Physiotherapy - Information for clients


If you have claimed physiotherapy before and would like more information, please see the physiotherapy policy.

Will the TAC pay for physiotherapy?

The TAC will pay for your physiotherapy when:

  • You have an accepted TAC claim
  • You have met the TAC's medical excess (this is waived if you were admitted to hospital as an inpatient).
  • Your physiotherapy is for your accident related injuries
  • Your physiotherapy is helping you make progress in your recovery.

The TAC will make decisions about paying for your physiotherapy in the time-frames set out in the TAC's Service Charter.

Can I choose my own physiotherapist, or will the TAC choose one for me?

  • You must choose your own physiotherapist, the TAC can't choose one for you
  • You do not need the TAC's approval before you start physiotherapy, you can call to make an appointment when you are ready
  • When you call to make your first appointment, let them know you are a TAC client and that you have an accepted TAC claim. You should talk to them about the TAC's payment limits
  • You do not need to fill out any TAC forms before you start your treatment.

How long the TAC can pay for physiotherapy

  • There is no maximum number of physiotherapy services the TAC can pay for
  • We can pay for your physiotherapy as long as it is helping you make progress in your recovery
  • We may ask your physiotherapist to submit a treatment plan which tells us what you need and for how long.

How the bills are paid

  • In most cases your physiotherapist will bill the TAC directly for your treatment
  • If you have paid a bill yourself, send the original receipt to the TAC for reimbursement. You do not need to fill out any TAC forms, but you can use the 'General Reimbursement form' if you wish 
  • We suggest that you make a copy of your receipts for your own records
  • There is a limit to how much the TAC will pay for each physiotherapy service. If your physiotherapist charges more than the TAC maximum, you will need to pay the difference. This is known as paying "the gap".

Exclusions

The TAC can't pay for:

  • aqua aerobics
  • swimming attire.

The TAC Medical Excess may apply to these services

Policy

The TAC can pay the reasonable costs of physiotherapy 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 physiotherapy services to ensure that the treatment and services remain reasonable for the transport accident injury and are payable under the Act.

Background

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.

This policy must be read in conjunction with the following:

Guidelines

What can the TAC pay for in relation to physiotherapy services?

The TAC can pay the reasonable costs of physiotherapy services:

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

Please note that the TAC will not pay for more than one initial consultation by the same provider or clinic unless there are exceptional circumstances, for example following a hospital admission or surgery, or where a significant period of time has elapsed since the client last received physiotherapy treatment

Supervised exercise programs

The TAC can pay the reasonable costs of supervised exercise programs provided by a physiotherapist. For unsupervised exercise programs, please refer to the Gym and Swimming Programs policy.

Group consultations

The TAC can pay the reasonable costs of group consultations provided by a physiotherapist. 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.

Extended consultations

Extended consultations require prior written approval from the TAC. The TAC can pay the reasonable costs of extended consultations where:

  • there is a need for direct patient contact time of greater than 30 minutes per session; and
  • they are clinically justified for a client who has:

The need for extended consultations will be reviewed at regular intervals. For more information refer to the Physiotherapy Fee Schedule

Out of rooms consultations

The TAC can pay the reasonable costs of out of rooms consultations where the client is medically unfit to travel and it is clinically justified that the treatment should be delivered in a community setting, for example home, work or school. For more information, refer to the Physiotherapy Fee Schedule.

Meeting attendance

The TAC can pay the reasonable costs for a physiotherapist to attend a meeting where:

  • attendance at the meeting has been requested by the TAC as part of the independence planning process, or
  • prior written approval has been provided by the TAC, and
  • the need for attendance is clinically justified.

Travel

The TAC can pay the reasonable costs of travel time for physiotherapists as a separate fee/item when:

  • prior written approval has been provided by the TAC
  • the treating physiotherapist has clinically justified the need for travel, such as a client being medically unfit and unable to attend the physiotherapist's rooms for treatment
  • the travel time is more than 30 minutes to the client (round trip), and
  • there is no physiotherapist situated within 30 minutes (round trip) travel time who can provide the equivalent physiotherapy services.

The TAC expects a client to seek treatment from a provider within their local area. In circumstances where a client requires treatment from a provider whose treatment modality or specialty is not available locally, the TAC can pay the reasonable expenses for a provider to travel outside their local area.

Where travel time is 30 minutes or less, travel as a separate fee/item will not be paid and the service will be considered as an out of room consultation. The fee for an out of rooms consultation includes travel.

Where travel as a separate item has been approved, an in rooms consultation should only be billed, with the travel component billed as a separate item. Refer to the Physiotherapy Fee Schedule for information about how to invoice travel.

