MBS items, care plan vs mental health plan decision, assessment tools, referral pathways, and documentation.
MBS July 2026CliniciansAURACGP · WHO ICD-11 · Services Australia
📋 No specific MBS item exists for long COVID. Management uses existing items — GPCCMP (965), MHTP, Better Access, specialist referrals, spirometry, and pathology. The key clinical decision is which care plan pathway applies.
WHO definition (ICD-11 RA02)
Post-COVID-19 condition: symptoms occurring 3+ months after confirmed or probable SARS-CoV-2 infection, lasting 2+ months, not explained by an alternative diagnosis. Fatigue, cognitive impairment, and breathlessness are the most common features. WHO Oct 2021 · ICD-11 RA02
⚠️ Exclusion first. Before attributing symptoms to long COVID, exclude: anaemia, thyroid dysfunction, iron deficiency, cardiac disease, depression, sleep disorder, and other chronic conditions. Document your differential and investigations. RACGP
MBS items — what to use
All fees MBS Book, July 2026 edition — verified August 2026. MBS Book July 2026
💰
Consultations: Item 23 ($45.05), 36 ($87.10), 44 ($128.35) — bill based on time and complexity. Long COVID consultations often warrant item 44 (prolonged, >40 min) given history-taking, care planning, and coordination required.
📋
GPCCMP (item 965) — $160.60: Core item for long COVID management if symptoms are chronic (lasting or expected to last 6+ months). Provides up to 5 individual allied health services per calendar year under items 10950–10970 (e.g. 10954 dietetics, 10956 mental health, 10958 physiotherapy, 10960 psychology, 10951 diabetes education) — see the allied health MBS item picker for the full breakdown. Can include physio, exercise physiology, OT, dietitian, speech pathology. No specific condition list — document clinical justification. MBS Book July 2026
📋
GPCCMP review (item 967) — $160.60: Review the plan as often as clinically needed. Reassess goals, allied health referrals, and whether additional specialist input is required. Document outcomes.
🧠
Mental Health Treatment Plan (MHTP) — items 2700/2701/2715/2717: For long COVID with significant anxiety, depression, or cognitive symptoms. Provides up to 10 Better Access psychology sessions per calendar year. Item 2715 ($108.95, ≥20–39 min) or 2717 ($160.50, ≥40 min) if you have completed Mental Health Skills Training; otherwise 2700 ($85.80) or 2701 ($126.35). Can be held alongside a GPCCMP. MBS Book July 2026
💨
Spirometry (item 11506 — $24.60): For persistent breathlessness. Documents airflow limitation and baseline for monitoring. Item 11503 ($165.95) is the more complex respiratory lab measurement, performed under specialist supervision — generally not ordered by GP for long COVID screening. MBS Book July 2026
🧪
Pathology — bulk billed via GP request: FBC, iron studies, thyroid (TSH), fasting glucose, renal/liver function, CRP/ESR, B12, Vitamin D. Document clinical justification. Repeat as needed for monitoring.
❤️
ECG — in-room: For cardiac symptoms (palpitations, chest pain). No separate MBS item needed — covered as part of the consultation.
GPCCMP vs MHTP — which applies?
Both can be active simultaneously. The question is whether the primary presentation is physical or mental health.
✅
GPCCMP (965) for the physical symptoms cluster — fatigue, breathlessness, pain, cognitive impairment — with allied health referrals. AND
✅
MHTP for anxiety, depression, mood, or cognitive/psychological symptoms. Both can coexist in the same patient. Document separately.
📝
Can be billed at the same consultation as the main consultation item. Document the time spent on each plan. MBS rules — GPCCMP and MHTP same-day billing permitted
Validated assessment tools — interactive
Tap a domain to see the recommended tool and how to use it in practice.
📋
Fatigue Severity Scale (FSS) — 9 items, scored 1–7: Score ≥36 indicates significant fatigue. Original validation: Krupp LB et al, Arch Neurol 1989. Free, validated, widely used for post-viral fatigue. Document baseline score at each review. PubMed PMID 2803071 ↗
⚠️
Post-exertional malaise (PEM) screening: Ask specifically — “Do symptoms worsen significantly after physical or mental exertion, even mild activity?” PEM is a hallmark of ME/CFS and influences management (graded exercise must be used cautiously if PEM is present). RACGP ME/CFS guidance
Referral pathways — when and to whom
🫀
Respiratory physician: Persistent breathlessness, abnormal spirometry, oxygen desaturation, or suspected pulmonary fibrosis. Include spirometry results and exercise tolerance in referral.
❤️
Cardiologist: Palpitations, POTS (postural tachycardia — HR rise ≥30 bpm on standing), chest pain, or abnormal ECG. Include lying/standing HR measurements in referral letter.
🧠
Neurologist: Severe or progressive cognitive impairment, neuropathy, or new neurological signs. RACGP
🩼
Rheumatologist: Joint inflammation, autoimmune features, or elevated inflammatory markers not explained by another condition.
🏋
Exercise physiologist (via GPCCMP): For fatigue management, pacing strategies, and careful graduated return to activity. Especially useful if PEM is present — unguided exercise can worsen PEM. Specify PEM status in referral. Source: RACGP ME/CFS guidance
🪑
Occupational therapist (via GPCCMP): Cognitive rehabilitation, work reintegration, pacing and energy management strategies. Specify cognitive and functional domains affected.
🌐
Long COVID clinic (VIC/NSW/QLD): For complex multi-system presentation. Accessed via GP referral. VIC ↗ · NSW ↗ · QLD ↗
🧪
Clinical trials: Active long COVID trials are recruiting in Australia. If standard management is not improving symptoms, discuss trial eligibility with the patient. Search: australianclinicaltrials.gov.au ↗ — 40+ studies in PubMed as of April 2026. PubMed Apr 2026
Documentation — what to record
📝
COVID infection history: Date of infection, severity, vaccination status at time of infection, variant if known.
📝
Symptom timeline: Onset, progression, functional impact, any partial recovery periods. Use a validated scale (FSS, K10, MRC dyspnoea scale) and record the score.
📝
Investigations: Document what was done and why, and the results. Record that common differentials have been considered and excluded.
📝
Care plan documentation: Record treatment goals, allied health referrals, review schedule. GPCCMP must be in writing and available to the patient.
📝
Work capacity: If the patient is working or has work-related impacts, document this clearly — may be relevant for WorkCover, insurance, or NDIS.