Orthoptics

Policy

The TAC can fund the reasonable cost of orthoptics services required as a result of transport accident injuries. The service must be performed by an orthoptist eligible for membership with the Orthoptics Association of Australia.

Transport Accident Act 1986 reference: s.3 'rehabilitation service', s.23 and s.60

Guidelines

What orthoptic services can the TAC fund?

The TAC can fund the cost of reasonable orthoptic services:

  • for a TAC client who has suffered a relevant injury as a result of a transport accident
  • that are part of an approved rehabilitation program.

Fees for orthoptic services performed within a private practice will be based on the TAC fee schedule for Orthoptic Services.

Fees for orthoptic services performed within a public hospital will be based on the Department of Human Services schedule of fees and charges for acute health services in Victoria.

What does the TAC require in order to consider funding orthoptic services?

The TAC requires a written request from a medical practitioner outlining the clinical need for this service and the way in which it relates to the clients transport accident injuries.

In all circumstances, written approval is required from the TAC prior to the commencement of this service.

Who can provide Orthoptics services?

The service must be provided by an orthoptist eligible for membership with the Orthoptics Association of Australia

Can the TAC fund orthoptic services where a significant gap in a client's treatment exists?

For the purpose of this policy, a gap in treatment is when no orthoptics services have been sought for more than 6 months and treatment commences or resumes after this period.

The TAC can fund orthoptics services after a gap in treatment, however, the TAC may telephone or write to a client and/or the service provider in order to:

  • ascertain the treatment claimed is related to the transport accident injury
  • determine the reason for the gap in treatment
  • obtain details of the proposed treatment plan.

Once this information is received the request for funding can be evaluated.

Can the TAC fund an orthoptist to travel?

Travel by orthoptists is incorporated into the out of rooms fee rates. The TAC will not pay any additional travelling expenses for orthoptists.

In all circumstances, prior written approval is required by the TAC to fund travel by orthoptists.

What billing information does the TAC require from a provider in order to fund orthoptic services?

The TAC requires that the actual provider of the service be identified on each account for payment. It is the responsibility of the provider to ensure accounts submitted to the TAC are correct, regardless of who has completed the account.

Can the TAC fund orthoptic services performed by a member of a client's immediate family?

Refer to the Funding Treatment by a Member of a Client's Immediate Family policy.

In relation to orthoptic services what will the TAC not fund?

The TAC will not fund:

  • services for a person other than the injured client
  • more than 1 initial consultation by the same orthoptist or orthoptics clinic, except where there is a gap in treatment of greater than 6 months
  • treatment, services or equipment where there is no published evidence in a recent peer-reviewed journal article that the treatment, service or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services policy 
  • services where prior written approval has not been obtained
  • services for a condition that existed before the transport accident or that is not a direct result of a transport accident injury
  • fees associated with non-attendance
  • the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
  • services subcontracted to a provider who is not eligible for membership with the Orthoptics Association of Australia
  • services received by the injured person outside the Commonwealth of Australia
  • 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.

Orthoptic Services

Effective 1 July 2017

Service DescriptionTAC Item Number2017/18 Maximum Payment Rate2016/17 Maximum Payment Rate
In Rooms
Initial ConsultationTH0040$56.91$56.08
Standard ConsultationTH0042$45.58$44.92
Out of Rooms
Initial ConsultationTH0041$79.43$78.27
Standard ConsultationTH0043$68.20$67.21

Fees for orthoptic services performed within a public hospital will be based on the Department of Human Services schedule of fees and charges for acute health services in Victoria.
Refer to www.health.vic.gov.au/feesman

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.