Gap Fee = Appointment Fee – Rebate
Below is an example of a Clinical Psychologist’s Medicare gap fee.
MEDICARE GAP FEE
Clinical Psychologist
50-min appointment
$299
Appointment Fee
Clinical Psychologist
50-min appointment
$141.85
Medicare Rebate
Clinical Psychologist
50-minute appointment
The overall investment in your mental health wellbeing depends on different factors, including the psychologist’s session fee, any funding and rebates you may be entitled to and the length of therapy.
Different psychologists have different fees. The Australian Psychological Society (APS) Recommended Schedule of Fees is used as a guide. The current recommended fee is $311 per 50-minute appointment.
Several schemes in Australia provide rebates for psychologist appointments. These include Medicare, Private Health, NDIS, DVA and WorkCover. Rebates depend on your eligibility and, at times, whether you see a General Psychologist or Clinical Psychologist.
The length of treatment depends on the number of appointments needed to achieve your goals and the frequency of the appointments. Appointments can be booked more or less often to suit your needs, e.g. weekly, fortnightly or every few weeks.
In Australia, several options are available to permanent residents, overseas visitors, and students to receive funding or partial reimbursement of psychologist session fees. Some of them include:
Medicare Rebates
The Australian government has implemented a rebate program under Medicare for people seeking treatment from a psychologist. The ‘Better Access’ program has helped Australians access affordable mental health care.
If you are experiencing a mental health disorder, you and your GP may be able to create a Mental Health Care Plan or Mental Health Treatment Plan. A Mental Health Care Plan will outline the support you need from mental health professionals when treatment is required. It should also have the goals you and your GP agreed upon and the treatment options. Your Mental Health Care Plan should include a safety plan to follow in a crisis or prevent relapse.
Your health information and treatment plan will be private. GPs can’t share your information unless you agree to it, such as if you both agree to send your Mental Health Care Plan to a mental health professional such as a Clinical Psychologist.
The Medicare rebate covers a portion of sessions with a General Psychologist and Clinical Psychologist. The out-of-pocket or gap fee will depend on the psychologist’s session fee.
As of the 1st of July 2024, the Medicare rebates are as follows:
You don’t need a Mental Health Care Plan or GP referral to see a psychologist. However, you need them to claim Medicare rebates.
To know whether you can get a Mental Health Care Plan and claim Medicare rebates, you must make a long appointment with your GP or see your psychiatrist. They will assess your eligibility and may refer you to a Psychologist under a Mental Health Care Plan. As part of the process, they may ask you to complete psychometrics, such as the K10 Anxiety and Depression test.
Eligible clients with a GP referral and Mental Health Care Plan can claim Medicare rebates for up to 10 individual sessions per calendar year.
After your appointment with a psychologist, they will invoice you the full session fee. Once the invoice has been paid in full, they can submit it to Medicare on your behalf (or you can submit it yourself). Once Medicare has assessed and approved your invoice, the corresponding rebate amount is deposited into your nominated bank account registered with Medicare, generally within 24 hours.
Medicare rebates are only available for individual therapy. Better Access does not cover the cost of psychological reports, non-attendance fees, and couples counselling.
The Medicare program covers the treatment of some of the most commonly presenting psychological conditions, such as:
Diagnostic assessments, such as ADHD or ASD assessments, among others, are not covered by the Medicare Better Access Program.
Private Health Rebates
Private Health Insurance options are available to both Australian residents and overseas students.
If you have private health insurance, you may be eligible to claim rebates for sessions with a psychologist.
Private health typically covers both in-person and online therapy sessions. These include individual therapy sessions, couples counselling and family therapy.
The level of cover and applicable waiting periods vary between insurance companies and depend on your extras cover policy.
Don’t hesitate to contact your private health insurance to determine eligibility and how much funding you can claim for psychological sessions. Your private health insurance may ask for the item code that will show on your invoice. Please see below the psychological session item codes:
100 – Initial Individual Therapy Session with a Psychologist
200 – Follow-up Individual Therapy Session with a Psychologist
300 – Online Couples Counselling / Family Therapy session with a Psychologist
701 – Initial Online Therapy Session with a Psychologist
801 – Follow-up Online Therapy Session with a Psychologist.
It is best to call your Private Health Insurance fund and find out if you are eligible, how many appointments you can claim and the exact amount of your rebates.
Suppose you can claim private health insurance rebates for appointments with a psychologist. In that case, your psychologist should be able to process your claim at the end of your appointment, and you then pay the ‘gap’ fee. Alternatively, you can claim rebates directly with your provider after the session with your psychologist, via an online portal or by completing one of their forms. You will need a copy of the invoice and receipt provided by your psychologist.
Overseas Student Cover (OSHC) Rebates
If you are an overseas student with Overseas Student Health Cover (OSHC) you may be entitled to private health insurance rebates from the following insurance companies:
Most health funds listed above provide students with a rebate similar to what Medicare offers under a Mental Health Care Plan. You may need a referral or Mental Health Care Plan from a GP to access a rebate that equals the Medicare rebate.
For more information about OSCH, visit PrivateHealth.org.au.
NDIS Funding
The NDIS scheme provides funding to eligible NDIS participants with psychological therapy and/or assessment included in their NDIS Plan. Most psychologists can work with NDIS participants who are either self-managed or plan-managed.
There are three ways to manage your NDIS funding. These include the following options:
Self-managed and plan-managed clients may access psychological services funded by NDIS from any psychologist.
The NDIS sets price limits for psychological services provided to NDIS participants. These limits specify the maximum amount a psychologist can charge for services to NDIS participants. These limits must be followed when a psychologist delivers services to patients using plan-managed or NDIA-managed funds. Check the NDIS website for the most up-to-date information on psychology services fees.
WorkCover
WorkCover Queensland typically provides support and compensation for the treatment of work-related mental health issues such as anxiety, depression, Post-traumatic Stress Disorder (PTSD), among other psychological issues. The coverage for psychological sessions may include the following:
WorkCover’s coverage varies depending on the specific circumstances of the worker’s injury or illness and the recommendations of medical professionals involved in their care. If you believe you are eligible for psychological treatment under the workers’ compensation scheme, you are to notify your employer or workplace insurer and seek guidance on how to initiate a claim with WorkCover Queensland.
WorkCover Queensland will likely require evidence to support your claim for psychological treatment, such as medical reports, treatment plans, and other relevant information. This ensures that any treatment you receive is appropriate and necessary for your recovery and return to work.
Other funding schemes and organisations in Australia that fund psychological treatment include:
If you are eligible for funding, your psychologist may need to be registered with the funding organisation for you to be able to claim rebates or seek reimbursement. It is always recommended to check with your psychologist to find out.
