Medicare Occupational Therapy (Term 4)

MEDICARE--OCCUPATIONAL THERAPY--1 Sept 2024

Medicare Benefits Schedule is found on the Australian Government website. MBS benefits are subject to change--according to MBS Online Standard Search | Medicare Benefits Schedule (health.gov.au)

Medicare (MBS) Telephone: 13 21 50 for further information

Children with an Approved Disability (Complex Neurodev; ASD) with Doctor's referral:

82010 Assessment >50 min duration (4 sessions permitted--same day): MBS Benefit: $85.20

82025 Therapy >30 min duration (20 sessions in a lifetime for under 25s): MBS Benefit: $85.20

93036 Telehealth therapy 30+ min duration (4 sessions permitted--same day): MBS Benefit: $85.20

93033 Complex neurodevelopmental disorder and approved disability telehealth services 30 min duration (4 sessions permitted--same day): MBS benefit $85.20

93041 Complex neurodevelopmental disorder and approved disability telephone services 50 min duration (4 sessions permitted--same day):  MBS benefit: $85.20

93044 Complex neurodevelopmental disorder and disability telephone services 30 min duration (4 sessions permitted--same day): MBS benefit: $85.20

Medicare Better Start for Children with an Approved Disability: Department of Health and Aged Care | Frequently Asked Questions - Better Start for Children with Disability

Case Conferences--Occupational Therapist attendance (Children with an eligible disability / complex neurodevelopmental disorder, such as ASD) with Doctor's referral:

82001 (15-19 mins) MBS Benefit: $47.35 

82002 (20-39 mins) MBS Benefit: $81.15

82003 (40+ mins) MBS Benefit: $135.00

Mental Health Care Plan (Occupational therapist approved to deliver Focused Psychological Strategies FPS) with GP referral

91173 >50 min: Telehealth: MBS Benefit $85.20

91186 >50 min: Telephone: MBS Benefit $85.20

Face to Face (Mental Health Care Plan FPS) Occupational therapist with GP referral

80135  >50 min (in rooms consultation rate): MBS Benefit $85.20

80140 >50 min (out of rooms consultation rate): MBS Benefit $109.75

80125 >20 min (in rooms consultation rate): MBS Benefit $60.35

80130 >20 min (out of rooms consultation rate): MBS Benefit $85.20

Group of 4-10 participants (Mental Health Care Plan FPS) Occupational therapist with GP referral

80145 (face-to-face), 80146 (telehealth): 60 mins duration. MBS Benefit $21.60 per person (up to 10 sessions per calendar year). Travel cost may be additional.

Case Conference--Mental Health Care Plan FPS Occupational therapist attendance invited by GP:

·    80176: 15-19 minutes: MBS Benefit: $47.35

80177: 20-39 minutes:  MBS Benefit: $81.15

80178: 40+ minutes: MBS Benefit: $135.00 

Parent/Carer session for Mental Health Care Plan--Occupational Therapy FPS (2 per year)

80141 >50 mins outside of consultation rooms: MBS Benefit: $109.75

80137  >50 mins at rooms: MBS Benefit: $85.20

91202 <20 mins Telephone: MBS Benefit: $60.35

91203 >50 mins Telephone: MBS Benefit: $85.20

91194 <20 mins Telehealth: MBS Benefit: $60.35

91195 >50 mins Telehealth: MBS Benefit: $85.20

Chronic Disease Management Occupational Therapy with GP referral:
(up to 5 sessions per calendar year--from January to December)

93000 Telehealth videoconference (20 mins): MBS Benefit: $60.35

93013 Telephone when video-conference is not available (20 mins): MBS Benefit: $60.35

10958  Face to Face (20 mins): MBS Benefit $60.35 (travel may be additional cost)

CDM Case Conference Occupational Therapist attendance: (at request of GP)

10955 (15-19 mins) MBS Benefit $47.35 

10957 (20-39 mins) MBS Benefit $81.15 

10959 (40 mins) MBS Benefit: $135.00

Chronic Disease Management Occupational Therapy--Aboriginal & Torres Strait Islander: (up to 10 sessions per calendar year) after a health check or GP Management Plan and OT referral

81330 Face to Face (20 mins): MBS Benefit $60.35 (travel may be additional cost)

93048 Telehealth (20 mins): MBS Benefit $60.35 

93062 Telephone (20 mins): MBS Benefit $60.35

BUPA CODES* (provide a description of service)

H100 - Occupational Therapy Initial Consultation

H200 - Occupational Therapy Subsequent Consult

H300 - Group assessment or therapy

H601 - Occupational Therapy Individual Initial / Referred Assessment by Teleconsultation

H602 - Occupational Therapy Individual Subsequent Treatment by Teleconsultation

Other

OT01 OT initial consult in rooms

OT07--OT subsequent consult in rooms

OT02--OT Initial consult home visit

OT08--OT subsequent consult home visit

*Private Health Insurance benefits vary according to the person's level of cover, amount used, and health fund conditions/services. 

The current Occupational Therapy rate applies. Travel may be additional if not covered in the Medicare schedule. Reports are costed at the hourly rate. Please contact me for further details. 

Sandra Kirkwood

Occupational Therapist B.Occ.Thy, B.Music, M.Phil, Grad Cert Education (Digital Learning & Leadership)

ABN 16 254 093 301
mobile 0488 624 362