An overview of the Medicare services for managing and treating patients with mental health care needs. Includes an Indigenous patient case study.
We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available at the MBS Online website.
Better Access initiative
Under the Better Access initiative, general practitioners (GPs) have a pathway using a GP Mental Health Treatment Plan (GPMHTP) to refer their patients for a range of Medicare subsidised allied mental health services.
GP Mental Health Treatment items
These MBS items are available for use in general practice by medical practitioners, including general practitioners but excluding specialists or consultant physicians. The term ‘GP’ is used as a generic reference to medical practitioners able to claim these items.
|Description||MBS item||Claiming details|
|Preparation of a GPMHTP||2700
|Review of GPMHTP or a Psychiatrist Assessment and Management Plan||2712||
|Professional Attendance for management of a patient's mental health condition||2713||
These are minimum periods for claiming the items above except where there has been a significant change in the patient's clinical condition. The GP must determine whether the service is clinically relevant when providing these services.
A 'clinically relevant' service is one which is generally accepted by the relevant profession as necessary for the appropriate treatment of the patient.
Exceptional circumstances means a significant change in:
- the patient’s clinical condition; or
- the patient’s care circumstances
Preparation of a GPMHTP
A GPMHTP allows GPs to provide better management of a patient's mental health treatment by providing a pathway for follow-up allied mental health services.
A patient is eligible if they've been assessed by their GP as having a mental disorder. A mental disorder is a clinically diagnosable disorder that significantly interferes with an individual’s cognitive, emotional or social abilities. A patient isn't required to have a chronic medical condition.
GPs providing treatment to in-patients must claim a GPMHTP item as an in-hospital service.
Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of this initiative.
There are 2 main components in the GPMHTP process.
- preparing a GPMHTP
- assessment of a patient - assess and plan
- preparation of the plan - provide and refer for appropriate treatment and services, if required
- reviewing a GPMHTP
For a Medicare rebate to be paid, during each step of the GPMHTP process a GP must ensure all servicing requirements have been undertaken, as described below:
Steps in the GPMHTP process
|Component||Description||Actions by the GP|
|Step 1 - Part A||Assessment of a patient||
|Step 1 - Part B||Preparation of a GPMHTP||
|Step 2||Reviewing a GPMHTP||
The parts associated with step 1 in the GPMHTP process can be completed over more than 1 consultation, but only the 1 GPMHTP item can be claimed for all the consultations.
Referrals for follow-up allied mental health services – MBS items 80000-80170
Under a GPMHTP, eligible patients can be referred to eligible mental health professionals for the following MBS allied mental health services:
- clinical psychologists for psychological therapy services - items 80000-80020
- registered psychologists for focussed psychological strategies (FPS) services - items 80100-80120
- occupational therapists for FPS services - items 80125-80145
- social workers for FPS services - items 80150-80170
- GP FPS services - items 2721-2727
All mental health professionals must be registered with us and meet the eligibility requirements as set out on the MBS Online website.
Under a GPMHTP, patients are entitled to get:
- up to a maximum of 10 individual allied mental health services per calendar year
- up to a maximum of 10 group therapy services per calendar year—these services are separate and don't count towards the maximum individual services
A patient is referred by a GP for a course of treatment, which:
- consists of the number of services stated on the patient's referral as determined by the GP
- can include a maximum of 6 services in any 1 referral
- can be for individual services and/or group services, involving 6-10 patients
- can be a combination of all the available allied mental health services, such as GP focussed psychological strategies, psychological therapy services, and focussed psychological strategies from other allied mental health professionals
A patient can be referred for more than 1 course of treatment, if determined as necessary by the GP, within the patient's maximum entitlement of services in the calendar year.
GPMHTP review item 2712 isn't required for providing subsequent referrals to the allied mental health professional.
GPs must provide a referral to the allied mental health professional before their first consultation with the patient. Similar information to GP referral requirements should be included in the referral, including a copy of the patient's GPMHTP and the patient's agreement. There are no specific referral forms.
It’s recommended that the allied mental health professional keep the referral for 24 months from the date the service was rendered.
Allied mental health professional reporting
Once a patient's course of treatment is completed, with the stated number of services on their referral provided, the allied mental health professional must provide a written report on the treatment to the GP.
Other referral pathways for allied mental health services
Eligible patients, who don't have a GPMHTP in place, can access MBS allied mental health services via referrals from:
- psychiatrists under an assessment and management plan item 291
- specialist psychiatrists or paediatricians under items 104-109
- consultant psychiatrists under items 293-370
- consultant physician paediatricians under items 110-133
For more information visit the MBS Online website.
You are a GP, with mental health skills training, practicing at a remote community health service. You have an 18 year old Indigenous patient who has a history of good physical health and has only required minimum medical attention in the past, with a recent health assessment undertaken.
The patient comes to visit you about a persistent sleep issue, including frequent occasions of insomnia. During your discussion, your patient becomes very teary and shows signs of mood swings. You assess that they’re not experiencing any other physical health issues requiring treatment for their sleep condition, however you are concerned about their mental wellbeing.
To address your patient’s mental health issues, you determine they would benefit from a GPMHTP (item 2715 or 2717). You discuss this plan and they agree with it and you record their acceptance to proceed.
You then collect information about your patient’s past and current conditions and perform a mental health examination. During your discussion, they reveal that for the last 6 months, besides their sleep condition, they have also been:
- experiencing feelings of isolation and low self esteem
- avoiding social contact from friends and family
- having periods of sadness
You assess that your patient is displaying signs and symptoms of depression and may require psychiatric evaluation.
Preparation of the GPMHTP
As part of your strategy to improve your patient’s mental wellbeing, you determine they should be referred for individual allied mental health services with a psychologist (item 80100).
You discuss your assessment and strategy for managing their mental wellbeing, including the subsidies provided under Medicare. They agree with your plan.
You complete the necessary referral and arrange an appointment for your patient with the psychologist. Finally, you ensure all required information is documented in their GPMHTP and provide them a copy.
Review and ongoing support
As part of your strategy to improve your patient’s mental health you:
- schedule an appointment for a GPMHTP review consultation (item 2712) in 4 weeks’ time
- assign follow-up services (item 10987) by the Aboriginal health practitioner to monitor risk of self-harm by providing assistance with reviews during weekly outreach visits to your patient’s community
- consider the need to refer your patient for a psychiatric assessment
- continue to provide ongoing care and management of their mental health disorder
- Education services for health professionals to access other education resources
- MBS Online to view the Schedule
Contact us at MBS item interpretation.
Read more information about our website disclaimer.