Medicare Benefits Schedule - Item 82350

Dietetics health service provided to an eligible patient by an eligible dietitian if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the service is provided to the patient individually and in person; and

(c)     the service is of at least 20 minutes in duration

Fee: $68.55 Benefit: 85% = $58.30

(See para MN.16.1, MN.16.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $205.65

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Eating Disorders General Explanatory Notes (items 82350, 82352, 82355, 82360, 82363, 82368, 82371, 82376, 82379, 82381, 82382, 82383; 93074, 93076, 93084, 93087, 93092, 93095, 93100, 93103)

This note provides a general overview of the full range of 1 November 2019 eating disorders items and supporting information more specifically on the on the Category 8 – Miscellaneous Services: Group M16 – Eating disorders services (items 82350, 82352, 82355, 82360, 82363, 82368, 82371, 82376, 82379, 82381, 82382, 82383; 93074, 93076, 93079, 93084, 93087, 93092, 93095, 93100, 93103).

It includes an overview of the items, model of care, patient eligibility, and links to other guidance and resources.

Overview

All 1 November 2019 eating disorders items:

The eating disorders items define services for which Medicare rebates are payable where service providers undertake assessment and management of patients with a diagnosis of anorexia nervosa and patients with other specified eating disorder diagnoses who meet the eligibility criteria (see – patient eligibility). It is expected that there will be a multidisciplinary approach to patient management through these items.

The items mean eligible patients are able to receive a Medicare rebate for development of an eating disorders treatment plan by a medical practitioner in general practice (Group A36, subgroup 1), psychiatry or paediatrics (Group A36, subgroup 2). Patients with an eating disorders treatment and management plan (EDP) will be eligible for comprehensive treatment and management services for a 12 month period, including:

• Up to 20 dietetic services under items 10954, 82350, 93074 and 93108.
• Up to 40 eating disorder psychological treatment services (EDPT service).  
• Review and ongoing management services to ensure that the patient accesses the appropriate level of intervention (Group A36, subgroup 3).
   

An EDPT service includes mental health treatment services which are provided by an allied health professional or a medical practitioner in general practice with appropriate mental health training. These treatment services include:

• Medicare mental health treatment services currently provided to patients under the ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (‘Better Access’) initiative.
  • This includes medical practitioner items 2721, 2723, 2725, 2727, 283, 285, 286, 287, 91818, 91819, 91820, 91821; 91842, 91843, 91844, 91845 and
  • This includes allied health items in Groups M6 and M7 of Category 8; and
• new items for EDPT services provided by suitably trained medical practitioners in general practice (items 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 92182, 92184, 92186 and 92188; 92194, 92196, 92198 and 92200)
• new items for EDPT services provided by eligible clinical psychologists (items 82352-82359, 93076 and 93079), eligible psychologists (items 82360-82367; 93084 and 93087; 93118, 93121), eligible occupational therapists (items 82368-82375; 93092 and 93095; 93126 and 93129) and eligible social workers (items 82376-82383; 93100 and 93103)
   

For any particular patient, an eating disorder treatment and management plan expires at the end of a 12 month period following provision of that service. After that period, a patient will require a new EDP to continue accessing EDPT services. 
 

Patient Eligibility

The eating disorder items are available to eligible patients in the community. These items do not apply to services provided to admitted (in-hospital) patients.

The referring practitioner is responsible for determining that a patient is eligible for an EDP and therefore EDPT and dietetic services.

‘Eligible patient’ defines the group of patients who can access the new eating disorder services. There are two cohorts of eligible patients.

1. Patients with a clinical diagnosis of anorexia nervosa; or
2. Patients who meet the eligibility criteria (below), and have a clinical diagnosis of any of the following conditions:
   1. bulimia nervosa;
   2. binge-eating disorder;
   3. other specified feeding or eating disorder.

The eligibility criteria, for a patient, is:

1. a person who has been assessed as having an Eating Disorder Examination Questionnaire score of 3 or more; and
2. the condition is characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour as manifested by 3 or more occurrences per week; and
3. a person who has at least two of the following indicators:
   1. clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder;
   2. current or high risk of medical complications due to eating disorder behaviours and symptoms;
   3. serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;
   4. the person has been admitted to a hospital for an eating disorder in the previous 12 months;
   5. inadequate treatment response to evidence based eating disorder treatment over the past six months despite active and consistent participation.

