Approval Requirements

Initial, Standard and Extended Consultations

• The treatment must be related to the client’s transport accident injuries and delivered in line with the Clinical Framework for the Delivery of Health Services
• Within the first 90 days of a client’s accident, and where the criteria mentioned in the descriptor are applicable, there is no need to contact the TAC for approval first. ​
• After the initial 90-day period, approval to provide consultations must be requested:
  • Via the Prosthetic Treatment Request Form or Orthotic Treatment Request Form;
  • In writing via a letter or email; or
  • As otherwise agreed with the Claims Manager.

Approval must be obtained before services are delivered.

Orthotic equipment

Off the shelf/non customised

Within the first 90 days of a client’s accident there is no need to contact the TAC for approval first.

Beyond 90 days after the client’s accident, approval is required. Please complete the Orthotic device request form to submit

requests.

Specialised/customised

Approval is required for specialised or customised orthotic equipment, including repairs. Please complete the Orthotic device request form to submit requests.

Prosthetic equipment

Our approval is required for any prosthetic equipment, including repairs. Please complete the Prosthetics: treatment request form to submit requests.

Minor repairs (PR610) of up to $250 inclusive of consumables, materials, consultation and manufacturing time can be requested in writing via letter or email - completion of the form is not required

Travel

• Within the first 90 days, and where the criteria mentioned in the descriptor are applicable, ​there is no need to contact the TAC for approval first. ​
• After the initial 90-day period, approval to provide travel must be requested:
  • In writing via a letter or email; or
  • As otherwise agreed with the Claims Manager.

Approval must be approved before travel is provided.

• Not for travel between clinics operated by the same operator​
• Travel to be divided between clients where applicable

Completion of forms

Approval is not required for completion of the prosthetic treatment request form, orthotic device request form or prosthetics management review forms but should not exceed required frequency

Attendance at a TAC Team Meeting

At the request of TAC.

Please refer to the Orthotic and prosthetic service policy for further information.

Orthotists and prosthetists are allied health professionals who support clients that require artificial limbs or other supportive devices such as back or ankle braces and callipers. They look at the physical needs of people with mobility issues caused by amputation or problems with their muscles, bones or nervous system.

An orthotist and prosthetist can make and fit devices such as:

• external prostheses
• osseo-integration for prostheses
• orthoses

An orthotist and prosthetist can also work with medical specialists and surgeons to help with the prescription and modification for surgically implanted prostheses.

For more information, see:

• Orthotist/prosthetist - Better Health Channel
• Australian Orthotic and Prosthetic Association

Section 60 of the Transport Accident Act 1986 (the Act) indicates that the TAC is responsible to pay the reasonable cost of a range of services, including medical, rehabilitation and disability services, for eligible persons who are injured as a result of a transport accident. These services must be performed and received in Australia, meaning the client and the provider must be in Australia to be eligible.

This policy applies to prosthetists who are defined as a medical service in the Transport Accident Act 1986 and orthotists which the TAC has authorised as a rehabilitation service under Section 23 of the Act.

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 transport 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.

• Directly to the service provider, when the client has given the provider their TAC claim number.
• The client can pay for the service and then send a copy of their receipt to the TAC for reimbursement using the myTAC app or by emailing invoices@tac.vic.gov.au.

Before providing a service, a provider can confirm that the client has an accepted TAC claim by either:

• Asking them to share their TAC claim number (found on their claim acceptance letter or the myTAC app)
• Calling the TAC so the claim can be confirmed.

The TAC will pay for treatment and services according to the relevant 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 expects allied health professionals to integrate the following principles of the Clinical Framework for the Delivery of Health Services in their daily practice:

1. Measure and demonstrate the effectiveness of treatment

Allied health providers are required to use valid outcome measures (including Patient Reported Outcome Measures where appropriate) to:

• identify outcomes that are important to the client,
• measure progress in achieving those outcomes, and
• tailor treatment based on the progress of client recovery.

Reports describing clinical measures of impairment such as range of motion and strength of muscle groups may also be requested by the TAC.

2. Adopt a biopsychosocial approach

Allied health professionals need to consider the whole person when treating TAC clients. Treatment should incorporate use of validated measures to assess psychological strengths and responses that may impact an individual’s recovery, including worries and fears, resilience, mood, willingness to self-manage and social and financial circumstances. The allied health professional should consider these factors when tailoring communication about recovery expectations. Outcomes of psychosocial screening should also influence education and potential referral to psychology.

3. Empower the injured person to manage their injury

Allied health professionals should promote client independence from treatment by developing self-management strategies and setting expectations early about treatment timelines and management of residual symptoms. Self-management strategies may include:

• a reduction in frequency of treatment as the client develops their self-management skills
• transitioning from supervised exercise to independent exercise programs
• correct wearing of splints, braces and orthoses.

The TAC does not support the provision of allied health treatment beyond a period of active recovery, except for clients with severe injury and permanent disability.

