Medicare Benefits Schedule - Item 272

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Category 1 - PROFESSIONAL ATTENDANCES

272

272 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Jul-2018
Schedule Fee Updated:
01-Jul-2021

Group
A7 - Acupuncture and Non-Specialist Practitioner Items
Subgroup
9 - Non-Specialist Practitioner mental health care

Professional attendance by a medical practitioner (who has not undertaken mental health skills training) of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

Fee: $59.70 Benefit: 75% = $44.80 100% = $59.70

(See para AN.7.1, AN.7.22 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $179.10


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.7.1

Attendances by Medical Practitioners

Items 179-181, 185-187, 189-197, 203-206, 215-287, 371, 372, 733-789, 792, 812-892, 90092-93, 90095-96, 90183, 90188, 90202, and 90212 relate to attendances rendered by a medical practitioner who is not a general practitioner, specialist or consultant physician, and who:


(a) is registered under section 3GA of the Act, to the extent that the person is practising during the period in respect of which, and in the location in respect of which, they are registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or


(b) is covered by an exemption under subsection 19AB(3) of the Act; or


(c) first became a medical practitioner before 1 November 1996. 

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 235 236 237 238 239 240 243 244 245 249 251 252 253 254 255 256 257 259 260 261 262 263 264 265 266 268 269 270 271 272 276 277 279 281 282 283 285 286 287 733 737 741 745 761 763 766 769 772 776 788 789 792 90092 90093 90095 90096 90183 90188 90202 90212

Category 1 - PROFESSIONAL ATTENDANCES

AN.7.22

Medical Practitioner Mental Health Treatment (Items 272 to 282)

This note provides information on the Mental Health Treatment items 272, 276, 277, 279, 281 and 282. It includes an overview of the items, patient and provider eligibility, what activities are involved in providing services rebated by these items, links to other Medicare items and additional claiming information.

Overview

The Mental Health Treatment items define services for which Medicare rebates are payable where medical practitioners undertake early intervention, assessment and management of patients with mental disorders. They include referral pathways for treatment by psychiatrists, clinical psychologists and other allied mental health workers. These items complement the mental health items for psychiatrists (items 296 - 299), clinical psychologists (items 80000 - 80021) and allied mental health providers (items 80100 - 80171).

The Mental Health Treatment items incorporate a model for best practice primary health treatment of patients with mental disorders, including patients with both chronic or non-chronic disorders, that comprises:

  • assess and plan;
  • provide and/or refer for appropriate treatment and services; and
  • review and ongoing management as required.

Who can provide

The GP Mental Health Treatment Plan, Review and Consultation items are available for use in general practice by medical practitioners, but excluding specialists or consultant physicians.

Training Requirements (item 281 and 282)

Medical practitioner providing GP Mental Health Treatment Plans, and who have undertaken mental health skills training recognised through the General Practice Mental Health Standards Collaboration, have access to items 281 and 282. For medical practitioners who have not undertaken training, items 272 and 276 are available. Items 272 provides for a GP Mental Health Treatment Plan lasting at least 20 minutes and item 276 provides for a GP Mental Health Treatment Plan lasting at least 40 minutes. It is strongly recommended that medical practitioners providing mental health treatment have appropriate mental health training. Medical professional organisations support the value of appropriate mental health training for medical practitioners using these items.

Which patients are eligible - Mental Disorder

These items are for patients with a mental disorder who would benefit from a structured approach to the management of their treatment needs. Mental disorder is a term used to describe a range of clinically diagnosable disorders that significantly interfere with an individual's cognitive, emotional or social abilities (Refer to the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD‑10 Chapter V Primary Care Version). Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of the Mental Health Treatment items.

These services are available to eligible patients in the community. Mental Health Treatment Plan and Review services can also be provided to private in‑patients (including private in‑patients who are residents of aged care facilities) being discharged from hospital. Where the service is provided as part of an episode of hospital treatment it must be claimed at the 75% MBS rebate - see GN.1.2. Medical practitioners are able to contribute to care plans for patients using item 231, Contribution to a Multidisciplinary Care Plan, and to care plans for residents of aged care facilities using item 232.

PREPARING A GP MENTAL HEALTH TREATMENT PLAN (Item 272, 276, 281 or 282)

What is involved - Assess and Plan

A rebate can be claimed once the medical practitioner has undertaken an assessment and prepared a GP Mental Health Treatment Plan by completing the steps from Assessment to the point where patients do not require a new plan after their initial plan has been prepared, and meeting the relevant requirements listed under 'Additional Claiming Information'. This item covers both the assessment and preparation of the GP Mental Health Treatment Plan. Where the patient has a carer, the practitioner may find it useful to consider having the carer present for the assessment and preparation of the GP Mental Health Treatment Plan or components thereof (subject to patient agreement).

