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

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.

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

Temporary MBS Telehealth Items for services to DVA clients

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.

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.

ahm

Funding for the provision of telehealth services for Speech Pathology will continue on an ongoing basis.

Australian Unity

Telehealth services will be covered indefinitely.

Bupa

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.

CBHS

CUA

Defence Health

Telehealth benefits for speech pathology consultations are now a standard inclusion on eligible covers.

GMHBA

GU health

Access to selected services, including speech pathology, via telehealth will be available permanently in line with level of Extras cover.

HBF 

Temporary health benefits for telehealth services have been extended until 31 December 2021. HBF have indicated the following needs to be on invoices:

  • Telehealth item number (refer to website 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).

HCF

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 HCFProviderRelations@hcf.com.au

Health Partners

Telehealth services for speech pathology services extended until further notice.

HIF

Latrobe

Latrobe Health Services will pay benefits for extras services delivered via telehealth on a permanent basis.

Medibank

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.

Note:

  • 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.

Mildura Health Fund

myOwn

nib

Telehealth rebates are "here to stay". 

Phoenix Health

Telehealth services have been extended for speech pathology services.

Police Health and Emergency Services Health

RT Health

St Lukes

Telehealth items are now permanent

Teachers Health

Telehealth items have been extended until 30th June 2021.

TUH

Funding individual or group sessions.

Westfund