Medicare Clinician FAQS
What are the eligibility criteria?
People diagnosed, as per DSM 5, with:
- Anorexia nervosa (automatically eligible), or
- Bulimia nervosa (and meets additional criteria) or
- Binge eating, (and meets additional criteria) or
- Other specified feeding or eating disorder (and meets additional criteria)
The patients (with a diagnosis other than anorexia nervosa) must have:
- A global EDE-Q score of 3 or higher; and
- Their condition is characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour as manifested by 3 or more occurrences per week
In addition, a these patients must have at least two (2) of the following indicators:
- Clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder.
- Current or high risk of medical complications due to eating disorder behaviours and symptoms.
- Serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function.
- Overnight inpatient admission for an eating disorder in the previous 12 months
- Inadequate treatment response to evidence based eating disorder treatment over the past six months despite active and consistent participation
Check out InsideOut's online screener and online Eating Disorder Examination Questionnaire (EDE-Q), which is automatically scored, graphed and normed online.
The eating disorder items are available to eligible patients in the community. These items do not apply to patients in hospital.
What is the process for a patient to receive an EDP?
To access Medicare items for Eating Disorders:
1. Initial Assessment and Eating Disorders Plan (EDP) – GP
The individual should book a long appointment with the GP. The GP then assesses eligibility for an EDP and then refers for an initial 10 sessions of psychological treatment services and/or up to 20 dietetic services.
Note: If the individual is not eligible the GP may refer for treatment under the existing Better Access to mental health care model or to the public system for treatment
2. Access to 10 psychological sessions and 20 dietetic services
3. 10 session review - GP
At 10 psychological sessions the individual will need a GP review. If recommended, the GP will refer for an additional 10 sessions
4. Access to psychological sessions 11-20
5. 20 session review –GP & psychiatrist/ paediatrician
At 20 psychological sessions if the individual continues to require treatment, they will need a GP review. Prior to this review the GP will need a written report from a psychiatrist or paediatrician who has assessed the individual. If further treatment is recommended by both the GP and specialist doctor, the GP will refer for an additional 10 sessions.
6. Access to psychological sessions 21-30
7. 30 session review – GP
At 30 psychological sessions the individual will need a GP review. If recommended, the GP will refer for an additional and final 10 sessions under the EDP for the year.
8. Access to psychological sessions 31-40
How is an Eating Disorder Plan (EDP) developed?
An eligible patient is required to receive an eating disorder plan (EDP) developed by a medical practitioner in general practice (items 90250-90257), psychiatry (items 90260-90262) or paediatrics (items 90261-90263).
InsideOut Institute in collaboration with GPs has developed a template for use in completing the EDP, which can be found here.
How often does the Eating Disorder Plan need to be reviewed?
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 plan as the patient is approaching the end of each course of 10 sessions of psychological treatment before they can access the next course.
After each course of treatment, relevant practitioners are 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 will inform the managing practitioner’s reviews of the plan and enable the practitioner to assess the patient’s progress, response to treatment and future needs.
An individual does not necessarily need to meet the initial eligibility criteria at each review point. As even if they are improving, they may continue to require further support, and the need for ongoing support will be assessed by the managing practitioner.
What items can be claimed for Eating Disorders?
The following items can be claimed under the new schedule
- Preparation of eating disorders treatment and management plans (90250-90257 and 90260-90263)
- Review of eating disorders treatment and management plans (90264-90269).
- Provision of eating disorders psychological treatment services (90271-90282) (82352-82383)
- Eating disorders dietitian health services (82350-82351)
See InsideOut’s summary document or the MBS Eating Disorders Quick
Reference Guide for more information.
What if the patient already has a treatment plan under Medicare?
Psychological Sessions
Individuals with an Eating Disorder Plan (EDP) may be eligible for up to a maximum of 40 sessions of psychological treatment. This includes not only the new EDPT services but also any sessions provided to the individual under the ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (‘Better Access’) initiative.
