Medicare Benefits Schedule - Item 92118

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), 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: $65.35 Benefit: 100% = $65.35

(See para AN.0.56, AN.0.78, AN.7.22 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $196.05

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Associated items: 272, 276, 277, 279, 281, 282, 2700, 2701, 2712, 2713, 2715, 2717, 92112, 92113, 92114, 92115, 92116, 92117, 92118, 92119, 92120, 92121, 92122, 92123, 92126, 92127, 92132, 92133

This note provides information on the preparation and review of GP Mental Health Treatment Plans under the Better Access initiative (refer to explanatory note AN.0.78 - Better Access Initiative).

Who can provide

The GP Mental Health Treatment Plan, Review and Consultation Medicare Benefits Schedule (MBS) items are available for use in general practice by a general practitioner or prescribed medical practitioner. The term 'GP' is used in these notes as a generic reference to general practitioners able to claim these items.

Patient Eligibility

These GP services are available to patients who meet the relevant eligibility requirements (refer to explanatory note AN.0.78 - Better Access Initiative).  GP Mental Health Treatment Plan and Review 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 GP Mental Health Treatment items define services for which Medicare benefits are payable where GPs 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 GP Mental Health Treatment Plan. These are:

For GPs providing GP 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
• Telehealth items 92116 and 92117

For GPs who have not undertaken mental health skills training:

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

For Prescribed Medical Practitioners providing GP 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
• Telehealth items 92122 and 92123

For Prescribed Medical Practitioners who have not undertaken mental health skills training:

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

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

Additionally, there are 6 items for the review of a GP Mental Health Treatment Plan or Psychiatrist Assessment and Management Plan. These are:

• GP face-to-face item: 2712
• GP telehealth items: 92114 and 92126 
• Prescribed medical practitioner face-to-face item: 277
• Prescribed medical practitioner telehealth items: 92120 and 92132

There are also additional 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.

There are 6 items for GP mental health treatment consultation. These are:

• GP face-to-face item: 2713
• GP telehealth items: 92115 and 92127 
• Prescribed medical practitioner face-to-face item: 279
• Prescribed medical practitioner telehealth items: 92121 and 92133

Preparation of a GP Mental Health Treatment Plan

A GP Mental Health Treatment Plan is intended to identify and document the care needs of patients with a diagnosable mental disorder to allow for a structured approach to the management of their treatment. Before proceeding with a GP Mental Health Treatment Plan service, the GP must ensure that:

• The GP Mental Health Treatment Plan preparation service and the steps involved in preparing a GP 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 GP 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 GP 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)
• Initial Assessment and Referral Decision Support Tool (IAR-DST)

GPs using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training. Once a GP has completed an assessment of a patient’s mental disorder, the GP must:

• 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 GP Mental Health Treatment Plan. Upon completion of preparation of a GP 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 GP Mental Health Treatment Plan item may be claimed. A copy of the GP Mental Health Treatment Plan must be added to the patient’s medical records. 

A patient's GP 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. 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 items.

Referral and Treatment Options

Once a GP 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 GP Mental Health Treatment Plan

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 Medicare benefit can be claimed once the GP who prepared the patient's GP Mental Health Treatment Plan (or another GP 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. The review item can also be used where a psychiatrist has prepared a referred Psychiatrist Assessment and Management Plan (item 291 or 92435), as if that patient had a GP Mental Health Treatment Plan. 

Before proceeding with any GP Mental Health Treatment review service, the GP must ensure that:

• The GP 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 must include:

• a review of the patient's progress against the goals outlined in the GP 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 GP Mental Health Treatment Plan if required.

If amendments are made to the patient’s GP 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 GP Mental Health Treatment Plan review service may be claimed. A copy of the amended plan must also be added to the patient’s medical records. 

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 benefit for a GP Mental Health Treatment Plan review service will not be paid more than once in a three-month period, or within four weeks following a claim for a GP Mental Health Treatment Plan item.

Mental Health Treatment Consultation 

The Mental Health Treatment Consultation items are 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 Better Access services, unless the patient is being managed by the GP under a GP Mental Health Treatment Plan or under a referred Psychiatrist Assessment and Management Plan (item 291 or 92435).

Additional claiming information

The GP Mental Health Treatment Plan, Review and Consultation items cover the consultations at which the relevant items are undertaken, noting that to co-claim a mental health MBS item and another 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. 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.

