Medicare Benefits Schedule - Item 90261

Professional attendance at consulting rooms by a consultant physician in the practice of the physician’s specialty of paediatrics to prepare an eating disorder treatment and management plan, if:

(a) the patient is referred; and

(b) the attendance lasts at least 45 minutes

Fee: $312.45 Benefit: 85% = $265.60

(See para AN.36.2, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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Eating Disorders Treatment and Management Plans Explanatory Notes (items 90250-90257, 92146-92153, 90260-90261, and 92162-92163)

This note provides information on Eating Disorders Treatment and Management Plan (EDTMP) items and should be read in conjunction with the Eating Disorders General Explanatory Notes

Eating Disorder Treatment and Management Plan (EDTMP) items overview

The EDTMP items define services for which Medicare benefits are payable where practitioners undertake the development of a treatment and management plan for patients with a diagnosis of anorexia nervosa, bulimia nervosa, binge-eating disorder and other specified feeding or eating disorder diagnoses who meet the eligibility criteria.

The EDTMP items trigger eligibility for items which provide delivery of eating disorders psychological treatment services (up to a total of 40 psychological services in a 12-month period) and dietetic services (up to a total of 20 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. Eating Disorders treatment services are not available to the patient if the EDTMP has expired.

Preparation of the EDTMP must include:

• discussing the patient’s medical and psychological health status with the patient and if appropriate their family/carer;
• identifying and discussing referral and treatment options with the patient and their family/carer where appropriate, including identification of appropriate support services;
• agreeing goals with the patient and their family/carer where appropriate - what should be achieved by the treatment - and any actions the patient will take;
• planning for the provision of appropriate patient and family/carer education;
• a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
• making arrangements for required referrals, treatment, appropriate support services, review and follow-up;
• documenting the results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date in the patient's plan;
• discussing and organising the appropriate reviews throughout the patient’s treatment; and
• discussing the need for the patient to be reviewed to access a higher intensity of eating disorder psychological treatment services in a 12-month period.
   

Preparing a Medical practitioner in general practice Eating Disorder Treatment & Management Plan (items 90250-90257 and 92146-92153)

Who can provide the service

Items in subgroup 1 of Group A36 can be rendered by a medical practitioner in general practice. 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.
• 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.

What is Involved - Assess and Plan

It is expected that the practitioner developing the EDTMP has either performed or reviewed the assessments and examinations required to make a judgement that the patient meets the eligibility criteria for accessing these items.

Items 90250-90257 and their equivalent telehealth items (92146-92153) provide services for development of the eating disorder treatment and management plan. Where a comprehensive physical examination is performed, either on the same occasion or different occasion, the appropriate item could be claimed provided the time taken performing the assessment is not included in the time for producing the plan, or time producing the EDTMP is not included in the time for assessment.

It is emphasised that it is best practice for the practitioner to perform a comprehensive physical assessment to facilitate ongoing patient management and monitoring of medical and nutritional status.

Patient Assessment

An assessment of a patient with an eating disorders includes:

• taking relevant history (biological, psychological, social, including family/carer support);
• eating disorder diagnostic assessment;
• medical review including physical examination and relevant tests;
• conducting an assessment of mental state, including identification of comorbid psychiatric conditions;
• an assessment of eating disorder behaviours;
• an assessment of associated risk and any medical co-morbidity, including as assessment on how this impacts on the patients functioning and activities of daily living;
• an assessment of family and/or carer support; and
• administering an outcome measurement tool, except where it is considered clinically inappropriate.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.

It should be noted that the patient's EDTMP should be treated as a living document for updating as required. In particular, the plan can be updated at any time to incorporate relevant information, such as feedback or advice from other health professionals on the diagnosis or treatment of the patient.

Preparing a Consultant Psychiatrist Eating Disorder Treatment & Management Plan (90260-90261 and 92162-92163)

Who can provide the service

Items in subgroup 2 of Group 36 can be rendered by consultant psychiatrists (items 90260 and 90261, and their respective telehealth items 92162 and 92163).

What is Involved – Assess and Plan

Items 90260-90261 and their equivalent telehealth items (92162 and 92163) provide access to specialist assessment and treatment planning. It is expected that items will be a single attendance. However, there may be particular circumstances where a patient has been referred by a GP for an assessment and management plan, but it is not possible for the consultant to determine in the initial consultation whether the patient is suitable for management under such a plan. In these cases, where clinically appropriate, other appropriate consultation items may be used. In those circumstances where the consultant undertakes a consultation (in accordance with the item requirements) prior to the consultation for providing the referring practitioner with an assessment and management plan. It is expected that such occurrences would be unusual for the purpose of diagnosis under item 90260.

