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Determinations/Health as made
This determination lists 30 new eating disorder treatment and management services provided by medical practitioners working in general practice, psychiatry and paediatrics.The new items provide Medicare benefits to subsidise access to evidence-based services for patients with anorexia nervosa and other eligible eating disorders.
Administered by: Health
Registered 10 Oct 2019
Tabling HistoryDate
Tabled HR14-Oct-2019
Tabled Senate14-Oct-2019
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019

 

I, Elizabeth Dowd, delegate of the Minister for Health, make the following determination.

Dated         9 October 2019                             

Elizabeth Dowd

Assistant Secretary

MBS Policy and Specialist Services Branch

Medical Benefits Division

Health Financing Group

Department of Health

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  


Contents

1.  Name

2.  Commencement....................................................................................................................... 1

3.  Authority................................................................................................................................. 1

4.  Definitions............................................................................................................................... 1

5.  Treatment of relevant services................................................................................................. 3

6.  Application of general provisions of the general medical services table.................................. 3

7.  General application provisions................................................................................................ 4

8.  Application of items in Subgroup 1 of Group A36................................................................. 4

9.  Application of items in Subgroup 2 of Group A36................................................................. 5

10.  Application of items in Subgroup 3 of Group A36............................................................... 5

11.  Application of items in Subgroup 4 of Group A36............................................................... 6

12.  Meaning of amount under section 12.................................................................................... 8

Schedule 1 – relevant services                                                                                    10

 


1.  Name

              This instrument is the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019.

2.  Commencement

 (1)    Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 November 2019

 

                Note:        This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

 (2)    Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3.  Authority

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4.  Definitions

 (1)    In this instrument:

Act means the Health Insurance Act 1973.

eating disorder examination questionnaire means the Eating Disorder Examination, 17th edition, as developed by the Centre for Research on Eating Disorders at Oxford (Fairburn et al), as existing on 1 November 2019.

Note:          The Eating Disorder Examination could in 2019 be viewed on the Centre for Research on Eating Disorders at Oxford’s website
www.credo-oxford.com/pdfs/EDE_17.0D.pdf.

eating disorder psychological treatment service means a service to which any of the following applies:

(a)                    items 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281 and 90282 of Schedule 1 of this instrument;

(b)                   items 2721, 2723, 2725, 2727 in the general medical services table;

(c)                    items 283, 285, 286, 287, 371 and 372 in the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018;

(d)                   items in Groups M7 and M16 (excluding items 82350 and 82351) of the Health Insurance (Allied Health Services) Determination 2014.

eating disorder treatment and management plan means a service to which an item in Subgroups 1 or 2 of Schedule 1 of this instrument applies.

eligible patient means a patient who:

(a)                    has a clinical diagnosis of anorexia nervosa; or

(b)                   meets the eligibility criteria, and has a clinical diagnosis of any of the following conditions:

(i)                      bulimia nervosa;

(ii)                    binge-eating disorder;

(iii)                  other specified feeding or eating disorder.

eligibility criteria, for a patient, is:

(a)                    the patient has been assessed as having an eating disorder examination questionnaire score of 3 or more; and

(b)                   the patient’s condition is characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour as manifested by 3 or more occurrences per week; and

(c)                    the patient has at least two of the following indicators:

(i)                      clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder;

(ii)                    current or high risk of medical complications due to eating disorder behaviours and symptoms;

(iii)                  serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;

(iv)                  the person has been admitted to a hospital for an eating disorder in the previous 12 months;

(v)                    inadequate treatment response to evidence based eating disorder treatment over the past six months despite active and consistent participation.

general practitioner has the meaning given in Part 3 of the general medical services table.

Modified Monash 4 area, Modified Monash 5 area, Modified Monash 6 area and Modified Monash 7 area have the meanings given in Part 3 of the general medical services table.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

residential care service has the meaning given in Part 3 of the general medical services table.

Schedule means a Schedule to this instrument.

telehealth eligible area has the meaning given in Part 3 of the general medical services table for items in Subgroups 2 and 3 of this instrument.

Note:   A number of expressions used in this instrument are defined in the Act, including the following:

·                     clinically relevant service;

·                     consultant physician

·                     general medical services table;

·                     item;

·                     medical practitioner;

·                     professional service.

(2)    Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

 

5.  Treatment of relevant services

For subsection 3C(1) of the Act, a relevant health service, provided in accordance with this instrument and as a clinically relevant health service, is to be treated, for the relevant provisions, as if:

(a)                    it were both a professional service and a medical service; and

(b)                   there were an item in the general medical services table that:

(i)                     related to the health service; and

(ii)                    specified in respect of the health service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

6.  Application of general provisions of the general medical services table

(1)          Clause 1.2.1 of the general medical services table shall have effect as if an item in Schedule 1 of this instrument were specified in Part 2 of the general medical services table.