The Eating Disorders Items Stepped Model of Care

The eating disorder items incorporate a ‘stepped model’ for best practice care for eligible patients with eating disorders that comprise:

• assessment and treatment planning
• provision of and/or referral for appropriate evidence based eating disorder specific treatment services by allied mental health professionals and provision of services by dietitians
• review and ongoing management items to ensure that the patient accesses the appropriate level of intervention.

The Stepped Model

‘STEP 1’ – PLANNING (trigger eating disorders pathway) 90250-90257, 92146-92153 and 90260-90261

An eligible patient receives an eating disorder plan (EDP) developed by a medical practitioner in general practice (items 90250-90257 and 92146-92153), psychiatry (items 90260) or paediatrics (items 90261).

 ‘STEP 2’ – COMMENCE INITIAL COURSE OF TREATMENT (psychological & dietetic services)

Once an eligible patient has an EDP in place, the 12 month period commences, and the patient is eligible for an initial course of treatment up to 20 dietetic services and 10 eating disorder psychological treatment (EDPT) services. A patient will be eligible for an additional 30 EDPT services in the 12 month period, subject to reviews from medical practitioners to determine appropriate intensity of treatment.

 ‘STEP 3” – CONTINUE ON INITIAL COURSE OF TREATMENT 90264-90267 (managing practitioner review and progress up to 20 EDPT services)

It is expected that the managing practitioner will be reviewing the patient on a regular, ongoing and as required basis. However, a patient must have a review of the EDP (90264-90267), to assess the patient’s progress against the EDP or update the EDP, before they can access more than 10 EDPT services. This is known as the ‘first review’. The first review should be provided by the patient’s managing practitioner, where possible.

‘STEP 4’ FORMAL SPECIALIST AND PRACTITIONER REVIEW 90266-90267 (continue beyond 20 EDPT services)

A patient must have two additional reviews before they can access more than 20 EDPT services. One review (the ‘second review’) must be performed by a medical practitioner in general practice (who is expected to be the managing practitioner), and the other (the ‘third review’) must be performed by a paediatrician (90267) or psychiatrist (90266). Should both recommend the patient requires more intensive treatment, the patient would be able to access an additional 10 EDPT services in the 12 month period. These reviews are required to determine that the patient has not responded to treatment at the lower intensity levels.

The patient’s managing practitioner should be provided with a copy of the specialist review.

The specialist review by the psychiatrist or paediatrician can occur at any point before 20 EDPT services. The practitioner should refer the patient for specialist review as early in the treatment process as appropriate. If the practitioner is of the opinion that the patient should receive more than 20 EDPT services, the referral should occur at the first practitioner review (after the first course of treatment) if it has not been initiated earlier.

Practitioners should be aware that the specialist review can be provided via telehealth. Where appropriate, provision has been made for practitioner participation on the patient-end of the telehealth consultation.

It is expected that the managing practitioner will be reviewing the patient on a regular, ongoing and as required basis. However, a patient must have a review of the EDP (90264-90267), to assess the patient’s progress against the EDP or update the EDP, before they can access the next course of treatment.

‘STEP 5’ ACCESS TO MAXIMUM INTENSITY OF TREATMENT 90266-90267 (continue beyond 30 EDPT services)

To access more than 30 EDPT treatment services in the 12 month period, patients are required to have an additional review (the ‘fourth review’) to ensure the highest intensity of treatment is appropriate. Subject to this review, a patient could access the maximum of 40 EDPT treatment services in a 12 month period. The fourth review should be provided by the patient’s managing practitioner, where possible. 

An Integrated Team Approach

A patient’s family and/or carers should be involved in the treatment planning and discussions where appropriate. The family can be involved in care options throughout the diagnosis and assessment, and are usually the support unit that help to bridge the gap between initial diagnosis and eating disorder specific treatment.

The National Standards for the safe treatment of eating disorders specify a multi-disciplinary treatment approach that provides coordinated psychological, physical, behavioural, nutritional and functional care to address all aspects of eating disorders. People with eating disorders require integrated inter-professional treatment that is able to work within a framework of shared goals, care plans and client and family information. Frequent communication is required between treatment providers to prevent deterioration in physical and mental health (RANZCP Clinical Guidelines: Hay et al., 2014). Consider regular case conferencing to ensure that the contributing team members are able to work within a shared care plan and with client and carers to achieve best outcomes.

