Professional attendance by a general practitioner (including 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: $103.70 Benefit: 75% = $77.80 100% = $103.70
(See para AN.0.56 of explanatory notes to this Category)
GP Mental Health Treatment Items
This note provides information on the GP Mental Health Treatment items 2700, 2701, 2712, 2713, 2715 and 2717, and is also applicable for video and phone equivalent MBS items 92112, 92113, 92114, 92115, 92116, 92117, 92126 and 92127. 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 GP Mental Health Treatment items define services for which Medicare rebates are payable where GPs 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 GP 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:
Who can provide
The GP Mental Health Treatment Plan, Review and Consultation items are available for use in general practice by general practitioner. The term 'GP' is used in these notes as a generic reference to general practitioners able to claim these items.
Training Requirements (items 2715, 2717, 92116 and 92117)
GPs providing 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 2715, 2717, 92116 and 92117. For GPs who have not undertaken training, items 2700, 2701, 92112 and 92113 are available. Items 2700, 2715, 92112 and 92116 provides for a Mental Health Treatment Plan lasting at least 20 minutes and item 2701, 2717, 92113 and 92117 provides for a Mental Health Treatment Plan lasting at least 40 minutes. It is strongly recommended that GPs providing mental health treatment have appropriate mental health training. GP organisations support the value of appropriate mental health training for GPs using these items.
What 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 GP Mental Health Treatment items.
These GP services are available to eligible patients in the community. GP 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. GPs are able to contribute to care plans for patients using item 729, Contribution to a Multidisciplinary Care Plan, and to care plans for residents of aged care facilities using item 731 or 92027.
PREPARING A GP MENTAL HEALTH TREATMENT PLAN - (Item 2700, 2701, 2715,2717, 92112, 92113, 92116 or 92117)
What is involved - Assess and Plan
A rebate can be claimed once the GP 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 general 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:
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 2700, 2701, 2715, 2717, 92112, 92113, 92116 or 92117.
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. GPs 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:
Treatment options can include referral to a psychiatrist; referral to a clinical psychologist for psychological therapies, or to an appropriately trained GP 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 item 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 GPs 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 GP.
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 2712, 92114 or 92126).
REVIEWING A GP MENTAL HEALTH TREATMENT PLAN - (Item 2712, 92114 or 92126)
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 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 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:
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 GP as part of ongoing management.
The recommended frequency for the review service, allowing for variation in patients' needs, is:
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 2713, 92115 or 92127)
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:
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 GP 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 GP is managing a patient under a referred psychiatrist assessment and management plan, a patient is eligible for up to 10 Medicare rebateable individual mental health services per calendar year by:
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 GPs 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 GP) and include:
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 GP 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 GP 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:
The GP 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
Then the treating practitioner can use their clinical judgment to provide services under the referral, noting the patient cannot receive more than:
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 GP can verbally refer a patient for Better Access services only if:
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 GP 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 GP must ensure that:
Before completing any GP Mental Health Treatment Plan or Review service and claiming a benefit for that service, the GP 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 GP 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:
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 the GP. 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.
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 721, 723, 729, 731 and 732) continue to be available for patients with chronic medical conditions, including patients with complex needs.