Private Health Telehealth Codes

Download a PDF version here.

Current 27 April 2020

As we have previously reported, most private health funds are allowing Telehealth consultations for psychology during the COVID-19 period. Unfortunately, the process for claiming is not universal. We have prepared the following information to assist our members and their clients.

Eligibility

To be eligible to provide psychological services via telehealth, Private Health Care Australia has set the follow stipulations:

  • The patient is undergoing an existing course of treatment, and has seen the psychologist providing the teleconsultation over the past six months, or

  • For new patients, the telepsychology service has been recommended by their general practitioner, and

  • The service is delivered before 30 September 2020, and

  • The service is undertaken in accordance with Australian Psychological Society guidelines.

  • Telehealth Considerations For Providers in open source format on their website. You can access this here.

  • The Code of Ethics is also open source and found here

 

Once you have the basics of compliance covered as above, each fund has different claiming procedures for members to get rebates for Private Health.

Rebates will also be dependent on the level of cover your client has.

HICAPS Codes Released

The codes that HICAPS has put out for providers to use are

701 – Individual Initial/Referred Assessment by teleconsultation (INDIVID INIT ASSESS T/C)

801 – Individual Subsequent Treatment by teleconsultation (INDIVID SUB TRMT T/C Funds that are HICAPS Participating Health Funds for Telehealth are;

• ACA Health

  • Australian Unity

  • Bupa

  • CBHS

  • CBHS

  • Defence Health

  • GMHBA

  • GU Health

  • Health.com.au

  • Nib

  • Nurses Midwives Health

  • Queensland Country Health Fund

  • RT health

  • St Lukes health

  • Teachers health fund

  • Transport health

  • Westfund.

    Under these exceptional and temporary circumstances, for the COVID-19 items only, Providers must document in the clinical notes of the patient that they have received in writing, by email or verbally through the technology the following:

  • Authority to submit the claim to the patients’ health fund on their behalf

  • confirmation from the patient that they give authority to the Health Fund to

    verify any aspect of this claim including through provision of treatment

    records

  • declaration that the service/s being claimed for has been provided to the

    person listed on the policy, and are not subject to Medicare reimbursement or any other form of compensation, and do not knowingly breach fund rules.

    Health funds may investigate potentially fraudulent claims by seeking to verify that the service was provided to a patient. These requirements are incorporated within the existing obligations under the current HICAPS Provider Terms and Conditions. For further information, please refer to this

    link: https://www.hicaps.com.au/forms/HICAPS_Agreements
    The Practitioner can then initiate the claim through the terminal by

    following the instructions below on how to key enter the card number:

    https://www.hicaps.com.au/coronavirus/How_To_Claim

 

Individual Fund Claiming

AHM

Individual Initial/Referred Assessment- Psychology 701

Individual Subsequent Treatment by- Psychology 801

Please note, in response to COVID-19, AHM has introduced new, temporary codes for teleservices. These codes are effective from 30/03/2020 until 30/09/2020 and our members with eligible levels of cover will be able to claim for these services online.

If you have any questions, please call our Provider Team on 134246, emailinfo@ahm.com.au<mailto:info@ahm.com.au> or visit ahm.com.au/providers.<http://www.ahm.com.au/providers>

Australian Unity

Member can claim the rebate themselves if they have an itemised receipt that indicates telehealth services were provided.

BUPA

Itemise the receipt and use the old codes for Initial Assessment and Subsequent Consultation.

CBHS (corporate and health)

Please give clients a fully itemised invoice using face to face item numbers. You need to quote telehealth on the invoice or in the description field. Member can then send to claims@cbhs.com.au

CUA

CUA has advised that psychologists can use the old codes but need to state on the receipt that services were provided by telehealth.

Defence Health

Are covering Initial Assessment and Subsequent Sessions via Telehealth. They have advised that members can claim on their website or app for any services prior to April

27. From that time providers will be able to claim via Hicaps. Invoices
must state that the session was provided via telehealth and whether it was via video or phone and include details about the length of the consultation.

