Opinion and report (MBS item 291): 5 key facts for GPs
This information is for Australian GPs who refer a patient to a psychiatrist for an 'opinion and report' (MBS item 291).
Referral to a psychiatrist
In Australia, a general practitioner (GP) can refer a patient to a psychiatrist for either:
- an 'opinion and report' (MBS item 291) – for the GP to manage as the primary health-care provider, or
- ongoing management where the patient becomes a patient of the psychiatrist.
Key facts about item 291
1. The GP must state that the referral is for an opinion and report (or item 291) on the referral form
This is needed so that the psychiatrist understands the purpose of the visit and which Medicare item number to use for the consultation.
2. An opinion and report can be completed in up to three appointments with the psychiatrist
If the psychiatrist determines that more than one appointment is required to make an opinion, Medicare rebates are available for up to three appointments.
3. The psychiatrist will provide the GP with a detailed written report within 2 weeks of the appointment
The psychiatrist will provide a detailed report to the referring GP within 2 weeks of the appointment. The psychiatrist will also provide a summary of this report to the patient (or carer) as appropriate.
The report should state:
- that a mental state examination has been conducted, and a psychiatric diagnosis has been made
- that the psychiatrist believes that:
- the patient can be appropriately managed without the need for ongoing treatment by the psychiatrist, or
- ongoing treatment by a psychiatrist is required.
- If the psychiatrist decides that the patient can be appropriately managed by the GP, he/she must provide a 12-month management plan, appropriate to the diagnosis, which:
- comprehensively evaluates the biological, psychological and social issues
- addresses the diagnostic psychiatric issues
- makes management recommendations addressing the biological, psychological and social issues.
4. The psychiatrist can see the patient for treatment after the report has been provided to the GP
If the psychiatrist recommends ongoing specialist psychiatric treatment in the report to the GP, the GP should discuss this with the patient and decide whether they agree with the opinion. The GP may refer the patient to a psychiatrist for ongoing treatment.
5. A patient is only eligible for one Medicare rebate on the opinion and report in a 12-month period, but there is a rebate for a review
There is provision for the psychiatrist to review the opinion and report previously prepared by them, within the 12 month period (MBS item 293).