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 a GP or prescribed medical practitioner. 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 GPs in provision of mental health care.

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: 272 276 277 279 281 282 2700 2701 2712 2713 2715 2717 92112 92113 92114 92115 92116 92117 92118 92119 92120 92121 92122 92123 92126 92127 92132 92133

Summary

This explanatory note provides an overview of The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule Initiative (Better Access), which commenced on 1 November 2006. Under this initiative, Medicare benefits are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, prescribed medical practitioners (PMPs), psychologists (clinical and registered) and eligible social workers and occupational therapists.

Better Access Initiative Explanatory Notes

All Medicare Benefits Schedule (MBS) explanatory notes that are associated with the Better Access initiative are listed below:

Explanatory Note	Relevant item numbers
AN.0.56 - GP Mental Health Treatment Plans and Consultation	272, 276, 277, 279, 281, 282, 2700, 2701, 2712, 2713, 2715, 2717, 92112, 92113, 92114, 92116, 92117, 92118, 92119, 92120, 92121, 92122, 92123, 92126, 92127, 92132, and 92133.
MN.6.2 - Provision of Psychological Therapy	80000, 80005, 80010, 80015, 80020, 80021, 80022, 80023, 80024, 80025, 91166, 91167, 91181, and 91182.
MN.7.4 - Provision of Focussed Psychological Strategies	283, 285, 286, 287, 2721, 2723, 2725, 2727, 80100, 80105, 80110, 80115, 80120, 80121, 80122, 80123, 80125, 80127, 80128,  80130, 80135, 80140, 80145, 80146, 80147, 80148,  80150, 80152, 80153, 80155, 80160, 80165, 80170, 80171, 80172, 80173, 80174, 80175, 91818, 91819, 91842, 91843, 91820, 91821, 91844, 91845, 91169, 91170, 91183, 91184, 91172, 91173, 91185, 91186, 91175, 91176, 91187 and 91188.
MN.6.3 - Referral requirements for Better Access Treatment Services	272, 276, 281, 282, 283, 285, 286, 287, 2700, 2701, 2715, 2717, 2721, 2723, 2725, 2727, 80000, 80005, 80010, 80015, 80020, 80021, 80022, 80023, 80024, 80025, 80100, 80105, 80110, 80115, 80120, 80121, 80122, 80123, 80125, 80127, 80128, 80130, 80135, 80140, 80145, 80146, 80147, 80148, 80150, 80152, 80153, 80155, 80160, 80165, 80170, 80171, 80172, 80173, 80174, 80175, 91167, 91169, 91170, 91172, 91173,  91175, 91176, 91181, 91182,91183, 91184, 91185, 91186, 91187, 91188,  91818, 91819, 91820, 91821,  91842, 91843, , 91844, 91845, 92112, 92113, 92116, 92117, 92118 and 92119. Note: for specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109 and items 91822, 91823 and 91833. For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 to 308, 310, 312, 314, 316, 318 or 319 through 349; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.
AN.15.1 - Mental Health Case Conferences	930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 80176, 80177 and 80178.
MN.7.5 - Family and Carer Participation	309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91859, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91861, 91862, 91863, 91864, 91865, 91866, and 91867.

 

Services provided under Better Access

Through Better Access, eligible patients can claim a Medicare benefit for up to 10 individual and 10 group mental health treatment services per calendar year. These services consist of:

• psychological therapy provided by eligible clinical psychologists (refer to explanatory note MN.6.2 - Provision of Psychological Therapy); and
• focussed psychological strategies provided by GPs, PMPs and eligible psychologists, occupational therapists, and social workers (refer to explanatory note MN.7.4 – Provision of Focussed Psychological Strategies).

A Medicare benefit is also available for a patient to involve another person, such as a family member or carer, in their treatment. Medicare benefits are available to a patient for up to 2 services provided to another person per calendar year. Any services delivered using these MBS items count towards the patient's course of treatment and calendar year allocations under Better Access. For further information on involving another person in a patient’s treatment, refer to explanatory note MN.7.5 – Family and Carer Participation.

There are also MBS items for the provision of mental health case conferencing services to establish and coordinate the management of the care needs of a patient. For further information refer to explanatory note AN.15.1– Mental Health Case Conferences.

Patient eligibility for Better Access services

Better Access services apply to people with an assessed mental disorder. 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. 

