MBSM41 July
2025
This module provides information for Medical Practitioners and Allied
Health Professionals about eating disorders treatment and management plans.
Conditions eligible for treatment and management plans
What needs to be in a treatment and management plan
Consultation items and treatment & management plan items
How this plan works with other care plans
Eating disorders plans MBS items
12 month cycle of
reviews and treatment items
Mental Health Case Conference (MHCC)
By the end of this module, you will have an understanding of:
·
Eating Disorders Treatment and
Management Plans (EDP)
·
the eligible conditions and
eligibility criteria
·
referrals for Eating Disorders
Psychological Treatment (EDPT) and dietetic services
·
Mental Health Case Conference
requirements.
For the purpose of this module the term:
·
General Practitioner (GP) is used
for a Medical Practitioner (MP) who either holds:
·
specialist registration in
the specialty of GP with the Australian Health Practitioner Regulation Agency
(Ahpra), or
·
general registration as a GP
on the Vocational Register.
·
Prescribed Medical Practitioner
(PMP) is an MP who is not a GP, Specialist, or Consultant Physician.
·
Specialist is used to mean an MP
in a specialty other than general practice.
To be eligible for an EDP, your
patient must be enrolled in Medicare and be diagnosed with anorexia
nervosa.
Your patient may also be eligible if they meet the following criteria:
·
be diagnosed with bulimia nervosa,
a binge-eating disorder or other feeding or eating disorder
·
a score of 3 or more on the Eating
Disorder Examination Questionnaire
·
rapid weight loss or frequent
binge eating or inappropriate compensatory behaviour 3 or more times a week.
Refer to Medicare Benefits Scheme
(MBS) item descriptions and notes for more details at MBS Online.
If your patient hasn’t been diagnosed with anorexia nervosa they must
also have at least 2 of these indicators:
·
body weight less than 85 percent
of expected weight as a result of an eating disorder
·
high risk of, or current medical
complications due to eating disorders behaviour and symptoms
·
serious co-morbid medical or
psychological conditions that significantly impact their medical or
psychological health functions
·
hospital admittance for an eating
disorder in the last 12 months
·
inadequate treatment response to
evidence-based eating disorders treatments over the last 6 months.
You must create an EDP before you
can claim Medicare benefits for EDP items.
Treatment and management plans must document:
·
diagnosis of your patient’s eating
disorder
·
results of assessment
·
patient needs
·
goals, treatments and referrals
needed to treat your patient’s condition for the next 12 months.
·
You need to offer your patient a
copy of their plan.
·
You can also offer your patient’s
carer a copy of the plan with your patient’s consent.
·
You can also give them education
material about their eating disorder.
Make sure you check the full item
descriptions and requirements at MBS Online.
Some EDP and review items can’t be claimed with some other consultation
items on the same day for the same patient.
The MBS item and explanatory notes provide more information about what
consultation items can’t be claimed with an EDP item.
You must review an EDP after every 10 EDPT services. An EDP expires
after 12 months.
You must renew a plan before your patient can access further EDPT or
dietetic services.
How many services can I refer my patient for?
You can refer your patient for up
to 10 EDPT services and 20 dietetics services when you create an EDP.
Your patient’s EDP must be
reviewed before they can access more than 10 EDPT services.
Note:
Your patient can view their EDP in their Medicare online account by navigating to My care plans
and selecting My care plan history. This provides a simple function for
patients to view how many services have been billed against one, or all, of
their care plans.
It’s expected that most patients
will only have one care plan in place, but it may be appropriate for your
patient to also have a Chronic Condition Management (CCM) or mental health
treatment plan. Any treatment services provided under these plans count toward
the total number of services your patient can access for eating disorders
treatment under their plan.
|
Plan type |
Services that count toward
eating disorder treatment total |
|
GP Mental Health Treatment Plan |
All Treatment services under the
Better Access Initiative. |
|
GP Chronic Condition Management
Plan (GPCCMP) |
Dietetic treatment service. |
How this plan works with other care plans example
You create a mental health treatment
plan for your patient on 5 July, and by 1 November in the same calendar year
they have had 4 treatment services.