(2)          Clause 1.2.2 of the general medical services table shall have effect as if items 90260, 90261, 90262, 90263, 90266, 90267, 90268 and 90269 of Schedule 1 of this instrument were specified in subclause 1.2.2(1) of the general medical services table.

(3)          Clauses 1.2.4 of the general medical services table shall have effect as if an item in Schedule 1 of this instrument were specified in subclause 1.2.4(1) of the general medical services table.

(4)          Clause 1.2.5 of the general medical services table shall have effect as if:

(a)                    an item in Schedule 1 of this instrument were specified in subclause 1.2.5(1) of the general medical services table; and

(b)                   items 90262, 90263, 90268, 90269, 90279, 90280, 90281 and 90282 of Schedule 1 of this instrument were specified in paragraph 1.2.5(3)(c) of the general medical services table.

(5)          Clause 1.2.6 of the general medical services table shall have effect as if:

(a)                    an item in Schedule 1 of this instrument were specified in subclause 1.2.6(1) of the general medical services table; and

(b)                   items 90262, 90263, 90268, 90269, 90279, 90280, 90281 and 90282 of Schedule 1 of this instrument were specified in paragraph 1.2.6(4)(c) of the general medical services table.

(6)          Clauses 1.2.7, 1.2.8 and 1.2.9 of the general medical services table shall have effect as if an item in Schedule 1 of this instrument were specified in those clauses of the general medical services table.

7.  General application provisions

(1)          Items in Schedule 1 of this instrument do not apply if the attendance is on a patient who is an admitted patient of a hospital.

(2)          Items in Subgroups 1 and 3 of Schedule 1 of this instrument do not apply if performed in association with a service to which items 2713 of the general medical services table applies.

(3)          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.

(4)          For any particular patient, items in Subgroup 1 and 2 of Schedule 1 of this instrument are applicable not more than once (in total for all items) in a 12 month period from the provision of any of the items.

8.  Application of items in Subgroup 1 of Group A36

(1)     For any particular patient:

(a)                    items in Subgroup 1 of Schedule 1 of this instrument do not apply in association with a service to which items 735 to 758 of the general medical services table apply; and

(b)                   items in Subgroup 1 of Schedule 1 of this instrument do not apply in association with a service to which items 235 to 244 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 apply.

(2)               Items 90252, 90253, 90256 and 90257 of Schedule 1 of this instrument apply only if the medical practitioner providing the service has successfully completed mental health skills training accredited by the General Practice Mental Health Standards Collaboration.

Note:   The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.

9.  Application of items in Subgroup 2 of Group A36

(1)     Items 90261 and 90263 of Schedule 1 of this instrument do not apply if performed in association with a service to which items 110, 116, 119, 132 or 133 of the general medical services table applies.

(2)     Items 90262 and 90263 of Schedule 1 of this instrument apply only to a service if the patient is:

(a)                    is located both:

(i)                      within a telehealth eligible area; and

(ii)                    at the time of the attendance—at least 15 kms by road from the medical practitioner; or

(b)                   is a care recipient in a residential care service; or

(c)                    is a patient of:

(i)                      an Aboriginal Medical Service; and

(ii)                    an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies.

(3)     Items 90262 and 90263 of Schedule 1 of this instrument do not apply if the patient or the medical practitioner travel to a place to satisfy the distance requirement in subparagraph 9(2)(a)(ii).

10.  Application of items in Subgroup 3 of Group A36

(1)     In items 90264 and 90265 of Schedule 1 of this instrument:

          associated medical practitioner working in general practice means a medical practitioner (not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

(2)     Items 90268 and 90269 of Schedule 1 of this instrument apply only to a service if the patient is:

(a)                    is located both:

(i)                      within a telehealth eligible area; and

(ii)                    at the time of the attendance—at least 15 kms by road from the medical practitioner; or

(b)                   is a care recipient in a residential care service; or

(c)                    is a patient of:

(i)                      an Aboriginal Medical Service; and

(ii)                    an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies.

(3)     Items 90268 and 90269 of Schedule 1 of this instrument do not only if the patient or the medical practitioner travels to a place to satisfy the distance requirement in subparagraph 10(2)(a)(ii).