Patient Assessment

In order to facilitate ongoing patient focussed management, an assessment of the patient must include:

• administering an outcome measurement tool during the assessment and review stages of treatment, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner;
• conducting a mental state examination;
• taking relevant history (biological, psychological, behavioural, nutritional, social);
• assessing associated risk and any co-morbidity; and
• making a psychiatric diagnosis for conditions meeting the eligibility criteria.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.
   

Where a consultant psychiatrist provides an EDTMP service, the service must also include:

• administering an outcome measurement tool, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner. Practitioners using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training; and
• conducting a mental state examination.

Consultation with the patient’s managing practitioner

A written copy of the EDTMP should be provided to the patient’s managing practitioner, within a maximum of two weeks of the assessment. It should be noted that two weeks is the outer limit and in more serious cases more prompt provision of the plan and verbal communication with the managing practitioner may be appropriate.

Additional Claiming Information (general conditions and limitations)

Patients seeking benefits for items 90250-90257 and 90260-90261 will not be eligible if the patient has had a claim within the last 12-months.

Items 90250-90257 cannot be claimed with Items 2713, 279, 735, 758, 235 and 244. Items 90261 cannot be claimed with Items 110, 116, 119, 132, 133.

Consultant psychiatrist and paediatrician EDTMP items 90260-90261 do not apply if the patient does not have a referral within the period of validity.

Before proceeding with the EDTMP the medical practitioner must ensure that:

(a) the steps involved in providing the service are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and

(b) the patient's agreement to proceed is recorded.

The medical practitioner must offer the patient a copy of the EDTMP and add the document to the patient's records. This should include, subject to the patient's agreement, offering a copy to their carer, where appropriate. The medical practitioner may, with the permission of the patient, provide a copy of the EDTMP, or relevant parts of the plan, to other providers involved in the patient's treatment.

The medical practitioner EDTMP cover the service of developing an EDTMP. A separate consultation item can be performed with the EDTMP if the patient is treated for an unrelated condition to their eating disorder. Where a separate consultation is performed, it should be annotated separately on the patient’s account that a separate consultation was clinically required/indicated.

All consultations conducted as part of the EDTMP must be rendered by the medical practitioner and include a personal attendance with the patient. A specialist mental health nurse, other allied health practitioner, Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker with appropriate mental health qualifications and training may provide general assistance to the medical practitioner in provision of this care.

Additional Claiming Information (interaction with Chronic Condition Management and Better Access)

It is preferable that wherever possible patients have only one plan for primary care management of their disorder. As a general principle the creation of multiple plans should be avoided, unless the patient clearly requires an additional plan for the management of a separate medical condition.

The Chronic Condition Management (CCM) items (items 231, 232, 392, 393, 729, 731, 965, 967, 92026, 92027, 92029, 92030, 92057, 92058, 92060 and 92061) continue to be available for patients with chronic medical conditions, including patients with complex needs. 

Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a CCM Plan, and to manage their eating disorder through an EDTMP. In this case, both items can be used. Where the patient receives dietetic services under the CCM arrangements (item 10954), these services will count towards the patients maximum of 20 dietetic services in a 12-month period. 

Where a patient has other psychiatric comorbidities, these conditions should be managed under the EDTMP. Once a patient has a claim for an EDTMP, the patient should not be able to have a claim for the development or review of a Mental Health Treatment plan by a GP (items 2700, 2701, 2715 and 2717) or medical practitioner in general practice (items 272, 276, 281 and 282) within 12-months of their EDTMP unless there are exceptional circumstances.

For the purpose of the 40 eating disorder psychological treatment count; eating disorder psychological treatment service includes a service provided under the following items: 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 2721, 2723, 2725, 2727, 283, 285, 286, 287 and items in Groups M6, M7 and M16 (excluding item 82350). 

