Ghel Practice - Fees & Medicare Rebates
Our fees are shown together with the relevant Medicare item numbers and estimated Medicare rebates to help you understand your expected out-of-pocket costs.
In general, our services fall into two categories:
Ongoing Care
These appointments are intended for patients who require ongoing psychiatric treatment, medication management, specialist reviews, or follow-up care.
One-Off Assessments
These appointments are intended for patients seeking a comprehensive psychiatric assessment, diagnostic clarification, and treatment recommendations that are then provided to their GP and other treating healthcare professionals.
Please note that all fees are payable in advance and must be received at least 24–48 hours prior to your appointment or before any requested service can be provided.
Understanding Medicare Item Numbers 291, 293 and 296
- Item 291 (telehealth: 92435) — Initial psychiatrist assessment and management plan for a new episode of care. Used for a first comprehensive assessment (including ADHD assessments) or when starting fresh after 12+ months.
- Item 293 (telehealth: 92436) — Review of an existing management plan, within 12 months of an Item 291 assessment. Used for a review of returning patients within 12 months of their assessment.
- Item 296 (telehealth: 92437) — Initial assessment for ongoing psychiatric care, referred by a GP, nurse practitioner, or another specialist — typically used when your GP wants us to manage your care directly going forward (titration, follow-ups included).
291 Assessment and titration or
296 for ongoing care (*)
| Service | Duration | Fee | Medicare item | Medicare rebate |
|---|---|---|---|---|
| First/Initial appointment for ongoing care | 45-60min | $590 | 296/92437 | $268.90 |
| ADHD Assessment (ongoing specialist care) | 45-60min | $1,195 | 291/92435 | $467.45 |
| Follow up consultation | 15min | $290 | 302/91828 (91838 **) | $89.30 |
| Follow up consultation | 30min | $390 | 304/91829 (91839 **) | $137.45 |
| Collateral consultation | 15min | $350 | 341/91875 (91883 **) | $89.30 |
For ongoing care, you need a 296 referral to claim Medicare rebates.
For an assessment including titration, you need a 291 referral with the text “For assessment and management plan (MBS Item 291), with titration if needed.”
(**) Phone consultations are usually not medico-legally suitable; video consultations are.
One-off / Assessments no titration (291/293)
| Service | Duration | Fee | Medicare item | Medicare rebate |
|---|---|---|---|---|
| ADHD Assessment (One-off. GP care afterwards) (*1) | 45-60min | $1,195 | 291/92435 | $467.45 |
| Comprehensive Mental Health Assessment | 45-60min | $1,195 | 291/92435 | $467.45 |
| Review (*2) Comprehensive review | 30-45min | $699 | 293/92436 | $292.20 |
(*1)
Please note that many GPs prefer us to manage the titration phase. In such cases, a referral with the text “For assessment and management plan (MBS Item 291), with titration if needed.” is required for Medicare rebates.
(*2) Comprehensive Review: Options & Timing
Our comprehensive review fee is fixed. Depending on the timing of your appointment and your patient status, Medicare regulations determine which rebate pathway applies to you:
Option A: Review within 12 months of your initial 291 assessment
Eligibility: For returning patients of Dr Caroline who received a Management Plan (MBS Item 291) less than 365 days ago and now require a formal re-evaluation.
MBS Item: 293 / 92436
GP Referral Required: Must explicitly request a “Review of Management Plan under MBS Item 293”.
Option B: Review after 12 months of your initial 291 assessment (Most Cost-Effective Pathway)
Eligibility: For returning patients of Dr Caroline whose original 291 assessment took place 366 days or more ago.
Explanation: Because the 12-month limit has expired, a completely new management plan is prepared, making you eligible for the higher initial rebate again.
MBS Item: 291 / 92435
GP Referral Required: Must be a fresh referral stating “For assessment and management plan (MBS Item 291), with titration if needed.”
Option C: New patients transferring care to our practice
Eligibility: For new patients transferring their care to our practice with an existing ADHD diagnosis from another Australian RANZCP psychiatrist.
MBS Item: 291 or 296, provided you have submitted your official diagnosis letter prior to booking.
Important: If your stimulant medication has been stopped for around 2 years or longer without ongoing specialist care, a full new ADHD assessment is usually required. More information: When is a new ADHD assessment required?
Please speak to your GP to ensure the correct referral wording is used based on your appointment date.
Transition from a paediatrician
| Service | Duration | Fee | Medicare item | Medicare rebate |
|---|---|---|---|---|
| Comprehensive Review | 45-60min | $699 | 291/92435 | $467.45 |
MBS Item: 291 / 92435
GP Referral Required: Must be a fresh referral stating “For assessment and management plan (MBS Item 291), with titration if needed.“
If you’re transitioning from paediatric to adult psychiatric care, your original diagnosis documents are available and your ADHD medication has not been discontinued for around 2 years or longer, you can usually be reviewed under this pathway without needing a new full assessment. An exception applies if the original documents are no longer available, or if your medication has been discontinued for around 2 years or longer without ongoing specialist care: in that case, a complete new clinical assessment is usually required, since a diagnosis can no longer be confirmed with confidence without them or after such a long medication-free period.
