Radiofrequency Denervation (RFD)

The TAC Medical Excess may apply to these services 

 

 

POLICY

The TAC can pay the reasonable costs of facet joint radiofrequency denervation (RFD) where required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act) where the treatment is provided by a medical specialist trained in its use.

This policy must be read in conjunction with the following:

DEFINITIONS

In this policy, facet joint radiofrequency denervation (RFD) refers to nerve blocking procedures where heat damage to the nerve is created via a needle. The nerve can be supplying a facet joint in the spine or any other body part. The aim of the procedure is to stop pain signals travelling along the nerve. This policy is about facet joint RFD.

positive Medial Branch Block is defined as at least 75% or greater relief of pain on pain scores concordant with the half-life of the anaesthetic. Judicious local anaesthetic use is required so that the only structure anaesthetised is the facet joint

GUIDELINES

What can the TAC pay for in relation to facet joint RFD?

The TAC can pay the reasonable costs of facet joint RFD for a client where required as a result of a transport accident injury: 

  • that are reasonable, necessary or appropriate in the circumstances
  • where safe and effective
  • where pain has been present for longer than 3 months, the pain score is 5/10 or higher and conservative therapy has not been successful after two positive Medial Branch Blocks have taken place
  • in accordance with the TAC's policies 
  • authorised by the TAC under the Transport Accident Act 1986 
  • in accordance with the MBS items, explanations, definitions, rules and conditions for services provided by medical practitioners unless otherwise specified by the TAC
  • treatment or services that are not covered by the MBS items, explanations, definitions, rules and conditions may be considered under the Non-Established, New or Emerging Treatments and Services Policy.  

Who may provide facet joint RFD? 

Facet joint RFD may be provided by any registered medical practitioner with sufficient training in facet joint RFD. Training must include appropriate patient selection as well as technical expertise.

What information does the TAC require to consider paying for facet joint RFD? 

The TAC requires the following information in order to approve a request for faced joint RFD:

  • The site of the pain, likely diagnosis and relationship to the transport accident injury
  • Outcome measures at Baseline and following Medial Branch Block, including location of block, type and volume of anaesthetic used, hourly pain scores +/- pain map/diagram for the duration of the anaesthetic action
  • The level to be targeted by the facet joint RFD
  • The expected management plan if the facet joint RFD is successful (e.g. who will facilitate return to work) or is not successful (e.g. other treatment options).

Where the request for facet joint RFD is approved, a short report of the procedure together with the real-time pain chart/diary is expected to be forwarded to the TAC.

To expedite payment of accounts and ensure the most appropriate services are provided to the injured worker, TAC encourages prior approval be sought by the client's treating practitioner.

How long can TAC pay for facet joint RFD?

A client who has experienced a positive outcome from facet joint RFD should continue to experience that outcome for at least 6 months. If relief persists for longer than 6 months and evidence of relief is through clinically significant change on a pain score as well as functional improvement and/or reduction in healthcare use, future requests for facet joint RFD will be considered. Dated pain diaries and charts must be submitted to the TAC upon request.

When will the TAC respond to a request? 

The TAC will respond to written treatment and service requests as set out in the TAC Service Charter.

To assist the TAC to make a decision regarding a request for facet joint RFD, a treatment request will be reviewed by the TAC Clinical Panel. The Clinical Panel may contact the requesting medical practitioner to seek further information and/or discuss the proposed treatment prior to making a recommendation to the TAC regarding the request. The TAC will respond to the request when they have received the Clinical Panel's recommendation.

Individual requests for procedures which are not supported by a high level of evidence such as sacro-iliac joint RFD, thoracic facet joint RFD, pulsed RFD, dorsal root ganglion RFD or peripheral nerve RFD will be subjected to expert review by the TAC Clinical Panel and/or IME and/or Medical Panel prior to a decision being made.

What are the TAC's invoice requirements? 

Please refer to:

What fees are payable for facet joint RFD?

Please refer to the Medicare Benefit Scheme.

In relation to facet joint RFD, what won't the TAC pay for?

The TAC will not pay for:

  • treatment or services for a person other than the client
  • treatment or services for a condition that existed before the transport accident injury
  • facet joint RFD where the area to be injected is not a major source of pain (e.g. VAS/NRS pain score is less than 5 out of 10) or where pain has not been present for longer than 3 months, or where conservative treatment has not been tried
  • facet joint RFD where there is less than 75% relief of pain for the duration of action of local anaesthetic from two medial branch blocks on the real-time pain chart/diary
  • any repeat facet joint RFD where there is less than 6 months duration of improvement in standardised outcome measures, functional imrovement and/or reduction in healthcare use
  • any repeat facet joint RFD where there is no significant change in pain scores after the first instance of the treatment on the real-time pain chart/diary
  • treatment or services not authorised by the TAC under the Transport Accident Act 1986
  • 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.

Medical Services Reimbursement Rates

The TAC has adopted the Medicare Benefits Schedule (MBS) items, explanations, definitions, rules and conditions for services provided by medical practitioners.  When invoicing for medical services, medical practitioners are expected to adhere to the MBS rules unless otherwise specified by the TAC in the Reimbursement Rates for Medical Services booklet or its medical policies.

The Reimbursement Rates for Medical Services booklet below must be read in conjunction with:

Current Rates

Previous Rates

At the time of production this publication contained up to date information as released by Medicare Australia (Medicare).  The relevant publication will be updated to reflect any further changes that are implemented by Medicare each year.  Please check our website for the latest version.

If you have any questions about these publications or the reimbursement rates, please contact the TAC on 1300 654 329. Alternatively, e-mail info@tac.vic.gov.au.