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Prosthetist and Orthotist Guidelines

As a prosthetist and orthotist (P&O), you play an important role in helping our clients to regain their mobility after their transport accident.

We can pay the reasonable costs of your patient’s P&O services once they have been approved in writing. Consultations, fittings, repair and maintenance are covered. We can also pay the reasonable cost of orthotic equipment under $1,000 without prior approval.

We will review our client’s services to ensure they're 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 14th February 2018 they may need to meet the medical excess before you can invoice the TAC for treatment.

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: P&O page and General guidelines.

This guideline should be read in conjunction with the general provider guideline: What do I need to know about working with the TAC?

Who can provide prosthetist and orthotist (P&O) services?

You can provide services if:

  • You are a P&O who has completed a Bachelor of Prosthetics and Orthotics and is eligible for full membership of the Australian Orthotic Prosthetic Association.
  • Standard orthotic equipment may be provided by an appropriately qualified physiotherapist, podiatrist, chiropractor, osteopath or occupational therapist.

What we can pay for

P&O services

We can pay for your P&O services if they have been approved in writing. We can pay for:

  • Initial, standard, long and prolonged consultations.
  • Prescription, manufacture and fitting of an orthosis or prosthesis.
  • Prosthetic equipment. See: <Prosthetic Treatment Request form>.
  • An initial, subsequent, definitive and back up prosthesis.
  • Repair, adjustment or replacement of a pre-existing prosthesis damaged as a result of the transport accident.
  • Maintenance of a prosthesis.
  • Repair, modification or replacement of a prosthesis outside of the manufacturer’s warranty.
  • Costs of surgery, for surgically implanted prosthesis after the first three months from date of accident.
  • Sporting or recreation prosthesis or components.

We will review our client’s services to ensure they're 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 and goals and how to best support them to get their life back on track. After a review we’ll let you and our client know the decision regarding further treatment.

Orthotic equipment

We can pay the reasonable cost of orthotic equipment under $1,000 without prior approval. This does not include your P&O consultation costs.

Our approval is required for equipment above $1,000 – complete the Orthotic Device Request form to submit requests.

It is expected that prosthetic components comply with ISO 10328 and the Therapeutic Goods (Medical Devices) Regulations 2002 (Cth).

Other things to note

Medical excess

For accidents that occurred prior to 14th 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.

Patients with a severe injury

  • If your patient has a severe injury, the discussion, referral 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, P&O services may be included as part of that.

How much we can pay

We can pay for services in line with our Prosthetic and Orthotic Services Fee Schedule.

What we cannot pay for

We cannot pay for:

  • Repair or replacement of a prosthesis or orthosis that we did not pay for, or one that was not damaged as a result of the transport accident.
  • Maintenance, repair, modification or replacement of a prosthesis or orthosis under warranty.
  • A replacement prosthesis, where the original prosthesis remains serviceable and there is no prescription change.
  • Repairs to a condemned prosthesis.
  • Supply of a reused prosthesis.
  • Insurance of a prosthesis.
  • Services that are included in a hospital inpatient bed fee.

Once we have paid for a prosthesis, the following conditions apply:

  • The prosthesis and its components must not be sold, traded, or disposed of without consultation with the treating P&O.
  • No modifications, additions or alterations may be made to the prosthesis without consultation with the treating P&O.
  • We expect that reasonable care is taken to prevent damage, loss or theft of the prosthesis.

This Guideline relates to the following client policies


Prosthetic and Orthotic Services

Effective 1 July 2019

For Prosthetic and orthotic services provided on or after 1 July 2019
Service DescriptionTAC Item NumberMaximum Payment Rate
Initial Consultation PR600 $60.64
Standard Consultation  PR602 $48.52
Long Consultation  PR604 $72.51
Prolonged Consultation  PR606 $96.90
Manufacture
Time to manufacture (per hour) (Greater than 1 hour should be charged pro-rata at hourly rate) PR608 $105.25
Purchase of Standard Products / Equipment
Standard products require the prior approval of the TAC and are payable at cost.
Details of the products must be included on the invoice for payment. PR 610 As approved
Major Repair (Prosthesis) PR 614 As approved
Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers. (Major repairs are any repairs above $250 inclusive of consumables)
New prostheses or change of prescription. (Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers) PR 612 As approved
Prosthetic Management Review Form - lower extremity or upper extremity. (Total cost for completion of Form) PR 618* $53.50
Orthosis (purchase)- Providers to use when submitting invoice for payment for orthotic equipment, aids & appliances - not to be used for clinical or manufacturing services - use of PR codes to be used for these service types EQ 0035 As approved
Standard Consultation      - up to 30 minutes
Long Consultation             - >30 minutes < 45 minutes
Prolonged Consultation    - >45 minutes <60 minutes
For Prosthetic and orthotic services provided between 1 July 2018 and 30 June 2019
Service DescriptionTAC Item NumberMaximum Payment Rate
Initial Consultation PR600 $59.42
Standard Consultation  PR602 $47.54
Long Consultation  PR604 $71.06
Prolonged Consultation  PR606 $94.96
Manufacture
Time to manufacture (per hour) (Greater than 1 hour should be charged pro-rata at hourly rate) PR608 $103.14
Purchase of Standard Products / Equipment
Standard products require the prior approval of the TAC and are payable at cost.
Details of the products must be included on the invoice for payment. PR 610 As approved
Major Repair (Prosthesis) PR 614 As approved
Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers. (Major repairs are any repairs above $250 inclusive of consumables)
New prostheses or change of prescription. (Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers) PR 612 As approved
Prosthetic Management Review Form - lower extremity or upper extremity. (Total cost for completion of Form) PR 618* $52.43
Orthosis (purchase)- Providers to use when submitting invoice for payment for orthotic equipment, aids & appliances - not to be used for clinical or manufacturing services - use of PR codes to be used for these service types EQ 0035 As approved
Standard Consultation      - up to 30 minutes
Long Consultation             - >30 minutes < 45 minutes
Prolonged Consultation    - >45 minutes <60 minutes

View Orthotics device request form

Orthotics device request form

Summary:

For medical and health providers – use this form to request orthotic devices when over $1,000. You will need to provide details of the orthotic devices you need, and the associated clinical services to improve the function and mobility of your patient.