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Telehealth Reimbursement for Allied Health Professionals in Australia

If your private practice has been struggling to adapt to the new normal after COVID-19, you’re not alone and it seems like every day there are new regulations and a new standard that needs to be met. Every governmental department has differing regulations and requirements, and even private health insurance providers vary widely in how they reimburse Telehealth appointments.

But while you’re trying to see clients and work with new technologies, it’s important that you don’t fall behind on the financial side of your business. With this in mind, we’ve created a reference guide to help make billing and receiving reimbursement for Telehealth services easier.

1. Medicare & Telehealth Reimbursements

Medicare’s response to COVID-19 has been to introduce Telehealth items that mirror existing in-person items. These item numbers are available until the end of September 2020, but they are subject to review so you need to keep checking for updates. A full updated view of COVID-19 Telehealth MBS items is available here.

Medicare COVID-19 Telehealth Items

ServiceItem NumberRebateExisting ItemsExpiry
Telehealth attendance by an eligible allied health practitioner for chronic disease management93000$53.8010950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 1097030 September, 2020
Speech pathology, occupational therapy,
audiology, optometry, orthoptic or
physiotherapy health service provided by
telehealth attendance to a child aged under
13 years
93033$75.9582005, 82010, 8203030 September, 2020
Speech pathology, occupational therapy,
audiology, optometry, orthoptic or physiotherapy health service provided by
telehealth attendance to a child aged
under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability
93036$75.9582020, 82025, 8203530 September, 2020
Chronic disease management services c
for people Aboriginal or Torres Strait Islander descent
93048$53.8081300, 81305, 81310, 81315, 81320, 81325, 81330, 81335, 81340, 81345, 81350, 81355, 8136030 September, 2020

2. Department of Veteran Affairs & Telehealth Reimbursement

The Department of Veteran Affairs (DVA) has introduced Telehealth item numbers that are valid until the end of September 2020. For an up-to-date list, please refer to the DVA’s website.

DVA COVID-19 Telehealth Item Numbers

ServiceCodeFeeExpiry
Initial ConsultationPH10$65.3030 September, 2020
Standard ConsultationPH20$65.3030 September, 2020
Extended ConsultationPH30$69.2030 September, 2020
Subsequent Consultation – Extended PresentationsDT30$68.3530 September, 2020

3. National Disability Insurance Scheme (NDIS) & Telehealth Reimbursement

Prior to COVID-19, the NDIS had already taken steps to make funding available for occupational therapy services delivered through Telehealth. This means that providers would submit payment requests as they would usually do if they were offering face-to-face services. They have increased the price limits for a limited number of Core Supports and Capacity Building Supports by 10% to cover the cost of technical upgrades. All the details are available on the NDIS website.

IMPORTANT UPDATE: 1 July, 2020

The first stages of post-coronavirus NDIS have been announced that include the conclusion of some of the temporary measures that were made available while the pandemic was at its peak.

As of 1 July, 2020 the NDIS has:

  • Removed the temporary 10% price loading;
  • Reduced the cancellation period to previous levels, and
  • Returned the Medium Term Accommodation period to 90 days (rolled back from 180 days).

All the details are here.

4. My Aged Care & Telehealth Reimbursement

The Commonwealth Home Support Programme (CHSP) and Home Care Packages Programme (HCP) are funding allied health services through Telehealth, and have been since before COVID-19. They allow for the reimbursement of Telehealth services as is available for in-person services. The full details can be seen in the CHSP Programme Manual, or in the HCP Guide.

5. Private Health Insurance & Telehealth Reimbursement

Coverage of Telehealth for allied health professionals varies widely between health insurers, so it’s important to speak to the specific insurance provider to confirm what Telehealth reimbursements they have available.

Private Health Insurance Telehealth Items

InsurerServiceCodeExpiryReference
BupaIndividual Initial/Referred Assessment by teleconsultation81130 September, 2020HICAPS Allied
Health Item
Numbers
BupaIndividual Subsequent Treatment by teleconsultation81230 September, 2020HICAPS Allied
Health Item
Numbers
HBFIndividual Initial Assessment Telehealth. At least 30 minutes via videoT81130 December, 2020HBF Telehealth Information for Providers
HBFIndividual Subsequent Treatment Telehealth. At least 45 minutes via videoT81230 December, 2020HBF Telehealth Information for Providers
HCFHCF requires providers to complete and sign a Telehealth Extras Claim Form for members to claim30 September, 2020HCF Telehealth Extras
MedibankIndividual Initial/Referred Assessment by teleconsultation81130 September, 2020Medibank for Providers
MedibankIndividual Subsequent Treatment by teleconsultation81230 September, 2020Medibank for Providers
nibAs per face-to-face appointments30 September, 2020nib Telehealth and your cover

* * * * * * * * * * * * * * * * * * *

With nearly 70% of Australia’s healthcare funding provided by the government, it’s helpful to know that Medicare is on-board with the shift to Telehealth solutions for allied health practitioners. It’s also essential in this unprecedented time of social distancing. Reimbursements for Telehealth appointments are making it easier for providers to offer necessary services for their clients, and for patients to access the care they need. We hope this resource will make the transition smoother for private practices as we all move towards a ‘new normal’.

If you know of a private practice that is struggling to navigate Telehealth claims, please pass on this article for their reference.


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