Assessment

An assessment of a patient must include:

  • recording the patient's agreement for the GP Mental Health Treatment Plan service;
  • taking relevant history (biological, psychological, social) including the presenting complaint;
  • conducting a mental state examination;
  • assessing associated risk and any co-morbidity;
  • making a diagnosis and/or formulation; and
  • administering an outcome measurement tool, except where it is considered clinically inappropriate.

The assessment can be part of the same consultation in which the GP Mental Health Treatment Plan is developed, or can be undertaken in different visits. Where separate visits are undertaken for the purpose of assessing the patient and developing the GP Mental Health Treatment Plan, they are part of the GP Mental Health Treatment Plan service and are included in item 272, 276, 281 or 282.

In order to facilitate ongoing patient focussed management, an outcome measurement tool should be utilised during the assessment and the review of the GP Mental Health Treatment Plan, except where it is considered clinically inappropriate. The choice of outcome measurement tools to be used is at the clinical discretion of the practitioner. Medical practitioners using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training.

Preparation of a GP Mental Health Treatment Plan

In addition to assessment of the patient, preparation of a GP Mental Health Treatment Plan must include:

  • discussing the assessment with the patient, including the mental health formulation and diagnosis or provisional diagnosis;
  • identifying and discussing referral and treatment options with the patient, including appropriate support services;
  • agreeing goals with the patient - what should be achieved by the treatment - and any actions the patient will take;
  • provision of psycho-education;
  • a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
  • making arrangements for required referrals, treatment, appropriate support services, review and follow-up; and
  • documenting this (results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date) in the patient's GP Mental Health Treatment Plan.

Treatment options can include referral to a psychiatrist; referral to a clinical psychologist for psychological therapies, or to an appropriately trained medical practitioner or allied mental health professional for provision of focussed psychological strategy services; pharmacological treatments; and coordination with community support and rehabilitation agencies, mental health services and other health professionals.

OOnce a GP Mental Health Treatment Plan has been completed and claimed on Medicare either through items 272, 276, 281 or 282 or through GP items 2700, 2701, 2715 or 2717, a patient is eligible to be referred for up to 10 (temporarily increased to 20 until 31 December 2022) Medicare rebateable mental health services per calendar year for psychological therapy or focussed psychological strategy services. Patients will also be eligible to claim up to 10 separate services for the provision of group therapy (either as part of psychological therapy or focussed psychological strategies).

When referring patients medical practitioners should provide the information outlined under the ‘Referral’ heading below. The necessary referrals should be made after the steps above have been addressed and the patient's GP Mental Health Treatment Plan has been completed. It should be noted that the patient's mental health treatment plan should be treated as a living document for updating as required. In particular, the plan can be updated at any time to incorporate relevant information, such as feedback or advice from other health professionals on the diagnosis or treatment of the patient.

On completion of a course of treatment provided through Medicare rebateable services, the service provider must provide a written report on the course of treatment to the medical practitioner. 

Many patients will not require a new plan after their initial plan has been prepared. A new plan should not be prepared unless clinically required, and generally not within 12 months of a previous plan. Ongoing management can be provided through the GP Mental Health Treatment Consultation and standard consultation items, as required, and reviews of progress through the GP Mental Health Treatment Plan Review item. A rebate for preparation of a GP Mental Health Treatment Plan will not be paid within 12 months of a previous claim for the patient for the same or another Mental Health Treatment Plan item or within three months following a claim for a GP Mental Health Treatment Review (item 277 or GP item 2712).

REVIEWING A GP MENTAL HEALTH TREATMENT PLAN (Item 277)

The review item is a key component for assessing and managing the patient's progress once a GP Mental Health Treatment Plan has been prepared, along with ongoing management through the GP Mental Health Treatment Consultation item and/or standard consultation items. A patient's GP Mental Health Treatment Plan should be reviewed at least once.

A rebate can be claimed once the medical practitioner who prepared the patient's GP Mental Health Treatment Plan (or another medical practitioner in the same practice or in another practice where the patient has changed practices) has undertaken a systematic review of the patient's progress against the GP Mental Health Treatment Plan by completing the activities that must be included in a review and meeting the relevant requirements listed under 'Additional Claiming Information'. The review item can also be used where a psychiatrist has prepared a referred assessment and management plan (item 291), as if that patient had a GP Mental Health Treatment Plan. The review service must include a personal attendance by the medical practitioner with the patient.