On 1 November you create an EDP
for your patient.
Your patient’s original mental
health treatment plan still has up to 6 treatment services left on it that
could be used until 31 December (these services are available per calendar
year). Your patient is eligible for a maximum of 40 EDPT services under their
plan. The 6 remaining services from the mental health plan contribute to the 40
psychological treatment services.
Example: Services provided over 2
calendars years
1 January to 31 December
Mental Health Plan 5 July to 31
December
4 treatment services
6 treatment services
Patient has completed their
initial course of treatment for the mental health plan. 10 psychological
treatment services.
1 January to 31 December
Eating Disorders Plan 1 November
to 1 November
10 treatment services
10 treatment services
10 treatment services
4 treatment services
Patient has completed their course
of treatment for the eating disorders plan. 40 psychological treatment
services.
GP and PMP
The items below include ongoing telehealth MBS items. Find out more about MBS Telehealth services.
|
Health professional |
Brief description |
|
|
GP (no mental health skills
training) |
90250, 90251, 92146, 92147 |
Prepare/Review an EDP |
|
GP (with mental health skills
training) |
90252, 90253, 92148, 92149 |
|
|
GP |
90264, 92170, 92176 |
|
|
PMP (no mental health skills training) |
90254, 90255, 92150, 92151 |
|
|
PMP (with mental health skills
training) |
90256, 90257, 92152, 92153 |
|
|
PMP |
90265, 92171, 92177 |
*Face to Face (F2F)
Psychiatrist
and Paediatrician
The items below include ongoing telehealth MBS items. Find out more about MBS Telehealth services.
|
Health professional |
F2F* and telehealth Items |
Brief description |
|
Consultant
Physician in Psychiatry |
90260, 92162 |
Prepare an EDP |
|
Consultant
Physician in Psychiatry |
90266, 92172 |
Review an EDP |
|
Consultant Physician in
Paediatrics |
90261, 92163 |
Prepare an EDP |
|
Consultant Physician in
Paediatrics |
90267, 92173 |
Review an EDP |
*Face to Face (F2F)
GPs and PMPs must be registered with
Medicare to provide Focussed Psychological Strategies (FPS) to claim these
items. The items below include ongoing telehealth MBS items. Find out more
about MBS Telehealth services.
|
Health professional |
F2F* and telehealth Items |
Brief description |
|
GP (FPS) |
90271 to 90274, 92182, 92184,
92194, 92196 |
Attendance items to provide
eating disorders psychological treatment services. |
|
PMP (FPS) |
90275 to 90278, 92186, 92188,
92198, 92200 |
*Face to Face (F2F)
Refer to these Steps.
|
Step 1 |
Service New EDP created by GP,
Consultant Physician in Psychiatry or Consultant Physician in Paediatrics. Documents EDP and referrals for psychological
and / or dietetics services. |
|
Step 2 |
Service Up to 10 EDPT services with
relevant health professionals. Up to 20 dietetics services with an eligible
dietitian (these can be used over the 12 month period). Documents Report back to referring health
professional. |
|
Step 3 |
Service Review EDP (GP, Consultant
Physician in Psychiatry or Consultant Physician in Paediatrics). Documents Additions or alternations to the
EDP. Referrals for EDPT services (and dietetics) if not all 20 were
referred initially. |
|
Step 4 |
Service Up to 10 EDPT with relevant
health professionals. Documents Report back to referring health
professional. |
|
Step 5 |
Service Referring health professional
and Consultant Physician in Psychiatry or Paediatrics review the EDP. Both
health professionals must review plan before more treatment services can be
provided to the patient. Documents Additions or alterations
to EDP. Referrals for EDPT services (and dietetics) if not all 20 were
referred yet. |
|
Step 6 |
Service Up to 10 EDPT services with
relevant health professionals. Any remaining referred dietetics services. Documents Report back to referring health
professional. |
|
Step 7 |
Service Review EDP (GP, Consultant
Physician in Psychiatry or Consultant Physician in Paediatrics). Documents Additions or alterations to the
EDP. Referrals for EDPT services (and dietetics) if not all 20
were referred yet. |
|
Step 8 |
Service Up to 10 EDPT services with
relevant health professionals. Any remaining referred dietetics services. Documents Report back to referring health
professional. |
MHCC eligibility
Patients are eligible for MHCC if they’re being
managed under either:
·
Better Access initiative for mental health
·
an eating disorders treatment and
management plan.