11.  Application of items in Subgroup 4 of Group A36

(1)     For an item in Subgroup 4 of Schedule 1 of this instrument, an eating disorder psychological treatment service must involve the provision of any of the following mental health care management strategies:

(a)                    family based treatment (including whole family, parent based therapy, parent only or separated therapy)

(b)                   adolescent focused therapy;

(c)                    cognitive behavioural therapy;

(d)                   cognitive behavioural therapy-anorexia nervosa;

(e)                    cognitive behavioural therapy for bulimia nervosa and binge-eating disorder;

(f)                    specialist supportive clinical management;

(g)                   maudsley model of anorexia treatment in adults;

(h)                   interpersonal therapy for bulimia nervosa and binge-eating disorder;

(i)                     dialectical behavioural therapy for bulimia nervosa and binge-eating disorder;

(j)                     focal psychodynamic therapy.

 (2)    An item in Subgroup 4 of Schedule 1 of this instrument applies to a service which is provided by a medical practitioner:

(a)                    whose name is entered in the register maintained by the Chief Executive Medicare under section 33 of the Human Services (Medicare) Regulations 2017; and

(b)                   who is identified in the register as a medical practitioner who can provide services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies; and

(c)                    who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration for providing services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.

 (3)    An item in Subgroup 4 of Schedule 1 of this instrument does not apply to:

(a)                    a service which:

(i)                      is provided to a patient who, in 12 month period from the provision of an eating disorder treatment and management plan, has already been provided with 10 eating disorder psychological treatment services; and

(ii)                    is provided before a medical practitioner has conducted a patient review (the first review) of the eating disorder treatment and management plan and recorded in the patient’s records the medical practitioner’s  recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period; and

(b)                   a service which:

(i)                      is provided to a patient who, in 12 month period from the provision of an eating disorder treatment and management plan, has already been provided with 20 eating disorder psychological treatment services; and

(ii)                    is provided before a medical practitioner in general practice (not including a specialist or consultant physician) has conducted a patient review (the second review) of the eating disorder treatment and management plan and recorded in the patient’s records the medical practitioner in general practice’s recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period; and

(iii)                  is provided before a consultant physician practising in the specialty of psychiatry or paediatrics has conducted a patient review (the third review) of the eating disorder treatment and management plan and recorded in the patient’s records the consultant physician’s recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period; and

(c)                    a service which:

(i)                      is provided to a patient who, in 12 month period from the provision of an eating disorder treatment and management plan, has already been provided with 30 eating disorder psychological treatment services; and

(ii)                    is provided before a medical practitioner has conducted a patient review (the fourth review) of the eating disorder treatment and management plan and recorded in the patient’s records the medical practitioner’s recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period.

(4)     For any particular patient, an item in Subgroup 4 of Schedule 1 of this instrument does not apply if the patient has had 40 eating disorder psychological treatment services in a 12 month period commencing from the provision of an eating disorder treatment and management plan.

(5)     An item in Subgroup 4 of Schedule 1 of this instrument does not apply if the patient’s eating disorder treatment and management plan has expired under subsection 7(3).

(6)     Items 90279, 90280, 90281 and 90282 of Schedule 1 of this instrument apply only to a service if the patient is:

(a)                    is located both:

(i)                      within a telehealth eligible area; and

(ii)                    at the time of the attendance—at least 15 kms by road from the medical practitioner.

 (7)    Items 90279, 90280, 90281 and 90282 of Schedule 1 of this instrument do not only if the patient or the medical practitioner travels to a place to satisfy the distance requirement in subparagraph 11(6)(a)(ii).

(8)     For the purpose of this subsection:

patient review means a service to which an item in Subgroup 3 of Schedule 1 of this instrument applies.

telehealth eligible area means an area that is a Modified Monash 4 area, Modified Monash 5 area, Modified Monash 6 area or Modified Monash 7 area.

 

12.  Meaning of amount under section 12

(1)     An amount under section 12, for an item mentioned in column 1 of table 12.1, means the sum of:

(a)                    the fee for the item mentioned in column 2 of the table; and

(b)                   either:

(i)                      if not more than 6 patients are attended at a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or

(ii)                    if more than 6 patients are attended at a single attendance—the amount mentioned in column 4 for the item.



