Medicare Benefits Schedule - Note AN.36.2

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

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Professional attendance at consulting rooms by a general practitioner, for providing focussed psychological strategies for assessed mental disorders by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

Fee: $108.20 Benefit: 100% = $108.20

(See para AN.0.78, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a general practitioner (not including a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

The fee for item 2721, plus $30.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2721 plus $2.40 per patient.
Ready Reckoner

(See para AN.0.78, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance at consulting rooms by a general practitioner, for providing focussed psychological strategies for assessed mental disorders by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

Fee: $154.85 Benefit: 100% = $154.85

(See para AN.0.78, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a general practitioner (not including a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

The fee for item 2725, plus $30.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2725 plus $2.40 per patient.
Ready Reckoner

(See para AN.0.78, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance by a general practitioner (including a general practitioner who has not undertaken mental health skills training) of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

Fee: $83.65 Benefit: 75% = $62.75 100% = $83.65

(See para AN.0.56, AN.0.78, AN.36.2 of explanatory notes to this Category)

Professional attendance by a general practitioner (including a general practitioner who has not undertaken mental health skills training) of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

Fee: $123.15 Benefit: 75% = $92.40 100% = $123.15

(See para AN.0.56, AN.0.78, AN.36.2 of explanatory notes to this Category)

Professional attendance by a general practitioner (including a general practitioner who has undertaken mental health skills training of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

Fee: $106.20 Benefit: 75% = $79.65 100% = $106.20

(See para AN.0.56, AN.0.78, AN.36.2 of explanatory notes to this Category)

Professional attendance by a general practitioner (including a general practitioner who has undertaken mental health skills training) of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

Fee: $156.45 Benefit: 75% = $117.35 100% = $156.45

(See para AN.0.56, AN.0.78, AN.36.2 of explanatory notes to this Category)

Contribution by a general practitioner by video, to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 235 to 240 or 735 to 758 of the general medical services table apply)

NOTE: It is a legislative requirement that this service must be performed by the patient’s eligible telehealth practitioner (please see Note AN.1.1 for the definitions as some exemptions do apply)

Fee: $82.10 Benefit: 100% = $82.10

(See para AN.15.3, AN.15.7, AN.36.2 of explanatory notes to this Category)

Contribution by a general practitioner by video to:
(a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or
(b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider.
(other than a service associated with a service to which items 235 to 240 or 735 to 758 of the general medical services table apply)

NOTE: It is a legislative requirement that this service must be performed by the patient’s eligible telehealth practitioner (please see Note AN.1.1 for the definitions as some exemptions do apply)

Fee: $82.10 Benefit: 100% = $82.10

(See para AN.15.3, AN.15.4, AN.15.6, AN.15.8, AN.36.2 of explanatory notes to this Category)

Video attendance by a general practitioner to prepare a GP chronic condition management plan for a patient

Fee: $156.55 Benefit: 100% = $156.55

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Video attendance by a general practitioner to review a GP chronic condition management plan prepared by the general practitioner or an associated medical practitioner

Fee: $156.55 Benefit: 100% = $156.55

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Contribution by a medical practitioner (not including a general practitioner, specialist or consultant physician) by video to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 235 to 240 or 735 to 758 of the general medical services table apply)

NOTE: It is a legislative requirement that this service must be performed by the patient’s eligible telehealth practitioner (please see Note AN.1.1 for the definitions as some exemptions do apply)

Fee: $65.70 Benefit: 100% = $65.70

(See para AN.15.3, AN.15.7, AN.36.2 of explanatory notes to this Category)

Contribution by a medical practitioner (not including a general practitioner, specialist or consultant physician) by video to:
(a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or
(b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider
(other than a service associated with a service to which items 235 to 240 or 735 to 758 of the general medical services table apply)

NOTE: It is a legislative requirement that this service must be performed by the patient’s eligible telehealth practitioner (please see Note AN.1.1 for the definitions as some exemptions do apply)

Fee: $65.70 Benefit: 100% = $65.70

(See para AN.15.3, AN.15.4, AN.15.6, AN.15.8, AN.36.2 of explanatory notes to this Category)