Who can provide physiotherapy services?

Services can be provided by a physiotherapist who is registered under the Health Practitioner Regulation National Law to practice in the physiotherapy profession (other than as a student).

What information does the TAC need?

For clients with a 'severe injury' treatment will be approved as part of the independence planning process. The physiotherapist will be required to submit initial baseline measures within 10 working 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 a physiotherapist before commencement of initial treatment for a client's transport accident injury. After initial treatment has commenced, the physiotherapist may be required to submit a Physiotherapy Treatment Notification Plan on request from the TAC. This also applies to clients who have previously:

  • been treated at another physiotherapist clinic, or
  • received physiotherapy treatment and it is more than 12 months since the last treatment session.

For all clients the TAC may contact the client or health physiotherapist for further information if required. In some circumstances a Physiotherapy Management Review (PMR) may be requested by the TAC. Physiotherapists should not submit a PMR or written reports unless specifically requested by the TAC.

In relation to physiotherapy services what won't the TAC pay for?

The TAC will not pay for:

  • treatment or services that are not in line with the Clinical Framework
  • concurrent treatment by physiotherapists, chiropractors, osteopaths and acupuncturists
  • treatment or services of the same type provided more than once on the same day to the same client. For example, two physiotherapy sessions attended by the client on the one day cannot be paid - however one physiotherapy session and one group hydrotherapy session attended by the client on the same day may be paid where clinically justified.
  • pharmacy items such as creams and gels supplied by health professionals - refer to the Pharmacy (Chemist Medications) policy
  • 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
  • treatment or 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.

In relation to hydrotherapy the TAC will not pay for:

  • pool charges - such as pool hire and entry fees, which are included in the hydrotherapy fee - refer to the Physiotherapy Fee Schedule
  • aqua aerobics
  • swimming attire.

Physiotherapy Services (Private)

Effective 1 July 2017

Registered for GSTNot Registered for GST
Service DescriptionTAC Item Number2017/18 Maximum Payment Rate2016/17 Maximum Payment RateTAC Item Number2017/18 Maximum Payment Rate2016/17 Maximum Payment Rate
In Rooms
Initial ConsultationPY600R$70.02$68.99   
Standard ConsultationPY602R$53.35$52.57   
Consultation, with Treatment Notification Plan (TNP)PY604R$70.02$68.99   
Out of Rooms (the fees for these items include travel) 
Initial ConsultationPY600H$99.94$98.48   
Standard ConsultationPY602H$79.96$78.79   
Consultation, with Treatment Notification Plan (TNP)PY604H$99.94$98.48   
Worksite / Home /Equipment Inspection and Report#PY620H*#$117.28$115.57PY620F^$106.63$105.07
Physiotherapy Management Review (PMR)
Completion of PMR (on request of TAC Physiotherapy Consultant)PY630R*$58.74$57.88PY630F$53.38$52.60
#Billed as an hourly rate inclusive of travel
Group (e.g. Pilates)
Two or more patients treated in a class or group session and receive constant overall supervision and intermittent attention for up to 30 minutes at a timePY602G$32.38$31.91   
Hydrotherapy (includes pool hire and entrance fees)
IndividualPH602R$53.35$52.57   
Group (Two or more patients treated in a class or group session and receive constant overall supervision and intermittent attention for up to 30 minutes at a time)PH602G$32.38$31.91   
Attendance at TAC Team Meeting (the fee for this item includes travel)
Attendance by treating physiotherapist at meeting where patient is present, where requested by TAC#PY625H*#$117.28$115.57   
Extended Consultations
Specific Criteria apply and pre-approval by the TAC required.  Refer to the TAC Physiotherapy policy regarding criteria for extended consultations: "Can the TAC fund extended physiotherapy consultations?" For Complex and Multi-site Orthopaedic (CMSO) Injuries, refer also to CMSO criteria
In Rooms
Between 31 and 40 minutes of direct patient contact timePY614R$66.74$65.77   
Greater than 40 minutes of direct patient contact timePY616R$106.60$105.05   
Out of Rooms (the fees for these items include travel)
Between 31 and 40 minutes of direct patient contact timePY614H$99.94$98.48   
Greater than 40 minutes of direct patient contact timePY616H$159.67$157.34   
Travel as a separate fee/item
Specific Criteria apply and pre-approval by the TAC required.  Refer to the TAC Physiotherapy policy:  "Can the TAC fund physiotherapists to travel as a separate fee/item?" 
For rural and regional travel of greater than 30 minutes (by prior approval from the TAC)^PY650#$106.43$104.88   

# Billed as an hourly rate inclusive of travel

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.


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