The review must include:

  • recording the patient's agreement for this service;
  • a review of the patient's progress against the goals outlined in the GP Mental Health Treatment Plan;
  • modification of the documented GP Mental Health Treatment Plan if required;
  • checking, reinforcing and expanding education;
  • a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and
  • re-administration of the outcome measurement tool used in the assessment stage, except where considered clinically inappropriate.

Note: This review is a formal review point only and it is expected that in most cases there will be other consultations between the patient and the medical practitioner as part of ongoing management.

The recommended frequency for the review service, allowing for variation in patients' needs, is:

  • an initial review, which should occur between four weeks to six months after the completion of a GP Mental Health Treatment Plan; and
  • if required, a further review can occur three months after the first review.

In general, most patients should not require more than two reviews in a 12 month period, with ongoing management through the GP Mental Health Treatment Consultation and standard consultation items, as required.

A rebate will not be paid within three months of a previous claim for the same item/s or within four weeks following a claim for a GP Mental Health Treatment Plan item.

GP MENTAL HEALTH TREATMENT CONSULTATION (Item 279)

The GP Mental Health Treatment Consultation item is for an extended consultation with a patient where the primary treating problem is related to a mental disorder, including for a patient being managed under a GP Mental Health Treatment Plan. This item may be used for ongoing management of a patient with a mental disorder. This item should not be used for the development of a GP Mental Health Treatment Plan. 

A GP Mental Health Treatment Consultation must include:

  • taking relevant history and identifying the patient's presenting problem(s) (if not previously documented);
  • providing treatment, advice and/or referral for other services or treatment; and
  • documenting the outcomes of the consultation in the patient's medical records and other relevant mental health plan (where applicable).

A patient may be referred from a GP Mental Health Treatment Consultation for other treatment and services. This does not include referral for Medicare rebateable services for focussed psychological strategy services, clinical psychology or other allied mental health services, unless the patient is being managed by the medical practitioner under a GP Mental Health Treatment Plan or under a referred psychiatrist assessment and management plan (item 291).

Consultations associated with this item must be at least 20 minutes duration.

REFERRAL

Once a GP Mental Health Treatment Plan has been completed and claimed on Medicare, or a medical practitioner is managing a patient under a referred psychiatrist assessment and management plan (item 291), a patient is eligible for up to 10 (temporarily increased to 20 until 31 December 2022) Medicare rebateable allied mental health services per calendar year for services by:

  • clinical psychologists providing psychological therapies; or
  • appropriately trained medical practitioners or allied mental health professionals providing focussed psychological strategy (FPS) services.

In addition to the above services, patients will also be eligible to claim up to 10 separate services for the provision of group therapy, in line with their clinical need.

Please note if a referral does not specify whether it relates to individual or group therapy, the patient can use a referral to access either individual or group therapy treatment options. The patient should speak to their medical practitioner about their treatment needs and the type of treatment that might be suitable for their particular circumstances.

A referral for mental health services should be in writing (signed and dated by the medical practitioner) and include:

  • the patient’s name, date of birth and address;
  • the patient’s symptoms or diagnosis, including whether a GP Mental Health Treatment Plan has been completed for the patient;
  • a list of any current medications;
  • the number of sessions the patient is being referred for (the ‘course of treatment’);
  • a statement about whether the patient has a mental health treatment plan, a shared care plan (prepared on or before 30 June 2021), or a psychiatrist assessment and management plan.

It may also be useful for a referral to include a statement clarifying whether it is for group and/or individual sessions.

Where appropriate, and with the patient’s agreement, the medical practitioner can also attach a copy of the mental health treatment plan to the referral.

Including these details on a referral will assist with any auditing undertaken by the Department of Health.

Number of Sessions

The medical practitioner can decide how many sessions the patient will receive in a course of treatment, within the maximum session limit for the course of treatment. The maximum session limit for each course of treatment is set out below:

  • Initial course of treatment – a maximum of six sessions.
  • Subsequent course of treatment – a maximum of six sessions up to the patient’s cap of ten sessions (for example, if the patient received six sessions in their initial course of treatment, they can only receive four sessions in a subsequent course of treatment).
  • Additional COVID-19 sessions (only available until 31 December 2022) – a maximum of ten sessions.

The medical practitioner should consider the patient's clinical need for further sessions after each course of treatment, including through considering the written report provided by the treating practitioner. This can be done using a GP Mental Health Treatment Plan Review, a GP Mental Health Treatment Consultation or a standard consultation item.

In the instance where a patient has received the maximum number of services available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year and is considered to clinically benefit from some additional services, the patient may be eligible for Primary Health Networks (PHNs) funded psychological therapies if they meet relevant eligibility criteria for the PHN commissioned services. It is recommended that providers refer to their PHN for further guidance.

