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Update on New Medicare Items for Eating Disorders commencing 1 November 2019



Below is a summary of key information regarding eligibility for Clinical Psychology services, under the new Medicare items for Eating Disorders commencing 1 November, 2019. 

For purposes of clarity, exhaustive details have not been provided.  For all Medicare-related queries, including queries regarding the Medicare Safety Net, please contact Medicare directly on 132 011 (7 days a week, 24 hours a day), check MBS online, or refer to the MBS Eating Disorders – Quick Reference Guide.

The new medicare items for clients with eating disorders are based on a stepped model of careTo determine the required intensity of services, progress reports and reviews (1st, 2nd & 3rd, and 4th) are required after each set of 10 Eating Disorder Psychology Treatment (EDPT) services. 

A maximum of 40 Medicare-subsidised psychology services can be claimed over a period of 12 months.  Note that unused sessions expire after the 12 month period.  If further services are required beyond 12 months, another plan will need to be prepared.



Eligibility for subsidised Clinical Psychology services under an Eating Disorder Plan commencing 1 November 2019

Eligible patients include those who have a Medicare card who are assessed by their referring medical practitioner as having:

  • A clinical diagnosis of Anorexia Nervosa;

       or

Medical practitioners can complete the template here for referral purposes. 

Patients who do not meet relevant eligibility criteria for an Eating Disorders Plan may be eligible to access subsidised sessions under other Medicare schemes (e.g., Better Access, Chronic Disease Management Plan), or Private Health Insurance.  For further information, click here.



What do I need to do to access the new MBS Eating Disorders items commencing 1 November 2019?

Step 1: PLANNING – See your medical practitioner to be assessed for eligibility for an Eating Disorders Plan

Patients who meet relevant eligibility criteria can obtain an Eating Disorders Plan from any of the following medical practitioners:

1) your general medical practitioner (MBS items 90250 – 90257), or
2) a consultant psychiatrist (MBS items 90260 – 90262), or
3) a consultant paediatrician (MBS items 90261 – 90263).

Medical practitioners can complete the template here for referral purposes. 



Step 2: COMMENCE INITIAL COURSE OF TREATMENT
(psychological and dietetic services)

Once an eligible patient has an Eating Disorders Plan in place, the 12 month period commences, and the patient is eligible for an initial 10 sessions of subsidised Eating Disorder Psychological Treatment (EDPT) services (MBS items 82352 – 82383, 90271 – 90282), and up to 20 Dietetic services (MBS items 82350 and 82351).

The current Medicare rebate for a standard 50 minute consultation with a Clinical Psychologist under an Eating Disorders Plan (MBS item 82355) is $126.50.  Note that this is the same rebate that applies to consultations under the Better Access scheme, and the same out-of-pocket gap applies, until you reach the Medicare Safety Net.

NB: Once you reach the Medicare Safety Net, out-of-pocket costs associated with Medicare-subsidized clinical psychology services reduce even further, making sessions even more affordable.



Step 3: EATING DISORDERS REVIEW TO CONTINUE ON INITIAL COURSE OF TREATMENT (‘1st review’)

After 10 Eating Disorder Psychological Treatment (EDPT) services, your clinical psychologist will provide your referring medical practitioner with a Session 1-10 Progress Report.  You will then need to make an appointment to see your medical practitioner for a 1st review (MBS items 90264 – 90269).

If, based on the ‘1st review’, your medical practitioner determines that further Eating Disorder Psychological Treatment (EDPT) services are appropriate, the medical practitioner can approve a further 10 subsidised clinical psychology sessions in the 12 month period.



Step 4: FORMAL SPECIALIST AND PRACTITIONER REVIEW (‘2nd & 3rd reviews’)

After 20 Eating Disorder Psychological Treatment (EDPT) services, your clinical psychologist will provide your referring medical practitioner with a Session 11-20 Progress Report.  You will then need to arrange two formal reviews –  a 2nd reviewby the medical practitioner (MBS items 90264 – 90265), and a 3rd review by a psychiatrist or paediatrician (MBS items 90267, 90269, 90266 or 90268).

If both your medical practitioner and the consultant paediatrician/psychiatrist recommend more intensive treatment based on the ‘2nd review’ and ‘3rd review’, you will be able to access a further 10 medicare subsidised Eating Disorder Psychological Treatment (EDPT) services in the 12 month period.



Step 5:
ACCESS TO MAXIMUM INTENSITY OF TREATMENT (‘4th review’)

After 30 Eating Disorder Psychological Treatment (EDPT) services, your clinical psychologist will provide your referring medical practitioner with a Session 21-30 Progress Report.  To access more than 30 (up to 40) Clinical Psychology services in the 12 month period, you will need to attend a 4th review (MBS items 90264 – 90269) with the general practitioner managing your Eating Disorders Plan.

If your referring medical practitioner considers that the maximum intensity of intervention is appropriate based on the ‘4th review’, they can then approve up to a further 10 Eating Disorder Psychological Treatment (EDPT) services to the maximum of 40 subsidised sessions in a 12 month period.



For all Medicare-related queries, including queries regarding the Medicare Safety Net, please contact Medicare directly on 132 011 (7 days a week, 24 hours a day), check MBS online, or refer to the MBS Eating Disorders – Quick Reference Guide.