Medicare Benefits Schedule - Note AN.36.1

Eating Disorders General Explanatory Notes (items 90250-90257, 90260, 90261, 90264-90267, 90271-90278, 92146-92153, 92162, 92163, 92170-92173, 92176, 92177, 92182, 92184, 92186 and 92188; 92194, 92196, 92198 and 92200)

This note provides a general overview of the full range of 1 November 2025 eating disorders items and supporting information more specifically on the Category 1 – Professional Attendances: Group A36 – Eating Disorders Services (90250-90257, 90260-90261, 90264-90267; 90271-90278, 92146-92153, 92162, 92163, 92170-92173, 92176, 92177, 92182, 92184, 92186 and 92188; 92194, 92196, 92198 and 92200).

It includes an overview of the items, model of care, patient eligibility, and links to other guidance and resources.

Overview

All 1 November 2025 Eating Disorders items:

The Eating Disorders items define services for which Medicare benefits are payable where service providers undertake assessment and management of patients with a diagnosis of anorexia nervosa and patients with other specified eating disorder diagnoses who meet the eligibility criteria (see – patient eligibility). It is expected that there will be a multidisciplinary approach to patient management through these items.

The items mean eligible patients are able to receive a Medicare benefit for development of an eating disorders treatment plan by a medical practitioner in general practice (Group A36, subgroup 1 and Group A40 subgroup 21), psychiatry or paediatrics (Group A36, subgroup 2 and Group A40, subgroup 23), psychiatry or paediatrics (Group A36, subgroup 2 and Group A40, subgroup 23). Patients with an eating disorders treatment and management plan (EDTMP) will be eligible for comprehensive treatment and management services for a 12-month period, including:

• Up to 20 dietetic services under items 10954, 82350, 93074 and 93108.
• Up to 40 eating disorder psychological treatment services (EDPT services).  
• Review and ongoing management services to ensure that the patient accesses the appropriate level of intervention (Group A36, subgroup 3).

EDPT services includes mental health treatment services which are provided by an eligible allied health professional. In addition, an eligible general practitioner (GP) or an eligible prescribed medical practitioner (PMP) who has the appropriate training recognised by the General Practice Mental Health Standards Collaboration can provide focussed psychological strategies services as part of an arrangement for the treatment of an assessed mental disorder under a Mental Health Treatment Plan. These treatment services include:

• Medicare mental health treatment services currently provided to patients under the ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (‘Better Access’) initiative.
  • This includes GP and PMP items 2721, 2723, 2725, 2727, 283, 285, 286, and 287
  • Their equivalent telehealth items 91818, 91819, 91842, 91843, 91820, 91844, 91821 and 91845
  • This includes allied health items in Groups M6 and M7; and
• Items for EDPT services provided by suitably trained medical practitioners in general practice (items 90271, 90278, 92182, 92184, 92186, 92188, 92194, 92198 and 92200)
• New items for EDPT services provided by eligible clinical psychologists (items 82352, 82354, 82355, 82357-82359; 93076, 93079, 93110 and 93113), eligible psychologists (items 82360, 82362-82363, 82365-82367; 93084, 93087, 93118 and 93121), eligible occupational therapists (items 82368, 82370-82371, 82373-82375; 93092, 93095, 93126 and 93129) and eligible social workers (items 82376, 82378-82379, 82381-82383; 93100, 93103, 93134 and 93137) 

 
For the purpose of the 40 eating disorder psychological services count; eating disorder psychological treatment service includes a service provided under the following items: 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198 and 92200, 2721, 2723, 2725, 2727, 283, 285, 286, 287, 91818, 91819, 91820 91821; 91842, 91843, 91844 and 91845 and items in Groups M6, M7 and M16 (excluding items 82350, 93074 and 93108).

For patients with co-occurring mental health issues which require a Mental Health Treatment Plan to access psychological services under the Better Access initiative, Better Access mental health treatment services provided before an EDTMP has commended do not count towards the EDPT services. However, any that are provided after the EDTMP has commenced do count as long as the patient still has a Mental Health Treatment Plan, valid referral and review requirements in place. Further information on the Better Access initiative is available at Note AN.0.78 – Better Access Initiative.

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 EDTMP to continue accessing eating disorder psychological services.

Patient Eligibility

The Eating Disorder items are available to eligible patients in the community. These items do not apply to services provided to admitted (in-hospital) patients.