This includes the following items:
- medical practitioner items 2721, 2723, 2725, 2727, 283, 285, 286, 287, 371, 372; and
- allied health items in Groups M6 and M7 of Category 8; and
- new items for EDPT services provided by suitably trained medical practitioners in general practice (items 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281, 90282)
- new items for EDPT services provided by eligible clinical psychologists (items 82352-82359), eligible psychologists (items 82360-82367), eligible occupational therapists (items 82368-82375) and eligible social workers (items 82376-82383)
It is recommended that providers do not use simultaneous care plans for psychological treatment and instead utilise the Mental Health Care Plan (MHCP) before or after the Eating Disorder Plan, keeping in mind that the total number of sessions under both plans cannot exceed 40 sessions in a 12-month period.
Dietetic Sessions
Individuals with an EDP are eligible for up to a maximum of 20 dietetic. This includes not only the new eating disorder items but also those claimed under a Chronic Disease Management Plan (CDMP).
Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a CDM Plan, and to manage their eating disorder through an EDP, keeping in mind that the total sessions under both cannot exceed a maximum of 20 sessions in a 12 month period.
For more information about the interaction between care plans see Eating Disorders Treatment and Management Plans Explanatory Note AN.36.2 on the MBS website.
What is the specialist review?
Once the individual has accessed 20 sessions of psychological treatment, they will require an assessment by a psychiatrist or paediatrician to access the final 20 sessions. This is in addition to the review being performed by the GP. This can occur at any point before session 20 and can be provided by telehealth*.
The psychiatrist/paediatrician will need to confirm the individual’s diagnosis, evaluate their response to therapy so far and make a recommendation as to whether further sessions are needed.
It would be helpful for the treating psychologist or mental health practitioner and dietitian to provide a report to the psychiatrist or paediatrician (as well as the GP) before the specialist review.
*where the individual is eligible for telehealth under the MBS
When should an individual be referred to psychiatrist/paediatrician for the specialist review?
The specialist review by the psychiatrist or paediatrician can occur at any point before 20 sessions of psychological treatment. 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 sessions of psychological treatment, the referral should occur at the first practitioner review (after the first course of treatment) if it has not been initiated earlier.
Note: regardless of when specialist review occurs the GP will still need to complete a review every 10 EDPT sessions for the person to continue with the course of treatment.
What if there is a waiting list to see a psychiatrist/paediatrician in private practice?
In some places there may be waiting lists to see a psychiatrist/paediatrician who can provide a review of the eating disorder plan. The following may help individuals to improve timely access psychiatrist/paediatrician for the specialist review:
Early referral - The practitioner (e.g. GP) should refer the patient for specialist review as early in the treatment process as appropriate if they are of the opinion that the patient should receive more than 20 sessions of psychological treatment.
Telehealth – The specialist review can be provided by telehealth where the individual and practitioner are eligible for telehealth under the MBS.
Public health services – A psychiatrist/paediatrician employed in the public health system could complete the review where available and appropriate if they are registered to provide Medicare services and they claim the specific item number for the review.
Does the GP decide what psychological treatment specifically the MH clinician will provide?
No. The GP (or other eligible referring practitioner) develops the eating disorder plan and then refers to a mental health provider who will determine the appropriate psychological approach from the range of acceptable treatments specified. The mental health provider should document the treatment approaches undertaken in their written reports to the GP.
How can I see how many sessions my patient has used under better access and/or Eating Disorder Plan?
The Health Professionals Online System (HPOS) is a fast and secure way for health professionals and administrators to check if a patient is eligible for a Medicare benefit for a specific item on the date of the proposed service. Professionals can check an individual client’s care plan history on HPOS.
Patients can also access their own claiming history with a My Health Record or by establishing a Medicare online account through myGov or the Express Plus Medicare mobile app.
