The two item numbers
Medicare classifies psychology sessions by the provider's registration, not by the problem you bring. Item 80110 covers focussed psychological strategies delivered by a registered psychologist in consulting rooms, with a schedule fee of $119.45 and a benefit of 85 per cent, or $101.55. Item 80010 covers psychological therapy delivered by a clinical psychologist, with a schedule fee of $175.30 and a benefit of $149.05.
Both items require the session to run at least 50 minutes, to be delivered individually, and to follow a valid referral. Equivalent video and phone items exist and pay the same benefit.
How the gap works
Psychologists set their own fees; the schedule fee is not a cap or a recommendation. Your out-of-pocket cost is simply the fee charged minus the Medicare benefit. Because fees vary between practices, the only reliable figure is the one your practice gives you in writing before you book.
We publish our current fee schedule on request — call 0433 819 540 or send an enquiry and we will send it with the rebate you would be eligible for.
The safety net
Out-of-pocket costs on Medicare-eligible mental health services count towards the Medicare safety net. Once the relevant threshold is passed, the Extended Medicare Safety Net increases the benefit, capped at $358.35 for item 80110 and $500.00 for item 80010. Costs for services that are not Medicare-eligible do not count towards the safety net.
Medicare or private health, not both
You cannot use private health insurance ancillary cover to top up a Medicare benefit on the same session. For any given appointment you use one or the other. Where you have used all the Medicare-funded sessions available for the calendar year, extras cover that includes psychology can be claimed for further sessions — how much depends on your level of cover.
Couples and family sessions do not attract a Medicare rebate at all, because Better Access items are for individual services. Private health extras may apply, and no referral is needed.
What is not covered
Medicare benefits are not payable where a service is funded by another Commonwealth or state program, or where you are an admitted hospital patient. Sessions beyond the annual limit of ten can be funded privately — the cap is on the benefit, not on treatment.