A future where every journey is a safe one

Medical practitioner guidelines

As medical practitioners, you play an important role in helping our clients recover from their transport accident injuries.

We can pay the reasonable costs of medical treatment, without prior approval, when it is required as a result of a transport accident injury. Patient consultations, prescriptions, surgery and hospital admissions, with some restrictions are covered. Travel and family or group services are also covered.

You may also refer patients to a number of services that we can pay for – although some may require approval first. Surgical procedures that occur three months after the transport accident will also require approval.

We will review our client’s treatment to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. We'll ask you and our client for information during these reviews and may temporarily stop funding treatment if we don’t receive it.  After a review we’ll let you and our client know the decision regarding further treatment.

If your patient's accident was prior to 14 February 2018 they may need to meet the medical excess before you can invoice the TAC for treatment. Some patient reporting may be required.

Click on the tabs above for full details on our requirements and what we can and cannot pay for.

For more information on working with us, see our Medical practitioner page and General Provider Guidelines.

These guidelines should be read in conjunction with our General provider guidelines and Medication guidelines.

Who can provide medical practitioner services?

You can provide services if you are a medical practitioner registered under the Health Practitioner Regulation National Law (e.g. AHPRA) to practice in the medical profession (other than as a student).

What we can pay for

We can pay the reasonable costs of medical treatment, without prior approval, when it is required as a result of a transport accident injury.

We will review our client’s treatment to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. We'll ask you and our client for information during these reviews and may temporarily stop funding treatment if we don’t receive it.

Reviews help us understand our client’s injuries, treatment needs, their goals and how to best support them get their lives back on track. After a review we’ll let you and our client know the decision regarding further treatment.

Patient consultations

We can pay for:

  • medical services with an MBS item number

Medication

We can pay for medication that is:

  • prescribed in accordance with the PBS
  • registered on the Australian Register of Therapeutic Goods

See our Medication guidelines for further information.

Equipment

We can pay for:

  • the provision of basic equipment

Our approval is required for specialised equipment. Please read our Medical and rehabilitation equipment guidelines and use the Equipment Prescription Form to submit written requests.

Travel

We can pay for:

  • Travel costs, where it is clinically justified to conduct treatment in the community.
  • Travel time, for travel to and from the practitioner's practice address and the appointment location. When more than one client is visited in a single travel period, total travel costs should be apportioned equally between clients.

Family and group services

We can pay for:

  • Family counselling to family members of an eligible client, when paid as a part of the claim of a person who dies or is severely injured as a result of a transport accident. Contact us to check client or family member eligibility.

The Family Counselling Allowance applies per claim, regardless of how many eligible family members access this service. The applicable amount for each claim is dependent on when a family member first accessed the service. This allowance is the maximum amount we can pay for family counselling, as set out in the Transport Accident Act 1986. This amount is indexed annually.

Note: “Family member” refers to any member of the immediate family (i.e. partner, parent, sibling or child) of the person who dies or is severely injured as a result of a transport accident. A parent of a dependent child includes:

  • A person who has day-to-day care and control of the child, with whom the child is normally resident.
  • A guardian of the child.

Referrals

You may refer patients to a number of services. We will pay for these services without prior approval.

  • nursing
  • allied health
  • basic medical and rehabilitation equipment, such as continence equipment and dose administration aids
  • family counselling, performed by a social worker or psychologist

You may also refer patients to specialist services. These services require our approval prior to payment.

  • in vitro fertilisation.
  • Multiple and Complex Needs Initiative (MACNI Outreach Services).
  • infusion therapy for pain management.
  • obstetrics including pregnancy (termination of).
  • spinal injection therapies.

Other services that require our approval prior to payment include:

  • domestic services such as home help, gardening and child care.
  • weight loss treatment and services.

Surgery and hospital admissions

  • Surgical procedures that occur in the first three months from the date of the transport accident do not require prior approval.
  • For surgical procedures after the first three months, prior approval from us is required.
  • If the patient has a severe injury, surgery is pre-approved for 12 months from the date of the transport accident.

How do I request surgery approval?

Requests for surgical procedures after three months should be submitted in writing and include:

  • The name and claim number of the client.
  • The name of the medical practitioner performing the surgery.
  • A brief description of the specific elective surgery.
  • The MBS item number(s) associated with the specific elective surgery requested.
  • Clinical indication for elective surgery and the relationship between the surgery and your patient’s transport accident injuries.
  • Details of anticipated prostheses, including clinical justification for the use of a gap-permitted or unlisted item, if required.

We will accept the above information in a letter from a surgeon to a third party, such as the referring GP, if it is provided to us with notification from the surgeon clearly stating that this is a request for funding.

For surgical procedures performed in a public or private hospital operating theatre, the principal surgeon must provide the hospital operation report generated at the time of the surgical procedure.

