Medicare Benefits Schedule - Note MN.16.3

Eating Disorders Psychological Treatment (EDPT) services (82352, 82354, 82355, 82357-82360, 82362, 82363, 82365-82368, 82370, 82371, 82373-82376, 82378, 82379, 82381-82383, 93076, 93079, 93084, 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134, 93137)

This note provides information on the Category 8 – Miscellaneous Services: Group M16 – Subgroups 2-5 (82352, 82354, 82355, 82357-82360, 82362, 82363, 82365-82368, 82370, 82371, 82373-82376, 82378, 82379, 82381-82383, 93076, 93079, 93084, 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134, 93137) and should be read in conjunction with MN.16.1 Eating Disorders General Explanatory Notes.

For the purpose of this note Allied mental health professional is the generic term used to describe providers eligible to provider services under these items, including; clinical psychologists, registered psychologists, eligible accredited mental health social workers and eligible occupational therapists.

Eating Disorder Psychological Treatment (EDPT) Services Overview

Provision of EDPT services by a suitably trained Allied mental health professional (82352, 82354, 82355, 82357-82360, 82362, 82363, 82365-82368, 82370, 82371, 82373-82376, 82378, 82379, 82381-82383, 93076, 93079, 93084, 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134, 93137) 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.

There are 24 items for the provision of eating disorder specific evidence based psychological treatment services by eligible allied mental health professionals:

• clinical psychologists (item 82352, 82354, 82355, 82357-82359, and their equivalent telehealth items 93076, 93079, 93110 and 93113)
• registered psychologists (item 82360, 82362, 82363, 82365-82367, and their equivalent telehealth items 93084, 93087, 93118 and 93121)
• occupational therapists (82368, 82370, 82371, 82373- 82375, and their equivalent telehealth items 93092, 93095, 93126 and 93129)
• accredited mental health social workers (items 82376, 82378, 82379, 82381-82383, and their equivalent telehealth items 93100, 93103, 93134 and 93137)

Psychological Treatment Service

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

‘Eating disorder psychological treatment service (EDPT) services’ is defined in the MN.16.1 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

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.

In order to provide EDPT services, the allied mental health professional must be recognised by Services Australia as eligible to provide treatment services under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative (see Provider Eligibility for more information). 

Under the Better Access initiative, eligible patients must be referred to mental health treatment services by either a GP or PMP at the general practice in which the patient is enrolled in MyMedicare, or regardless of whether the patient is enrolled in MyMedicare, by the patient’s usual medical practitioner who is managing the patient under a Mental Health Treatment Plan. This also includes a GP or PMP who is located at a medical practice that has provided the majority of their care over the previous 12 months or will be providing the majority of their care over the next 12 months. In addition, eligible patients can be referred under a Psychiatrist Assessment and Management Plan, or on direct referral from an psychiatrist or paediatrician. Further information on the Better Access initiative is available at AN.0.78 – Better Access Initiative.  

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 MN.16.1 Eating Disorders General Explanatory Notes). 

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
   

After each course of treatment, the relevant allied mental health professional 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).

Checking patient eligibility for services

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

Patients seeking benefits for EDPT services must have had an EDTMP 90250-90257; 92146-92153 or 90260-90261; 92162-92163 in the previous 12 Months. The plan must require that the patient needs mental health services for treatment of their eating disorder, and the patient must be provided with a referral for access to the allied health services.

If the EDTMP has not yet been claimed, 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.

Provider Eligibility

Advice about registering with Services Australia to provide focussed psychological strategies is available from the Services Australia provider inquiry line on 132 150.

Eligible clinical psychologist - MN.6.4 - Clinical Psychologist Professional Eligibility

Eligible providers who can provide mental health treatment services under the Better Access Initiative

Under the Better Access initiative, focussed psychological strategies services may only be provided by an eligible GP, an eligible PMP, eligible psychologist (registered), eligible occupational therapist, or eligible social workers. The eligibility requirements for each profession are set out at MN.7.4 – Provision of Focussed Psychological Strategies. Eligible allied health professionals must be registered with Services Australia.

Psychological therapy services under the MBS may only be provided by eligible clinical psychologists. To provide psychological therapy services to eligible patients under the Better Access initiative, eligible clinical psychologists must meet the provider eligibility requirements set out at MN.6.2 – Provision of Psychological Therapy and be registered with Services Australia.

