) and 400 (group treatment), plus a two-digit primary condition code from 10 to 70. Telehealth uses 701 and 801. Counsellors and social workers have their own codes, and each fund decides what it pays.

Those numbers come from the HICAPS item code reference, which states that the psychology list was developed in conjunction with the Australian Psychological Society. The rest of this guide covers the condition code that trips up new front-desk staff, the telehealth and counselling variants, the Medicare overlap rule, and the setup that keeps claims from bouncing at the terminal.

What are the private health item numbers for psychology?

The current HICAPS psychologist item number guide lists four in-person items:

100: Individual Assessment (terminal description INDIVIDUAL ASSESS)
200: Individual Treatment/Management (INDIVIDUAL TRMT)
300: Couple/Family Treatment/Management (COUPLE/FAMILY TRMT)
400: Group Treatment (GROUP TREATMENT)

Notice what the descriptions do and don't say. They separate assessment from treatment, not a first session from later ones. If your first appointment is mostly intake and assessment, 100 fits. If a later session is a formal reassessment, 100 can fit again. Key the item that describes what actually happened in the room, and make sure your clinical note supports it. Our guide to writing a psychology intake assessment covers what that first-session note should contain.

One small trap: the printed PDF repeats "Individual Treatment/Management" as the full description for item 300, while the abbreviation and the HICAPS web page both say couple or family. Go by the web page.

What is the clinical code that goes with the item number?

This is the part that gets missed. The HICAPS guide says that, in addition to the item number, "a 2 digit indicator code representing the PRIMARY CONDITION must be keyed in the Clinical Code field." The seven codes are:

10: Cognition
20: Relationships
30: Behavioural Issues, Conduct
40: Behavioural Issues, Thought/Perception Disturbance
50: Adjustment
60: Affect
70: Other Psychosocial Factors not otherwise specified

The codes are based on the primary presenting issue, using the "B" level of the allied health Indicator for Intervention framework from a 2000 National Allied Health Casemix Committee report. They are deliberately broad. Depression, for example, maps naturally to 60 (Affect), and couple work to 20 (Relationships). Pick the code from your formulation, record it in the client file, and keep it consistent across the course of treatment so your claims history matches your notes.

Because the clinical code discloses something about a client's mental health to their insurer, it is worth mentioning in your informed consent process that claiming through a fund involves sharing session and condition information with that fund.

Which item numbers do you use for telehealth?

HICAPS publishes a separate telehealth item number guide for psychologists, dated October 2025. The two fund items are:

701: Individual Initial/Referred Assessment by teleconsultation
801: Individual Subsequent Treatment by teleconsultation

The same document also lists a long run of five-digit numbers such as 91166, 91167, 93331 and 93351. Those are Medicare Benefits Schedule items, several of them written around COVID-19 public health orders. They are not fund codes, and keying one into an extras claim will not work.

Two practical points. First, not every fund or policy pays for telehealth psychology, so check before the session rather than after. PACFA's guidance for counsellors puts it plainly: "Ensure your client's health fund accepts telehealth claims." Second, a telehealth session still needs the same documentation standard as a face-to-face one. Our telehealth documentation guide covers what to record.

What item numbers do counsellors and social workers use?

If your practice employs more than psychologists, your front desk needs more than one code list.

Social workers (psychological therapies), from the same HICAPS guide:

110: Initial Consultation
210: Subsequent Consultation
310: Couple or Family Therapy
410: Group Consultation
711: Individual Initial Referred Assessment by Teleconsultation
811: Individual Subsequent Treatment by Teleconsultation
812: Couple or Family Attendance by Teleconsultation

Counsellors and psychotherapists registered with PACFA use a different series, published on PACFA's private health funds page:

500: Individual consultation
600: Couple or family consultation
700: Group consultation
800: Individual telehealth consultation
900: Couple or family telehealth consultation

PACFA lists agreements with Bupa, Medibank and ahm, HCF and the ARHG group of funds, and says PACFA clinical registration is a requirement of all of them. Its page also states that provider numbers are cancelled if membership is not renewed by 31 July each year, and that a current first aid certificate and professional indemnity cover are compulsory. A counsellor's claims can fail on 1 August for reasons that have nothing to do with the session.