You must consult with a
multidisciplinary team for MHCC.
A GP, PMP, Consultant Psychiatrist or Consultant Paediatrician
organises and coordinates the case conference and at least 2 other members of
the multidisciplinary case conference team attend the case conference.
MHCC team members can be:
·
GP,
PMP
·
Consultant
Physicians in either:
o
Psychiatry
o
Paediatrics
·
Allied
Mental Health Professionals who meet the qualification requirements of a:
o
psychological
therapy health service
o
focussed
psychological health service
o
dietetics
health service.
Each person in the team must be providing a different type of
ongoing treatment or service. For further information refer to MHCC items.
MHCC requirements
When coordinating the MHCC you should discuss all
of the following with your patient:
·
the steps involved in developing the
MHCC
·
the multidisciplinary team who’ll
contribute to the MHCC and provide treatments and services
·
whether your patient agrees to
proceed and note their response in your patient’s medical records.
When documenting the MHCC, include:
·
treatment and service goals for your
patient
·
treatment and services that
collaborating health professionals have agreed to give
·
actions your patient needs to take
·
review dates.
Once you
have completed the MHCC document:
·
offer a copy of it to your patient
·
give copies of the relevant parts of
the document to the collaborating health professionals
·
add a copy of the document to your
patient's medical record.
MHCC MBS items
|
Health
professional |
Attend,
organise and coordinate |
Attend
and participate |
|
GP |
930, 933,935 |
937, 943, 945 |
|
PMP |
969, 971, 972 |
973, 975, 986 |
|
Psychiatrist or Paediatrician |
946,
948, 959 |
961,
962, 964 |
|
Allied
mental health professional |
n/a |
80176, 80177, 80178 |
Health professional groups for
MHCC
|
Group |
Health
professionals eligible for mental health case conference team |
|
Medical
Practitioner |
Patient’s GP |
|
Consultant
Physicians in the practice of their specialty of Psychiatry or Paediatrics |
|
|
Allied
mental health professional |
Dietitians,
Occupational Therapists, Psychologists, Clinical Psychologists, Social
Workers |
Use the MBS items online checker
to check eligibility. Alternatively, you can call Medicare provider enquiries
to check eligibility for MBS items that you intend to use.
Benefits to using
HPOS infographic
MBS items online
checker simulation
MBS items online
checker infographic
View patient care
plan history simulation
View patient care
plan history infographic
Eating Disorders
Treatment and Management Plan (EDP) infographic
Additional
education resources are available on the Health
Professional Education Resources website, including more information on
the Medicare Benefits Schedule.
Glossary
Ahpra
Australian Health Practitioner Regulation Agency
CCM Chronic Condition Management
EDPT Eating Disorders Psychological
Treatment
EDP Eating Disorders Treatment and
Management Plan
F2F Face to Face
FPS Focussed Psychological
Strategies
GP General
Practitioner
GPCCMP
GP Chronic Condition Management Plan
HPOS Health Professional Online
Services
MBS
Medicare Benefits Schedule
MHCC Mental Health Case Conference
MP Medical Practitioner
PMP
Prescribed Medical Practitioner
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