Prosthetist and orthotist guidelines
These guidelines should be read in conjunction with our General provider guidelines.
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
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 the Prosthetics 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.
We can pay the reasonable cost of basic orthotic equipment (off the shelf, non-customised) without prior approval. This does not include your P&O consultation costs.
Our approval is required for specialised or customised orthotic equipment, including major repairs (over $250). Please complete the Orthotic device request form to submit requests.
Our approval is required for any prosthetic equipment, including major repairs (over $250). Please complete the Prosthetics: treatment 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
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.
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 fees.
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.