Table 12.1—amount under section 12

Item

Column 1

Item/s of the table

Column 2

Fee

Column 3

Amount if not more than 6 patients (to be divided by the number of patients) ($)

Column 4

Amount if more than 6 patients ($)

1

90272

The fee for item 90271

26.35

2.05

2

90274

The fee for item 90273

26.35

2.05

3

90276

The fee for item 90275

21.10

1.65

4

90278

The fee for item 90277

21.10

1.65

 

 

Schedule 1 – relevant services

Group A36Eating Disorders Services

 

Column 1

Item

Column 2

Service

Column 3

Fee ($)

Subgroup 1—GP and medical practitioner eating disorders treatment and management plans

90250

Professional attendance by a general practitioner who has not undertaken mental health skills training (not including a specialist or consultant physician), of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

72.85

90251

 

Professional attendance by a general practitioner who has not undertaken mental health skills training (not including a specialist or consultant physician), of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

107.25

90252

Professional attendance by a general practitioner who has undertaken mental health skills training (not including a specialist or consultant physician), of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

92.50

90253

Professional attendance by a general practitioner who has undertaken mental health skills training (not including a specialist or consultant physician), of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

136.25

90254

Professional attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has not undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

58.30

90255

Professional attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has not undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

85.80

90256

Professional attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

74.00

90257

Professional attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)     the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)     the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)     the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)     the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

109.00

Subgroup 2 Consultant psychiatrist and paediatrician eating disorders treatment plans

90260

Professional attendance of at least 45 minutes in duration at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)  the patient has been referred by a referring practitioner; and

(b)  during the attendance, the consultant psychiatrist:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(c)  within 2 weeks after the attendance, the consultant psychiatrist:

(i)  prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that:

(A) covers the next 12 months; and

(B) is appropriate to the patient’s diagnosis; and

(C) comprehensively evaluates the patient’s biological, psychological and social issues; and

(D) addresses the patient’s diagnostic psychiatric issues; and

(E) makes management recommendations addressing the patient’s biological, psychological and social issues; and

(iii) gives the referring practitioner a copy of the diagnosis and     the management plan; and

(iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

466.80

90261

Professional attendance of at least 45 minutes in duration at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)     the patient has been referred by a referring practitioner; and

(b)     during the attendance, the consultant paediatrician undertakes an assessment that covers:

(i)    a comprehensive history, including psychosocial history and medication review; and

(ii)   comprehensive multi or detailed single organ system assessment; and

(iii)    the formulation of diagnoses; and

(c)  within 2 weeks after the attendance, the consultant paediatrician:

(i)  prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that involves:

(A) an opinion on diagnosis and risk assessment; and

(B) treatment options and decisions; and

(C) medication recommendations; and

(iii) gives the referring practitioner a copy of the diagnosis and     the management plan; and

(iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

272.15

90262

Professional attendance of at least 45 minutes in duration by video conference by a consultant physician in the practice of the consultant physician’s specialty of psychiatry for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)  the patient has been referred by a referring practitioner; and

(b)  during the attendance, the consultant psychiatrist:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

 (c)  within 2 weeks after the attendance, the consultant psychiatrist:

(i)  prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that:

(A) covers the next 12 months; and

(B) is appropriate to the patient’s diagnosis; and

(C) comprehensively evaluates the patient’s biological, psychological and social issues; and

(D) addresses the patient’s diagnostic psychiatric issues; and

(E) makes management recommendations addressing the patient’s biological, psychological and social issues; and

(iii) gives the referring practitioner a copy of the diagnosis and     the management plan; and

(iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

466.80

90263

Professional attendance of at least 45 minutes in duration by video conference by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)     the patient has been referred by a referring practitioner; and

(b)     during the attendance, the consultant paediatrician undertakes an assessment that covers:

(i)       a comprehensive history, including psychosocial history and medication review; and

(ii)   comprehensive multi or detailed single organ system assessment; and

(iii)    the formulation of diagnoses; and

(c)  within 2 weeks after the attendance, the consultant paediatrician:

(i)  prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that involves:

(A) an opinion on diagnosis and risk assessment; and

(B) treatment options and decisions; and

(C) medication recommendations; and

(iii) gives the referring practitioner a copy of the diagnosis and     the management plan; and

(iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

272.15

Subgroup 3 Review of eating disorder treatment and management plans

90264

Professional attendance by a general practitioner to review an eligible patient’s eating disorder treatment and management plan prepared by the general practitioner, an associated medical practitioner working in general practice, or a consultant physician practising in the specialty of psychiatry or paediatrics, if:

(a)     the general practitioner reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)     modifications are made to the eating disorder treatment and management plan, recorded in writing, including:

(i)       recommendations to continue with treatment options detailed in the plan; or

(ii)     recommendations to alter the treatment options detailed in the plan, with the new arrangements documented in the plan; and

(c)  initiates referrals for a review by a consultant physician practising in the specialty of psychiatry or paediatrics, where appropriate; and

