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The TAC Medical Excess may apply to these services |
Policy
The TAC can pay the reasonable cost of Joint Fluid Therapy for osteoarthritis of the knee which is for injuries that are the result of the transport accident.
Transport Accident Act 1986 reference: s.3 'medical service' and s.60
Definition
The treatment involves a viscoelastic material designed for use in the treatment of osteoarthritis of the knee joint. It is designed to be injected into the knee joint to supplement the joint's synovial fluid.
Guidelines
Who is eligible for treatment?
The TAC will fund Joint Fluid Therapy only where the treating medical practitioner:
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confirms the diagnosis of osteoarthritis of the knee joint
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specifies the clinical or radiological evidence for the diagnosis
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confirms that the osteoarthritis directly relates to the injuries received in the transport accident and there are no apportionment issues
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confirms that Joint Fluid Therapy is being used only where NSAIDS (non-steroidal anti- inflammatory drugs) or analgesic therapy has failed.
In all cases prior approval in writing must be obtained from the TAC.
What will the TAC pay?
The TAC will pay for a maximum of one injection per week for each week of the course up to a maximum of two courses in any six month period.
The TAC will pay the reasonable cost of the drug in accordance with the manufacturers recommended price list.
Which treatments will the TAC pay for?
Currently the TAC will only consider funding the use of Joint Fluid Therapies registered by the Therapeutic Goods Administration Branch of the Commonwealth Department of Health and Family Services, and when prescribed by a registered medical practitioner.
Can the TAC fund Joint Fluid Therapy services prescribed or administered by a member of a client's immediate family?
Refer to the Funding Treatment by a Member of a Client's Immediate Family policy.
What Joint Fluid Therapy services will the TAC not fund?
The TAC will not fund:
- treatment or services for a person other than the injured client
- treatment or services for a condition that existed before the transport accident or that is not a direct result of the transport accident
- treatment or services where there is no objective evidence that a treatment or service is safe and effective
- treatment or services where there is no clinical justification for the treatment or service
- the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
- fees associated with non-attendance
- treatment or services subcontracted to a non-registered provider
- treatment or services provided outside the Commonwealth of Australia
- treatment or services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.
Medical Services Reimbursement Rates
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 in the Reimbursement Rates for Medical Services booklet or its medical policies.
The Reimbursement Rates for Medical Services booklet below must be read in conjunction with:
- Medicare Benefits Schedule (MBS)
- Clarification of Medicare Benefits Schedule (MBS) rules
- The TAC invoicing guidelines for medical practitioners PDF, 0.07MB
- The TAC's medical practitioner policy
- Other policies outlined within the Medical Practitioners section of our website
Current Rates
Please note: There was an error in the fees payable for A23 item numbers 5223, 5227, 5228, 5260, 5263, 5265 and the multiple patient step-downs. If you have accessed these fee schedules prior to 5 July 2017, you will need to download these updated schedules and correct your systems.
- Reimbursement Rates for Medical Services performed on or after 1 July 2017 XLSX, 0.16MB
- Reimbursement Rates for Medical Services performed on or after 1 July 2017 PDF, 1.42MB
Previous Rates
- Reimbursement Rates for Medical Services performed between 1 July 2016 and 30 June 2017 XLSX, 0.14MB
- Reimbursement Rates for Medical Services performed between 1 July 2016 and 30 June 2017 PDF, 1.44MB
- Reimbursement Rates for Medical Services performed between 1 July 2015 and 30 June 2016 PDF, 1.42MB
- Reimbursement Rates for Medical Services performed between 1 July 2015 and 30 June 2016 XLSX, 0.21MB
- Reimbursement Rates for Medical Services performed between 1 July 2014 and 30 June 2015 PDF, 1.46MB
- Reimbursement Rates for Medical Services performed between 1 July 2014 and 30 June 2015 (Includes 1 November 2014 MBS updates) XLSX, 0.19MB
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.