Alternatively, health professionals can call the Department of Human Services on 132 150 to check this information, while patients can seek clarification by calling 132 011.
Are there case conference items for Mental Health practitioners?
No. The Eating Disorder Items do not include case conferencing for mental health practitioners. However, please note that The National Standards for the safe treatment of eating disorders specify a multidisciplinary 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 interprofessional treatment that can 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. Consider regular case conferencing to ensure that the contributing team members can work within a shared care plan and with client and carers to achieve best outcomes
I want to know more about the Eating Disorder Examination Questionnaire (EDE- Q)
What is it?
The Eating Disorder Examination Questionnaire (EDE- Q; Fairburn & Beglin, 2008) is a 28 item self-report measure used for assessing eating disorder behaviours and attitudes over the previous 28 days. It provides a measure of the range and severity of eating disorder features. As well as a Global Score the EDE-Q yields four subscales that reflect the severity of aspects of the psychopathology of eating disorders. These include Restraint, Eating Concern, Weight Concern and Shape Concern. There are also behavioural items regarding the frequency of overeating, bingeing, purging, laxative use and compulsive exercise. Only the Global Score is required for the development of the Eating Disorder Treatment and Management Plan.
Who completes it?
The EDE-Q is self-report so is completed by the patient. There is no specification of who provides the EDE-Q to the patient to complete however the referring practitioner (e.g. GP) is responsible for determining that a patient is eligible for an EDP and therefore will need at minimum access to the completed questionnaire and global score.
How to access it?
The EDE-Q is freely available and you can find a paper version and an electronic version on our website
What age group is the EDE-Q suitable for?
The MBS does not specify what version of the EDE-Q is required however it may be relevant to consider normative data and use of an amended scoring structure from some groups (e.g. adolescents) may be clinically indicated. Ultimately this will be determined by the referring practitioner (e.g. GP) who is responsible for determining patient eligibility.
Is there support available for family members under the new MBS items?
At present there are no specific items that cover family consultations separate to the patient as the MBS is a patient benefits scheme. In general, Medicare subsidises services based on a patients' clinical condition/s and related clinical needs. The attendance of family members, carers or guardians to patients' services is a matter for patients and their providers, taking into consideration clinical appropriateness and privacy.
There are ways, as part of a treatment delivered to a patient, where a provider may (with the patient's consent) hold a conversation with their family without the patient being physically present in the room so long as this approach meets the requirements of an item descriptor.
For example: the new item 82360 requires an eligible psychologist to deliver a service of at least 20 but less than 50min. So long as this item included at least 20 minutes patient time it would satisfy the requirements of the descriptor and could also accommodate any additional discussions with the patient’s family. However, other item numbers have different time requirements e.g. clinical psychology item 82355 mandates at least 50 minutes with the patient, so any time with the family without the patient present would need to be in addition to this 50 minutes in order for the patient to claim the rebate.
Who can provide dietetic treatment under the new items?
In order to provide eating disorder dietetic services, Dietitians must be an
'Accredited Practising Dietitian' as recognised by the Dietitians Association of Australia (DAA).
Provider eligibility requirements are set out in the legislation and explanatory notes for each of the services available on the Medicare website.
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.
Who can provide psychological treatment under the new items?
Psychological treatment can be provided by an allied health professional or a medical practitioner in general practice with appropriate mental health training.
- Medical practitioners in general practice who meet 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.
- The allied mental health professional must be recognised by the Department of Human Services as eligible to provide focussed psychological strategies (FPS) services under the Better Access to Mental Health items.
Please note that psychological treatment is restricted to a list of evidenced based treatments and mental health professionals providing services for eating disorders are expected to meet the national workforce core competencies for the safe and effective identification of and response to eating disorders.
What psychological treatments can be provided?
A range of acceptable treatments has been approved for use by practitioners providing psychological treatment under the eating disorder items. 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
Where can I get training?
All health professionals who plan to deliver services covered under the items must be appropriately trained.
