Physiotherapy

Physiotherapists are health professionals who diagnose neuro-musculoskeletal conditions and deliver appropriate evidence-based treatment. Physiotherapy treatment may include manual therapy, exercise prescription, education and development of self-management strategies. Physiotherapists can also prescribe equipment and train disability support providers to implement therapy support. Clients can find a physiotherapist on the Australian Physiotherapy Association website.

The TAC can pay the reasonable cost of physiotherapy provided to TAC clients which is required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay the reasonable cost of physiotherapy. This includes:

• Physiotherapy consultations, which may involve:
  • assessing and diagnosing injuries
  • developing treatment plans
  • reviewing progress using outcome measures
  • conducting psychosocial screening
  • providing education, manual therapy and exercise-based treatment
  • working with the client to identify and achieve activity goals such as return to work, social or domestic activities
  • advising on non-pharmaceutical pain management options
  • advising on the use of botulinum toxin (Botox/Dysport)
  • preparing Certificates of Capacity
  • monitoring and evaluating independent exercise programs (see the Gym and pool memberships policy)
  • training support providers
  • prescribing equipment.
• Group consultations of two or more patients in a class or group session that is led by a physiotherapist.
• Extended consultations for treatment that cannot be adequately addressed in a standard consultation for a client who has either:
  • complex injuries, such as a significant acquired brain injury or spinal cord injury
  • multisite injuries
  • two or more entirely separate injuries.
• Services delivered under the Early Intervention Physiotherapy Framework by eligible registered providers.
• Provider travel when the client is medically unfit to travel or where treatment in the client’s functional environment is clinically justified. This may be paid as either:
  • an out of rooms consultation (inclusive of fee for up to 30 mins of travel)
  • a separate item for rural and regional travel of greater than 30 minutes (by prior approval from the TAC).
• Meeting attendance, at the request of the TAC, where the TAC client is present.
• Workplace assessments and reports conducted by physiotherapists when requested by the TAC.
• Equipment prescription in accordance with the Medical and rehabilitation equipment policy.
• Completion of an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC will pay for treatment and services in accordance with the Physiotherapy fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Physiotherapy provided by students or by practitioners who are not registered with AHPRA.
• Physiotherapy that is already included as part of a hospital inpatient bed fee or outpatient program.
• Exercise attire, swimwear and footwear.
• Vitamins and supplements recommended by a physiotherapist.
• Costs incurred by the physiotherapist for admission to a gym or aquatic centre.
• Concurrent treatment where a client is receiving physiotherapy at the same time as osteopathy or chiropractic treatment for the same injury site, except in exceptional circumstances. See the Allied Health Policy for further information.
• Concurrent physiotherapy treatment if the client is also accessing a multi-disciplinary treatment program which includes physiotherapy, for example a Network Pain Management Program.
• Concurrent exercise physiology and physiotherapy treatment unless it is required for a brief handover period as part of a coordinated rehabilitation program. It is expected that physiotherapy will cease as exercise physiology treatment progresses. Concurrent physiotherapy and exercise physiology may be approved for clients with severe injury and permanent disability as part of their MyPlan if clinically justified.
• Massage when it is performed by a masseur or myotherapist. The TAC can only pay for massage when it is performed by a registered physiotherapist, osteopath or chiropractor.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for physiotherapy services without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified, and outcome focused.

If a client needs physiotherapy beyond 90 days after their transport accident, the provider must seek TAC approval before funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

Physiotherapists must complete an Allied Health Treatment and Recovery Plan to request further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC funded physiotherapy, a physiotherapist must:

• be registered under the Health Practitioner Regulation National Law (AHPRA) to practice in the physiotherapy profession (other than as a student)
• comply with the TAC Allied Health Policy
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that physiotherapists promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their injury and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.