Item 92460 — DELETED
Deleted 1 March 2024. Using this item causes claim rejection. Replace with 91876 (Carer Interview 30–45 min video).
Initial vs Follow-up Items — Billing Guide
These rules determine which MBS item to bill. Billing team follows clinician advice on item numbers — if unsure, check the MBS website before submitting.
Initial / First Consult Items BILL ONCE ONLY
These items are for initial or first consultations and can only be billed once per service episode:
| Item | Video | Description | Key Rule |
|---|---|---|---|
296 | 92437 | Initial consultation — new patient | New GP referral required. Cannot rebill unless patient discharged & re-referred. |
291 | 92435 | GP Management Plan — preparation | GP/NP referral only. Report due within 14 days. |
297 | — | Initial consultation — admitted hospital patient | In-person only. Patient must be admitted to hospital. |
299 | — | Initial consultation — home visit | In-person only. Patient seen at home or other institution. |
Follow-up Items ONGOING
These items are for all subsequent consultations after the initial assessment. Billed based on consultation duration:
| Item | Video | Duration | Our Fee | Rebate |
|---|---|---|---|---|
300 | 91827 | ≤15 min | $120 | $43.65 |
302 | 91828 | 15–30 min | $240 | $87.05 |
304 | 91829 | 30–45 min | $355 | $134.00 |
306 | 91830 | 45–75 min | $475–$535 | $179.85 |
308 | 91831 | >75 min | $595 | $211.40 |
⚠️ Item 296 Rebilling Rule
You cannot bill Item 296 multiple times for the same patient unless:
- The patient has been formally discharged from your care
- A new GP referral has been obtained
- You are seeing the patient as a new service episode
If the patient was seen within the last 24 months by the same clinician, use a follow-up item (300–308) instead. Use the eligibility checker below to verify.
💡 Staff Guidance
Billing team will always follow your advice on item numbers. If you are unsure what you are billing:
- Check the MBS Online website before entering the item number
- Ask your billing team for clarification — they're happy to help
- When in doubt, use a follow-up item (300–308) based on consultation duration
⚠️ Item 294 — Use F2F Item Number Only
When claiming Item 294 (50% fee loading for bulk-billed video telehealth in MM2–MM7 areas), always bill using the face-to-face item number:
- ✅ Correct:
304+294→ Medicare accepts - ❌ Wrong:
91829+294→ Medicare rejects
Item 294 itself carries the telehealth component. Using a telehealth item number alongside 294 double-counts and causes claim rejection. Use the Item 294 Checker below to verify eligibility.
Psychiatry — Video Telehealth
All rebates verified MBS Online 17 March 2026
| Appointment | Item | Schedule Fee | Rebate (85%) | Our Fee | OOP |
|---|---|---|---|---|---|
| Initial Assessment | 92437 | $308.30 | $262.10 | $530 | ~$268 |
| GP Mgmt Plan — Prepare | 92435 | $535.95 | $455.60 | $980 | ~$524 |
| GP Mgmt Plan — Review | 92436 | $335.05 | $284.80 | $655 | ~$370 |
| Follow-up ≤15 min | 91827 | $51.30 | $43.65 | $120 | ~$76 |
| Follow-up 15–30 min | 91828 | $102.40 | $87.05 | $240 | ~$153 |
| Follow-up 30–45 min | 91829 | $157.60 | $134.00 | $355 | ~$221 |
| Follow-up 45–75 min | 91830 | $211.60 | $179.85 | $475–$535 | ~$295 |
| Follow-up >75 min | 91831 | $248.70 | $211.40 | $595 | ~$384 |
| NDD Tx Plan under 25 | 92434 | $312.45 | $265.60 | $745 | ~$479 |
| Eating Disorder Plan | 92162 | $535.95 | $455.60 | $980 | ~$524 |
| Eating Disorder Review | 92172 | $335.05 | $284.80 | $655 | ~$370 |
| Carer interview 30–45 min | 91876 | $157.60 | $134.00 | $355 | ~$221 |
Psychiatry — In-Person (Rooms)
All rebates verified MBS Online 17 March 2026
| Appointment | Item | Schedule Fee | Rebate (85%) | Our Fee | OOP |
|---|---|---|---|---|---|
| Initial Assessment | 296 | $308.30 | $262.10 | $530 | ~$268 |
| GP Mgmt Plan — Prepare | 291 | $535.95 | $455.60 | $980 | ~$524 |
| GP Mgmt Plan — Review | 293 | $335.05 | $284.80 | $655 | ~$370 |
| Follow-up ≤15 min | 300 | $51.30 | $43.65 | $120 | ~$76 |
| Follow-up 15–30 min | 302 | $102.40 | $87.05 | $240 | ~$153 |
| Follow-up 30–45 min | 304 | $157.60 | $134.00 | $355 | ~$221 |
| Follow-up 45–75 min | 306 | $211.60 | $179.85 | $475–$535 | ~$295 |
| Follow-up >75 min | 308 | $248.70 | $211.40 | $595 | ~$384 |
| NDD Tx Plan under 25 | 289 | $312.45 | $265.60 | $745 | ~$479 |
| Eating Disorder Plan | 90260 | $535.95 | $455.60 | $980 | ~$524 |
| Eating Disorder Review | 90266 | $335.05 | $284.80 | $655 | ~$370 |
| Carer interview 30–45 min | 345 | $157.60 | $134.00 | $355 | ~$221 |
Carer / Family Interview — Full Range
| Rooms | Video | Duration | Rebate | Limit |
|---|---|---|---|---|
| 341 | 91874 | ≤15 min | $41.15 | Max 15/yr per patient |
| 343 | 91875 | 15–30 min | $82.15 | Max 15/yr |
| 345 | 91876 | 30–45 min | $134.00 | Max 15/yr |
| 347 | 91877 | 45–75 min | $174.45 | Max 15/yr |
| 349 | 91878 | >75 min | $202.45 | Max 15/yr |
Note: Item 92460 DELETED.
