Eating disorder treatment services

Health professional eligibility

You can provide eating disorder treatment services if you’re one of the following health professionals:

• dietitian
• clinical psychologist
• registered psychologist
• occupational therapist
• social worker
• general practitioner (GP)
• medical practitioner.

You must meet the qualification requirements and register with us before providing these services.

Read about eligibility requirements on MBS Online.

Patient eligibility

Patients can claim Medicare benefits for eating disorder psychological treatment and dietetic services if they have all the following:

• a current EDTMP
• a valid referral
• the treatment service recommended in their EDTMP.

The referring practitioner decides whether a patient is eligible for an EDTMP. Read about EDTMP eligibility requirements.

If you’re unsure whether a patient is eligible you can contact the referring medical practitioner.

You can call us to confirm whether a patient has claimed an EDTMP and how many services they have already claimed.

You can use HPOS to view your patient's care plan history. You need your patient’s consent to access this information.

Patients must also meet the review requirements under their EDTMP to continue accessing services.

You can provide treatment to patients without a current EDTMP, but they can’t claim Medicare benefits for these services.

Course of treatment

A course of treatment is the number of services approved in the referral.

A referral can include up to:

• 20 dietetic treatment services
• 10 eating disorder psychological treatment services, if needed.

Patients receiving eating disorder psychological treatment services need an EDTMP review:

• after each course of 10 services
• before accessing more than 20 services.

To access more than 20 services, the review must include input from a consultant psychiatrist or paediatrician and the treating practitioner.

Patients can access up to 40 eating disorder psychological treatment services in a 12 month period, subject to the review requirements.

Referral requirements and validity

You need a valid referral before providing eating disorder treatment services.

There’s no specific referral form for these services. A signed and dated referral letter is acceptable if it includes the number of services requested.

The referral needs to include all the following:

• the patient’s name
• date of birth
• address
• symptoms or diagnosis
• current medications
• the number of treatment services requested.

The referring health professional decides:

• which allied health treatment services the patient needs, up to the applicable limits
• whether allied health eating disorder treatment services are appropriate for the patient.

Allied health professionals must not:

• accept a partially completed referral
• provide a partly completed referral for a referring health professional to sign
• pre-empt decisions about the services a patient needs.

A referral is valid for the approved number of services, even if the patient changes health professionals. It remains valid until the patient’s EDTMP expires.

Keep a copy of the referral for 2 years.

Reporting requirements

If you’re an allied health professional, provide a written report to the referring medical practitioner:

• after the first service
• after the last service
• at other times if clinically appropriate.

You can provide additional reports if clinically appropriate.

Include all the following in the report:

• assessments carried out on the patient
• treatment provided
• recommendations for the patient’s future care.

If appropriate, you can give the report to the patient or their carer with the patient’s agreement.

Keep copies of reports provided to the referring medical practitioner for 2 years.

Claiming limits

Eligible patients can access the following services in a 12 month period:

• 40 eating disorder psychological treatment services
• 20 dietetic treatment services.

The 12 month period starts on the date of the patient’s EDTMP.

Mental health treatment plan services under Better Access count towards the patient’s EDTMP service limit from the EDTMP start date.

Patients can’t claim Medicare benefits for eating disorder treatment services after their EDTMP expires.

Billing and Telehealth

For billing and telehealth information:

• check EDTMP item numbers and billing rules for eating disorder and treatment management plans
• read about telehealth services and billing rules on MBS Online.

You can provide some eating disorder psychological treatment and dietetic services by telehealth where clinically appropriate.