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 on the Reimbursement Rates for Medical Services information page or its medical policies.

The Reimbursement Rates for Medical Services must be read in conjunction with:

• Medicare Benefits Schedule (MBS)
• Clarification of Medicare Benefits Schedule (MBS) rules
• Other policies outlined within the Medical Practitioners section of our website

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.

We’re here to help you get your life back on track after your transport accident. To help you recover we will pay for consultations and treatment with appropriate and qualified medical specialists and surgeons in Australia.

There are two types of surgery:

• Emergency surgery – urgent surgery to save the person’s life or preserve function of a body part.
• Elective surgery – non-urgent surgery required for your ongoing health or quality of life.

What will my surgeon or specialist do?

You might require surgery, or a consultation with a medical specialist, to help with your transport accident injuries. Your surgeon or specialist may carry out diagnosis, prevention, reconstruction and transplantation procedures.

In the first 90 days after your accident, surgery is approved

We will pay for emergency surgery or elective surgery you need because of your accident injuries within the first 90 days of the date of your accident.

Surgery after 90 days from the date of a transport accident

If you need elective surgery after 90 days from the date of your accident, we will pay for a consultation with your doctor. After that consultation your doctor may then refer you to a specialist or surgeon to treat your transport accident injuries.

We require a letter from your surgeon:

• Describing the surgery or procedure required, including Medicare item numbers.
• Providing a clinical justification for how the surgery relates to your transport accident injuries.
• Providing information about your expected recovery time, the rehabilitation services you'll need and any limitations you'll have after surgery.

We may contact your surgeon or specialist to discuss your progress or request an assessment to make sure that:

• You have access to appropriate treatment and supports required for your transport accident injuries.
• You are getting proven, evidence-based treatment and not receiving treatment that isn't helping you recover.
• You are moving towards getting your life back on track and being able to live independently.

How surgery and specialist treatment is paid for

We pay for your treatment:

• Directly to your surgeon or specialist, when you have given them your TAC claim number, or
• If you have to pay, use myTAC to send a copy of your receipt to us and we will repay you.

We pay for your services in line with our responsibilities under the Transport Accident Act 1986.

How much we will pay

We will pay for your surgery, including anaesthesia, when you are admitted to hospital and require surgery as a result of your transport accident injuries. We can also pay the cost of subsequent elective surgery required as a result of your transport accident injuries.

We will pay for your treatment and services according to our fee schedule. If your provider charges more than the TAC rate, you may need to pay the difference. If you have already paid for your surgical treatment we can repay those expenses up to our maximum amount.

For a list of TAC rates, see: Elective surgery.

For accidents that happened before 14 February 2018, we can only pay for these services once any required medical excess has been reached. Find out if the medical excess applies to you.

What we won’t pay for

We can’t pay for services that:

For providers

If you are a specialist, surgeon or anaesthetist, please refer to our TAC provider guidelines.

TAC surgery service charter

We understand that having surgery is an important part of your health and recovery.  We will be transparent and timely when we make a decision about paying for your surgery.

We are here to:

• support your recovery from your transport accident-related injuries, and
• make sure your surgery is in line with what we can pay for under the Transport Accident Act 1986.

Information we need from your surgeon

For us to make a decision about whether we can pay for your surgery, we need a request from your surgeon, which includes:

• a description of the surgery,
• why you need the surgery,
• how the surgery relates to your transport accident injuries,
• how the surgery will help you with your recovery, and
• any relevant diagnostic findings (like x-rays and pathology results).

Your surgeon can use the surgery request form to provide this information.

What you can expect from us

We will contact you within 10 business days to let you know we have received a request for your surgery.

Then, we will follow the steps below to make a decision about whether we can pay for your surgery.

If we have all the information we need to make a decision

We will review the information and let you and your surgeon know our decision within 20 business days of receiving the surgery request.

If we need more information to make a decision

1. We will contact you within 20 business days of receiving the surgery request to explain:
   1. what further information we need,
   2. what we are doing to get that information,
   3. if we have questions about the information already provided
2. Sometimes we need to ask for recommendations from a member of the TAC Clinical Panel, or an Independent Medical Examiner. This helps us make a decision in line with the Transport Accident Act. It ensures that the surgery request is reasonable and related to your transport accident.  If we need to do this, we will contact you within 20 business days of receiving the request to give you:
   1. an estimate of how long we think it will take to get information from the Clinical Panel. This can take up to 8 weeks.
   2. the details of any appointments made with an Independent Medical Examiner. These appointments can have a wait time of up to 6 months.
      
      In these cases, if you have a lawyer, or someone else helping you with your claim, we will also contact them to explain what we are doing. They might be able to help us get the information we need, as soon as possible.

3. We will make a decision about whether we can pay for your surgery within 20 business days of receiving the information and recommendations we need. We will write to you and your surgeon to let you know our decision.

We will keep you up to date

We will let you know when:

• we request more information, and from whom
• we send your request to the TAC Clinical Panel or an Independent Medical Examiner
• we make a decision.

If we can’t pay for your surgery, we will explain why

• We will explain your rights for review or appeal of our decision.
• There may be other ways to pay for your surgery. Talk with your surgeon or doctor about what is available through private health insurance or the public hospital system.

How to contact us about your request

If you need help with your surgery request or have any questions about your TAC claim, we're here to help. You can reach out to your TAC claims manager, who will be more than happy to assist you with any concerns or questions you have. Simply call their usual number.

Or, if you don't have your claims manager's number or would like to speak with someone else, call us on 1300 654 329. Our friendly and knowledgeable team is available Monday to Friday, 8.30am to 5.30pm to answer your call and help you with any questions or concerns.