Medicare Benefits Schedule - Item 82359

Search Results for Item 82359

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Category 8 - MISCELLANEOUS SERVICES

82359

82359 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2020

Group
M16 - Eating Disorders Services
Subgroup
2 - Eating disorder psychological treatment services provided by eligible clinical psychologists

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible clinical psychologist if:

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

(b)     the person is not an admitted patient of a hospital; and

(c)     the attendance is by video conference; and

(d)     the patient is located within a telehealth eligible area; and

(e)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(f)      the service is at least 60 minutes in duration.

Fee: $38.35 Benefit: 85% = $32.60

(See para MN.16.1, MN.16.3, MN.16.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $115.05


Associated Notes

Category 8 - MISCELLANEOUS SERVICES

MN.16.1

Eating Disorders General Explanatory Notes

Eating Disorders General Explanatory Notes (items 82350-82383)


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 (82350-82383).

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

Overview

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 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 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

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 82351 82352 82353 82354 82355 82356 82357 82358 82359 82360 82361 82362 82363 82364 82365 82366 82367 82368 82369 82370 82371 82372 82373 82374 82375 82376 82377 82378 82379 82380 82381 82382 82383

Category 8 - MISCELLANEOUS SERVICES

MN.16.3

Eating Disorders Psychological Treatment (EDPT) Services

Eating Disorders Psychological Treatment (EDPT) services (82352-82383)


This note provides information on the Category 8 – Miscellaneous Services: Group M16 – Subgroups 2-5 (82352-82383) and should be read in conjunction with MN.16.1 Eating Disorders General Explanatory Notes

For the purpose of this note Allied mental health professional is the generic term used to describe providers eligible to provider services under these items, including; clinical psychologists, registered psychologists, eligible accredited mental health social workers and eligible occupational therapists.

Eating Disorder Psychological Treatment (EDPT) Services Overview

Provision of EDPT services by a suitably trained Allied mental health professional (82352-82383) 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.

There are 24 items for the provision of eating disorder specific evidence based psychological treatment services by eligible allied mental health professionals:

  • clinical psychologists (item 82352-82359)
  • registered psychologists (item 82360-82367)
  • occupational therapists (82368- 82375)
  • accredited mental health social workers (items 82376-82383)

Psychological Treatment Service

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 MN.16.1 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

In order to provide EDPT services, the allied mental health professional must be recognised by the Department of Human Services as eligible to provide focussed psychological strategies (FPS) services under the Better Access to Mental Health items (see Provider Eligibility for more information). 

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 MN.16.1 Eating Disorders General Explanatory Notes). 

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
     

After each course of treatment, the relevant allied mental health professional 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).

Checking patient eligibility for services

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

Patients seeking rebates for EDPT services must have had an EDP 90250-90257 or 90260-90263 in the previous 12 Months. The plan must require that the patient needs mental health services for treatment of their eating disorder, and the patient must be provided with a referral for access to the allied health services.

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 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 Department of Human Services on 132 150 to check this information, while patients can seek clarification by calling 132 011.

Provider Eligibility

Advice about registering with the Department of Human Services to provide focussed psychological strategies - allied mental health services is available from the Department of Human Services provider inquiry line on 132 150.

Eligible clinical psychologist - MN.6.4 - Clinical Psychologist Professional Eligibility

Eligible allied health professionals

A person is an allied health professional in relation to the provision of Better Access to Mental Health items if the person meets one of the following requirements:

  1. the person is a psychologist who holds general registration in the health profession of psychology under the applicable law in force in the State or Territory in which the service is provided;
  2. the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as the meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers 2014’ as in force on 25 September 2014;
  3. the person:
    1. is an occupational therapist who is registered with the Australian Health Practitioners Regulatory Agency as a person who can provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and
    2. is accredited by Occupational Therapy Australia as:
      • having a minimum of two years experience in mental health; and
      • having undertaken to observe the standards set out in the document published by Occupational Therapy Australia's 'Australian Competency Standards for Occupational Therapists in Mental Health' as in force on 1 November 2006; and
      • having undertaken to observe the standards set out in the 2018 ‘Australian Occupational Therapy Competency Standards’ published the Occupational Therapy Board of Australia.