Related Items: 110 116 119 132 133 231 232 235 244 272 276 281 282 283 285 286 287 392 393 729 731 735 758 965 967 2700 2701 2715 2717 2721 2723 2725 2727 82350 90250 90251 90252 90253 90254 90255 90256 90257 90260 90261 90271 90272 90273 90274 90275 90276 90277 90278 92026 92027 92029 92030 92057 92058 92060 92061 92146 92147 92148 92149 92150 92151 92152 92153 92162 92163 92182 92184 92186 92188 92194 92196 92198 92200

A number of telehealth (video and phone) items are permanently available.

The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards.  

Providing telehealth by video/videoconference is the preferred substitute for a face-to-face consultation. However, providers can provide a phone consultation via telephone where it is clinically relevant (and the service is covered by a relevant phone item).

A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.

Table 1 – Ongoing telehealth items and equivalent face-to-face services (out of hospital patients)

Service	Face-to-face items	Video items	Phone items
Specialist Services
Specialist. Initial attendance	104	91822	-
Specialist. Subsequent attendance	105	91823	91833
Gynaecologist Specialist Services
Specialist gynaecologist long consult initial attendance	125	127	-
Specialist gynaecologist long consult subsequent attendance	126	129	-
Consultant Physician Services			-
Consultant physician. Initial attendance	110	91824	-
Consultant physician. Subsequent attendance	116	91825	92440
Consultant physician. Subsequent minor attendance	119	91826	91836
Consultant physician. Initial assessment, patient with at least 2 morbidities, prepare a treatment and management plan, at least 45 minutes	132	92422	-
Consultant physician, Subsequent assessment, patient with at least 2 morbidities, review a treatment and management plan, at least 20 minutes	133	92423	92443
Specialist and Consultant Physician Services
Specialist or consultant physician, develop a treatment and management plan, patient aged under 25, with an eligible disability	137	92141	-
Geriatrician Services
Geriatrician, prepare an assessment and management plan, patient at least 65 years, more than 60 minutes	141	92623	-
Geriatrician,  review a management plan, more than 30 minutes	143	92624	92448
Consultant Psychiatrist services
Consultant psychiatrist, develop a treatment and management plan, patient aged under 25, with a complex neurodevelopmental disorder (such as autism spectrum disorder), at least 45 minutes	289	92434	-
Consultant psychiatrist, prepare a management plan, more than 45 minutes	291	92435	-
Consultant psychiatrist, review management plan, 30 to 45 minutes	293	92436	92444
Consultant psychiatrist, attendance, new patient (or has not received attendance in preceding 24 mths), more than 45 minutes	296	92437	-
Consultant psychiatrist. Consultation, not more than 15 minutes	300	91827	91837
Consultant psychiatrist. Consultation, 15 to 30 minutes	302	91828	91838
Consultant psychiatrist. Consultation, 30 to 45 minutes	304	91829	91839
Consultant psychiatrist. Consultation, 45 to 75 minutes	306	91830	-
Consultant psychiatrist. Consultation, more than 75 minutes	308	91831	-
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving group of 2 to 9 unrelated patients or a family group of more than 3 patients, each referred to consultant psychiatrist	342	92455	-
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving family group of 3 patients, each referred to consultant psychiatrist	344	92456	-
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving family group of 2 patients, each referred to consultant psychiatrist	346	92457
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient, 20 to 45 minutes	348	92458	-
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient,  45 minutes or more	350	92459	-
Consultant psychiatrist, interview of a person other than patient, in the course of continuing management of patient, not less than 20 minutes, not exceeding 4 attendances per calendar year	352	92460	-
Consultant psychiatrist, prepare an eating disorder treatment and management plan, more than 45 minutes	90260	92162
Consultant psychiatrist, to review an eating disorder plan, more than 30 minutes	90266	92172	92441
Paediatrician Services (also refer to consultant physician services)
Paediatrician, develop a treatment and management plan, patient aged under 25, with a complex neurodevelopmental disorder (such as autism spectrum disorder), at least 45 minutes	135	92140
Paediatrician, prepare an eating disorder treatment and management plan, more than 45 minutes	90261	92163
Paediatrician, to review an eating disorder plan, more than 20 minutes	90267	92173	92442
Public Health Physician Services
Public health physician, level A attendance	410	92513	92521
Public health physician, level B attendance, less than 20 minutes	411	92514	92522
Public health physician, level C attendance, at least 20 minutes	412	92515	-
Public health physician, level D attendance, at least 40 minutes	413	92516	-
Neurosurgery attendances
Neurosurgeon, initial attendance	6007	92610	-
Neurosurgeon, minor attendance	6009	92611	92618
Neurosurgeon, subsequent attendance, 15 to 30 minutes	6011	92612	92445
Neurosurgeon, subsequent attendance, 30 to 45 minutes	6013	92613	92446
Neurosurgeon, subsequent attendance, more than 45 minutes	6015	92614	92447
Anaesthetist attendance
Anaesthetist, professional attendance, advanced or complex	17615	92701	-
Consultant occupational physician
Consultant occupational physician, initial attendance	385	92748	-
Consultant occupational physician, subsequent attendance	386	92749	92750
Pain medicine services
Pain medicine specialist or consultant, initial attendance	2801	92751	-
Pain medicine specialist or consultant, subsequent attendance	2806	92752	-
Pain medicine specialist or consultant, subsequent minor attendance	2814	92753	92754
Palliative medicine
Palliative medicine specialist or consultant physician, initial attendance	3005	92755	-
Palliative medicine specialist or consultant physician, subsequent attendance	3010	92756	-
Palliative medicine specialist or consultant physician, subsequent minor attendance	3014	92757	92758
Addiction medicine services
Addiction medicine specialist, initial attendance	6018	92759	-
Addiction medicine specialist, subsequent attendance	6019	92760	-
Addiction medicine specialist, subsequent minor attendance	119	-	92761
Addiction medicine specialist, initial attendance, patient with at least 2 morbidities not less than 45 minutes	6023	92762	-
Addiction medicine specialist, subsequent attendance with review of patient with at least 2 morbidities, not less than 20 minutes	6024	92763	-
Sexual health medicine services
Sexual health medicine specialist, initial attendance	6051	92764	-
Sexual health medicine specialist, subsequent attendance	6052	92765	-
Sexual health medicine specialist, subsequent minor attendance	119	-	92766
Sexual health medicine specialist, initial attendance, patient with at least 2 morbidities not less than 45 minutes	6057	92767	-
Sexual health medicine specialist, subsequent attendance with review of patient with at least 2 morbidities, not less than 20 minutes	6058	92768	-

