Referral pathways for GPs

Referral has to be made by:

• a GP who is managing the patient under a GP Mental Health Treatment Plan (GP MHTP) (Items 2715 or 2717), or
• a review of a GP MHTP or a Psychiatrist Assessment and Management Plan (Items 2712)
• a medical practitioner (including a GP but not a specialist or consultant physician) who is managing the patient under a referred psychiatric assessment or management plan (Items 132 or 133).

Psychiatrists and pediatricians are able to directly refer patients with mental health disorders for
Medicare rebateable allied mental health services.

Items 2715 and 2717

• Should not be prepared unless clinically required.
• Item will NOT be paid within 12 months of previous claim
• Item will NOT be paid within 3 months of a claim for item 2712

Item 2712

• Item will NOT be paid within 3 months of a previous claim for item 2712
• Item will NOT be paid within 4 weeks of a previous claim for item 2700, 2701, 2715 or 2717

For the purposes of these items, Dementia, Delirium, Tobacco-use Disorder and Mental Retardation are not regarded as a mental disorder.

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. Conditions that are eligible
include:

Medicare rebates are available for up to 10 individual consultations in a calendar year by an allied mental health professional.

Allied mental health services under this initiative include psychological assessment and therapy services provided by clinical psychologists, and focused psychological strategies services provided by appropriately qualified GPs and eligible psychologists, social workers and occupational therapists.

Referrals are provided for an initial course of treatment commencing with a maximum of 6 sessions.

On completion of the initial course of treatment, the psychologist must provide a written report (within 4 weeks to 6 months of the date of referral) to the referring medical practitioner, which includes assessments carried out on the patient and recommendations on future management of the patient’s disorder.

At the discretion of the psychologist and referring GP, another 4 sessions can be assigned to the patient on review of the GP Mental Health Treatment Plan (Items 2712) and in accordance to the patient’s on-going management and treatment of their presenting mental disorder.

A written report must also be provided to the referring medical practitioner at the completion of any subsequent course(s) of treatments provided to the patient.

The 10 individual sessions in a calendar year can either be 50 minute sessions hour (Item 80010; Clinical Psychologist), or 30 minute sessions (Item 80000; Clinical Psychologist).

Patients will also be eligible to claim up to 10 separate services within a calendar year for group therapy (Item 80020, clinical psychologist). These group services are separate from the individual consultations. They can be on the same GP MHTP, but must be specified by the doctor.

Medicare rebates with a GP MHTP will be 128.40 for a one-hour consultation with a clinical psychologist and $87.45 for a 30-minute consultation with a psychologist. This is rebated on the day of service into the patient’s bank account. To receive this rebate you must have an Eftpos card to accept the rebate into your bank account. Once you reach your safety net your rebate will increase.

There will be an out-of- pocket payment for all clients who are not bulk billed.

Only clients experiencing financial hardship are bulk billed.

The Chronic Disease Management enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Referrals are provided for an initial course of treatment with a maximum of 5 sessions per referral in a calendar year (including any services to which the items 10950 to 10970 apply).

On the first and last service, the eligible allied health professional (e.g., Dietetics Item 10954; Psychology Item 10968) must provide a written report to the referring medical practitioner, which includes assessments carried out on patient, management plan, and recommendations on future management of the patient’s.

Medicare rebates on a Chronic Disease Management Plan are $53.80 per appointment, regardless of session length. This is rebated on the day of service into the patient’s bank account. To receive this rebate, you must have an Eftpos card to accept the rebate into your bank account. Out-of- pocket costs depend on the session length. Chronic Disease Management sessions ARE NOT bulk billed.

accepted injuries or conditions that are war caused or service related;

malignant cancer, pulmonary tuberculosis, any mental health condition whether war caused or not; and

the symptoms of unidentifiable conditions that arise within 15 years of service (other than peacetime service).