Additionally, Better Access MBS treatment items will not attract a Medicare benefit unless the patient has been referred for Better Access services by a referring practitioner. For the purposes of these services, referring practitioner means:

• a medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan (refer to explanatory note AN.0.56 – GP Mental Health Treatment Plans and Consultation) or a Psychiatrist Assessment and Management Plan (refer to explanatory note AN.0.30 - Consultant Psychiatrist – Referred Patient Assessment and Management Plan); or
• a specialist or consultant physician specialising in the practice of their field of psychiatry; or
• a specialist or consultant physician specialising in the practice of their field of paediatrics.

For more information on referral requirements for Better Access services, refer to explanatory note MN.6.3 - Referral requirements for Better Access Treatment Services.

If there is any doubt about a patient's eligibility, Services Australia will be able to confirm whether a GP Mental Health Treatment Plan and/or a Psychiatrist Assessment and Management Plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of Better Access services already claimed by the patient during the calendar year.

Allied health providers can call Services Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011.

A patient will not be eligible to receive a Medicare benefit if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Services Australia will not be aware of the patient's eligibility. In this case the treating practitioner should, with the patient's permission, contact the referring practitioner to ensure a relevant referring service has been provided to the patient.

Better Access redesign from 1 November 2025

As announced through the 2024-25 Budget, the Australian Government is making changes to the Better Access initiative from 1 November 2025 (subject to the passage of legislation) to respond to the Better Access evaluation, better meet the needs of individuals, and improve equity of access.

As part of this, GP Mental Health Treatment Plan review and mental health consultation MBS items will be removed, and GPs will be able to use general attendance items to review and provide mental health care recognising the time spent with patients to provide quality care. GP Mental Health Treatment Plan MBS items will be retained.

Out-of-pocket expenses and Medicare safety net

Charges in excess of the Medicare benefit for Better Access MBS items are the responsibility of the patient. However, any out-of-pocket costs will count towards the Medicare safety net for that patient. The out-of-pocket costs for mental health services which are not Medicare eligible do not count towards the Medicare safety net.

Publicly funded services

Better Access MBS items do not apply for services that are provided by any other Commonwealth or state funded services or provided to an admitted patient of a hospital. Unless an exemption under subsection 19(2) of the Health Insurance Act 1973 applies for a Medicare benefit to be payable, all requirements of the service must be met, including registration with Services Australia.

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to 'top up' the Medicare benefit paid for the services.

Record keeping and reporting requirements

The Department of Health and Aged Care undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. All practitioners providing Better Access services should ensure they keep adequate and contemporaneous records, including documenting the date, time and people who attended. Only clinical details recorded at the time of attendance count towards the time of the consultation. Other notes or reports added at a later time are not included. For information on what constitutes adequate and contemporaneous records, refer to explanatory note GN.15.39 - Practitioners should maintain adequate and contemporaneous records.

Relevant Legislation

Details about the legislative requirements of the Better Access Initiative MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au.

Attendance items are set out in three regulatory instruments:

Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 - Clinical psychologist, psychologist, social worker, and occupational therapist items.

Health Insurance (General Medical Services Table) Regulations 2021 – General practitioner, prescribed medical practitioner and psychiatrist items.

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 – telehealth (video) and telephone attendance items – General practitioner, prescribed medical practitioner, clinical psychologist, psychologist, social worker, and occupational therapist items.

Further information

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

For providers, further information is also available 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: 272 276 277 279 281 282 283 285 286 287 309 311 313 315 930 933 935 937 943 945 946 948 959 961 962 964 969 971 972 973 975 986 2700 2701 2712 2713 2715 2717 2721 2723 2725 2727 2739 2741 2743 2745 80000 80002 80005 80006 80010 80012 80015 80016 80020 80021 80022 80023 80024 80025 80100 80102 80105 80106 80110 80112 80115 80116 80120 80121 80122 80123 80125 80127 80128 80129 80130 80131 80135 80137 80140 80141 80145 80146 80147 80148 80150 80152 80153 80154 80155 80156 80160 80162 80165 80166 80170 80171 80172 80173 80174 80175 80176 80177 80178 91166 91167 91168 91169 91170 91171 91172 91173 91174 91175 91176 91177 91181 91182 91183 91184 91185 91186 91187 91188 91194 91195 91196 91197 91198 91199 91200 91201 91202 91203 91204 91205 91818 91819 91820 91821 91842 91843 91844 91845 91859 91861 91862 91863 91864 91865 91866 91867 92112 92113 92114 92116 92117 92118 92119 92120 92121 92122 92123 92126 92127 92132 92133