Clinical guidelines and other resources

Eating Disorders Training

It is expected that allied health professionals who are providing services under these items have appropriate training, skills and experience in treatment of patients with eating disorders and meet the national workforce core competencies for the safe and effective identification of and response to eating disorders. More information is available at National Eating Disorders Collaboration and ANZAED. 

Training Services

Allied health professionals should contact their professional organisation to identify education and training which may assist to practitioners to gain the skills and knowledge to provide services under these items.

The following organisations provide training which may assist practitioners to meet the workforce competency standards:

• The Australia and New Zealand Academy of eating disorders (ANZAED) - National
• InsideOut Institute - National
• The Victorian Centre of Excellence in Eating Disorders (CEED) - VIC
• Queensland Eating Disorder Service (QuEDS) - QLD
• Statewide Eating Disorder Service (SEDS) - SA
• WA Eating Disorders Outreach & Consultation Service (WAEDOCS) – WA

This list is not exhaustive, but has been included to provide examples on the types of training available which may assist practitioners to upskill in this area.

 

 

Related Items: 82350 82352 82354 82355 82357 82358 82359 82360 82362 82363 82365 82366 82367 82368 82370 82371 82373 82374 82375 82376 82378 82379 82381 82382 82383

Eating Disorders Dietetic Treatment Services (82350, 93074 and 93108)

This note provides information on the Category 8 – Miscellaneous Services: Group M16 – Subgroup 1 (82350, 93074 and 93108) and should be read in conjunction with MN.16.1 Eating Disorders General Explanatory Notes.

Eating Disorder Dietetic Treatment Services Overview

Provision of eating disorder dietetic services by a suitably trained Dietitian (82350, 93074 and 93108) are for patients with anorexia nervosa and other patients with complex presentations of diagnosed eating disorders who meet the eligibility requirements and would benefit from a structured approach to the management of their treatment needs in the community setting.

A patient with an EDP plan can access up to 20 dietetic services under items 10954, 82350, 93074 and 93108 in a 12-month period. For any particular patient, an eating disorder treatment and management plan expires at the end of a 12-month period following provision of that service. After that period, a patient will require a new EDP to continue accessing eating disorders dietetic services.

Provider Eligibility

In order to provide eating disorder dietetic services, Dietitians must be an 'Accredited Practising Dietitian' as recognised by the Dietitians Association of Australia (DAA). 

Checking patient eligibility for services

Note: The 12 month period commences from the date of the EDP.

Patients seeking rebates for eating disorders dietetic services must have had an Eating Disorder Treatment Plan (EDP) 90250-90257, 92146-92153, 90260 or 90261 in the previous 12 months. The plan must require that the patient needs dietetic services for treatment of their eating disorder, and the patient must be provided with a referral for access to the dietetic health services.

If the EDP service has not yet been claimed, the Services Australia will not be aware of the patient's eligibility. In this case the allied health professional should, with the patient's permission, contact the practitioner who developed the plan to ensure the relevant service has been provided to the patient.

Support:

If there is any doubt about whether a patient has had a claim for an eating disorder service, health professionals can access the Health Professionals Online System (HPOS). HPOS is a fast and secure way for health professionals and administrators to check if a patient is eligible for a Medicare benefit for a specific item on the date of the proposed service. However, this system will only return advice that the service/item is payable or not payable.

Patients can also access their own claiming history with a My Health Record or by establishing a Medicare online account through myGov or the Express Plus Medicare mobile app.

Alternatively, health professionals can call the Services Australia on 132 150 to check this information, while patients can seek clarification by calling 132 011.

Additional Claiming Information (general conditions and limitations)

Reporting Back

After each course of treatment, the relevant dietitian is required to provide the referring medical practitioner with a written report on assessments carried out, treatment provided and recommendations for future management of the patient’s condition. This reporting is required after the first service, as clinically required following subsequent services and after the final service.

This reporting will inform the managing practitioner’s reviews of the EDP and enable the practitioner to assess the patient’s progress and response to treatment.

Written reports should include, at a minimum:

• any investigations, tests, and/or assessments carried out on the patient;
• any treatment provided; and
• future management of the patient's condition or problem.

The report to the Practitioner must be kept for 2 years from the date of service.

Where appropriate, it is expected that the report will also be provided to the patients and/or the patient’s family/carer (with the patient’s agreement).

Related Items: 82350 93074 93108