Medicare Benefits Schedule - Note MN.16.3

Eating Disorders Psychological Treatment (EDPT) services (82352, 82354, 82355, 82357-82360, 82362, 82363, 82365-82368, 82370, 82371, 82373-82376, 82378, 82379, 82381-82383)

This note provides information on the Category 8 – Miscellaneous Services: Group M16 – Subgroups 2-5 (82352, 82354, 82355, 82357-82360, 82362, 82363, 82365-82368, 82370, 82371, 82373-82376, 82378, 82379, 82381-82383) 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, 82354, 82355, 82357-82360, 82362, 82363, 82365-82368, 82370, 82371, 82373-82376, 82378, 82379, 82381-82383) 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, 82354, 82355, 82357-82359)
• registered psychologists (item 82360, 82362, 82363, 82365-82367)
• occupational therapists (82368, 82370, 82371, 82373- 82375)
• accredited mental health social workers (items 82376, 82378, 82379, 82381-82383)

Psychological Treatment Service

Patients seeking rebates for EDPT services must have had an EDP 90250-90257 or 90260-90261 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 Services Australia 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 90260-90261 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, 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 Services Australia on 132 150 to check this information, while patients can seek clarification by calling 132 011.

Provider Eligibility

Advice about registering with Services Australia to provide focussed psychological strategies - allied mental health services is available from Services Australia 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 82354 82355 82357 82358 82359 82360 82362 82363 82365 82366 82367 82368 82370 82371 82373 82374 82375 82376 82378 82379 82381 82382 82383

• Previous - Note MN.16.2
• Next - Note MN.16.4

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible social worker 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 at least 20 minutes but less than 50 minutes in duration

Fee: $68.55 Benefit: 85% = $58.30

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible social worker 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 at least 20 minutes but less than 50 minutes in duration

Fee: $96.55 Benefit: 85% = $82.10

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

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible social worker 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 at least 50 minutes in duration

Fee: $96.80 Benefit: 85% = $82.30

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible social worker 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 at least 50 minutes in duration

Fee: $124.75 Benefit: 85% = $106.05

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

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

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

(b)     the service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $24.55 Benefit: 85% = $20.90

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

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

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

(b)     the attendance is by video conference; and

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

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

(e)     the service is at least 60 minutes in duration

Fee: $24.55 Benefit: 85% = $20.90

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

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible occupational therapist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $68.55 Benefit: 85% = $58.30

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible occupational therapist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $96.55 Benefit: 85% = $82.10

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

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible occupational therapist 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 at least 50 minutes in duration

Fee: $96.80 Benefit: 85% = $82.30

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible occupational therapist 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 at least 50 minutes in duration

Fee: $124.75 Benefit: 85% = $106.05

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

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

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

(b)     the service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $24.55 Benefit: 85% = $20.90

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

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

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

(b)     the attendance is by video conference; and

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

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

(e)     the service is at least 60 minutes in duration

Fee: $24.55 Benefit: 85% = $20.90

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

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible psychologist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $77.85 Benefit: 85% = $66.20

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible psychologist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $105.85 Benefit: 85% = $90.00

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

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible psychologist 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 at least 50 minutes in duration

Fee: $109.80 Benefit: 85% = $93.35

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible psychologist 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 at least 50 minutes in duration

Fee: $137.90 Benefit: 85% = $117.25

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

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

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

(b)     the service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $28.00 Benefit: 85% = $23.80

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

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

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

(b)     the attendance is by video conference; and

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

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

(e)     the service is at least 60 minutes in duration

Fee: $28.00 Benefit: 85% = $23.80

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

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible clinical psychologist 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 at least 30 minutes but less than 50 minutes in duration

Fee: $109.80 Benefit: 85% = $93.35

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible clinical psychologist 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 at least 30 minutes but less than 50 minutes in duration

Fee: $137.25 Benefit: 85% = $116.70

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

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible clinical psychologist 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 at least 50 minutes in duration

Fee: $161.20 Benefit: 85% = $137.05

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

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible clinical psychologist 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 at least 50 minutes in duration

Fee: $188.60 Benefit: 85% = $160.35

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

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 service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $40.90 Benefit: 85% = $34.80

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

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 attendance is by video conference; and

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

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

(e)     the service is at least 60 minutes in duration

Fee: $40.90 Benefit: 85% = $34.80

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