The referring practitioner is responsible for determining that a patient is eligible for an EDTMP and therefore eating disorder psychological and dietetic services.

‘Eligible patient’ defines the group of patients who can access eating disorder services. There are two cohorts of eligible patients.

1. Patients with a clinical diagnosis of anorexia nervosa; or
2. Patients who meet the eligibility criteria (below), and have a clinical diagnosis of any of the following conditions:
   1. bulimia nervosa;
   2. binge-eating disorder;
   3. other specified feeding or eating disorder.

The eligibility criteria, for a patient, is:

1. a person who has been assessed as having an Eating Disorder Examination Questionnaire score of 3 or more; and
2. the condition is characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour as manifested by 3 or more occurrences per week; and
3. a person who has at least two of the following indicators:
   1. clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder;
   2. current or high risk of medical complications due to eating disorder behaviours and symptoms;
   3. serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;
   4. the person has been admitted to a hospital for an eating disorder in the previous 12-months;
   5. inadequate treatment response to evidence-based eating disorder treatment over the past six months despite active and consistent participation.

Practitioners should have regard to the relevant diagnostic criteria set out in the Diagnostic and Statistical Manual of the American Psychiatric Association – Fifth Edition (DSM-5)

Practitioners can access the Eating Disorder Examination Questionnaire at https://www.credo-oxford.com/pdfs/EDE_17.0D.pdf

The Eating Disorders Items Stepped Model of Care

The eating disorder items incorporate a ‘stepped model’ for best practice care for eligible patients with eating disorders that comprise:

• assessment and treatment planning
• provision of and/or referral for appropriate evidence based eating disorder specific treatment services by allied mental health professionals and provision of services by dietitians
• review and ongoing management items to ensure that the patient accesses the appropriate level of intervention.

The Stepped Model

‘STEP 1’ – PLANNING (trigger eating disorders pathway) 90250-90257, 92146-92153, 90260, 90261, 92162 or 92163 

An eligible patient receives an EDTMP developed by a medical practitioner in general practice (items 90250-90257 or 92146-92153), psychiatry (items 90260 or 92162) or paediatrics (items 90261 or 92163).

 ‘STEP 2’ – COMMENCE INITIAL COURSE OF TREATMENT (psychological & dietetic services)

Once an eligible patient has an EDTMP in place, the 12-month period commences, and the patient is eligible for an initial course of treatment up to 20 dietetic services and 10 eating disorder psychological treatment (EDPT) services. A patient will be eligible for an additional 30 eating disorder psychological treatment services in the 12-month period, subject to reviews from medical practitioners to determine appropriate intensity of treatment.

For patients with co-occurring mental health issues which require a Mental Health Treatment Plan to access psychological services under the Better Access initiative, Better Access mental health treatment services provided before an EDTMP has commenced do not count towards the EDPT services. However, any that are provided after the EDTMP has commenced do count as long as the patient still has a Mental Health Treatment Plan, valid referral and review requirements in place. Further information on the Better Access initiative is available at AN.0.78 – Better Access Initiative.

 ‘STEP 3' – CONTINUE ON INITIAL COURSE OF TREATMENT 90264-90267 (managing practitioner review and progress up to 20 EDPT services)

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 (90264-90267; 92170-92173, 92176 and 92177), to assess the patient’s progress against the EDTMP or update the EDTMP, before they can access more than 10 eating disorder psychological services. This is known as the ‘first review’. The first review should be provided by the patient’s managing practitioner, where possible.

‘STEP 4’ FORMAL SPECIALIST AND PRACTITIONER REVIEW 90266 and 90267 (continue beyond 20 EDPT services)

A patient must have two additional reviews before they can access more than 20 eating disorder psychological treatment services. One review (the ‘second review’) must be performed by a medical practitioner in general practice (who is expected to be the managing practitioner), and the other (the ‘third review’) must be performed by a paediatrician (90267 or 92173) or psychiatrist (90266 or 92172). Should both recommend the patient requires more intensive treatment, the patient would be able to access an additional 10 eating disorder psychological treatment services in the 12-month period. These reviews are required to determine that the patient has not responded to treatment at the lower intensity levels.

The patient’s managing practitioner should be provided with a copy of the specialist review.

