The New MBS Item Numbers for Eating Disorders - launched 1 November 2019
A joint response from Butterfly, NEDC & ANZAED
An individual who has a clinical diagnosis of Anorexia Nervosa OR
An individual has a clinical diagnosis of bulimia nervosa, binge eating disorder or other specified feeding or eating disorder (OSFED) and meets the following eligibility criteria:
Eligibility can be assessed by the GP (item 90250-90253) or by a Psychiatrist (item PSY1) or Paediatrician (PAED1). It is their responsibility to either conduct assessments or to review the results of assessments conducted by others. Allied Health professionals may contribute assessment information but are not eligible to make the decision about eligibility. Practitioners should have regard to the relevant diagnostic criteria set out in the Diagnostic and Statistical Manual of the American Psychiatric Association – Fifth Edition (DSM-5)
These are determined by the clinical experience and judgement of the clinician making the assessment or providing recommendations. Clinicians must adequately document and justify their clinical judgments as per usual practice.
Overall assessment and eligibility is determined by a GP, a Psychiatrist, or a Paediatrician. However, GP’s may refer to MHP to conduct assessments, such as the EDE-Q and these can be considered when assessing eligibility.
The EDE-Q is available for clinicians to download online for non-commercial purposes, including on the NEDC and ANZAED websites
Interpretation of eligibility is a matter of clinical judgement. The GP, psychiatrist or paediatrician will review the patient's progress against the EDP and assessment for ongoing use of the EDP will be based on factors including; client progress, client engagement, treatment effectiveness and overall suitability.
MHPs are expected to provide a written progress report to the GP or Psychiatrist at or before the end of each course of 10 sessions of treatment. This may include recommendations for the next course of treatment.
Yes, if their EDE-Q score is 3 or higher and they meet 2 of the 5 specified indicators.
It can be understandably challenging for individuals to share their experiences of an eating disorder with others, however they are encouraged to reflect on how the eating disorder is impacting their day-to-day life and openly share these experiences with their GP and MHP (who will advise the GP) so that they can make an accurate assessment of their eligibility.
If an individual does not think that the assessment of their eating disorder is correct, they are entitled to seek another opinion.
They are entitled to be assessed by their GP for a Better Access to Health Mental Health Care Plan, where they can receive up to 10 sessions per calendar year.
Mental Health Professionals who are currently eligible to provide focused psychological services under the Better Access program. This includes psychiatrists, GPs, clinical psychologists, psychologists, mental health social workers and mental health occupational therapists.
The new items are specifically for evidence based eating disorders treatment:
No. However all clinicians treating eating disorders are expected to be knowledgeable and experienced in assessment and management of eating disorders. View the NEDC clinician core competencies
Yes. Dietitians are eligible to provide up to 20 sessions of at least 20 minutes if the GP has provided a referral.
Dietitians can provide sessions for as long as they deem necessary. Individuals may need to pay out of pocket expenses regardless of the session length, as Medicare only reimburses dietetic sessions at one fixed amount.
Practitioners should contact their professional organisation to identify education and training. In addition, there is general information available at:
And at State-based eating disorder organisations:
No. The EDP start and finish date is calculated on a rolling year. E.g. if an EDP is commenced on the 3rd March 2020, it will be valid until 2nd of March 2021. Therefore, a person can use up to 40 sessions (upon completion of reviews) from the start date until the end of 12 months.
There is a maximum of 40 eating disorder psychological treatment sessions allowed in a rolling and/or calendar year. This means that a person cannot exceed 40 psychological treatment sessions from 1st of January to 31st December AND from the start date of the EDP to 12 months later (e.g. 2nd March 2020 to 1st March 2021).
To check how many sessions you or your client is eligible for, you can contact Medicare on;
No. A course of psychological treatment is considered to be 10 sessions, with a maximum of 4 courses of treatment. There are ongoing reviews required by the GP and a Psychiatrist or Paediatrician once each course of treatment has been completed.
No. MHCP sessions amounts will be deducted from the total of 40.
Providers are discouraged from using a MHCP and EDP simultaneously. It is possible for a person to use a MHCP before or after an EDP (still not exceeding 40 sessions) however, not at the same time.
Yes, individuals can access reimbursements for issues other than eating disorders under the CDMP however no one can receive rebates for more than 40 psychological treatment sessions in a year. If the person is receiving treatment for a comorbid psychiatric condition then that treatment must be included in the ED plan. A CDMP may be helpful for someone with a physical condition such as diabetes or heart disease. Providers are encouraged to make it very clear in records that the use of the CDMP is very separate to the eating disorder.
Yes however, they will be deducted from the 20 EDP sessions even though they are for a separate presenting issue.
If a person requires simultaneous treatment for another condition other than the eating disorder, this can be included in the EDP. An individual will not be entitled to additional Medicare sessions above 40. If an EDP is not suitable then they can transitioned to the Better Access Medicare scheme for the treatment of their co-morbid conditions. Treatments provided by a psychiatrist are not affected by this restriction.
A review by a GP is required after sessions 10, 20 and 30 of the EDP and a review by a psychiatrist or paediatrician is required by session 20 of the EDP. Reviews can be completed any time prior to the cut off session. For instance, the psychiatrist or paediatrician review can be completed any time up until or after session 20. However, an individual cannot access more than 20 sessions if they have not completed a psychiatrist or paediatrician review.
No, a person can receive the 20 dietetic sessions at any time during the EDP and reporting is required after the 1st and 20th session and as clinically required.
Individuals are encouraged to obtain a psychiatrist or paediatrician referral early in their EDP and book an appointment as soon as possible. Individuals may feel uncertain about booking this in advance given they may be unsure if they will need it, but it can always be cancelled if no longer required at a later stage.
The new EDP items can be accessed over telehealth, so for some individuals who do not have easy access to a psychiatrist or paediatrician, booking a telehealth appointment can be useful.
Psychiatrists and paediatricians in the Public Health system can provide the 20-session review providing they are registered with Medicare to provide Medicare services. Individuals are encouraged to check that public health clinicians are registered and therefore eligible to provide the review. The reviewing psychiatrist or paediatrician will need to have claimed a specific new MBS item number for the review to activate access to more than 20 psychological sessions under the EDP.
Yes, all providers of an EDP can provide Telehealth Services (items 90264 and 90265) via video (not telephone or email). Telehealth may be used if the clinician is satisfied that it is clinically appropriate. Patient and clinician must be located a minimum of 15 kilometres apart at the time of the video consultation. Geographic eligibility standards for telehealth services apply. Eligible areas are those within MMM classifications 4 to 7.
Check eligibility using the locator on the Department of Health’s website. There is no restriction on the number of services that can be provided via telehealth arrangements.
Telehealth Patient-end Support Services may be provided by GP for video consultation with psychiatrist (items 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199 and 2220 in Group A30).
You can contact several organisations for guidance and support, including;
Yes, a review of the Medicare eating disorder items will be reviewed after 12 months.
It is important that you provide your feedback about the challenges and success of these items to inform this review. You can provide this feedback to;
It can be extremely difficult raising the subject of eating disorders with a friend or loved one. To be supportive one needs to learn what to say and what not to say.
We can help you with knowing when to talk to your friend and what to say. ›
Communicating your concern with your child about eating and dieting behaviour can be extremely difficult. Butterfly offers a range of services that can provide you with skills and information related to communicating with your child.
We can help you with recognising issues and what to do. ›
Teachers and those working with young people are often the first to become aware of dis-ordered eating behaviours. Butterfly Education provides early intervention and prevention skills for professionals working with young people.We have a range of advice & resources ›