Eligibility for an EDTMP

Patient eligibility

Before you prepare an EDTMP, make sure your patient is eligible. They must have either of the following:

• a clinical diagnosis of anorexia nervosa
• a clinical diagnosis of bulimia nervosa, or binge-eating disorder or other specified feeding or eating disorder and meet the additional eligibility criteria.

Additional eligibility criteria

If your patient has bulimia nervosa or binge-eating disorder or other specified feeding or eating disorder, they must meet both of these criteria:

• a score of 3 or more on the Eating Disorder Examination Questionnaire
• rapid weight loss or frequent binge eating or inappropriate compensatory behaviour at least 3 times a week.

They also need at least 2 of the following indicators:

• body weight less than 85% of expected body weight because of an eating disorder
• current medical complications or high risk of complications due to eating disorder behaviours and symptoms
• serious comorbid medical or psychological conditions that significantly impact their health
• hospital admission for an eating disorder in the last 12 months
• inadequate response to evidence-based eating disorder treatment in the last 6 months.

To claim Medicare benefits for eating disorder psychological treatment and dietetic services, your patient needs to have all the following:

• be eligible for an EDTMP
• have a valid EDTMP
• have a referral.

Read about EDTMP patient eligibility on MBS Online.

Once you've confirmed your patient is eligible, prepare an EDTMP that reflects their needs and circumstances.

Eligibility checks in HPOS

Use the MBS items online checker in HPOS to check your patient’s eligibility and whether you can bill an item. You need your patient’s consent to access this information. You can also search for item numbers on MBS Online.

You can use HPOS to view your patient's care plan history.

You can call Medicare if you need help.