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Better Access (Mental Health Care Plan)

Better Access is the Medicare scheme that subsidises psychology, occupational therapy (mental health), and accredited mental health social work for Australians with a diagnosable mental health condition. It's the scheme most Praxi practitioners bill against, and the one with the most moving parts — eligibility, referrals, an annual cap, a mid-treatment GP review, and telehealth-specific item numbers.

Official sources (Services Australia / Health):

Default annual session caps and official source URLs are maintained in Praxi’s Medicare configuration and mirrored in this page for practitioners.

This page is the practitioner's end-to-end reference. It walks through the full workflow from the client's first GP visit through to their final session of the year.

What Better Access is​

Better Access is a Medicare-funded scheme introduced in 2006 to improve access to mental health treatment. It allows eligible patients to claim a Medicare rebate on a capped number of sessions per calendar year with registered providers, after a GP assessment.

The scheme covers:

  • Psychology — both General Registration and Clinical Psychology endorsement.
  • Occupational Therapy — OTs with AHPRA registration and a mental health endorsement.
  • Mental Health Social Work — AASW accredited Mental Health Social Workers.

Other allied health professions (e.g. physiotherapy, dietetics) are not part of Better Access. They access Medicare through the separate EPC / Chronic Disease Management pathway.

Who is eligible​

Eligibility is determined by the patient's GP, not the receiving practitioner. The GP assesses the patient and decides whether to issue a Mental Health Treatment Plan (MHCP). The patient must:

  • Hold a current Medicare card (Australian citizen, permanent resident, or visa-eligible).
  • Have a diagnosable mental health condition that the GP considers will benefit from focussed psychological intervention.

There is no age limit. Children, adolescents, adults, and older adults are all eligible. For children under 13, parental or guardian consent processes follow the same Family Law Act rules Praxi enforces across the rest of the clinical record.

The annual cap​

Service typeAnnual cap
Individual sessions10
Group sessions10
Family/carer sessions (count toward individual cap, max 2)—

The caps reset on 1 January each calendar year. They do not roll forward. A session claimed on 31 December counts against the prior year; a session on 1 January starts the new year's count.

A client can claim up to 10 individual + 10 group sessions in the same calendar year — they're separate caps. Family/carer sessions (item 80165 and equivalents) count toward the individual cap, capped at 2 per calendar year.

Praxi tracks session usage automatically via SessionTracking keyed by the client's Medicare HMAC, the calendar year, and your organisation. The count is shown on the Medicare Submit Sheet before every claim and on the client's Profile → Funding & Referrals section.

If a claim would exceed the cap, Praxi blocks submission with a session-limit rejection.

The full workflow​

Step 1 — Client books with GP for MHCP assessment​

The client visits their GP and discusses mental health concerns. The GP conducts an MHCP assessment — typically a longer consultation, often using items 2700, 2701, 2715, or 2717 from the GP MBS schedule. The GP assesses diagnosis, documents treatment goals, and decides whether to issue an MHCP.

Step 2 — GP issues the MHCP and referral letter​

If the GP determines the client is eligible, they produce two documents:

  • The MHCP / MHTP — the formal Mental Health Treatment Plan. Under current scheme rules the plan itself does not carry a hard 12-month statutory expiry (Praxi does not auto-expire MHTPs). Session claiming is still limited by the calendar-year Better Access caps and by a valid referral.
  • The referral letter — names the receiving practitioner (you or your practice) and authorises a course of treatment (typically up to 6 individual services for the initial course; subsequent courses use remaining sessions up to the calendar-year maximum of 10). Keep the letter on file for claiming.

The GP gives the documents to the client (or sends them directly to your practice if they have a referral pathway set up).

Step 3 — Client books with the receiving practitioner​

The client contacts your practice to book. At booking, your reception or intake team captures:

  • Client identification details (including Medicare card number and IRN).
  • Funding source — set to Medicare with sub-type Better Access.
  • The referring GP's name and provider number.
  • The MHCP and referral letter — upload as part of intake, or capture in the first session.

If the client doesn't have the MHCP or referral letter at booking, Praxi flags the funding source as "Better Access — referral pending" so you know to capture the documents before the first claim.

Step 4 — Pre-session verification​

Before the first appointment, run an OPVW (online patient verification) check to confirm the client's Medicare card details against SA's records. Praxi runs this automatically before the first claim submission if auto-verify is enabled in your Medicare settings.

Upload the referral letter via Profile → Referrals & Funding → New Referral. The MHCP can be uploaded as a supporting document on the same record. Both documents are stored as encrypted file attachments.

Step 5 — First session and submit the claim​

After the first appointment:

  1. Open the appointment and click Create Invoice (or it's created automatically if auto-invoicing is on).
  2. Praxi's MBS item picker suggests the correct item based on session duration, mode, and your endorsement scope.
  3. Open the Medicare Submit Sheet from the invoice.
  4. Choose the claim type:
    • Bulk-billed — practitioner accepts the rebate as full payment, no gap fee. Uses BBSW. Requires DB4 bulk-bill consent (Praxi prompts).
    • Patient claim with gap fee — client pays full fee at the session, then claims the rebate back. Uses PCIW. Real-time assessment.
  5. Click Submit to Medicare.