Can a client claim Medicare and private health for the same session?

No. Medibank's guide to mental health treatment costs states it directly: "you can't claim both Medicare and private health insurance for the same appointment."

What clients can do is use each for different sessions. The common pattern is Medicare rebates under a mental health treatment plan until the calendar-year allocation runs out, then extras cover after that, or extras cover from the start for clients who don't want a GP referral. Our posts on psychologist fees and rebates and mental health treatment plan referrals cover the Medicare side, including the 2026-27 rebate amounts.

For the practice, the risk is administrative: a session billed to Medicare and then swiped on a HICAPS terminal as well. The fix is to record the funding source on every appointment before it is invoiced, not at the terminal.

How much do funds pay for psychology?

It varies by fund, by policy and sometimes by state, and funds change benefits during the year. As one real example, Bupa's Top Extras information statement (single cover, NSW and ACT) shows at the time of writing:

a 2-month waiting period for psychology
a $450 per policy annual limit, shared with acupuncture, Chinese medicine and exercise physiology
example maximum benefits of $120.00 for an initial visit and $101.50 for a subsequent visit

Two things follow for your fee conversations. A shared limit means a client who has already used acupuncture this year may have less psychology cover than they expect. And the benefit is paid against the fund's own schedule, not your fee, so the gap is whatever is left. Encourage clients to check their policy's Private Health Information Statement on privatehealth.gov.au before booking a run of sessions, and put that advice in your cancellation and fees policy.

Why do psychology health fund claims get rejected?

Most rejections trace back to a short list of causes, each of which can be checked before the client is in the chair.

The fund or policy doesn't cover the profession. Tyro Health's list of supported professions places psychology, counselling and accredited mental health social work among professions "supported by some, but not all health funds".
The provider number isn't registered with that fund or terminal. Each practitioner needs a provider number recognised by the fund, and it has to be set up on the terminal you are swiping through.
The clinical code is missing. The item number alone is not a complete psychology claim on HICAPS.
Telehealth isn't accepted by that fund or policy.
Waiting periods or annual limits have not been served or have already been used.
The session was already claimed through Medicare.

A two-minute eligibility check at booking, with the client's fund name, membership number and a note of whether the session is Medicare or extras, removes most of these.

How should a practice set up for health fund claiming?

For a new or growing practice, the checklist is short:

Get a HICAPS or Tyro HealthPoint terminal, and register every practitioner's provider numbers on it. Our guide to starting a private psychology practice covers where this fits in the setup sequence.
Keep the code list for each profession you employ at the front desk: psychology (100 to 400, 701, 801), social work (110 to 812) and counselling (500 to 900).
Record the primary condition code once, from the formulation, and reuse it.
Store each client's insurer, member ID and policy number on their record, and flag the funding source on every appointment.
Reconcile fund payments against invoices weekly, so a rejected claim is followed up while the client still remembers the session.

PractaLuma is AI-native practice management software for Australian mental-health practices. It stores clients' private health details on their record, handles invoicing, and supports Medicare and DVA claiming through its Tyro Health integration. Private health fund claims themselves still run through your HICAPS or HealthPoint terminal. See the full feature list or pricing.

FAQ

Is item 100 only for the first session?

No. The HICAPS description is "Individual Assessment", not "initial consultation". Use 100 when the session is an assessment and 200 when it is treatment or management, whichever number session it is.

Do clients need a GP referral to claim psychology on extras?

Generally no. Referrals and treatment plans are Medicare requirements. Medibank, for example, says members don't need a mental health treatment plan to claim psychology on its extras cover. Other funds set their own rules, so check the policy statement.

Are the item numbers the same for every fund?

The HICAPS list is the standard set used for psychology claims through HICAPS terminals. What each fund pays against those items, and whether it covers telehealth, differs by fund and policy.

Can a provisional psychologist claim private health rebates?

That depends on the fund's provider recognition rules, which are not published in the HICAPS guide. Ask each fund directly before offering rebates to clients.

This article is general information for practice administration, not financial or legal advice. Item numbers and fund rules change; confirm current codes with HICAPS, Tyro Health or the relevant fund.

Private Health Insurance Item Numbers for Psychology (2026)