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Grounded Scribe
Reference only — not billing advice

MBS items change. Verify the current descriptor, fee, and rules on MBS Online before billing. This page does not include a fee amount. Last reviewed 1 May 2026.

  • Specialist
  • Consultant Psychiatrist

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.

  • TimeMore than 45 minutes
  • FrequencyOnce per 12-month period (combined with telehealth item 92435).
  • ReferralRequired
  • ProfessionConsultant Psychiatrist

Requirements to bill

Conditions imposed by the descriptor that must be met to claim this item.

  1. Current 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).
  2. Attendance must be at consulting rooms and last more than 45 minutes face-to-face.
  3. Mental state examination of the patient must be performed and documented.
  4. A comprehensive diagnostic assessment of the patient must be performed.
  5. A 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.
  6. In 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 record to match what the item asks.

  • 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.

Templates that document this item

Note templates inside Grounded Scribe that produce documentation aligned to this MBS item.

In-depth reading in the Library

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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