50-Session Stepdown
| Normal item | Stepdown | Video stepdown | Normal rebate | Stepdown rebate | Extra OOP |
|---|---|---|---|---|---|
| 300 | 310 | 91868 | $43.65 | $43.65 | $0 |
| 302 | 312 | 91869 | $87.05 | $43.65 | +$43 |
| 304 | 314 | 91870 | $134.00 | $60.90 | +$73 |
| 306 | 316 | 91871 | $179.85 | $92.55 | +$87 |
| 308 | 318 | 91872 | $211.40 | $92.55 | +$119 |
Referral Requirements
| Appointment | Who can refer | Valid | Key rule |
|---|---|---|---|
| Initial Assessment | Any GP, specialist, NP | 12 months | Standard referral letter |
| GP Mgmt Plan — Prepare | GP or NP only | 12 months | Must request assessment + plan |
| GP Mgmt Plan — Review | GP or NP only | Once/12 months | Only after 291/92435 |
| Follow-up | Original referral | 12 months | Check expiry |
| NDD Tx Plan under 25 | Any | Once per lifetime | Under 25 only |
Psychology Fees
| Session | Video Item | Rooms Item | Rebate | Fee | OOP |
|---|---|---|---|---|---|
| Better Access — Initial | 91167 | 80000 | $145.25 | $250 | ~$105 |
| Better Access — Subsequent | 91167 | 80010 | $145.25 | $250 | ~$105 |
| Private / NDIS self-managed | None | None | None | $250 | $250 |
| Extended Assessment (75–90 min) | None | None | None | $480 | $480 |
| Report Writing | None | None | None | $480 | $480 |
| Assessment Feedback (60 min) | None | None | None | $250 | $250 |
| DBT Skills Group (per participant) | None | None | None | $120/pt | $120/pt |
| Neurodevelopmental Package (4 sessions + report) | None | None | None | $1,800 | $1,800 |
MHTP Rules
Must be from MyMedicare GP or usual GP (from 1 Nov 2025). Max 10 sessions/year.
Professional Benchmarks — Psychology Supervision Rates
| Body | Recommended Hourly Rate |
|---|---|
| Australian Psychological Society (APS) | $318/hr |
| Australian Association of Psychologists Inc (AAPi) | $330/hr |
Reference rates for professional benchmarking. Our $250/session fee sits below both recommended rates.
Psychiatric Registrar billing — onboarding pending. See Registrar page for activation checklist.
⚠️ Group A2 Items ONLY
The Registrar bills under Group A2 (OMP items) — NOT Group A8 consultant psychiatrist items. Using items 291, 296, 300–308 for the registrar will cause Medicare claim rejection.
Registrar MBS Items — Bulk Billed ($0 to patient)
| Duration | F2F | Video | Phone | Schedule Fee |
|---|---|---|---|---|
| ≤5 min | 52 | 91792 | — | $11.00 |
| 5–25 min | 53 | 91803 | — | $21.00 |
| 25–45 min | 54 | 91804 | 91903 | $38.00 |
| 45–60 min | 57 | 91805 | 91913 | $61.00 |
| >60 min | 151 | 91923 | — | $98.40 |
Financial Consent Summary
Fee − Rebate = Gap. Use this to generate a clear breakdown for patient consent.
Out-of-Pocket Calculator
Session Counter — 50-Session Stepdown
24-Month Rule — Item 296 Eligibility
Item 296 (Initial Assessment) is blocked if the patient was seen by the same clinician in the last 24 months.
Item 291 — 14-Day Report Deadline
GP Management Plan report must be completed within 14 days of the Item 291/92435 appointment.
Safety Net Tracker
Track patient progress toward Medicare Safety Net thresholds (OMSN & EMSN).
Better Access Endorsement Check — Item 80010
Verify clinician endorsement before billing Item 80010/91167.
Reports & Special Assessments
| Type | Fee | Notes |
|---|---|---|
| NDIS Psychiatric Report | $530–$745 | Admin arranges |
| WorkCover / CTP Report | $530–$745 | Confirm QLD registration first |
| IME / Medico-Legal | $980 (AMA AJ300) | Legal/insurer funded |
| Fitness to Drive | $530 | Private |
| Second Opinion | $530 | Standard 92437/296 items if GP referral exists |