Specifying the Number of Sessions in a Referral

If the medical practitioner:

  • Does not specify the number of sessions
  • Specifies a number of sessions above the maximum allowed for the course of treatment
  • Specifies a number of sessions above the maximum allowed for the calendar year (including any sessions the patient has already received that year) 

Then the treating practitioner can use their clinical judgment to provide services under the referral, noting the patient cannot receive more than:

  • the maximum number of sessions allowed for that particular course of treatment (as set out above), and
  • the maximum number of sessions allowed in a calendar year. 

The treating practitioner must still provide a report at the end of a course of treatment in line with standard practice for these services. The referring medical practitioner should therefore consider the treating practitioner’s report on the services provided to the patient, and the need for further treatment.

Verbal Referral

A medical practitioner can verbally refer a patient for Better Access services only if:

  • in their clinical judgement they consider it is necessary for the patient to have immediate access to support from an allied mental health professional, and
  • it is not practicable in the circumstances to provide a written referral – for example, to do so would cause delays in treatment to the patient’s detriment, and
  • the allied mental health professional documents in writing that they are treating the patient based on the medical practitioner’s verbal referral, and
  • the medical practitioner provides a written referral to the allied mental health professional as soon as possible afterwards.

While waiting for the referring practitioner to provide a written referral, the treating practitioner can provide treatment according to the verbal referral until the referred number of sessions have been completed. If there is any doubt about the number of sessions the patient was verbally referred for, the treating practitioner should follow the guidance provided above under the heading ‘Specifying the number of sessions in a referral’. 

A verbal referral does not replace the requirement for the medical practitioner to review the patient’s progress (taking into account the written report from their treating allied health professional) after each course of treatment.

ADDITIONAL CLAIMING INFORMATION

Before proceeding with any GP Mental Health Treatment Plan or Review service the medical practitioner must ensure that:

  1. the steps involved in providing the service are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and
  2. the patient's agreement to proceed is recorded.

Before completing any GP Mental Health Treatment Plan or Review service and claiming a benefit for that service, the medical practitioner must offer the patient a copy of the treatment plan or reviewed treatment plan and add the document to the patient's records. This should include, subject to the patient's agreement, offering a copy to their carer, where appropriate. The medical practitioner may, with the permission of the patient, provide a copy of the GP Mental Health Treatment Plan, or relevant parts of the plan, to other providers involved in the patient's treatment.

The GP Mental Health Treatment Plan, Review and Consultation items cover the consultations at which the relevant items are undertaken, noting that:

  • if a GP Mental Health Treatment item is undertaken or initiated during the course of a consultation for another purpose, the GP Mental Health Treatment Plan, Review or Consultation item and the relevant item for the other consultation may both be claimed;
  • if a GP Mental Health Treatment Plan is developed over more than one consultation, and those consultations are for the purposes of developing the plan, only the GP Mental Health Treatment Plan item should be claimed; and
  • if a consultation is for the purpose of a GP Mental Health Treatment Plan, Review or Consultation item, a separate and additional consultation should not be undertaken in conjunction with the mental health consultation, unless it is clinically indicated that a separate problem must be treated immediately.

Where separate consultations are undertaken in conjunction with mental health consultations, the patient's invoice or Medicare voucher (assignment of benefit form) for the separate consultation should be annotated (e.g. separate consultation clinically required/indicated).

A benefit is not claimable and an account should not be rendered until all components of the relevant item have been provided.

All consultations conducted as part of the GP Mental Health Treatment items must be rendered by the medical practitioner and include a personal attendance with the patient. A specialist mental health nurse, other allied health practitioner, Aboriginal and Torres Strait Islander health practitioner or Aboriginal Health Worker with appropriate mental health qualifications and training may provide general assistance to medical practitioners in provision of mental health care.

Links to other Medicare Services

It is preferable that wherever possible patients have only one plan for primary care management of their mental disorder. As a general principle the creation of multiple plans should be avoided, unless the patient clearly requires an additional plan for the management of a separate medical condition.

The Chronic Disease Management (CDM) care plan items (items 229, 230, 231, 232 and 233, and GP items 721, 723, 729, 731 and 732) continue to be available for patients with chronic medical conditions, including patients with complex needs.

  • Where a patient has a mental health condition only, it is anticipated that they will be managed under the GP Mental Health Treatment items.
  • Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a GP Management Plan, and to manage their mental health condition through a GP Mental Health Treatment Plan. In this case, both items can be used.
  • Where a patient has a mental health condition as well as significant co-morbidities and complex needs requiring team-based care, the medical practitioner is able to use both the CDM items (for team-based care) and the GP Mental Health Treatment items.

Related Items: 272 276 277 279 281 282


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change