GMHBA

GMHBA has advised that they have no specified item numbers for Telehealth services. The procedure they would like followed is to put it through as per usual. Itemise any receipts stating telehealth services were provided.

GU Health

GU Health is happy to provide coverage for Telehealth Psychology services under the standard Hicaps and psychology item numbers for psychology consultations.

Please indicate on the invoice in words that the claim has been done as a Telehealth service but just bill as per normal in regards to items. Other standard rules will still apply, such as needing the provider number on the itemised invoice, and the service needing to be done within Australia.

If you need any further assistance, please call your Member Relations Team on 1800 249 966 between 8.30am and 5pm (AEST) Monday to Friday, or email corporate@guhealth.com.au.

HBF

Treatments covered – Psychology, Clinical Psychology via phone or video conference. Covers individual treatment, couples treatment, family treatment for at least 30 minutes.
Information that must be included on the receipt – delivery method (phone or video), start and end time, duration of session.

Psychology Codes;
• SPSTE Individual consultation telehealth – at least 30 minutes via phone or

video.
Clinical Psychology codes;

  • Y701 Individual Assessment Telehealth – at least 30 minutes via phone or video

  • Y801 Individual Treatment and Management Telehealth – at least 30 minutes

    via phone or video

  • Y301 Couple or Family Treatment Telehealth – at least 30 minutes via phone

    or video

    HCF

    HCF has advised they are not currently funding telehealth for private practice psychology.

    Health Partners

    Continue your current billing practices. Use current item numbers and itemise the receipt to indicate telehealth service.

    

HIF

Hif have advised that they are covering Telehealth consultations for Psychology. Claiming codes are;
Initial consultation 701
Subsequent consultation 801

The health fund member will need to manually submit their claim with a claim form and an itemised invoice that specifies the item number and that the service was provided via telehealth.

LaTrobe

La Trobe have advised that the HICAPS code for providers to use is A9131.

Medibank

Initial telehealth Individual Assessment code 701 Subsequent telehealth Consultation 801

Mildura Health Fund

701 Individual Initial/Referred Assessment by teleconsultation (INDIVID INIT ASSESS T/C)
801 Individual Subsequent Treatment by Teleconsultation (INDIVID SUB TRMT T/C)

My Own

We do not require item number at this stage for tele-consultation, as long as it is not Medicare item number. You can continue to use the 100, 200 for consultation. However, if it is a tele consultation, please change the service description to reflect this.

NIB

Must note Telehealth Psychology on the receipt. Initial Consultation code 701
Subsequent Consultation code 801

Phoenix Health

Have advised there are no codes for telehealth and to ensure that it is identified on the receipt that services were provided by telehealth. Member can then claim their rebate through their online claim process.

RT Health Fund

RT Health are providing rebates for Telehealth Psychology Consults to members. They would like an itemised receipt and the member will put this claim through in their usual way.

St Lukes Health

Have advised they are unable to provide item numbers that are utilised internally. However, please indicate on the invoice that the service is provided via the platform ‘Telehealth’ as this satisfies a key criteria for the fund to processes a claim relating to telehealth consultations. Additionally, the Governments COVID-19 Telehealth items can be added to the invoice.

Teachers Health Fund

Item 701 Individual Initial/Referred Assessment by teleconsultation (short description INDIVID INIT ASSESS T/C)
Item 801 Individual Subsequent Treatment by Teleconsultation (Short description INDIVID SUB TRMT T/C)

Transport Health

This fund has not determined whether they are going to participate in telehealth. We may have more information in 1 week and will update you then.

TUH

TUH has advised to use the old HICAPS codes (100 and 200) or provide an itemised receipt to the fund member specifying telehealth.

Westfund

Can be claimed using HICAPS. Members can also claim online or call 1300 937 838 or email enquiries@westfunds.com.au