This should include:

  • Patient's name and date of birth.
  • Date of surgery.
  • Date of report.
  • Name of the principal surgeon.
  • Name of assistants.
  • Description of all services performed: the approach, procedure, closure, any prostheses used and the side and site of the procedure. This is particularly important when more than one procedure is being performed.
  • Appropriate item numbers.
  • A signature/authorisation.

Reporting

You only need to provide a report when we request it. In some cases we may contact you regarding your patient’s treatment and services. We may send you a customised request for a report and ask you to include information regarding the patient’s history, diagnosis, prognosis, progress, outcomes, capacity for work and medical management.

Types of reports we may request:

  • short report (up to 3 questions)
  • standard report (4 to 6 questions)
  • comprehensive report (7 to 10 questions)
  • other specific reports

For general practitioners, we will pay for these reports in line with the Medical reports (TAC requested) fees: treating medical practitioners.

For other medical practitioners, will pay for these reports in line with:

Other things to note

Medical excess

For accidents that occurred prior to 14 February 2018 a medical excess may apply. Visit the medical excess page to see if it applies to your patient.  If the medical excess applies you will need to invoice the client directly.

Gap in treatment

If our client has not received treatment in 6 months they will need to seek approval from us before we will pay for further treatment.  Ask our client for a copy of their approval if you haven’t seen them in 6 months.

Certificate of capacity

As part of your patient’s treatment, you may be required to complete Certificates of Capacity to assess and certify your patient’s capacity for work.

Patients with a severe injury

If your patient has a severe injury, your discussions, referrals and approval of services may form part of the independence planning process between the patient's treating team and our TAC coordinator.

If your patient already has an individualised funding package, medical services may be included as part of that.

How much we can pay

Medical services

We pay for services in line with the Medicare Benefits Schedule (MBS). We do not accept Australian Medical Association item numbers. See Medical services reimbursement rates.

Surgical services

For payment of surgical services, we have adopted the MBS explanations, definitions, rules and conditions for services provided by medical practitioners – with the following exceptions:

Multiple operations – orthopaedic operations only

  • 100% for the item with the greatest TAC fee, plus 75% for each other item
  • For multiple dislocations or fractures requiring an operative or manipulative procedure, the fee for each dislocation or fracture shall be 100% of the TAC fee.
  • For multiple dislocations or fractures where the second or subsequent conditions do not require operative or manipulative treatment, the fee for the second and each subsequent procedure shall be 75% of the TAC fee.
  • When fractures or dislocations are associated with a compound (open) wound, an additional fee of 50% of the fracture or dislocation fee shall apply. The additional 50% applies only to the fracture or dislocation fee and does not apply to the fees for any other procedures that may be performed during the surgery. The medical practitioner must state on their invoice 'Open' or 'Compound' next to the procedure item number.
  • Except where otherwise specified by the TAC, the fee for a fracture-dislocation to the same site shall be the fee for the fracture or dislocation, whichever is the greater, plus 50% of the TAC fee for the lesser procedure.

Fracture and dislocations for two or more operations performed on a patient on the one occasion:

What we cannot pay for

We cannot pay for:

  • treatment and services that are included in a hospital inpatient bed fee
  • the provision of a hospital operation report
  • GP participation in a GP return to work case conference that is not initiated by us or the vocational rehabilitation provider
  • hire charges for surgical equipment associated with a patient’s surgery procedures

This Guideline relates to the following client policies


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:

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.

Medical services fees: GP return to work activities

Effective 1 July 2019

For Return to work case conferences held on or after 1 July 2019
Service DescriptionTAC Item NumberMaximum
Payment
Rate
GP Participation in a RTW Case Conference✝
< 20 minutes RTWCC1 $116.96
20 - 40 minutes RTWCC2 $187.05
> 40 minutes RTWCC3 $257.05
 
GP organise and coordinate a RTW Case Conference✝ RTWCC4 $245.60
GP RTW Worksite Visit (employer agreement required) RTWWV $467.17
RTW Phone call between GP & Employer RTWPC $31.50
For Return to work case conferences held between 1 July 2018 and 30 June 2019
Service DescriptionTAC Item NumberMaximum
Payment
Rate
GP Participation in a RTW Case Conference✝
< 20 minutes RTWCC1 $114.43
20 - 40 minutes RTWCC2 $183.01
> 40 minutes RTWCC3 $251.49
 
GP organise and coordinate a RTW Case Conference✝ RTWCC4 $240.29
GP RTW Worksite Visit (employer agreement required) RTWWV $457.07
RTW Phone call between GP & Employer RTWPC $30.82

Note : These items are restricted for use by General Practitioners only and should be read in conjunction with the Medical Practitioner policy and the General Practitioner Participation in RTW Activities information sheet.

The General Practitioner can either organise and coordinate or participate in a case conference, the practitioner cannot bill both items at the same case conference.