The specialist review by the psychiatrist or paediatrician can occur at any point before 20 eating disorder psychological treatment services. The practitioner should refer the patient for specialist review as early in the treatment process as appropriate. If the practitioner is of the opinion that the patient should receive more than 20 eating disorder psychological treatment services, the referral should occur at the first practitioner review (after the first course of treatment) if it has not been initiated earlier.

Practitioners should be aware that the specialist review can be provided via video (92172 and 92173). Where appropriate, provision has been made for practitioner participation on the patient-end of the video consultation.

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 (90264-90267, 92170-92173, 92176 or 92177), to assess the patient’s progress against the EDTMP or update the EDTMP, before they can access the next course of treatment.

‘STEP 5’ ACCESS TO MAXIMUM INTENSITY OF TREATMENT 90266-90267 (continue beyond 30 EDPT services)

To access more than 30 eating disorder psychological treatment services in the 12-month period, patients are required to have an additional review (the ‘fourth review’) to ensure the highest intensity of treatment is appropriate. Subject to this review, a patient could access the maximum of 40 eating disorder psychological treatment services in a 12-month period. The fourth review should be provided by the patient’s managing practitioner, where possible. 

An Integrated Team Approach

A patient’s family and/or carers should be involved in the treatment planning and discussions where appropriate. The family can be involved in care options throughout the diagnosis and assessment, and are usually the support unit that help to bridge the gap between initial diagnosis and eating disorder specific treatment.

The National Standards for the safe treatment of eating disorders specify a multi-disciplinary treatment approach that provides coordinated psychological, physical, behavioural, nutritional and functional care to address all aspects of eating disorders. People with eating disorders require integrated inter-professional treatment that is able to work within a framework of shared goals, care plans and client and family information. Frequent communication is required between treatment providers to prevent deterioration in physical and mental health (RANZCP Clinical Guidelines: Hay et al., 2014). Consider regular case conferencing to ensure that the contributing team members are able to work within a shared care plan and with client and carers to achieve best outcomes.

Clinical guidelines and other resources

It is expected that the consultants providing services under these items should have the appropriate skills, knowledge and experience to provide eating disorders treatment. However, there are a number of resources which may be of assistance to practitioners in supporting and developing an EDTMP, these include:

• The  Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders
• The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Referred Patient Assessment and Management Plan Guidelines
• ANZAED eating disorder treatment principles and general clinical practice and training standards:

Heruc, G., Hurst, K., Casey, A. et al. ANZAED eating disorder treatment principles and general clinical practice and training standards. J Eat Disord 8, 63 (2020). 

• ANZAED practice and training standards for dietitians providing eating disorder treatment: 

Heruc, G., Hart, S., Stiles, G. et al. ANZAED practice and training standards for dietitians providing eating disorder treatment. J Eat Disord 8, 77 (2020).

• ANZAED practice and training standards for mental health professionals providing eating disorder treatment:

Hurst, K., Heruc, G., Thornton, C. et al. ANZAED practice and training standards for mental health professionals providing eating disorder treatment. J Eat Disord 8, 58 (2020). 

Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs. An electronic version of the Guidelines is available on the RANZCP website at www.ranzcp.org

National Eating Disorders Collaboration Eating Disorders: a professional resources for general practitioners available at www.nedc.com.au

Eating Disorders Training

It is expected that practitioners who are providing services under these items have appropriate training, skills and experience in treatment of patients with eating disorders and meet the national workforce core competencies for the safe and effective identification of and response to eating disorders more information available at the National Eating Disorders Collaboration website.

Training Services

Practitioners should contact their professional organisation to identify education and training which may assist to practitioners to gain the skills and knowledge to provide services under these items.

The following organisations provide training which may assist practitioners to meet the workforce competency standards:

• The Australia and New Zealand Academy of eating disorders (ANZAED) - National
• InsideOut Institute (IOI) - National
• The National Eating Disorders Collaboration (NEDC) - National
• The Victorian Centre of Excellence in Eating Disorders (CEED) - VIC
• Queensland Eating Disorder Service (QuEDS) - QLD
• Statewide Eating Disorder Service (SEDS) - SA
• WA Eating Disorders Outreach & Consultation Service (WAEDOCS) – WA

This list is not exhaustive but has been included to provide examples on the types of training available which may assist practitioners to upskill in this area.

 

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