Video attendance by a prescribed medical practitioner to prepare a GP chronic condition management plan for a patient

Fee: $125.30 Benefit: 100% = $125.30

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Video attendance by a prescribed medical practitioner to review a GP chronic condition management plan prepared by the prescribed medical practitioner or an associated medical practitioner

Fee: $125.30 Benefit: 100% = $125.30

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Contribution by a general practitioner (not including a specialist or consultant physician) to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of item 735, 739, 743, 747, 750 or 758 applies)

Fee: $82.10 Benefit: 100% = $82.10

(See para AN.15.3, AN.15.7, AN.36.2 of explanatory notes to this Category)

Contribution by a general practitioner (not including a specialist or consultant physician) to:

(a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or

(b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider

(other than a service associated with a service to which item 735, 739, 743, 747, 750 or 758 applies)

Fee: $82.10 Benefit: 100% = $82.10

(See para AN.15.3, AN.15.4, AN.15.6, AN.15.8, AN.36.2 of explanatory notes to this Category)

Professional attendance by a general practitioner to prepare a GP chronic condition management plan for a patient

Fee: $156.55 Benefit: 75% = $117.45 100% = $156.55

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Professional attendance by a general practitioner to review a GP chronic condition management plan prepared by the general practitioner or an associated medical practitioner

Fee: $156.55 Benefit: 75% = $117.45 100% = $156.55

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner (who has not undertaken mental health skills training), lasting at least 20 minutes but less than 40 minutes, for the preparation of a GP mental health treatment plan for a patient

Fee: $66.90 Benefit: 75% = $50.20 100% = $66.90

(See para AN.0.56, AN.0.78, AN.7.1, AN.36.2 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner (who has not undertaken mental health skills training), lasting at least 40 minutes, for the preparation of a GP mental health treatment plan for a patient

Fee: $98.50 Benefit: 75% = $73.90 100% = $98.50

(See para AN.0.56, AN.0.78, AN.7.1, AN.36.2 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner (who has undertaken mental health skills training), lasting at least 20 minutes but less than 40 minutes, for the preparation of a GP mental health treatment plan for a patient

Fee: $84.95 Benefit: 75% = $63.75 100% = $84.95

(See para AN.0.56, AN.0.78, AN.7.1, AN.36.2 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner (who has undertaken mental health skills training), lasting at least 40 minutes, for the preparation of a GP mental health treatment plan for a patient

Fee: $125.20 Benefit: 75% = $93.90 100% = $125.20

(See para AN.0.56, AN.0.78, AN.7.1, AN.36.2 of explanatory notes to this Category)

Professional attendance at consulting rooms by a prescribed medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:
(a) for providing focussed psychological strategies for mental disorders that have been assessed by a medical practitioner; and
(b) lasting at least 30 minutes but less than 40 minutes

Fee: $86.60 Benefit: 100% = $86.60

(See para AN.0.78, AN.7.1, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a prescribed medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:
(a) for providing focussed psychological strategies for mental disorders that have been assessed by a medical practitioner; and
(b) lasting at least 30 minutes but less than 40 minutes

The fee for item 283, plus $24.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 283 plus $1.90 per patient.
Ready Reckoner

(See para AN.0.78, AN.7.1, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance at consulting rooms by a prescribed medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:
(a) for providing focussed psychological strategies for mental disorders that have been assessed by a medical practitioner; and
(b) lasting at least 40 minutes

Fee: $123.90 Benefit: 100% = $123.90

(See para AN.0.78, AN.7.1, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a prescribed medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:
(a) for providing focussed psychological strategies for mental disorders that have been assessed by a medical practitioner; and
(b) lasting at least 40 minutes

The fee for item 286, plus $24.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 286 plus $1.90 per patient.
Ready Reckoner

(See para AN.0.78, AN.7.1, AN.36.2, MN.6.3, MN.7.4 of explanatory notes to this Category)

Professional attendance by a general practitioner to prepare an eating disorder treatment and management plan, lasting at least 20 minutes but less than 40 minutes.

