Medicare Benefits Schedule - Item 92116

Video attendance, by a general practitioner who has 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: $106.20 Benefit: 100% = $106.20

(See para AN.0.56 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $318.60

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Mental Health Treatment Plans and Consultation Items

Associated items: 272, 276, 281, 282, 2700, 2701, 2715, 2717, 92112, 92113, 92114, 92117, 92118, 92119, 92122 and 92123.

This note provides information on the preparation and review of Mental Health Treatment Plans under the Better Access initiative by a general practitioner (GP) or prescribed medical practitioner (PMP) at the patient’s MyMedicare registered practice or by their usual medical practitioner (refer to explanatory note AN.0.78 – Better Access Initiative).

Who can provide

The Mental Health Treatment Plan Medicare Benefits Schedule (MBS) items are available for use by a GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner

Under MyMedicare and usual medical practitioner requirements, GPs and PMPs will be able to access time-tiered professional (general) attendance items to review a Mental Health Treatment Plan and refer and/or provide ongoing management of a patient’s mental health condition, recognising the time spent with patients to provide quality care. There will be no limitation on the number of health-related issues that can be addressed as part of a general attendance consultation, if the requirements of the service are met, and adequate and contemporaneous records are maintained. Key principles for using time-tiered professional (general) attendance items and any specific requirements is available at AN.0.9 | Using time-tiered professional (general) attendance items.

Patient eligibility

These services are available to patients who meet the relevant eligibility requirements (refer to explanatory note AN.0.78 – Better Access Initiative) undertaken by either a GP or PMP at the general practice in which the patient is enrolled in MyMedicare, or regardless of whether the patient in enrolled in MyMedicare, by the patient’s usual medical practitioner. This also includes a GP or PMP who is located at a medical practice that has provided the majority of their care over the previous 12 months or will be providing the majority of their care over the next 12 months. These services can also be provided to private inpatients (including private inpatients who are residents of aged care facilities) being discharged from hospital. Where the service is provided as part of an episode of hospital treatment, the service must be claimed at the 75% MBS benefit.

Services attracting Medicare benefits

The Mental Health Treatment Plan items define services for which Medicare benefits are payable where a patient’s GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner to undertake early intervention, assessment, and management of patients with diagnoseable mental disorders. For information on the service requirements of these items, please see the relevant headings below.

There are 16 MBS items for the preparation of a Mental Health Treatment Plan. These are:

For GPs providing Mental Health Treatment Plans who have undertaken mental health skills training recognised through the General Practice Mental Health Standards Collaboration: 

• Face-to-face items: 2715 and 2717
• Video items 92116 and 92117

For GPs who have not undertaken mental health skills training:

• Face-to-face items 2700 and 2701
• Video items 92112 and 92113

For PMPs providing Mental Health Treatment Plans who have undertaken mental health skills training recognised through the General Practice Mental Health Standards Collaboration:

• Face-to-face items 281 and 282
• Video items 92122 and 92123

For PMPs who have not undertaken mental health skills training:

• Face-to-face items 272 and 276
• Video items 92118 and 92119

It is strongly recommended that GPs and PMPs providing mental health treatment have appropriate mental health training. GP organisations support the value of appropriate mental health training for practitioners using these items.

There are items that exist for the review of Psychiatrist Assessment and Management Plans. For further information, refer to explanatory note AN.0.30 – Consultant Psychiatrist – Referred Patient Assessment and Management Plan.

Preparation of a Mental Health Treatment Plan

A Mental Health Treatment Plan is intended to identify and document the care needs of patients with a clinically diagnosed mental disorder to allow for a structured approach to the management of their treatment. For the purposes of Better Access services, a mental disorder is defined as a significant impairment of an individual's cognitive, affective and/or relational abilities which may require intervention and may be a recognised, medically diagnosable illness or disorder. This definition is informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. For the purposes of Better Access services, dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders.

Before proceeding with a Mental Health Treatment Plan service, the GP or PMP at the patient’s MyMedicare registered practice or their usual medical practitioner must ensure that:

• the Mental Health Treatment Plan preparation service and the steps involved in preparing a Mental Health Treatment Plan are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and
• the patient's agreement to proceed is recorded.

