Item 291
Psychiatrist assessment and management plan
Professional attendance lasting more than 45 minutes at consulting rooms by a consultant psychiatrist following referral, providing a comprehensive diagnostic assessment and a management plan that is sent in writing to the referring practitioner within 2 weeks of the attendance.
Plain-English summary. See MBS Online for the verbatim descriptor of each item.
More than 45 minutes
Once per 12-month period (combined with telehealth item 92435).
Required
Consultant Psychiatrist
Requirements to bill
Conditions imposed by the descriptor that must be met to claim this item.
- 1Current referral from a medical practitioner in general practice (a GP) OR a participating nurse practitioner. Specialists and consultant physicians cannot refer for 291 (this differs from the 296/297/299/92437 family, where specialists and consultant physicians ARE permitted referrers under AN.0.75).
- 2Attendance must be at consulting rooms and last more than 45 minutes face-to-face.
- 3Mental state examination of the patient must be performed and documented.
- 4A comprehensive diagnostic assessment of the patient must be performed.
- 5A written report containing the diagnostic assessment AND a management plan must be prepared and sent to the referring practitioner within 2 weeks of the attendance.
- 6In the preceding 12 months, no service to which item 291 or 92435 applies has been provided to the patient.
Your notes must show
Documentation tests — what clinical notes need to demonstrate to survive a PSR audit.
- Date, start time, end time, and total face-to-face duration (>45 min).
- Referral details — referrer name, profession (must be GP or participating nurse practitioner — NOT a specialist or consultant physician), referral date, and validity period.
- Presenting concern, history of presenting complaint, past psychiatric history, past medical history, family history, social and developmental history.
- Mental state examination — appearance and behaviour, speech, mood and affect, thought form and content, perception, cognition, insight, judgement.
- Risk assessment — suicide, self-harm, harm to others, vulnerability, capacity, with both static and dynamic factors and any safety-plan elements.
- Diagnosis or differential diagnosis — DSM-5-TR or ICD-11 framing with reasoning and rule-outs.
- Biopsychosocial formulation — predisposing, precipitating, perpetuating, and protective factors.
- Management plan — pharmacological reasoning, non-pharmacological modalities, monitoring, psychoeducation, and review interval.
- Confirmation that a written report containing both the diagnostic assessment and the management plan has been provided to the referring practitioner within 2 weeks. Record the date the letter was sent.
- Documentation that no prior 291 / 92435 service has been provided to this patient in the preceding 12 months.
Common audit failures
Patterns the Professional Services Review scheme and Medicare audits flag.
- Item 291 claimed without the mandatory written report being sent to the referrer within 2 weeks — this is the defining requirement of 291 and the most common rejection ground.
- Written report sent but does not contain both elements (diagnostic assessment AND management plan).
- Item billed within 12 months of a previous 291 (or 92435) for the same patient.
- Consultation under 45 minutes face-to-face.
- No documented MSE or risk assessment — both are required for "comprehensive diagnostic assessment".
- Item 291 used where item 296 would apply — 291 carries the higher fee specifically because of the management-plan-letter requirement; auditors check the letter is on file.
- Item 291 claimed on a referral from a specialist or consultant physician — 291 referrals are GP or participating nurse practitioner only. The 296/297/299/92437 family allows specialist/consultant-physician referrals via AN.0.75; 291 does not.
Related MBS items
Diagnostic codes commonly billed under this item
ICD-10-AM diagnoses whose Medicare pathway includes this item. Click through to the diagnostic-code reference for differential codes and clinical context.