Last reviewed: 1 November 2023

This note provides information on the Mental Health Treatment items 272, 276, 277, 279, 281 and 282, and is also applicable for video and phone equivalent MBS items 92118, 92119, 92120, 92121, 92122, 92123, 92132 and 92133. 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 prescribed medical practitioners (see note AN.7.1) 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, 297, 299 and 92437), clinical psychologists (items 80000, 80005, 80010, 80015, 91166, 91167, 91181 and 91182) and allied mental health providers (items 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160, 80165, 91169, 91170, 91172, 91173, 91175, 91176, 91183, 91184, 91185, 91186, 91187 and 91188). 

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 prescribed medical practitioners.

Training Requirements (items 281, 282, 92122 and 92123)

Prescribed medical practitioners 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, 282, 92122 and 92123. For prescribed medical practitioners who have not undertaken training, items 272, 276, 92118 and 92119 are available. Items 272, 281, 92118 and 92122 provides for a GP Mental Health Treatment Plan lasting at least 20 minutes and items 276, 282, 92119 and 92123 provides for a GP Mental Health Treatment Plan lasting at least 40 minutes. It is strongly recommended that prescribed medical practitioners providing mental health treatment have appropriate mental health training. Medical professional organisations support the value of appropriate mental health training for prescribed 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 note GN.1.2. Prescribed 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, 282, 92118, 92119, 92122 or 92123)

What is involved - Assess and Plan

A rebate can be claimed once the prescribed 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, 282, 92118, 92119, 92122 or 92123.

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. Prescribed 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.

Once a GP Mental Health Treatment Plan has been completed and claimed on Medicare either through items 272, 276, 281, 282, 92118, 92119, 92122 or 92123 or through GP items 2700, 2701, 2715, 2717 92112, 92113, 92116 or 92117, a patient is eligible to be referred for up to 10 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). Please note group therapy does not include family and couples therapy.

When referring patients prescribed 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 prescribed 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, 92120 or 92132, or GP item 2712, 92114 or 92126).

REVIEWING A GP MENTAL HEALTH TREATMENT PLAN (Item 277, 92120 or 92132)

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 prescribed 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 or 92435), as if that patient had a GP Mental Health Treatment Plan.

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 prescribed 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, 92121 or 92133)

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 prescribed medical practitioner under a GP Mental Health Treatment Plan or under a referred psychiatrist assessment and management plan (item 291 or 92435).

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 prescribed medical practitioner is managing a patient under a referred psychiatrist assessment and management plan, a patient is eligible for up to 10 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 group therapy does not include family and couples therapy.

When preparing a patient’s Mental Health Treatment Plan and making a referral prescribed medical practitioners should speak to the patient about their treatment needs and the type of treatment, for example individual and/or group sessions, that might be suitable for their particular circumstances.

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 or both individual and group therapy treatment options.

A referral for mental health services should be in writing (signed and dated by the prescribed 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 or a psychiatrist assessment and management plan.

It may be useful for a referral to include a statement indicating whether group sessions could be considered.

Where appropriate, and with the patient’s agreement, the prescribed 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 and Aged Care.

Number of Sessions

The prescribed 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).

The prescribed 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 prescribed 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 prescribed 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 prescribed 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 prescribed medical practitioner’s verbal referral, and
• the prescribed 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 prescribed 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.

Referrals for the Additional 10 Sessions (available until 31 December 2022)

In response to the COVID-19 pandemic, the number of Medicare rebateable individual mental health services was temporarily increased from 10 to 20 per calendar year until 31 December 2022.

A patient does not need a new referral to access Better Access sessions from 1 January 2023. If the patient has a current referral (either for the initial 10 sessions or the additional 10 sessions) and has not used all of the sessions, they can use that referral to access sessions in 2023. However, they cannot receive more than 10 individual sessions in 2023.

ADDITIONAL CLAIMING INFORMATION

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

• 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
• 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 prescribed 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 prescribed 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 an additional consultation is undertaken, both services must be clinically relevant and all item requirements must be met. For example, for item 272, 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.

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 prescribed medical practitioner. 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 prescribed 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 prescribed 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 92118 92119 92120 92121 92122 92123 92132 92133