The preparation of a Mental Health Treatment Plan involves the assessment of a patient’s mental disorder and preparation of a plan to assist the patient in managing their mental disorder. The preparation of a Mental Health Treatment Plan must be documented in writing, and include an assessment process consisting of:

• the administration of an outcome measurement tool (except if considered clinically inappropriate); and
• the formulation of the mental disorder, including a provisional or formal diagnosis.

An outcome measurement tool refers to a tool used to monitor changes in a patient’s health that occur in response to treatment received by the patient.

The choice of the evidence-based outcome measurement tool/s to be used is at the clinical discretion of the practitioner, however examples of appropriate outcome tools include:

• Kessler Psychological Distress Scale (K10)
• DASS 21 (Depression, Anxiety and Stress)

GPs using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training.

Once a GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner has completed an assessment of a patient’s mental disorder, the following must be undertaken:

• identify and discuss referral and treatment options with the patient, including appropriate support services;
• agree upon treatment goals with the patient and any actions the patient will take;
• provide relevant and suitable education about the patient’s mental disorder;
• create a plan for crisis intervention and/or for relapse prevention; and
• make arrangements for required referrals, treatment, appropriate support services, review and follow-up.  

This information must be recorded in writing in the patient's Mental Health Treatment Plan. The Initial Assessment and Referral Decision Support Tool (IAR-DST) can be used by the GP or PMP at the patient’s MyMedicare registered practice or their usual medical practitioner. It helps to determine the most appropriate level of mental health care needed and informs a suitable referral decision. The IAR-DST aligns with the assessment components required in a patient’s Mental Health Treatment Plan and can be incorporated during its preparation. This enables streamlined referrals to mental health services, many of which require a completed IAR at the point of entry. Referrals for treatment services under the Better Access initiative should be utilised for patients who require at least a moderate level of support.

Upon completion of the preparation of a Mental Health Treatment Plan, a copy must be offered to the patient, and where relevant and if the practitioner considers it appropriate, the patient’s carer, before a Mental Health Treatment Plan item may be claimed. A copy of the Mental Health Treatment Plan must be added to the patient’s medical records. 

A 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. A new plan should not be prepared unless clinically required, and generally not within 12 months of a previous plan, unless exceptional circumstances exist, e.g. if the patient has had a significant change to their mental health. Ongoing mental health consultations and reviews of progress can be provided by the GP or PMP through the time-tiered professional (general) attendance MBS items, as required.

MBS Telehealth (video) services for Mental Health Treatment Plans

MyMedicare and usual medical practitioner requirements apply to GP and PMP telehealth (video) items for Mental Health Treatment Plans, with these services not exempt from the MBS telehealth eligibility criteria. For further information on the MBS telehealth eligibility criteria, refer to explanatory note AN.1.1.

Referral and treatment options

When referring a patient for mental health treatment services under the Better Access initiative, services should be utilised for patients who require at least a moderate level of support. Consideration should be given to other treatment interventions and pathways (e.g. digital mental health services, Medicare Mental Health Centres, etc) should the patient’s level of support not require psychological intervention under the Better Access initiative.

Once a Mental Health Treatment Plan has been completed and claimed on an appropriate Medicare service, a patient is eligible to access relevant treatment and referral options. Relevant treatment and referral options consist of support services, psychiatric services, and relevant services provided under the Better Access initiative (refer to explanatory note AN.0.78 – Better Access Initiative).

Reviewing a Mental Health Treatment Plan

A review of a patient’s Mental Health Treatment Plan, including referral of treatment services and ongoing management of a patient’s mental healthcare, is a key component for assessing and managing the patient’s progress. A Mental Health Treatment Plan should be reviewed at least once a year by a GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner using time-tiered professional (general) attendance MBS items. Key principles for using time-tiered professional (general) attendance items and any specific requirements is available at explanatory Note AN.0.9 | Using time-tiered professional (general) attendance items.

Once a systematic review of the patient's progress against the Mental Health Treatment Plan review requirements has been completed, a Medicare benefit can be claimed using the time-tiered professional (general) attendance items. Where a psychiatrist has prepared a referred Psychiatrist Assessment and Management Plan (item 291 or 92435), as if that patient had a Mental Health Treatment Plan, the dedicated MBS items for a review of a Psychiatrist Assessment and Management Plan (items 293, 296, 297, 299 or 92436 or 92437) can be used. 