Fee: $83.65 Benefit: 100% = $83.65

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

Professional attendance by a general practitioner to prepare an eating disorder treatment and management plan, lasting at least 40 minutes

Fee: $123.15 Benefit: 100% = $123.15

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

Professional attendance by a general practitioner to prepare an eating disorder treatment and management plan, lasting at least 20 minutes but less than 40 minutes, if the practitioner has successfully completed mental health skills training.

Fee: $106.20 Benefit: 100% = $106.20

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

Professional attendance by a general practitioner to prepare an eating disorder treatment and management plan, lasting at least 40 minutes, if the practitioner has successfully completed mental health skills training.

Fee: $156.45 Benefit: 100% = $156.45

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

Professional attendance by a medical practitioner (other than a general practitioner, specialist or consultant physician) to prepare an eating disorder treatment and management plant, lasting at least 20 minutes but less than 40 minutes.

Fee: $66.90 Benefit: 100% = $66.90

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

Professional attendance by a medical practitioner (other than a general practitioner, specialist or consultant physician) to prepare an eating disorder treatment and management plan, lasting at least 40 minutes.

Fee: $98.50 Benefit: 100% = $98.50

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

Professional attendance by a medical practitioner (other than a general practitioner, specialist or consultant physician) to prepare an eating disorder treatment and management plan, lasting at least 20 minutes but less than 40 minutes, if the practitioner has successfully completed mental health skills training.

Fee: $84.95 Benefit: 100% = $84.95

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

Professional attendance by a medical practitioner (other than a general practitioner, specialist or consultant physician) to prepare an eating disorder treatment and management plan, lasting at least 40 minutes, if the practitioner has successfully completed mental health skills training.

Fee: $125.20 Benefit: 100% = $125.20

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

Professional attendance at consulting rooms by a consultant physician in the practice of the physician’s specialty of psychiatry 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: $535.95 Benefit: 85% = $455.60

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

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)

Video attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan.

Fee: $108.20 Benefit: 100% = $108.20

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

Video attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan.

Fee: $154.85 Benefit: 100% = $154.85

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

Video attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

Fee: $86.60 Benefit: 100% = $86.60

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

Video attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

Fee: $123.90 Benefit: 100% = $123.90

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

Either:
(a) contribution to a multidisciplinary care plan, for a patient, prepared by another provider; or
(b) contribution to a review of a multidisciplinary care plan, for a patient, prepared by another provider;
by a prescribed medical practitioner, other than a service associated with a service to which any of items 235 to 240, 735, 739, 743, 747, 750 or 758 apply

Fee: $65.70 Benefit: 75% = $49.30 100% = $65.70

(See para AN.7.1, AN.15.3, AN.15.7, AN.36.2 of explanatory notes to this Category)

Either:
(a) contribution to a multidisciplinary care plan, for a patient in a residential aged care facility, prepared by that facility, or contribution to a review of a multidisciplinary care plan, for a patient, prepared by such a facility; or
(b) contribution to a multidisciplinary care plan, for a patient, prepared by another provider before the patient is discharged from a hospital or contribution to a review of a multidisciplinary care plan, for a patient, prepared by another provider;
by a prescribed medical practitioner, other than a service associated with a service to which any of items 235 to 240, 735, 739, 743, 747, 750 or 758 apply

Fee: $65.70 Benefit: 75% = $49.30 100% = $65.70

(See para AN.7.1, AN.15.3, AN.15.4, AN.15.6, AN.15.8, AN.36.2 of explanatory notes to this Category)

Attendance by a prescribed medical practitioner, as a member of a multidisciplinary case conference team, to organise and coordinate:
(a) a community case conference; or
(b) a multidisciplinary case conference in a residential aged care facility; or
(c) a multidisciplinary discharge case conference;
if the conference lasts for at least 15 minutes but less than 20 minutes, other than a service associated with a service to which any of items 231, 232, 392, 393, 729, 731, 965, 967, 92029, 92030, 92060 or 92061 apply

Fee: $66.05 Benefit: 75% = $49.55 100% = $66.05

(See para AN.7.1, AN.36.2 of explanatory notes to this Category)