Further information can be found on the MBS Telehealth Services factsheet page on MBS Online.

Eligible providers

All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and phone items.

Restrictions

All MBS telehealth (video and phone) attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item.

Billing Requirements

Bulk billing of specialist (and Allied Health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.

Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at www.mbsonline.gov.au.

Relevant definitions and requirements

Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes occupational and environmental health medicine specialists.

Consultant physician video services (91824, 91825 and 91826) and phone services (92440 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. 

Consultant physician video services to prepare and review a management plan (92422 and 92423) and phone services (92443) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. 

The specialist and consultant physician service for diagnosis and treatment for patients with an eligible disability (92141) can be billed by specialists and consultant physicians that are able to item 137.

Single course of treatment

The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or phone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (phone) should be billed if the patient sees the specialist remotely for the same condition.

Anaesthetist services

The Anaesthetist video service (92701) can be billed by practitioners that can currently bill item 17615.

Service limits

At present, the service limits that apply to standard psychiatry services do not currently apply to the video and phone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and phone psychiatry items as long as they meet the item descriptor requirements.

In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and phone psychiatry items as long as they meet the item descriptor requirements.

The Department of Health, Disability and Ageing will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and phone.

Interview item (92460)

Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year.

Management Plan items (92435 and 92436)

The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information.

Group psychotherapy items (92455, 92456 and 92457)

The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations.

Technical Requirements

The services can be provided by telehealth (video and phone). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. 

Video attendance means a professional attendance by video conference where the medical practitioner:

1. has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains a visual and audio link with the patient; and
4. is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor.

No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available at: www.cyber.gov.au

Phone attendance means a professional attendance by telephone where the health practitioner:

1. has the capacity to provide the full service through this means safely and in accordance with professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains an audio link with the patient.

Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist)

In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. 

Clinicians should record the date, time and duration of the consultation, and retain these records.

Related Items: 104 105 110 116 119 125 126 127 129 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 385 386 410 411 412 413 2801 2806 2814 3005 3010 3014 6007 6009 6011 6013 6015 6018 6019 6023 6024 6051 6052 6057 6058 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 92440 92441 92442 92443 92444 92445 92446 92447 92448 92748 92749 92750 92751 92752 92753 92754 92755 92756 92757 92758 92759 92760 92761 92762 92763 92764 92765 92766 92767 92768