Continuing professional development (CPD) for Occupational Therapists and Social Workers providing focussed psychological strategies (FPS) services

Occupational therapists and accredited mental health social workers providing FPS services are required to have completed 10hours FPS CPD. A CPD year for the purposes of these items is from 1 July to 30 June annually.

Part-time allied mental health professionals are required to have 10 hours of FPS related CPD, the same as full-time allied mental health professionals.

Occupational Therapists and Social Workers who are registered during the course of the CPD year, their obligation to undertake CPD will be on a pro-rata basis. The amount of units will be calculated from the 1st of the month immediately succeeding the month they obtained initial registration. The obligation will be one-twelfth of the yearly requirement for each month.

CPD activities must be relevant to delivering FPS services. Acceptable CPD activities where the content is related to FPS can include formal postgraduate education, workshops, seminars, lectures, journal reading, writing papers, receipt of supervision and peer consultation, and online training. 

There is flexibility in the CPD activities that can be undertaken to meet individual professional needs and their practice/client base and client needs. For example, activities could also include assessment and treatment of specific disorders and client types such as youth, or different modalities and delivery such as working with groups.

Additional Claiming Information (general conditions and limitations)

Other than Consultation Room (items 82354, 82357, 82362, 82365, 82370, 82373, 82378, 82381)

It is expected that this service would be provided only for patients who are unable to attend the practice. 

Related Items: 82352 82353 82354 82355 82356 82357 82358 82359 82360 82361 82362 82363 82364 82365 82366 82367 82368 82369 82370 82371 82372 82373 82374 82375 82376 82377 82378 82379 82380 82381 82382 82383

Category 8 - MISCELLANEOUS SERVICES

MN.16.4

Eating Disorders Services Telehealth

Eating Disorders Services Telehealth – (items 82351, 82353, 82356, 82359, 82361, 82364, 82367, 82369, 82372, 82375, 82377, 82380, 82383)


This note provides telehealth supporting information for eating disorders Items provided via telehealth by a medical practitioner in general practice and should be read in conjunction with Eating Disorders General Explanatory Notes.

Eligible Geographical Areas

Geographic eligibility for eating disorders telehealth services funded under Medicare (in Group M16) is determined according to the Modified Monash Model (MMM) classifications. Telehealth Eligible Areas are those areas that are within MMM classifications 4 to 7. Patients and providers are able to check their eligibility using the Modified Monash Model locator on the Department of Health’s website at Health Workforce Locator. 

There is a requirement for the patient and practitioner to be located a minimum of 15 kilometres apart at the time of the consultation. Minimum distance between practitioner and patient video consultations are measured by the most direct (ie least distance) route by road. The patient or the practitioner is not permitted to travel to an area outside the minimum 15 kilometres distance in order to claim a video consultation.

Record Keeping

Participating telehealth practitioners must keep contemporaneous notes of the consultation including documenting that the service was performed by video conference, the date, time and the people who participated.

Only clinical details recorded at the time of the attendance count towards the time of the consultation. It does not include information added at a later time, such as reports of investigations.

Aftercare Rule

Video consultations are subject to the same aftercare rules as allied health practitioners providing face-to-face consultations.

Multiple Attendances on the Same Day

In some situations a patient may receive a consultation via video conference and a face-to-face consultation by the same or different clinical psychologist on the same day.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same clinical psychologist, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations. Clinical psychologists will need to provide the times of each consultation on the patient’s account or bulk-billing voucher.

Referrals

The referral procedure for a video consultation is the same as for conventional face-to-face consultations.

 

Related Items: 82351 82353 82356 82359 82361 82364 82367 82369 82372 82375 82377 82380 82383


Legend

  • 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