Mental health professionals providing services for eating disorders are expected to meet the national workforce core competencies for the safe and effective identification of and response to eating disorders.
InsideOut’s Essentials eLearning Program is the only online learning program available that meets the NEDC competency framework specified by Medicare. Our Essentials program covers the basic training requirements for all health professionals delivering services under Medicare.
We also offer a detailed online training program for dietitians planning to treat people with eating disorders, and mini-trainings in two of the listed evidence-based treatments for psychological providers under the MBS (CBT and FBT).
Check out all these trainings and more at our eLearning Centre:
You can read more about the evidence based psychological treatments including links to readings and upcoming training here.
We also recommend that professionals providing services for eating disorders access continued professional development and clinical supervision.
Additionally, we recommend you get in contact with your professional organisations, the following may be able to assist:
- Dietitians Association of Australia (DAA)
- The Australia and New Zealand Academy of eating disorders (ANZAED)
- The Victorian Centre of Excellence in Eating Disorders (CEED)
- Queensland Eating Disorder Service (QuEDS)
- Statewide Eating Disorder Service (SEDS) in South Australia
- Western Australia Eating Disorders Outreach & Consultation Service
(WAEDOCS)
How often do I need to provide reports?
Providers have the following reporting requirements:
The referring medical practitioner (e.g. GP)
- is required to create an Eating Disorder Treatment Plan and
- EDTP reviews after psychological sessions 10, 20 and 30
The treating dietitian should provide a written report to the referrer including any assessments carried out, treatment provided and recommendations for future management of the patient’s condition following the:
- initial assessment (after sessions 1 to 2) (required)
- the final assessment (required)
The treating mental health provider should provide a written report to the referrer including any assessments carried out, treatment provided and recommendations for future management of the patient’s condition following the:
- initial assessment (after sessions 1 to 2) (recommended but not mandated)
- prior to care plan reviews at or before EDPT session 10, 20 and 30 (required)
The consultant psychiatrist/paediatrician is required to complete a report following the specialist review. This will involve a written diagnosis and management plan.
- prior to care plan reviews at or before EDPT session 20 (required)
For more information including report templates see the InsideOut Medicare page for Health Professionals.
What if the patient has comorbidities that require treatment?
Treatment for any psychiatric comorbidities wherever possible should be included in the Eating Disorder Treatment and Management Plan. If a patient’s presentation is unsuitable for treatment under the EDP, they may be required to transition to the Better Access Mental Health Care Plan.
Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a Chronic Disease Management Plan, and to manage their eating disorder through an EDP (not exceeding a maximum of 20 dietetic sessions in a 12-month period).
Can the items be provided via telehealth?
Yes, people in eligible rural and remote locations areas of Australia have access to specialist video consultations under Medicare.
Relevant services can be delivered by eligible health practitioners such as:
-
Clinical psychologists;
-
psychologists;
-
occupational therapists;
-
social workers
-
general practitioners;
-
medical practitioners
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consultant psychiatrists
-
consultant paediatricians
-
dietitians
The requirements for these services may include:
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the service is recommended in the patient’s eating disorder treatment and management plan; and
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not an admitted patient of a hospital; and
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the attendance is via video conference; and
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the patient is located in a telehealth eligible area; and
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the patient is, at the time of the attendance, at least 15km by road from the provider; and
-
can only be claimed if the item requirements of the face to face service are met.
See individual item descriptors in the Quick Reference Guide for more specific information
Will the new items and the Eating Disorder Plan process be reviewed?
Yes. There will be an evaluation of the new items after 12 months to assess if the items are operating as intended for patients, providers and the Government. If you wish to provide feedback on the MBS Review, you may do so by emailing the Taskforce at MBSReviews@health.gov.au
My question isn’t covered. Where can I get more information?
The full item descriptor(s) and information on other changes to the MBS will be made available on the MBSOnline website.
http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-EatingDisorders
