Medicare Mental Health Treatment Plan (Australia): GP Referral Documentation

What Is a Medicare Mental Health Treatment Plan?

A Medicare Mental Health Treatment Plan (MHTP) is a structured clinical document prepared by a general practitioner (GP) under the Australian Government's Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative. The MHTP assesses the patient's mental health needs, establishes a diagnosis, and outlines a treatment plan that includes referral to allied mental health professionals — most commonly psychologists.

For psychologists, the MHTP and its accompanying GP referral are the gateway documents that allow clients to access Medicare-rebated psychology sessions. Without a current MHTP and valid referral, you cannot bill Medicare for your services. Understanding how this system works — including session limits, referral validity, re-referral processes, and report-back requirements — is essential for every psychologist practising in Australia who accepts Medicare clients.

While the GP writes the MHTP, the psychologist's role in this system involves verifying referral validity, providing clinical services within the session allocation, and reporting back to the referring GP at key points during treatment. The report-back is not optional — it is a condition of the MBS item descriptors and a Medicare compliance requirement.

When You Need It

You interact with the Medicare mental health system in these situations:

• Receiving a new client referral — when a GP refers a patient to you under the Better Access program, you need to verify the MHTP and referral are valid and current before booking the first session
• Reporting back to the GP — after initial assessment, at the conclusion of the first 6 sessions, and at the conclusion of the additional 4 sessions (if a re-referral is issued)
• Requesting a re-referral — when a client has used their initial 6 sessions and requires the remaining 4, you communicate with the GP about the need for a re-referral
• Recommending medication review — when your assessment or treatment progress suggests the client would benefit from pharmacological intervention or medication adjustment
• Concluding treatment — when treatment is complete or the client is being referred elsewhere, you provide a final report to the GP
• Raising safety concerns — when there is a significant change in risk (suicidality, self-harm, psychotic symptoms) that warrants GP involvement

Key Components / Requirements

Verifying the Referral

Before the first session, confirm you have received a valid referral that includes the GP's name and provider number, the patient's name and date of birth, the diagnosis or presenting issue, the number of sessions authorised (up to 6 initially), the date of the MHTP, and whether the referral specifies you by name or is an open referral. A referral is valid for 12 months from the date of issue or until the allocated sessions are used, whichever comes first.

MBS Item Number Selection

Select the correct MBS item number based on your registration status (registered psychologist vs. clinical psychologist), session duration, and modality (face-to-face vs. telehealth). Incorrect item number selection is one of the most common Medicare compliance issues for psychologists.

Clinical Records

Maintain clinical records that meet APS and AHPRA standards. Your session notes should be sufficient to justify the MBS item billed — meaning they must document the clinical service provided, the duration, and the clinical rationale. Medicare audits require that your records support every claim you have made.

Report Back to the Referring GP

The MBS requires that you report back to the referring GP. This report should include your clinical impressions, the diagnosis (confirmed or provisional), a summary of the treatment provided, the client's progress, and your recommendations. It should be concise — typically one to two pages — and written in language accessible to a GP audience.

Re-referral Process

After the initial 6 sessions, the client must return to their GP for a review before the GP can issue a re-referral for the remaining 4 sessions. Your report to the GP after the initial 6 sessions should include sufficient information for the GP to conduct this review and make the re-referral decision.

How to Write It

Step 1: Verify the referral before the first session. Confirm the GP referral is valid, current, and includes all required information. If the referral is incomplete (missing diagnosis, missing MHTP date, expired), contact the GP to request a corrected version before seeing the client.

Step 2: Track sessions carefully. Maintain a clear record of how many sessions have been attended against the referral allocation. The first referral allows up to 6 sessions; the re-referral allows up to 4 more. Going over the allocation without a valid re-referral means you cannot claim Medicare.

Step 3: Administer outcome measures at intake and regular intervals. The Better Access program emphasises measurable outcomes. Use validated instruments (PHQ-9, GAD-7, K10, DASS-21) at the first session and repeat at clinically appropriate intervals. These scores form the backbone of your report to the GP.

Step 4: Write the GP report in accessible language. Remember your audience is a GP, not a psychologist. Avoid therapy-specific jargon without explanation. Be clear about diagnosis, progress, and recommendations. The GP needs to understand whether to re-refer, whether to consider medication, and whether there are safety concerns.

Step 5: Submit the report promptly. Send your report to the GP after the initial assessment and again after the first 6 sessions (before the client needs their re-referral appointment). If you wait too long, the client may struggle to get a timely re-referral and lose continuity of care.

Step 6: Keep copies. Retain a copy of all GP correspondence in your clinical file. This is both an APS ethical requirement and a Medicare compliance safeguard.

Common Mistakes

• Seeing clients without a valid referral. If the referral has expired, the MHTP is not current, or you never received the referral letter, you cannot claim Medicare. Retrospective referrals do not make previous sessions claimable.
• Not reporting back to the GP. This is a Medicare compliance requirement, not an optional courtesy. Failure to report back can trigger Medicare audit flags and places you at risk of compliance action.
• Using incorrect MBS item numbers. Registered psychologists and clinical psychologists use different item numbers. Using clinical psychology item numbers when you hold general registration is a compliance breach. Similarly, billing a 50+ minute item for a 45-minute session is incorrect.
• Exceeding the session allocation. Providing more sessions than the referral authorises and billing Medicare for them is a serious compliance issue. Track your session count carefully.
• Writing overly detailed clinical reports to the GP. The GP does not need your full case formulation or session-by-session notes. They need diagnosis, outcome measure scores, a progress summary, and clear recommendations. Keep it to one to two pages.
• Forgetting that the calendar year resets the session count. The 10-session limit is per calendar year, not per referral period. A new MHTP and referral are required each calendar year.