(d)     the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

72.85

90265

Professional attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review an eligible patient’s eating disorder treatment and management plan prepared by the medical practitioner, an associated medical practitioner working in general practice, or a consultant physician practising in the specialty of psychiatry or paediatrics, if:

(a)     the medical practitioner reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)     modifications are made to the eating disorder treatment and management plan, recorded in writing, including:

(i)       recommendations to continue with treatment options detailed in the plan; or

(ii)     recommendations to alter the treatment options detailed in the plan, with the new arrangements documented in the plan; and

(c)  initiates referrals for a review by a consultant physician practising in the specialty of psychiatry or paediatrics, where appropriate; and

(d)     the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

58.30

90266

Professional attendance of at least 30 minutes in duration at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry for an eligible patient, if:

(a)  the consultant psychiatrist reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)  the patient has been referred by a referring practitioner; and

(c)  during the attendance, the consultant psychiatrist:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the eating disorder treatment and management plan; and

(d)  within 2 weeks after the attendance, the consultant psychiatrist:

(i)  prepares a written diagnosis of the patient; and

(ii)  revises the eating disorder treatment and management; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) is the patient’s carer (if any), if the patient agrees

291.80

90267

Professional attendance of at least 20 minutes in duration at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for an eligible patient, if:

(a)  the consultant paediatrician reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)  the patient has been referred by a referring practitioner; and

(c)     during the attendance, the consultant paediatrician reviews the eating disorder treatment and management plan, including a:

(i)         review of initial presenting problems and results of diagnostic investigations; and

(ii)       review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii)      comprehensive multi or detailed single organ system assessment; and

(iv)     review of original and differential diagnoses; and

(d)  within 2 weeks after the attendance, the consultant paediatrician:

(i)  prepares a written diagnosis of the patient; and

(ii)  revises the eating disorder treatment and management; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) is the patient’s carer (if any), if the patient agrees

136.25

90268

Professional attendance of at least 30 minutes in duration by video conference by a consultant physician in the practice of the consultant physician’s specialty of psychiatry for an eligible patient, if:

(a)  the consultant psychiatrist reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)  the patient has been referred by a referring practitioner; and

(c)  during the attendance, the consultant psychiatrist:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the eating disorder treatment and management plan; and

(d)  within 2 weeks after the attendance, the consultant psychiatrist:

(i)  prepares a written diagnosis of the patient; and

(ii)  revises the eating disorder treatment and management; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) is the patient’s carer (if any), if the patient agrees

291.80

90269

Professional attendance of at least 20 minutes in duration by video conference by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for an eligible patient, if:

(a)  the consultant paediatrician reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)  the patient has been referred by a referring practitioner; and

(c)     during the attendance, the consultant paediatrician reviews the eating disorder treatment and management plan, including a:

(i)        review of initial presenting problems and results of diagnostic   investigations; and

(ii)       review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii)      comprehensive multi or detailed single organ system assessment; and

(iv)     review of original and differential diagnoses; and

(d)  within 2 weeks after the attendance, the consultant paediatrician:

(i)  prepares a written diagnosis of the patient; and

(ii)  revises the eating disorder treatment and management; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) is the patient’s carer (if any), if the patient agrees

136.25

Subgroup 4 GP and medical practitioner eating disorders psychological treatment services

90271

Professional attendance at consulting rooms by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

94.25

90272

Professional attendance at a place other than consulting rooms by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

Amount under section 12

 

90273

Professional attendance at consulting rooms by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

134.85

90274

Professional attendance at a place other than consulting rooms by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

Amount under section 12

 

90275

Professional attendance at consulting rooms by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

75.40

90276

Professional attendance at a place other than consulting rooms by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

Amount under section 12

 

90277

Professional attendance at consulting rooms by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

107.90

90278

Professional attendance at a place other than consulting rooms by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

Amount under section 12

 

90279

Professional attendance at consulting rooms by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan, if:

(a)     the attendance is by video conference; and

(b)     the patient is not an admitted patient; 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 general practitioner

94.25

90280

Professional attendance at consulting rooms by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan, if:

(a)     the attendance is by video conference; and

(b)     the patient is not an admitted patient; 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 general practitioner

134.85

90281

Professional attendance at consulting rooms by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan, if:

(a)     the attendance is by video conference; and

(b)     the patient is not an admitted patient; 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 medical practitioner

75.40

90282

Professional attendance at consulting rooms by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan, if:

(a)     the attendance is by video conference; and

(b)     the patient is not an admitted patient; 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 medical practitioner

107.90