Step 6 — GP review after 6 sessions​

After the sixth individual session, SA expects the referring GP to provide a written review letter on file before sessions 7–10 are claimed. Praxi prompts you on the seventh appointment booking with a soft warning, and hard-blocks the claim submission for session 7 until the review letter is uploaded.

The review letter is typically a short note from the GP confirming the client remains in active treatment and that the GP is monitoring progress. To add the review letter, open the client's MHCP card and click GP Letter, then attach the document.

Step 7 — Sessions 7–10​

Once the review letter is on file, sessions 7–10 are submitted using the same workflow as sessions 1–6. The session counter on the client's profile increments after each claim is Assessed by SA.

Step 8 — Cap reached​

When the client reaches the 10 individual calendar-year cap (or the 10 group cap), Praxi blocks further Better Access claims for that service type (session-limit rejection). Under current Services Australia education there is no routine “session 11–20” Better Access extension (the temporary COVID expansion ended). At this point, options for ongoing treatment are:

  • Private payment — the client pays out-of-pocket. No Medicare claim.
  • NDIS funding — if the client has an NDIS plan with mental health supports, work continues through that channel. See NDIS Invoicing.
  • Transition to a different scheme — EPC if the client has a chronic condition, DVA if they're a veteran, or WorkCover for work-related conditions.

The decision sits with the client and the referring GP. Praxi's role is to surface the cap status and enforce SA's rules at submission time.

Telehealth vs in-person​

Better Access has supported telehealth since 2020. Each in-person item has a paired telehealth item number:

In-person itemVideo equivalentTelephone equivalent
80000 (clinical endorsement, indiv. 30–49 min)9116691181
80010 (clinical endorsement, indiv. 50+ min)9116791182
80100 (general registration, indiv. 20–49 min)9116991183
80110 (general registration, indiv. 50+ min)9117091184

Group items (80020 clinical endorsement, 80120 general registration) have their own telehealth equivalents — use the MBS Item Picker, which filters to the items payable for your registration type and delivery mode, rather than mapping by hand.

Telephone-only telehealth is supported for some items but has stricter eligibility rules — confirm against the current MBS schedule before billing a phone-only session. Praxi's MBS picker filters out telephone items where the eligibility criteria aren't met.

The session mode is captured on the appointment record. The MBS picker uses it to filter to the right item number — you don't have to remember which item maps to which mode.

Group therapy​

Group items (80020, 80125, 80170) cover sessions with multiple participants, all of whom must have a current MHCP and referral. Each participant gets their own claim against their own session count.

Praxi's group session workflow captures each attendee against the appointment and generates separate invoices and claims for each. The 10 group sessions are tracked against each participant's annual group cap, separate from their individual cap.

Cancellation policy​

Medicare doesn't pay for cancellations or no-shows. If a client cancels or doesn't attend, the appointment doesn't generate a Medicare claim. Your practice's cancellation fee (if any) is charged to the client as a private payment.

Praxi's appointment lifecycle marks cancelled appointments distinctly from attended ones. Only attended appointments unlock the Medicare claim workflow.

Remote area and rural practitioners​

The Modified Monash Model (MMM) classifies geographic areas by remoteness. Bulk-bill incentive items (10990, 10991) are available where the patient is a concession card holder or a child under 16. Where both conditions apply, Praxi uses the practice location's MMM rating to select the correct incentive item (10991 for MMM 3–7 locations, 10990 for MMM 1–2 locations).

First Nations clients​

Better Access provides additional supports for Aboriginal and Torres Strait Islander clients:

  • Item 81325 — collaboration between an allied health professional and an Aboriginal health worker on care for an Aboriginal or Torres Strait Islander patient. Where applicable, this item recognises the collaborative care structure.
  • Cultural identification — clients can self-identify as Aboriginal or Torres Strait Islander on their profile. Praxi surfaces this on the appointment record so practitioners can incorporate culturally appropriate practices.

Confirm eligibility against the current MBS schedule — collaboration items have specific requirements (e.g. documented joint care planning).

Common pitfalls​

  • Wrong item for endorsement scope. General Registration psychologists who bill 80100 series items will get an item-not-payable-for-provider rejection. See MBS Item Picker for the endorsement-to-item mapping.
  • Forgotten review letter at session 7. Praxi prompts, but if you override the prompt and submit anyway, SA can return a referral rejection or hold the claim in pending review.
  • Session 11+. The 10-individual-session calendar-year cap is a hard limit — the temporary COVID extension (sessions 11–20) has ended and there is no current additional-sessions pathway. SA rejects claims beyond the cap as a session-limit breach; discuss private, NDIS or EPC options with the client instead.
  • MHCP from a prior calendar year. The MHCP itself does not expire — a client returning in January does not need a fresh plan. Their annual session count resets on 1 January, so the full 10 individual sessions are available again. Check the referral letter separately: it has its own 12-month validity and may need renewal.
  • Telehealth without an appropriate item. Phone-only telehealth has stricter rules than video. Defaulting to video items for phone-only sessions is a compliance risk.

Cross-references​

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Verified against the current Praxi product surface, MBS Better Access item range (80000–80175), and Department of Health Better Access policy on 2026-06-05.