Medical reports (TAC requested) fees: treating medical practitioners

The fees below outline the reimbursement rates for Treating Medical Practitioner reports when requested by the TAC

Effective 1 July 2019

For reports completed on or after 1 July 2019
Service Description TAC Item Number TAC FEE GST Maximum Payment Rate
Treating Medical Practitioner Reports
Specialist Standard Report TTR010 $742.03 $74.20 $816.23
Specialist Follow-up Report*** TTR020 $371.03 $37.10 $408.13
General Practitioner Short Report
(up to 3 questions)
TTR310 $71.33 $7.13 $78.46
General Practitioner Standard Report
(4-6 questions)
TTR320 $178.28 $17.83 $196.11
General Practitioner Comprehensive Report
(7 - 10 questions)
TTR330 $356.54 $35.65 $392.19

*** A follow-up report obtained from a treating practitioner is interpreted as a report providing additional in relation to the ongoing treatment of the patient. A follow-up report will only be requested subsequent to the provision of a standard report.

For impairment reports completed on or after July 2019
Service Description TAC Item Number TAC FEE GST 2017/18 Maximum Payment Rate

Impairment Treating Medical Practitioner Reports

Specialist Standard Report (12 questions) TTR070 $742.03 $74.20 $816.23
Specialist up to date Report (5 questions) TTR080 $358.02 $35.80 $393.82
General Practitioner Comphrensive report
(13 Questions)
TTR090 $376.55 $37.66 $414.21
General Practitioner up to date report
(5 questions)
TTR100 $189.38 $18.94 $208.32
Copy of Treater Clinical Records per page IN0025    20c
Psychiatrist Report TTR070 $742.03 $74.20 $816.23
Psychology Report TSP010 $249.31 $24.93 $274.24

For reports completed between 1 July 2018 and 30 June 2019
Service Description TAC Item Number TAC FEE GST Maximum Payment Rate
Treating Medical Practitioner Reports
Specialist Standard Report TTR010 $725.99 $72.59 $798.58
Specialist Follow-up Report*** TTR020 $363.00 $36.30 $399.30
General Practitioner Short Report
(up to 3 questions)
TTR310 $69.79 $6.98 $76.77
General Practitioner Standard Report
(4-6 questions)
TTR320 $174.43 $17.44 $191.87
General Practitioner Comprehensive Report
(7 - 10 questions)
TTR330 $348.83 $34.88 $383.71

*** A follow-up report obtained from a treating practitioner is interpreted as a report providing additional in relation to the ongoing treatment of the patient. A follow-up report will only be requested subsequent to the provision of a standard report.

For impairment reports completed between 1 July 2018 and 30 June 2019
Service Description TAC Item Number TAC FEE GST 2017/18 Maximum Payment Rate

Impairment Treating Medical Practitioner Reports

Specialist Standard Report (12 questions) TTR070 $725.99 $72.59 $798.58
Specialist up to date Report (5 questions) TTR080 $350.28 $35.03 $385.31
General Practitioner Comphrensive report
(13 Questions)
TTR090 $368.41 $36.84 $405.25
General Practitioner up to date report
(5 questions)
TTR100 $185.29 $18.53 $203.82
Copy of Treater Clinical Records per page IN0025    20c
Psychiatrist Report TTR070 $725.99 $72.59 $798.58
Psychology Report TSP010 $244.30 $24.43 $268.73

View Certificate of Capacity form

Certificate of Capacity form

Summary:

The Certificate of Capacity form is for authorised providers to provide information about their TAC patient's transport accident conditions and to assess and certify their capacity for work as a result of these injuries.

IMPORTANT NOTICE:
It is an offence under the legislation to provide false or misleading information. A person who provides a false or misleading certificate of capacity could be liable to prosecution.

Please provide feedback about the Certificate of Capacity to medicalcertificatefeedback@tac.vic.gov.au

View General Practitioner Participation in Return to Work Activities factsheet

General Practitioner Participation in Return to Work Activities factsheet

Summary:

Here’s how you can help your patient to stay at work, or facilitate their return to work, after a transport accident. The best way to support them is to keep everyone talking - the patient, the employer, the rehabilitation or vocational provider and the TAC claims coordinator.

View Urgent psychiatric admission: Request for funding form

Urgent psychiatric admission: Request for funding form

Summary:

For registered medical practitioners – complete this form to request urgent psychiatric admission for our client.

The form requires a clinical diagnoses of the client's condition and an explanation of why the admission is needed urgently.

View Clarification of Medicare Benefits Schedule (MBS) rules

Clarification of Medicare Benefits Schedule (MBS) rules

Summary:

We pay for medical services in line with the Medicare Benefits Schedule (MBS) items, explanations, definitions, rules and conditions, unless otherwise specified. Here’s what we can and cannot pay for, in relation to specific MBS item combinations.

View Reimbursement Rates for Medical Services Information Sheet

Reimbursement Rates for Medical Services Information Sheet

Summary: This Information sheet provides an introduction to TAC's fee schedule for Medical Practitioners.

View Billing review program information sheets

Billing review program information sheets

Summary:

We conduct periodic reviews of payments made to our medical and allied health service providers through our Billing Review Program. The primary focus is to ensure that payments made to providers are appropriate and comply with TAC policies and fee schedules.