More information: When is a new ADHD assessment required?
Medicare rebate notes
Administrative Fees
Since 1 June 2026, certain administrative services attract separate fees.
Please note that administrative fees do not apply to services that are directly connected to a scheduled appointment.
For example, the consultation fee already includes:
- Your assessment report and treatment recommendations provided to your GP following a first / comprehensive or ADHD assessment.
- Prescriptions issued as part of a scheduled assessment or follow-up appointment.
- Routine clinical correspondence directly arising from your consultation.
Administrative fees generally apply only to additional requests outside of scheduled appointments, such as repeat prescription requests, medical letters, hand-over letters, forms, certificates, and other non-consultation services.
These fees are not listed on this page but are outlined in our Patient Guide. Please contact us if you would like a copy.
Frequently Asked Questions
What is Medicare item 291?
Item 291 is the MBS item for an initial psychiatrist assessment and management plan — used for a first comprehensive or ADHD assessment, or a fresh assessment more than 12 months after a previous one. It requires a GP referral and carries a Medicare rebate of $467.45. The telehealth equivalent is item 92435.
What is Medicare item 293?
Item 293 is used for a review of an existing management plan, within 12 months of an Item 291 assessment — for example, a comprehensive review for returning patients. The Medicare rebate is $292.20. The telehealth equivalent is item 92436.
What is Medicare item 296?
Item 296 is an initial assessment for patients starting ongoing psychiatric care, and can be referred by a GP, nurse practitioner, or another specialist. It includes titration and up to 9 follow-ups, and carries a Medicare rebate of $268.90. The telehealth equivalent is item 92437.
What are items 92435, 92436 and 92437?
These are the telehealth (video consultation) versions of items 291, 293 and 296 respectively — same rebate, same requirements, just for a video appointment instead of an in-person one. All of our consultations are via telehealth, so these are the item numbers that apply.
How much is the Medicare rebate for a psychiatrist appointment?
It depends on the item number: $467.45 for an initial assessment (291/92435), $292.20 for a review (293/92436), $268.90 for an initial ongoing-care assessment (296/92437), and $89.30–$137.45 for follow-up consultations. See the fee tables above for the full breakdown by service.
Do I need a referral to see a psychiatrist?
A referral isn’t required to book an appointment with us, but you do need a valid GP referral to claim a Medicare rebate. The wording of the referral determines which item number (and rebate) applies — see the notes above and below for what your GP should include.
How long is a referral valid?
A standard GP referral to a psychiatrist is valid for 12 months. For details on how referral wording affects titration and follow-up eligibility under items 291 and 296, see the “Medicare rebate notes” section above.
Does a review after 12 months cost the same as a new assessment?
No. Our review fee stays at $699, whether it’s billed under item 293/92436 or — under the “Most Cost-Effective Pathway” described in the review options above — under item 291/92435 once more than 12 months have passed since your last 291 assessment. The higher Medicare rebate available under 291/92435 benefits you; it does not change our fee. The full assessment fee of $1,195 applies only to a genuine new assessment (such as an ADHD Assessment or Comprehensive Mental Health Assessment), or in the rare case where ADHD medication has been discontinued for around 2 years or longer without ongoing specialist care, which usually requires a complete new clinical assessment before treatment can resume.
I’m transitioning from a paediatrician to adult psychiatric care — do I need a new assessment?
Not necessarily. If your original diagnosis documents are available and your ADHD medication has not been discontinued for around 2 years or longer, you can usually book a Review ($699, item 291/92435) instead of a full $1,195 assessment. If the documents are no longer available, or your medication has been discontinued for around 2 years or longer without ongoing specialist care, a complete new clinical assessment is usually required, since a diagnosis can no longer be reliably confirmed without them or after such a long medication-free period.
How do I start
Everything you need to know.
About booking, assessment, and the follow-up process.
1. Ask your GP for a referral
The referral letter should include your personal details, relevant mental health history, and any previous investigations or treatments.
A new referral can be addressed to Ghel Practice for Psychiatry.
However, if you already have a referral addressed to another psychiatrist, you can still use that.
Click here for more detailed info
2. Upload the referral
Click here for our upload page
Sources and further reading
Medicare item numbers and rebates are set by the Australian Government. You can check the official item descriptions here:
- MBS Online: Item 291 – psychiatrist assessment and management plan (telehealth equivalent 92435)
- MBS Online: Item 293 – review of a management plan (telehealth equivalent 92436)
- MBS Online: Item 296 – initial consultation for ongoing care (telehealth equivalent 92437)
- Services Australia: Medicare
- RANZCP Your Health in Mind: Cost to see a psychiatrist