Exercise Physiology

This policy applies to services provided (in a community setting) on or after 1 March 2010.

POLICY

The TAC can pay the reasonable costs of exercise physiology services when required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act).

The TAC will periodically review a client's entitlement to exercise physiology services to ensure that the treatment and services remain reasonable for the transport accident injury and are payable under the Act.

BACKGROUND

Exercise physiology is a rehabilitation service that uses exercise as a form of therapy. The role of the exercise physiologist is to apply the principles of exercise for rehabilitation to the specific needs of the client and their injuries. The exercise physiologist will also aim to equip the client with the necessary skills and knowledge to progress their own exercise program independently.

The TAC has developed the Clinical Framework for the Delivery of Health Services (Clinical Framework) to set out key principles for delivery of services to clients.

The Clinical Framework is based on the following principles:

  • Measurement and demonstration of the effectiveness of treatment
  • Adoption of a biopsychosocial approach
  • Empowering the client to manage their injury
  • Implementing goals focused on optimising function, participation and/or return to work/health
  • Base treatment on best available research evidence.

The TAC expects that all health professionals providing services to clients integrate the principles of the Clinical Framework into their daily practice.

Further information about the Clinical Framework can be found at www.tac.vic.gov.au.

GUIDELINES

What can the TAC pay for in relation to exercise physiology services?

The TAC can pay the reasonable costs of exercise physiology services when recommended by a client's treating medical practitioner, physiotherapist, osteopath or chiropractor, and the services:

  • are required as a result of the transport accident injury
  • are clinically justified, safe and effective
  • have a clear rehabilitative purpose and are not for non-transport accident injury rehabilitative purposes
  • are likely to achieve or maintain a measurable functional improvement
  • promote progress towards functional independence, participation and self-management.

Exercise physiology services are expected to be provided on a short term basis to educate the client and progress them towards self-management of their condition and exercise program.

Refer to the Gym and Swimming Memberships policy for information about unsupervised exercise programs that the TAC can pay for.

Group consultations

The TAC can pay the reasonable costs of group consultations provided by an exercise physiologist. Group consultations involve two or more clients being treated in the same treatment sessions receiving constant overall supervision and intermittent individual attention. The maximum number of participants in a group should not exceed six.

Who can provide exercise physiology services?

Services can be provided by an exercise physiologist who has obtained accreditation by the Exercise and Sports Science Australia as an exercise physiologist.

What information does the TAC need?

For clients with a 'severe injury' treatment will be approved as part of the independence planning process. The exercise physiologist will be required to submit initial baseline measures within 10 days of approval of treatment from the TAC. Outcome measures are to be maintained and recorded throughout the treatment and provided to the TAC upon request.

For all other clients the TAC does not require any information from exercise physiologists before treating a client. However, an exercise physiologist must submit an Exercise Physiology Review (EPR), including baseline measures, when:

  • requested by the TAC, or
  • there has been a gap in exercise physiology treatment of more than 12 months.

The TAC may contact the client or exercise physiologist for further information if required. Exercise physiologists should not submit an EPR or written reports unless specifically requested by the TAC.

What won't the TAC pay for in relation to exercise physiology?

The TAC will not pay for:

  • treatment or services that are not in line with the Clinical Framework
  • more than one initial consultation by the same provider or clinic, except in exceptional circumstances
  • treatment provided more than once on the same day to the same client
  • treatment or services where the cost is included in the hospital bed fee - refer to the Public Hospitals Policy and the Private Hospitals Policy
  • treatment or services for a person other than the client
  • treatment or services subcontracted to, or provided by a non-registered provider
  • fees associated with cancellation or non attendance
  • treatment or services provided outside the Commonwealth of Australia
  • treatment or services provided by telephone or other non face to face mediums
  • telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
  • services or travel to services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.

Exercise Physiology Services

Effective 1 July 2017

Service DescriptionTAC Item Number2017/18 Maximum Payment Rate2016/17 Maximum Payment Rate
Exercise Physiology Standard Consultation (1 hour)EXP001$93.38$92.02
Exercise Physiology Group Consultation - Per person (1 hour)EXP002$23.38$23.04
QuestionnaireEXP003*$51.43$50.68

GST

*The TAC maximum fee includes a 10% allowance for GST for items which TAC believes are taxable supplies.  If you are a provider not registered for GST:

  • You are not legally permitted to charge GST
  • You should indicate on all invoices submitted your status as 'not registered for GST purposes'
  • The TAC will only reimburse you an amount which excludes the GST component for items billed where the maximum fee includes a 10% allowance for GST

If you are not registered for GST please state on all invoices the TAC item number listed for providers not registered.


View Information for people with soft tissue injuries

Information for people with soft tissue injuries

Summary:

This booklet provides information about soft tissue injuries (e.g. painful strains, sprains and bruises) and how health care professionals can help you recover faster by getting moving. As well as explaining the types of treatment and services the TAC can fund, there are handy tips about working with your therapy providers, staying motivated and measuring progress.

View Exercise Physiology Review form (for Provider use only)

Exercise Physiology Review form (for Provider use only)

Summary:

An Exercise Physiology Review form (EPR) includes information relating to a TAC client's clinical diagnoses, proposed treatment plan, self-management strategies and outcome measures.  A EPR is required to be submitted to the TAC if there has been a gap in treatment of longer than 12 months. For most new clients you will not need to complete a EPR unless specifically asked to do so. Clients with a 'severe injury' or in receipt of an 'Immediate approval of services' letter do not need an EPR submitted to the TAC prior to treatment. The TAC may request a EPR at other times during your patient's treatment.