Continuing professional development for occupational therapists and social workers providing focussed psychological strategies services

In addition to meeting the relevant professional eligibility requirements, under the Better Access initiative, eligible occupational therapists and eligible social workers are required to complete continuing professional development each year to provide focussed psychological strategies. A year for the purposes of these items is from 1 July to 30 June annually. Further information is outlined at MN.7.4 – Provision of Focussed Psychological Strategies.

Additional Claiming Information (general conditions and limitations)

Other than Consultation Room (items 82354, 82357, 82362, 82365, 82370, 82373, 82378, 82381)

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

Related Items: 82352 82354 82355 82357 82358 82359 82360 82362 82363 82365 82366 82367 82368 82370 82371 82373 82374 82375 82376 82378 82379 82381 82382 82383

• Previous - Note MN.16.2
• Next - Note MN.16.4

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible social worker 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 at least 20 minutes but less than 50 minutes in duration

Fee: $72.65 Benefit: 85% = $61.80

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible social worker 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 at least 20 minutes but less than 50 minutes in duration

Fee: $102.35 Benefit: 85% = $87.00

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible social worker 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 at least 50 minutes in duration

Fee: $102.60 Benefit: 85% = $87.25

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible social worker 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 at least 50 minutes in duration

Fee: $132.20 Benefit: 85% = $112.40

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $26.00 Benefit: 85% = $22.10

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the attendance is by video conference; and

(c)     the patient is located within a telehealth eligible area; and

(d)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)     the service is at least 60 minutes in duration

Fee: $26.00 Benefit: 85% = $22.10

(See para MN.16.1, MN.16.3, MN.16.4 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible occupational therapist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $72.65 Benefit: 85% = $61.80

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible occupational therapist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $102.35 Benefit: 85% = $87.00

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible occupational therapist 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 at least 50 minutes in duration

Fee: $102.60 Benefit: 85% = $87.25

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible occupational therapist 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 at least 50 minutes in duration

Fee: $132.20 Benefit: 85% = $112.40

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $26.00 Benefit: 85% = $22.10

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the attendance is by video conference; and

(c)     the patient is located within a telehealth eligible area; and

(d)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)     the service is at least 60 minutes in duration

Fee: $26.00 Benefit: 85% = $22.10

(See para MN.16.1, MN.16.3, MN.16.4 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible psychologist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $82.50 Benefit: 85% = $70.15

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible psychologist 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 at least 20 minutes but less than 50 minutes in duration

Fee: $112.20 Benefit: 85% = $95.40

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible psychologist 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 at least 50 minutes in duration

Fee: $116.40 Benefit: 85% = $98.95

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible psychologist 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 at least 50 minutes in duration

Fee: $146.20 Benefit: 85% = $124.30

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $29.70 Benefit: 85% = $25.25

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the attendance is by video conference; and

(c)     the patient is located within a telehealth eligible area; and

(d)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)     the service is at least 60 minutes in duration

Fee: $29.70 Benefit: 85% = $25.25

(See para MN.16.1, MN.16.3, MN.16.4 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible clinical psychologist 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 at least 30 minutes but less than 50 minutes in duration

Fee: $116.40 Benefit: 85% = $98.95

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible clinical psychologist 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 at least 30 minutes but less than 50 minutes in duration

Fee: $145.45 Benefit: 85% = $123.65

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible clinical psychologist 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 at least 50 minutes in duration

Fee: $170.85 Benefit: 85% = $145.25

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible clinical psychologist 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 at least 50 minutes in duration

Fee: $199.90 Benefit: 85% = $169.95

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the service is provided in person; and

(c)     the service is at least 60 minutes in duration

Fee: $43.35 Benefit: 85% = $36.85

(See para MN.16.1, MN.16.3 of explanatory notes to this Category)

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)     the attendance is by video conference; and

(c)     the patient is located within a telehealth eligible area; and

(d)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(e)     the service is at least 60 minutes in duration

Fee: $43.35 Benefit: 85% = $36.85

(See para MN.16.1, MN.16.3, MN.16.4 of explanatory notes to this Category)