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Category 1 - PROFESSIONAL ATTENDANCES
90274 - Additional Information
Professional attendance at a place other than consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes.
Derived Fee: The fee for item 90273, plus $27.45 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 90273 plus $2.15 per patient.
Category 1 - PROFESSIONAL ATTENDANCES
Eating Disorders General Explanatory Notes
Eating Disorders General Explanatory Notes (items 90250-90257, 90260-90269 and 90271-90282)
This note provides a general overview of the full range of 1 November 2019 eating disorders Items and supporting information more specifically on the Category 1 – Professional Attendances: Group A36 – Eating Disorders Services (90250-90257, 90260-90269 and 90271-90282).
It includes an overview of the items, model of care, patient eligibility, and inks to other guidance and resources.
All 1 November 2019 Eating Disorders new 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 and 82351.
- 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, 371, 372; 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, 90279, 90280, 90281, 90282)
- new items for EDPT services provided by eligible clinical psychologists (items 82352-82359), eligible psychologists (items 82360-82367), eligible occupational therapists (items 82368-82375) and eligible social workers (items 82376-82383)
For the purpose of the 40 EDPT count; eating disorder psychological treatment service includes a service under provided under the following items: 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281, 90282, 2721, 2723, 2725, 2727, 283, 285, 286, 287, 371, 372 and items in Groups M6, M7 and M16 (excluding items 82350 and 82351).
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.
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.
- Patients with a clinical diagnosis of anorexia nervosa; or
- Patients who meet the eligibility criteria (below), and have a clinical diagnosis of any of the following conditions:
- bulimia nervosa;
- binge-eating disorder;
- other specified feeding or eating disorder.
The eligibility criteria, for a patient, is:
- a person who has been assessed as having an Eating Disorder Examination Questionnaire score of 3 or more; and
- 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
- a person who has at least two of the following indicators:
- clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder;
- current or high risk of medical complications due to eating disorder behaviours and symptoms;
- serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;
- the person has been admitted to a hospital for an eating disorder in the previous 12 months;
- inadequate treatment response to evidence based eating disorder treatment over the past six months despite active and consistent participation.
Practitioners should have regard to the relevant diagnostic criteria set out in the Diagnostic and Statistical Manual of the American Psychiatric Association – Fifth Edition (DSM-5)
Practitioners can access the Eating Disorder Examination Questionnaire at https://www.credo-oxford.com/pdfs/EDE_17.0D.pdf
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 and 90260-90263
An eligible patient receives an eating disorder plan (EDP) developed by a medical practitioner in general practice (items 90250-90257), psychiatry (items 90260-90262) or paediatrics (items 90261-90263).
‘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 90264-90269 (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 (90264-90269), 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 90266-90269 (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 90269) or psychiatrist (90266 or 90268). 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 (90268 and 90269). 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 (90264-90269), 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 90266-90269 (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
It is expected that the consultants providing services under these items should have the appropriate skills, knowledge and experience to provide eating disorders treatment. However, there are a number of resources which may be of assistance to practitioners in supporting and developing eating disorders treatment plans, these include:
- The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders
- The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Referred Patient Assessment and Management Plan Guidelines
Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs. An electronic version of the Guidelines is available on the RANZCP website at www.ranzcp.org
Eating Disorders Training
It is expected that practitioners 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 available at National Eating Disorders Collaboration
Practitioners 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.
Category 1 - PROFESSIONAL ATTENDANCES
Eating Disorders Psychological Treatment (EDPT) Services
Eating Disorders Psychological Treatment (EDPT) services (90271-90282)
This note provides information on the Category 1 – Professional Attendances: Group A36 – Subgroup 4 (90271-90282) and should be read in conjunction the AN.36.1 Eating Disorders General Explanatory Notes
Eating Disorder Psychological Treatment (EDPT) Services Overview
Provision of EDPT by a suitably trained medical practitioner in general practice (90271 – 90282) is 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.
Patients seeking rebates for EDPT services must have had an EDP 90250-90257 or 90260-90263 in the previous 12 Months.
An ‘eating disorder psychological treatment service’ (EDPT) is defined in the AN.36.1 Eating Disorders General Explanatory Note. 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.
Rendering an EDPT item
Who can provide the service
Items in subgroup 4 of Group A36 can be rendered by a medical practitioner in general practice with the required mental training. This includes:
- Medical practitioners who can render a general practitioner service in Group A1 of the MBS (see note AN.0.9 for the types of medical practitioners). These medical practitioners can render a ‘general practitioner’ service for items in subgroup 1 of Group A36. These doctors must have the mental health training requirements as specified below.
- Medical practitioners who are not general practitioners, specialists or consultant physicians. These medical practitioners can render a ‘medical practitioner’ service for items in subgroup 1 of Group A36. These doctors must have the mental health training requirements as specified below.
Mental health training
Medical practitioner in general practice who meets the training and skills requirements as determined by the General Practice Mental Health Standards Collaboration, and are entered on the Register as being eligible to render a focussed psychological strategy service, can render an eating disorders psychological treatment service.
Note: The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.
What is Involved in an EDPT service
The eating disorder items incorporate a ‘stepped model’ for best practice care for eligible patients with eating disorders. Under the Eating Disorders Items Stepped Model of Care a course of treatment is defined as 10 eating disorder psychological treatment (EDPT) services. It is required that a patient must have a review (an EDR item in subgroup 3 of A36) after each course of treatment (see AN.36.1 Eating Disorders General Explanatory Notes).
After each course of treatment, the relevant practitioners should provide the medical practitioner who is the managing the patient’s EDP (where appropriate) with a written report.
A range of acceptable treatments has been approved for use by practitioners in this context. It is expected that professionals will have the relevant education and training to deliver these services. The approved treatments are:
- Family Based Treatment for Eating Disorders (EDs) (including whole family, Parent Based Therapy, parent only or separated therapy)
- Adolescent Focused Therapy for EDs
- Cognitive Behavioural Therapy (CBT) for EDs (CBT-ED)
- CBT-Anorexia Nervosa (AN) (CBT-AN)
- CBT for Bulimia Nervosa (BN) and Binge-eating Disorder (BED) (CBT-BN and CBT-BED)
- Specialist Supportive Clinical Management (SSCM) for EDs
- Maudsley Model of Anorexia Treatment in Adults (MANTRA)
- Interpersonal Therapy (IPT) for BN, BED
- Dialectical Behavioural Therapy (DBT) for BN, BED
- Focal psychodynamic therapy for EDs
Checking patient eligibility for services
Note: The 12 month period commences from the date of the EDP.
Patients seeking rebates for EDPT 90271-90282 must have had an EDP 90250-90257 or 90260-90263 in the previous 12 months.
If the EDP service has not yet been claimed, the Department of Human Services will not be aware of the patient's eligibility. In this case the practitioner should, with the patient's permission, contact the practitioner who developed the plan to ensure the relevant service has been provided to the patient.
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 Department of Human Services on 132 150 to check this information, while patients can seek clarification by calling 132 011.
Additional Claiming Information (general conditions and limitations)
Other than Consultation Room (items 90272, 90274, 90276, 90278)
It is expected that this service would be provided only for patients who are unable to attend the practice.
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change