Attendance by a prescribed medical practitioner, as a member of a case conference team, to participate in a multidisciplinary case conference on a patient with cancer, to develop a multidisciplinary treatment plan, if the case conference lasts at least 10 minutes, with a multidisciplinary team of at least 4 medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health or other relevant health professionals

Fee: $30.15 Benefit: 75% = $22.65 100% = $30.15

(See para AN.0.65, AN.7.1, AN.36.2 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to prepare a GP chronic condition management plan for a patient

Fee: $125.30 Benefit: 75% = $94.00 100% = $125.30

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to review a GP chronic condition management plan prepared by the prescribed medical practitioner or an associated medical practitioner

Fee: $125.30 Benefit: 75% = $94.00 100% = $125.30

(See para AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2 of explanatory notes to this Category)

Professional attendance at consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes.

Fee: $108.20 Benefit: 100% = $108.20

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes

The fee for item 90271, plus $30.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 90271 plus $2.40 per patient.
Ready Reckoner

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Professional attendance at consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes.

Fee: $154.85 Benefit: 100% = $154.85

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a general practitioner to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes

The fee for item 90273, plus $30.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 90273 plus $2.40 per patient.
Ready Reckoner

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Professional attendance at consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes.

Fee: $86.60 Benefit: 100% = $86.60

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 30 minutes but less than 40 minutes

The fee for item 90275, plus $24.20 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 90275 plus $1.90 per patient.
Ready Reckoner

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Professional attendance at consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes.

Fee: $123.90 Benefit: 100% = $123.90

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms by a medical practitioner (other than a general practitioner, specialist or consultant physician) to provide treatment under an eating disorder treatment and management plan, lasting at least 40 minutes

The fee for item 90277, plus $24.20 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 90277 plus $1.90 per patient.
Ready Reckoner

(See para AN.36.2, AN.36.4 of explanatory notes to this Category)

Phone attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan.

Fee: $108.20 Benefit: 100% = $108.20

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

Phone attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan.

Fee: $154.85 Benefit: 100% = $154.85

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

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

Fee: $86.60 Benefit: 100% = $86.60

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

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan.

Fee: $123.90 Benefit: 100% = $123.90

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

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-initial attendance in a single course of treatment

Fee: $178.70 Benefit: 75% = $134.05 85% = $151.90

(See para AN.0.7, AN.0.24, AN.0.25, AN.36.2, AN.40.1, MN.10.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each attendance (other than a service to which item 119 applies) after the first in a single course of treatment

Fee: $89.40 Benefit: 75% = $67.05 85% = $76.00

(See para AN.0.7, AN.0.24, AN.0.25, AN.0.70, AN.3.1, AN.36.2, AN.40.1, MN.10.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each minor attendance after the first in a single course of treatment

Fee: $50.95 Benefit: 75% = $38.25 85% = $43.35

(See para AN.0.7, AN.0.21, AN.0.24, AN.0.25, AN.0.70, AN.3.1, AN.36.2, AN.40.1, MN.10.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) lasting at least 45 minutes for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to the consultant physician by a referring practitioner, if:

(a) an assessment is undertaken that covers:

      (i) a comprehensive history, including psychosocial history and medication review; and

      (ii) comprehensive multi or detailed single organ system assessment; and

      (iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

      (i) an opinion on diagnosis and risk assessment; and

      (ii) treatment options and decisions; and

      (iii) medication recommendations; and

(c) an attendance on the patient to which item 110, 116, 119, 91824, 91825, 91826 or 91836 applies did not take place on the same day by the same consultant physician; and

(d) this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician

Fee: $312.45 Benefit: 75% = $234.35 85% = $265.60

(See para AN.0.23, AN.0.24, AN.36.2, AN.40.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) lasting at least 20 minutes after the initial attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:

(a) a review is undertaken that covers:

(i) review of initial presenting problems and results of diagnostic investigations; and

(ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii) comprehensive multi or detailed single organ system assessment; and

(iv) review of original and differential diagnoses; and

(b) the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

(i) a revised opinion on the diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) revised medication recommendations; and