Before proceeding with any Mental Health Treatment review service, the GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner must ensure:

• the Mental Health Treatment Plan review service and the steps involved are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and
• the patient's agreement to proceed is recorded.

The review, undertaken using time-tiered professional (general) attendance MBS items, must include:

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

A medical practitioner may administer an appropriate triage tool, such as the IAR-DST, to determine the most appropriate level of mental health care required. This tool can also support and inform a practitioners referral decision.

If amendments are made to the patient’s Mental Health Treatment Plan, a copy of the amended plan must be offered to the patient, and where relevant and appropriate, the patient’s carer, before a Mental Health Treatment Plan review service (undertaken using time-tiered professional [general] attendance MBS items), may be claimed. A copy of the amended plan must also be added to the patient’s medical records. GPs and PMPs are able to address a number of health-related issues, in addition to reviewing a Mental Health Treatment Plan, as part of using time-tiered professional (general) attendance MBS items, as long as the requirements of the service are met, and adequate and contemporaneous records are maintained.

In general, most patients should not require more than 2 time-tiered professional (general) attendance items, for the specific purpose of reviewing a Mental Health Treatment Plan in a calendar year. A review of a Mental Health Treatment Plan should not be undertaken more than once in a 3-month period, or within 4 weeks following a claim for a Mental Health Treatment Plan item. When reviewing a Mental Health Treatment Plan, any referrals for additional treatment services under the Better Access initiative should be utilised for patients who require at least a moderate level of support. Consideration should be given to other treatment interventions and pathways (e.g. digital mental health services, Medicare Mental Health Centres, etc) should the patient’s level of support no longer require psychological intervention under the Better Access initiative.

Patients will be required to obtain a new referral from their referring practitioner after they have received the number of services stated on the referral, or the maximum number of services (10 group therapy mental health treatment services) allowed in a calendar year.

Mental health treatment consultation 

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 Mental Health Treatment Plan, time-tiered professional (general) attendance items can be used. These items should not be used for the initial development of a Mental Health Treatment Plan. Time-tiered professional (general) attendance items should only be used for Mental Health Treatment Plan review services and to deliver mental health care and support to patients.

A 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;
• documenting the outcomes of the consultation in the patient's medical records and other relevant mental health plan (where applicable); and
• any other requirement set out in the item descriptor for the time-tiered professional (general attendance) items.

A patient may be referred from this consultation for other treatment and services. This does not include referral for Better Access services, unless the patient is being managed by a GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner under a Mental Health Treatment Plan or under a Psychiatrist Assessment and Management Plan (item 291 or 92435). A direct referral may also be made by a psychiatrist or paediatrician.

Additional claiming information

The time-tiered professional (general) attendance items should be used to review a Mental Health Treatment Plan and deliver mental health care and support to patients. There will be no limitation on the number of health-related issues that can be addressed in the time-tiered professional (general) attendance items, as long as the requirements of the service are met (as part of a review of a Mental Health Treatment Plan or a Mental Health Treatment Consultation) and adequate and contemporaneous records are maintained. For information on what constitutes adequate and contemporaneous records, refer to explanatory note GN.15.39 - Practitioners should maintain adequate and contemporaneous records. To co-claim a Mental Health Treatment Plan MBS item and another attendance item, both services must be clinically relevant and distinct services.

Where an additional consultation is undertaken, both services must be clinically relevant, and all item requirements must be met which are set out in the item descriptor for the time-tiered professional (general attendance) items. For example, for item 2700, the duration of the service must have been at least 20 minutes. The time of the preceding consultation must not be counted towards the time of the mental health service.

All consultations conducted as part of the Mental Health Treatment Plan must be rendered by a GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner. A specialist mental health nurse, other allied health professionals, Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker with appropriate mental health qualifications and training may provide assistance to GPs in provision of mental health care, however, for a Medicare benefit to be payable all requirements of the item must be met.

Further information

For further information on the Better Access Initiative, refer to explanatory note AN.0.78 – Better Access Initiative.

For further information about Medicare Benefits Schedule items, please visit the MBS online website at www.health.gov.au/mbsonline.

Further information is available for providers from the Services Australia provider enquiry line on 132 150.

If you are a patient seeking advice about Medicare services, patient benefits, or your Medicare claims, please contact Services Australia on the Medicare General enquiry line on 132 011.

Related Items: 272 276 281 282 2700 2701 2715 2717 92112 92113 92116 92117