4. Implement goals focused on optimising function, participation and return to work

Goal setting should be a collaborative process which focuses on identifying goals that are meaningful and motivating for the client. Realistic goals provide direction for treatment, help to redirect treatment when goals are not being met, and provide an endpoint for treatment when they are achieved. By prioritising functional improvements, the client can regain their ability to engage in meaningful activities and enhance their overall wellbeing, even in the presence of symptoms.

5. Base treatment on best available research evidence

Treatment needs to be informed by the best available and highest-level research evidence. This includes incorporating evidence-based treatment and referring clients to other services if they are likely to result in better outcomes. When clinical evidence demonstrates that an intervention is ineffective, it should not be used.

The discussion, referral and approval of allied health services for clients with a severe injury and permanent disability (such as acquired brain injury or paraplegia) may be considered as part of a goal-based therapy and support plan (MyPlan). The TAC pays for allied health supports for clients with severe injury and permanent disability to maximise independence, maintain function and promote social and economic participation.

The TAC expects that all allied health professionals will follow the Code of Conduct required by the Australian Health Practitioner Regulation Agency and/or the relevant code of conduct or professional standards for their profession.

Allied health providers who are treating TAC clients must also comply with the Funding treatment by a member of the client's immediate family policy.

The TAC expects that all TAC-funded services are delivered in a way that optimises the client’s health, wellbeing and overall recovery. These services must always be safe and of high quality and performed in a way that keeps clients safe from abuse and neglect.

TAC has a zero tolerance approach to abuse, neglect and exploitation.

More information can be found on our providing quality and safe services page.

Concerns and complaints can be raised directly with the TAC by contacting us.

The TAC can pay the reasonable cost of orthotic and prosthetic services required to treat a TAC client’s transport accident injuries.

Where a pre-existing condition has become worse after 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 how much the transport accident has worsened that condition.

A medical excess may apply for accidents that occurred prior to 14 February 2018.

The TAC will pay the reasonable cost of orthotic and prosthetic services. This includes:

• orthotic and prosthetic consultations, which may involve:
  • assessing and diagnosing injuries
  • developing treatment plans
  • reviewing progress using outcome measures
• extended consultations for treatment that cannot be adequately addressed in a standard consultation (applicable from 1 December 2026)
• provider travel when the client is medically unfit to travel or where treatment in the client’s functional environment is clinically justified (applicable from 1 December 2026)
• attendance at a TAC-requested meeting, where the TAC client is present (applicable from 1 December 2026)
• manufacturing time for orthotics and prosthetics
• repairs and purchase of standard products and equipment
• new prosthetic equipment or change of prescription
• 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
• when requested by the TAC completion of:
  • Prosthetic Treatment Request Form
  • Prosthetic Management Review Lower Extremity Form
  • Prosthetic Management Review Upper Extremity Form
  • Orthotic Device Request Form
    (applicable from 1 December 2026)

The TAC will pay for treatment and services at the rates listed in the Orthotic and Prosthetic Fee Schedule. If a provider charges more 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.

• services that are not required for the treatment of transport accident-related injuries
• services provided by individuals who do not meet the TAC orthotist and prosthetist provider registration requirements or comply with the TAC’s Allied Health Policy.
• services that are not evidence based, reasonable, safe, clinically justified and outcome focused.
• 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
• devices and products not listed on the Prescribed List of Medical Devices and Human Tissue Products
• devices and products that have received a negative determination, as determined by the Australian Government’s Medical Devices and Human Tissue Advisory Committee (MDHTAC)
• 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.

Also see general items we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for orthotic and prosthetic services which include consultation costs and the reasonable cost of basic orthotic equipment (off the shelf, non-customised) without prior TAC approval. The TAC may contact clients or their service providers to discuss progress and to ensure that treatment is clinically justified and outcome focused.

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

To request further treatment, an orthotist or prosthetists must complete an Orthotic Device Request Form or a Prosthetics: Treatment Request Form. 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 orthotics and prosthetics, an orthotist or prosthetist must:

• have completed a Bachelor of Prosthetics and Orthotics and is eligible for full membership of the Australian Orthotic Prosthetic Association
• Comply with the TAC’s Allied Health Policy
• Adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Where the total cost of consumables, materials, consultation and manufacturing time are $250 or under a short written request directly to the TAC claim manager will be accepted and a formal treatment or device request form is not required.

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

Prosthetic and orthotic treatment and services provided in Victorian public hospitals

From 1 July 2026, the TAC will provide a single bundled payment directly to public health services, through the Department of Health, for each episode of care. This funding change includes prosthetics and orthotics services provided to TAC clients in Victorian public health services.

For further information on the implications of the change, please refer to the Public Hospitals fees webpage and the section of FAQs on prosthetics and orthotics.

This policy should be read in conjunction with the TAC’s Allied Health Policy, Surgery and Medical Specialists Policy and the Medical and Rehabilitation Equipment Policy.