Dementia in Alzheimer's Disease
Organic Mental Disorders
Vascular Dementia
Organic Mental Disorders
Dementia in Other Diseases Classified Elsewhere
Organic Mental Disorders
Unspecified Dementia
Organic Mental Disorders
Organic Amnesic Syndrome Not Induced by Alcohol or Other Psychoactive Substances
Organic Mental Disorders
Delirium Not Induced by Alcohol and Other Psychoactive Substances
Organic Mental Disorders
Other Mental Disorders Due to Brain Damage and Dysfunction and to Physical Disease
Organic Mental Disorders
Personality and Behavioural Disorders Due to Brain Disease, Damage, and Dysfunction
Organic Mental Disorders
Unspecified Organic or Symptomatic Mental Disorder
Organic Mental Disorders
Mental and Behavioural Disorders Due to Alcohol Use
Substance Use Disorders
Mental and Behavioural Disorders Due to Opioid Use
Substance Use Disorders
Mental and Behavioural Disorders Due to Cannabinoid Use
Substance Use Disorders
Mental and Behavioural Disorders Due to Sedatives or Hypnotics
Substance Use Disorders
Mental and Behavioural Disorders Due to Cocaine Use
Substance Use Disorders
Mental and Behavioural Disorders Due to Other Stimulants Including Caffeine
Substance Use Disorders
Mental and Behavioural Disorders Due to Hallucinogens
Substance Use Disorders
Mental and Behavioural Disorders Due to Tobacco Use
Substance Use Disorders
Mental and Behavioural Disorders Due to Multiple Drug Use
Substance Use Disorders
Schizophrenia
Psychotic Disorders
Schizotypal Disorder
Psychotic Disorders
Persistent Delusional Disorders
Psychotic Disorders
Acute and Transient Psychotic Disorders
Psychotic Disorders
Induced Delusional Disorder
Psychotic Disorders
Schizoaffective Disorders
Psychotic Disorders
Other Nonorganic Psychotic Disorders
Psychotic Disorders
Unspecified Nonorganic Psychosis
Psychotic Disorders
Manic Episode
Mood Disorders
Bipolar Affective Disorder
Mood Disorders
Depressive Episode
Mood Disorders
Recurrent Depressive Disorder
Mood Disorders
Persistent Mood Disorders
Mood Disorders
Other Recurrent Mood Disorders — Unipolar Mania
Mood Disorders
Other Mood (Affective) Disorders
Mood Disorders
Unspecified Mood Disorder
Mood Disorders
Phobic Anxiety Disorders
Anxiety Disorders
Other Anxiety Disorders
Anxiety Disorders
Obsessive-Compulsive Disorder
Anxiety Disorders
Reaction to Severe Stress and Adjustment Disorders
Anxiety Disorders
Dissociative (Conversion) Disorders
Anxiety Disorders
Somatoform Disorders
Anxiety Disorders
Other Neurotic Disorders
Anxiety Disorders
Nonorganic Sleep Disorders
Behavioural Syndromes
Sexual Dysfunction Not Caused by Organic Disorder or Disease
Behavioural Syndromes
Mental and Behavioural Disorders Associated with the Puerperium
Behavioural Syndromes
Psychological and Behavioural Factors Associated with Disorders or Diseases Classified Elsewhere
Behavioural Syndromes
Abuse of Non-Dependence-Producing Substances
Behavioural Syndromes
Specific Personality Disorders
Personality Disorders
Mixed and Other Personality Disorders
Personality Disorders
Enduring Personality Changes Not Attributable to Brain Damage and Disease
Personality Disorders
Habit and Impulse Disorders
Personality Disorders
Gender Identity Disorders
Personality Disorders
Disorders of Sexual Preference
Personality Disorders
Psychological and Behavioural Disorders Associated with Sexual Development and Orientation
Personality Disorders
Other Disorders of Adult Personality and Behaviour
Personality Disorders
Specific Developmental Disorders of Speech and Language
Developmental Disorders
Specific Developmental Disorders of Scholastic Skills
Developmental Disorders
Specific Developmental Disorder of Motor Function
Developmental Disorders
Mixed Specific Developmental Disorders
Developmental Disorders
Other Disorders of Psychological Development
Developmental Disorders
Unspecified Disorder of Psychological Development
Developmental Disorders
Hyperkinetic Disorders / ADHD
Childhood & Adolescent Disorders
Conduct Disorders
Childhood & Adolescent Disorders
Mixed Disorders of Conduct and Emotions
Childhood & Adolescent Disorders
Emotional Disorders with Onset Specific to Childhood
Childhood & Adolescent Disorders
Disorders of Social Functioning with Onset in Childhood
Childhood & Adolescent Disorders
Tic Disorders
Childhood & Adolescent Disorders
Other Behavioural and Emotional Disorders with Onset in Childhood
Childhood & Adolescent Disorders
Templates that document this item
Note templates inside Grounded Scribe that produce documentation aligned to this MBS item.
In-depth reading in the Library
Mental Health Tribunal and Medico-Legal Report Writing: What Psychiatrists Need to Document
Psychiatrists regularly prepare reports for Mental Health Tribunals, courts, WorkCover, and insurers. This guide covers the anatomy of a defensible medico-legal report, state Mental Health Act requirements, and how structured dictation can reduce report-writing time.
Documenting Medication Changes During Psychiatric Reviews: A Structured Approach
Medication management is the backbone of psychiatric practice, yet many psychiatrists lack a consistent framework for documenting changes. This guide provides a structured approach to recording medication decisions, clinical reasoning, and monitoring plans during psychiatric reviews.
Psychiatric Consultation MBS Documentation: A Practitioner Guide
Australian psychiatrists bill from three groups of MBS attendance items: 291 (assessment-and-management-plan), the 296/297/299 new-patient comprehensive-consultation family, and the 300/302/304/306/308 duration-tier follow-up family. Each group has distinct schedule rules — 291 carries a mandatory management-plan letter and a 12-month limit; 296/297/299 require no attendance from this psychiatrist in the preceding 24 months; the 300-series shares a 50-attendances-per-calendar-year combined cap. This guide walks through documentation tests for each.
Source authority
Documentation tests on this page reference the descriptor conditions and PSR-audit patterns covered in our existing Library guides. Always confirm current rules against the official descriptor.
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