COVID-19: Medicare, DVA and Private Health Funds

This diagram explains the rebates available to speech pathologists for telehealth Download a PDF that outlines the rebates for telepractice.

On this page Speech Pathology Australia has provided information on the response to COVID-19 as it relates to the following:

Medicare

Temporary Telehealth Medicare Items for COVID-19

The MBS telehealth items as result of COVID 19 Information Sheet provides a summary and links to important information from the Department of Health about the new temporary telehealth items introduced as a result of COVID-19. View the MBS telehealth items as result of COVID 19 Information Sheet This graphic is associated with the hyperlink that precedes it and indicates the document is in PDF.This is an amimated Gif that flashes the word updated in black out of a yellow background.

The information could change in response to the circumstances and advocacy work that the Association is continuing to do at this time.

Members should continue to check MBS Online, the latest News for MBS Online, and updates on the Medicare, DVA and Private Health Funds page this website, to ensure they are aware of the most recent information in this area.

The Department of Health provides an email advice service for providers seeking advice on interpretation of the MBS items and rules and the Health Insurance Act 1973 and associated regulations. Members with a query relating to the COVID-19 telehealth items should use this email COVIDResponse@health.gov.au

For all other queries relating to all other items in the Schedule use this email askMBS@health.gov.au

HICAPS

HICAPS and telehealth

HICAPS has extended its telehealth support by enabling telehealth services for speech pathology services (in addition to the new temporary MBS item codes) via the HICAPS terminal. The following information is on the HICAPS website

  • Step by step guide to performing a manual/key entry claim transaction
  • A list of Participating health funds ( as not all health funds are currently supporting this via HICAPS – this list is being updated as more PHFs approve this process)
  • Telehealth Item number guides
  • FAQ’s.

Department of Veterans' Affairs

UPDATES: MBS telehealth item billing and DVA sessions via telehealth (please read through all of this post) 1 April 2020

BREAKING NEWS: Medicare items and gap payments for telehealth items

The Association has been informed that gap payments will be able to be charged alongside the new MBS telehealth item numbers. No details are available on the MBS website so we will inform members of any details as soon as they are announced. DO NOT start charging gap payments until we have this formal announcement and details that can be shared about how this process will be managed. Hopefully this will be soon. This is a result of the advocacy done by SPA and AHPA.

DVA updates to fee schedules to allow clients to access allied health services via telehealth

Allied health providers are able to claim for telehealth items from 1 April 2020 until 30 September 2020.

In response to the COVID-19 pandemic, consultations and clinical assessments may be delivered by speech pathologists to all eligible DVA clients via telephone or video conferencing attendance for the period 1 April to 30 September 2020.

Telehealth services may only be provided if the full service can be delivered safely and in accordance with all relevant professional standards and clinical guidelines.

The updated fee schedule for speech pathologists that incorporates the telehealth items and information about determining if it is clinically appropriate to deliver a service via telehealth can be found on the Department of Veterans’ Affairs website.

Private Health Funds (updated)

As a result of the advocacy work done recently, the Association is aware that Private Health Funds (PHFs) are announcing that customers who have extras cover for speech pathology will be able to make a claim for speech pathology services delivered via telehealth.

Below is a list of providers and details if they have announced changes to billing. This page will continue to be updated as more information is made available. Some PHFs have provided information, particularly in regards to billing codes, directly to the Association. This information is listed below.

The Association recommends that members providing services that attract a PHF rebate are familiar with individual PHF provider rules around billing as there are variations amongst PHFs. These include:

  • Different item codes
  • Start and finish dates for services to be provided via telehealth
  • Referral requirements for new clients
  • Sessions being for individual (and not group) consultations.

The Association is continuing to work with individual PHFs about telehealth items both during COVID 19 and after the pandemic period.

ahm

  • 501: Individual Initial/Referred Assessment by teleconsultation 502: Individual subsequent treatment by teleconsultation

Australian Unity

Bupa

  • 501: Individual Initial/Referred Assessment by teleconsultation
  • 502: Individual subsequent treatment by teleconsultation

Cover is available for:

  • clients undergoing an existing course of treatment or has been a patient of the clinic/health professional in the past six months, new patients where there is preference is for a referral from treating specialist or GP.
    (NB. The clinician should use their clinical reasoning to determine if the patient is clinically appropriate to receive the service via telehealth and must work within their scope of practice and the service is undertaken in accordance with each profession’s telehealth policy and guidelines. Provider queries relating to Medibank can be directed to the Medibank provider help desk.).

CBHS

CUA

Defence Health

GMHBA

GU health

HBF

HBF will fund individual treatment provided via video conference. For initial individual consults/assessments, the service duration must be at least 45 minutes. For subsequent individual consults/treatment, the service duration must be at least 30 minutes.

The treatment must be delivered by an HBF Approved Provider and Medicare benefits must not be payable for the treatment. The telehealth treatment must be delivered via synchronous communication (i.e. in real time) and in accordance with the relevant association and/or industry guidelines. Normal waiting periods, benefits, limits and exclusions apply. Some additional exclusions (including group consults and classes) also apply.

In addition to normal requirements outlined in the HBF Approved Provider Terms & Conditions, telehealth accounts issued by providers must clearly indicate:

  • Delivery method – i.e. video conference
  • Treatment start and end times (e.g. 1 pm to 1.30 pm)
  • Duration (e.g. 30 minutes).

Queries: (08) 9265 8878 or email AncillaryProviders@hbf.com.au

  • 501: Individual Initial/Referred Assessment by teleconsultation at least 45 min via video/p>
  • 502: Individual subsequent treatment by teleconsultation 30-45 minutes
  • 503: Individual Subsequent Treatment Telehealth >45 minutes over 45 minutes

HBF has created some resources to share with providers to promote their paying telehealth benefits for speech pathology services and encourage clients that are fund members to take up the temporary benefits. Details can be found in the attached documents:

HCF

Health care providers conducting their consultation by telehealth must complete and sign the HCF Provider Telehealth claim form and attach it to their invoice so HCF members can claim. Download the HCF Telehealth Extras Claim Form (available until 30 June 2020).

  • 501: Individual Initial/Referred Assessment by teleconsultation
  • 502: Individual subsequent treatment by teleconsultation

Applies to services delivered between 30 March and 30 June 2020 (with the latter date subject to further review during the period).

Queries: 1300 799 275 or email HCFProivderRelations@hcf.com.au

Health Partners

HIF

  • 501: Individual Initial/Referred Assessment by teleconsultation
  • 502: Individual subsequent treatment by teleconsultation

Latrobe

Medibank

  • 501: Individual Initial/Referred Assessment by teleconsultation
  • 502: Individual subsequent treatment by teleconsultation

Cover is available for:

  • clients undergoing an existing course of treatment or has been a patient of the clinic/health professional in the past six months.
  • new patients where there is preference is for a referral from treating specialist or GP.

(NB. The clinician should use their clinical reasoning to determine if the patient is clinically appropriate to receive the service via telehealth and must work within their scope of practice and the service is undertaken in accordance with each profession’s telehealth policy and guidelines. Provider queries relating to Medibank can be directed to the Medibank provider help desk.)

Mildura Health Fund

myOwn

NIB

  • 501: Individual Initial/Referred Assessment by teleconsultation
  • 502: Individual subsequent treatment by teleconsultation

Phoenix Health

Police Health and Emergency Services Health

  • Existing codes 310 and 340 but clearly mark the service as telehealth

RT Health

St Lukes

Teachers Health

TUH

Westfund