Billing Restrictions

The EDP is valid for a 12 month period, rather than one calendar year  

The EDP starts from the date it is billed and lasts for a 12 month period. After 12 months the plan will expire. A new assessment and EDP will be needed to unlock a further 40 sessions over the next 12 month period if the patient requires further treatment.

Patients can escalate from a MHCP to an EDP within the same calendar year if needed. The 12 month period will begin from the date the EDP is billed and start from session 1.  

Keep in mind: Patients are only eligible for 40 sessions within any 12 month period. So, if all the allocated sessions have been used, a new EDP or MHCP can only be completed 12 months after the first EDP was billed, regardless of the calendar year. 

Specialist review needed for EDP  

To access sessions 21-40 with Mental Health Practitioners on an EDP the treating GP will need to assess the patient after they have seen a psychiatrist or paediatrician and review the plan. To unlock sessions 20-30, the specialist will need to have billed using the EDP item number and the GP will need to bill an EDP Review at this time. 

Treating other mental health issues during this 12 month period with an EDP 

The treating GP can also refer a patient to a mental health practitioner for other issues such as anxiety or depression, these sessions can be billed against the EDP or a MHCP, but all sessions with a mental health practitioner (billed against either plan) are included in the 40 sessions available on the EDP.

The referral should clearly state that the patient is on an EDP and those item numbers should be used by the health practitioner to ensure access to the full set of 40.

Using a MHCP & reviews 

After a full assessment and completion of the MHCP, the correct item no. must be billed to unlock the rebate on mental health practitioner sessions for your patient.

When reviewing a patient, the treating GP can bill any appropriate item no. (i.e., long consultation, mental health consultation, review of a MHCP, etc.) and recommend further sessions with a standard referral letter or a MHCP review template.

The Medicare Review item number does not need to be billed to activate further sessions and need only be billed when a plan is reviewed (i.e., the diagnosis changes).

A GP referral lasts for up to 6 sessions unless otherwise specified. After 6 sessions a new referral is needed. As indicated in the referral section above, a good, detailed referral is ideal, a copy of the review template can also be sent if completed and relevant. Keep in mind that when treatment spans over the calendar year and further sessions become available, a new referral is only needed every 6 sessions.  

Using multiple care plans - MBS additional information  

MBS explanatory notes AN.36.2 

Additional Claiming Information (interaction with Chronic Disease Management and Better Access)

It is preferable that wherever possible, patients have only one plan for primary care management of their disorder. As a general principle the creation of multiple plans should be avoided unless the patient clearly requires an additional plan for the management of a separate medical condition.  

The Chronic Disease Management (CDM) care plan items (items 721, 723, 729, 731 and 732) continue to be available for patients with chronic medical conditions, including patients with complex needs.  

Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a CDM Plan, and to manage their eating disorder through an EDP. In this case, both items can be used. Where the patient receives dietetic services under the CDM arrangements (item 10954), these services will count towards the patient's maximum of 20 dietetic services in a 12 month period. 

Where a patient has other psychiatric comorbidities, these conditions should be managed under the EDP. Once a patient has a claim for an EDP, the patient should not be able to have a claim for the development or review of a Mental Health Treatment plan by a GP (items 2700, 2701, 2715 and 2717) or medical practitioner in general practice (items 272, 276, 281 and 282) within 12 months of their EDP unless there are exceptional circumstances.  

For the purpose of the 40 EDPT count; eating disorder psychological treatment service includes a service under provided under the following items: 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281, 90282, 2721, 2723, 2725, 2727, 283, 285, 286, 287, 371, 372 and items in Groups M6, M7 and M16 (excluding items 82350 and 82351).

Link: Medicare Benefits Schedule - Note AN.36.2