(c) an attendance on the patient to which item 110, 116, 119, 91824, 91825, 91826 or 91836 applies did not take place on the same day by the same consultant physician; and

(d) item 132 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same consultant physician who claimed item 132 or a locum tenens; and

(f) this item or item 92423 or 92443 has not applied more than twice in any 12 month period

Fee: $156.45 Benefit: 75% = $117.35 85% = $133.00

(See para AN.0.23, AN.36.2, AN.40.1 of explanatory notes to this Category)

Dietetics health service provided to an eligible patient by an eligible dietitian 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 of at least 20 minutes in duration

Fee: $72.65 Benefit: 85% = $61.80

(See para AN.36.2, MN.16.1, MN.16.2 of explanatory notes to this Category)

Video attendance of at least 45 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of psychiatry for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)  the patient has been referred by a referring practitioner; and

(b)  during the attendance, the consultant psychiatrist:

    (i) uses an outcome tool (if clinically appropriate); and

    (ii) carries out a mental state examination; and

    (iii) makes a psychiatric diagnosis; and

(c)  within 2 weeks after the attendance, the consultant psychiatrist:

    (i)  prepares a written diagnosis of the patient; and

    (ii) prepares a written management plan for the patient that:

          (A) covers the next 12 months; and

          (B) is appropriate to the patient’s diagnosis; and

          (C) comprehensively evaluates the patient’s biological, psychological and social issues; and

          (D) addresses the patient’s diagnostic psychiatric issues; and

          (E) makes management recommendations addressing the patient’s biological, psychological and social issues; and

    (iii) gives the referring practitioner a copy of the diagnosis and     the management plan; and

    (iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

          (A) the patient; and

          (B) the patient’s carer (if any), if the patient agrees.

Fee: $535.95 Benefit: 85% = $455.60

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

Video attendance of at least 45 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)     the patient has been referred by a referring practitioner; and

(b)    during the attendance, the consultant paediatrician undertakes an assessment that covers:

    (i)   a comprehensive history, including psychosocial history and medication review; and

    (ii)  comprehensive multi or detailed single organ system assessment; and

    (iii)  the formulation of diagnoses; and

(c)  within 2 weeks after the attendance, the consultant paediatrician:

    (i)  prepares a written diagnosis of the patient; and

    (ii) prepares a written management plan for the patient that involves:

          (A) an opinion on diagnosis and risk assessment; and

          (B) treatment options and decisions; and

          (C) medication recommendations; and

    (iii) gives the referring practitioner a copy of the diagnosis and     the management plan; and

    (iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

          (A) the patient; and

          (B) the patient’s carer (if any), if the patient agrees.

Fee: $312.45 Benefit: 85% = $265.60

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

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which item 729, 731, 965, 967, 231, 232, 392, 393, 92026, 92027, 92029, 92030, 92057, 92058, 92060 or 92061 applies)

Fee: $82.50 Benefit: 75% = $61.90 100% = $82.50

(See para AN.0.49, AN.36.2 of explanatory notes to this Category)

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 40 minutes (other than a service associated with a service to which item 729, 731, 965, 967, 231, 232, 392, 393, 92026, 92027, 92029, 92030, 92057, 92058, 92060 or 92061 applies)

Fee: $172.85 Benefit: 75% = $129.65 100% = $172.85

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

Video attendance by a general practitioner who has not undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder.

Fee: $83.65 Benefit: 100% = $83.65

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

Video attendance by a general practitioner who has not undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder.

Fee: $123.15 Benefit: 100% = $123.15

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

Video attendance by a general practitioner who has undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder.

Fee: $106.20 Benefit: 100% = $106.20

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

Video attendance by a general practitioner who has undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder.

Fee: $156.45 Benefit: 100% = $156.45

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

Video attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has not undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

Fee: $66.90 Benefit: 100% = $66.90

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

Video attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has not undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

Fee: $98.50 Benefit: 100% = $98.50

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

Video attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

Fee: $84.95 Benefit: 100% = $84.95

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

Video attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a) the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b) the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c) the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d) the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

Fee: $125.20 Benefit: 100% = $125.20

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