Medicare Benefits Schedule - Item 90267

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

(a) the patient is referred; and

(b) the attendance lasts at least 20 minutes

Fee: $156.45 Benefit: 85% = $133.00

(See para AN.36.3, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $469.35

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Eating Disorders Treatment and Management Plan Reviews (items 90264-90267, 92170-92173, 92176 and 92177)

This note provides information on eating disorder treatment and management Plan (EDTMP) review items and should be read in conjunction with the AN.36.1 Eating Disorders General Explanatory Notes and the AN.36.2 Eating Disorders Treatment and Management Plans Explanatory Notes.

Eating Disorder Treatment Plan review (EDR) items overview

The EDR items define services for which Medicare benefits are payable where practitioners undertake to review the efficacy of the patient’s eating disorder treatment and management plan (EDTMP). This includes modifying the patient’s plan, where appropriate, to improve patient outcomes. The review services can be provided by medical practitioners working in general practice, psychiatry and paediatrics.

An EDR may be provided by the managing practitioner who prepared the patient's initial plan (or another practitioner in the same practice or in another practice where the patient has changed practices) and should include a systematic review of the patient's progress against the initial EDTMP (whether it was prepared by a GP, psychiatrist or paediatrician) and by completing the activities that must be included in a review (see below).

When to render an EDR review item

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 EDTMP to assess the patient’s progress against the EDTMP or update the EDTMP, as the patient is approaching the end of each course of treatment before they can access the next course of treatment.

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 after each course of treatment (see AN.36.1 Eating Disorders General Explanatory Notes). 

Reviewing an Eating Disorders Treatment Plan

The EDR must include:

• recording the patient's agreement for this service;
• referral to a psychiatrist or paediatrician for review under items 90266-90267 or their equivalent telehealth items 92172-92173, if this has not been initiated at an earlier stage;
• a review of the patient's progress against the goals outlined in the EDTMP, including discussion with the patient and/or their family/carer as to whether the EDPT services are meeting their needs;
• modification of the documented EDTMP if required;
• checking, reinforcing and expanding education;
• a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and
• reviewing reports back from the allied mental health professional on the patient’s response to treatment and documenting a recommendation on whether patient should continue with another course of EDPT services with that health professional or another health professional.
   

Where a consultant psychiatrist or paediatrician provides an EDR, the consultant physician must give the referring practitioner a copy of the diagnosis and the revised EDTMP within 2 weeks after the attendance. Where a consultant psychiatrist provides an EDR service, the review 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.

Note: It is expected there will be other consultations between the patient and the managing practitioner as part of ongoing patient and medical management, including the ordering and reviewing of the required testing for monitoring the patients’ medical and nutritional status. All other ongoing patient reviews should be claimed under the appropriate item.

Checking patient eligibility for services

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

To provide an EDR service in items 90264-90267, 92170-92173, 92176-92177, the patient must have had an EDTMP 90250-90257, 90260-90261, 92146-92153, 92162-92163 in the previous 12 months.

If the EDTMP service has not yet been claimed, Services Australia will not be aware of the patient's eligibility. In this case the practitioner should, with the patient's permission, contact the referring practitioner to ensure the relevant service has been provided to the patient.

Support:

If there is any doubt about a patient’s eligibility, Services Australia will be able to confirm whether a patient has had a claim for an eating disorder service, as well as the number of services already claimed by the patient. Additionally, providers can also access the Health Professionals Online System (HPOS) to view a patient’s history.

Allied health professionals can call Services Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011 or view their care plan history in their Medicare online account through myGov to help track services that have been claimed.

 Additional Claiming Information (general conditions and limitations)

Items 90264-90265 cannot be claimed with item 2713 and 279.

Consultant psychiatrist and paediatrician EDTMP items 90266-90267 do not apply if the patient does not have a referral within the period of validity.

Before proceeding with the EDR service 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 reviewed 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 revised EDTMP, or relevant parts of the plan, to other providers involved in the patient's treatment.

The medical practitioner EDR items cover the service of reviewing 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 or review 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 Better Access)

Items 90264-90265 for an EDR, performed by a medical practitioner working in general practice, should not be performed in association with a GP mental health consultation review service (item 2712 and 277).

Related Items: 90264 90265 90266 90267

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)

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