COVID-19: Medicare, DVA and Private Health Funds
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: continuing advocacy to improve access to services
On 13 December, Minister Greg Hunt announced that MBS telehealth items would be made permanent. This media release also discussed amendments to MBS items for allied health including, “improving access to complex allied health services for children and young adults living with disabilities and pervasive developmental disorder…” These are consistent with the Medicare Benefits Schedule Review Taskforce’s recommendations in response to a report from the Allied Health Reference Group.
The following recommendations are of particular interest to the speech pathology profession:
- Recommendation 6: Improve access to paediatric allied health assessments
- Recommendation 7: Improve access to complex paediatric allied health assessments for children with potential ASD (Autism Spectrum Disorder), CND (Complex Neurodevelopmental Disorder), or eligible disability diagnosis
- Recommendation 10: Improve access to M10 items for patients with severe speech and language disorders
- Recommendation 11: Improve access to the ASD and eligible disability assessment to people under 25
- Recommendation 12: Improve allied health collaboration during assessments.
Speech Pathology Australia has sought clarification from the Department of Health on the status of these and have learned that Recommendations 6, 7, 11, and 12 are being actioned by the Taskforce.
The Association continues to advocate for these and Recommendation 10 (specific to Autism, Pervasive Developmental Disorder and Disability Services) and will share updated information with members as it becomes available.
Aboriginal and Torres Strait Islander Australians
Temporary MBS items available to allied health practitioners to deliver health services for Aboriginal and Torres Strait Islander Australians residing in Residential Aged Care Facilities
To access these allied health services, the client must have had a health assessment. The temporary COVID-19 MBS items are available until 30 June 2022. The item code for speech pathology services is 81360.
Further information available online.
MBS Telehealth Items Extended to 31 December 2021
The Federal Government have announced that Temporary MBS Telehealth Items will be extended to 31 December 2021. This extension is part of the 2021-22 Budget in which the Government is investing more than $114 million to extend Telehealth until the end of the year. Prior to this announcement, the temporary telehealth items were scheduled to end 30 June. Read the Minister for Health and Aged Care’s media release.
There are different item numbers for telehealth sessions. The telehealth item numbers should be used on invoices and receipts.
- 93000 should be used for telehealth sessions using video conferencing.
- 93013 for telehealth sessions provided over the phone when videoconferencing is not available.
Members can find updated information and item numbers on the MBS Online webpage.
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
Department of Veterans' Affairs
DVA temporary telehealth arrangements
DVA has re-introduced temporary telehealth arrangements for allied health providers delivering consultations to eligible Veteran Card holders. Under these arrangements speech pathologists will be able to deliver the first consultation of each treatment cycle by telehealth during the period between 1 January and 30 June 2022. These arrangements are a temporary change to the permanent telehealth services introduced on 1 January 2022.
Speech pathologists can find information about the claiming rules for both permanent and temporary telehealth arrangements under DVA’s allied health care arrangements at Notes for Allied Health Care Providers and the Schedule of Fees for Speech Pathologists.
MBS telehealth item billing and DVA sessions via telehealth 1 April 2020
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.
Private Health Funds (updated 27 May 2021)
As a result of the advocacy work, 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 and links to relevant information on their websites. This page will continue to be reviewed and updated.
Telehealth codes typically used by PHFS are
- 501 – Individual Initial /Referred assessment by teleconsultation
- 502 – Individual subsequent treatment by teleconsultation
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 as well as different item codes and varying dates around when rebates will be provided for telehealth services.
The Association is continuing to work with individual PHFs about telehealth items both during COVID-19 and after the pandemic period.
Funding for the provision of telehealth services for Speech Pathology will continue on an ongoing basis.
Telehealth services will be covered indefinitely.
Bupa has announced that they have made a long term commitment to providing rebates for speech pathology services delivered via telehealth.
See Bupa’s telehealth guidelines for providers.
Telehealth benefits for speech pathology consultations are now a standard inclusion on eligible covers.
Access to selected services, including speech pathology, via telehealth will be available permanently in line with level of Extras cover.
HBF have permanently extended telehealth benefits for speech pathology services up to available limits provided that the service being claimed is delivered in line with HBF’s telehealth criteria; normal Waiting Periods apply.
In addition to HBF’s standard invoicing requirements outlined in the HBF Approved Provider Terms and Conditions, providers must issue the member with an invoice that clearly specifies:
- Refer to HBF Telehealth item number for item numbers
- Delivery method (i.e. video call)
- Duration (must be at least 45 minutes for an initial consult or at least 30 minutes for a subsequent consult for a benefit to be paid).
Questions, email HBF or telephone 1300 810 475 on Monday – Friday, 8 am – 4 pm AWST.
HCF are currently updating their website but have indicated verbally that telehealth services for speech pathology services will be extended until end 2021.
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.
Queries: 1300 799 275 or email [email protected]
Telehealth services for speech pathology services extended until further notice.
Latrobe Health Services will pay benefits for extras services delivered via telehealth on a permanent basis.
Funding for the provision of telehealth services for speech pathology will continue on an ongoing basis .Provider queries relating to Medibank can be directed to the Medibank provider help desk.
- 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.
- The service is undertaken in accordance with each profession’s telehealth policy and guidelines.
- The suitability of the telehealth modality is decided upon by the clinician in consultation with their client (including client’s access to technology and comfort levels with telehealth as a substitution for face to face services).
- The clinician and the client are both located in Australia at the time of the service provision.
Telehealth rebates are "here to stay".
Telehealth services have been extended for speech pathology services.
Telehealth items are now permanent
Telehealth items have been extended until 30th June 2021.
Funding individual or group sessions.