Medicare Benefits Schedule - Item 93074

Dietetics health service provided by video attendance to an eligible patient by an eligible dietitian:

(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

(c) the service is of at least 20 minutes in duration

Fee: $72.65 Benefit: 85% = $61.80

(See para MN.16.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $217.95

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Eating Disorders Dietetic Treatment Services (82350, 93074 and 93108)

This note provides information on the Category 8 – Miscellaneous Services: Group M16 – Subgroup 1 (82350, 93074 and 93108) and should be read in conjunction with MN.16.1 Eating Disorders General Explanatory Notes.

Eating Disorder Dietetic Treatment Services Overview

Provision of eating disorder dietetic services by a suitably trained Dietitian (82350, 93074 and 93108) 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.

A patient with an eating disorder treatment and management plan (EDTMP) can access up to 20 dietetic services under items 10954, 82350, 93074 and 93108 in a 12-month period. For any particular patient, an EDTMP expires at the end of a 12-month period following provision of that service. After that period, a patient will require a new EDTMP to continue accessing eating disorders dietetic services.

Provider Eligibility

In order to provide eating disorder dietetic services, Dietitians must be an 'Accredited Practising Dietitian' as recognised by the Dietitians Association of Australia (DAA). 

Checking patient eligibility for services

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

Patients seeking benefits for eating disorders dietetic services must have had an Eating Disorder Treatment Plan (EDTMP) 90250-90257, 92146-92153, 90260, 90261, 92162 or 92163 in the previous 12 months. The plan must require that the patient needs dietetic services for treatment of their eating disorder, and the patient must be provided with a referral for access to the dietetic health services.

If the EDTMP service has not yet been claimed, the 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 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)

Reporting Back

After each course of treatment, the relevant dietitian 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 EDTMP 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).

Related Items: 82350 93074 93108