Medicare Benefits Schedule - Note AN.36.4

Eating Disorders Psychological Treatment (EDPT) services (90271-78; 92182, 92184, 92186, 92188; 92194, 92196, 92198 and 92200)

This note provides information on the Category 1 – Professional Attendances: Group A36 – Subgroup 4 (90271-90278) should be read in conjunction the AN.36.1 Eating Disorders General Explanatory Notes

Eating Disorder Psychological Treatment (EDPT) Services Overview

Provision of EDPT services by a suitably trained medical practitioner in general practice (90271-90278;92182, 92184, 92186, 92188; 92194, 92196, 92198 and 92200) is 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.

Patients seeking benefits for EDPT services must have had an EDTMP 90250-90257, 92146-92153, 90260 or 90261; 92162 or 92163 in the previous 12 months.

An ‘eating disorder psychological treatment (EDPT) services’ is defined in the AN.36.1 Eating Disorders General Explanatory Note. 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 EDPT services.

Rendering an EDPT service item

Who can provide the service

Items in subgroup 4 of Group A36 can be rendered by a medical practitioner in general practice with the required mental training. 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. These doctors must have the mental health training requirements as specified below.
• 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. These doctors must have the mental health training requirements as specified below.

Mental health training

Medical practitioner in general practice who meets the training and skills requirements as determined by the General Practice Mental Health Standards Collaboration, and are entered on the Register as being eligible to render a focussed psychological strategy service, can render an eating disorders psychological treatment service.

Note: The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.

What is Involved in EDPT services

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 (an EDR item in subgroup 3 of A36) after each course of treatment (see AN.36.1 Eating Disorders General Explanatory Notes). 

After each course of treatment, the relevant practitioners should provide the medical practitioner who is managing the patient’s EDTMP (where appropriate) with a written report.

A range of acceptable treatments has been approved for use by practitioners in this context. It is expected that professionals will have the relevant education and training to deliver these services. The approved treatments are:

• Family Based Treatment for Eating Disorders (EDs) (including whole family, Parent Based Therapy, parent only or separated therapy)
• Adolescent Focused Therapy for EDs
• Cognitive Behavioural Therapy (CBT) for EDs (CBT-ED)
• CBT-Anorexia Nervosa (AN) (CBT-AN)
• CBT for Bulimia Nervosa (BN) and Binge-eating Disorder (BED) (CBT-BN and CBT-BED)
• Specialist Supportive Clinical Management (SSCM) for EDs
• Maudsley Model of Anorexia Treatment in Adults (MANTRA)
• Interpersonal Therapy (IPT) for BN, BED
• Dialectical Behavioural Therapy (DBT) for BN, BED
• Focal psychodynamic therapy for EDs
   

Checking patient eligibility for services

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

Patients seeking benefits for EDPT services 90271-90278; 92182, 92184, 92186, 92188; 92194, 92196, 92198, 92200 must have had an EDTMP 90250-90257; 92146-92153; 90260, 90261; 92162 or 92163 in the previous 12 months.

If the EDTMP has not yet been claimed, the Services Australia will not be aware of the patient's eligibility. In this case the practitioner 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)

Other than Consultation Room (items 90272, 90274, 90276, 90278)

It is expected that this service would be provided only for patients who are unable to attend the practice. 

Related Items: 90271 90272 90273 90274 90275 90276 90277 90278

• Previous - Note AN.36.3
• Next - Note AN.36.5

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)