Medicare Benefits Schedule - Note AN.36.4

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Category 1 - PROFESSIONAL ATTENDANCES

AN.36.4

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.

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.

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. 

 

 

Related Items: 90271 90272 90273 90274 90275 90276 90277 90278 90279 90280 90281 90282


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

90271

90271 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes.

Fee: $98.05 Benefit: 100% = $98.05

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90272

90272 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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 30 minutes but less than 40 minutes.

The fee for item 90271, 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 90271 plus $2.15 per patient.
Ready Reckoner

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90273

90273 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes.

Fee: $140.30 Benefit: 100% = $140.30

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90274

90274 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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.
Ready Reckoner

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90275

90275 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes.

Fee: $78.45 Benefit: 100% = $78.45

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90276

90276 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at a place other than consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes.

Derived Fee: The fee for item 90275, plus $21.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 90275 plus $1.75 per patient.
Ready Reckoner

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90277

90277 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes.

Fee: $112.25 Benefit: 100% = $112.25

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90278

90278 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at a place other than consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes.

Derived Fee: The fee for item 90277, plus $21.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 90277 plus $1.75 per patient.
Ready Reckoner

(See para AN.36.1, AN.36.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90279

90279 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes, if the attendance is by video conference
.

Fee: $98.05 Benefit: 100% = $98.05

(See para AN.36.1, AN.36.4, AN.36.5 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90280

90280 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes, if the attendance is by video conference.

Fee: $140.30 Benefit: 100% = $140.30

(See para AN.36.1, AN.36.4, AN.36.5 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90281

90281 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes, if the attendance is by video conference.

Fee: $78.45 Benefit: 100% = $78.45

(See para AN.36.1, AN.36.4, AN.36.5 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90282

90282 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

Professional attendance at consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes, if the attendance is by video conference.

Fee: $112.25 Benefit: 100% = $112.25

(See para AN.36.1, AN.36.4, AN.36.5 of explanatory notes to this Category)


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