Prosthetist/Orthotist

As a prosthetist and orthotist (P&O), you play an important role in helping our clients to regain their mobility after their transport accident.

We can pay the reasonable costs of your patient’s P&O services once they have been approved in writing.

Consultations, fittings, repair and maintenance are covered. We can also pay the reasonable cost of orthotic equipment under $1,000 without prior approval.

If your patient's accident was prior to 14th February 2018 they may need to meet the medical excess before you can invoice the TAC for treatment.

Click on the links below to see the full Prosthetist and Orthotist guideline, to view the fee schedule and to find any documents and forms you may need.

Prosthetist and Orthotist Guidelines

This guideline should be read in conjunction with the general provider guideline: What do I need to know about working with the TAC?

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

P&O services

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: <Prosthetic 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.

Orthotic equipment

We can pay the reasonable cost of orthotic equipment under $1,000 without prior approval. This does not include your P&O consultation costs.

Our approval is required for equipment above $1,000 – complete the Orthotic Device 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

Medical excess

For accidents that occurred prior to 14th 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.

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 Services Fee Schedule.

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.

Fee Schedules

Prosthetic and Orthotic Services

Effective 1 July 2017

Service DescriptionTAC Item Number2017/18 Maximum Payment Rate
Initial Consultation PR600 $58.15
Standard Consultation  PR602 $46.53
Long Consultation  PR604 $69.54
Prolonged Consultation  PR606 $92.93
Manufacture
Time to manufacture (per hour) (Greater than 1 hour should be charged pro-rata at hourly rate) PR608 $100.94
Purchase of Standard Products / Equipment
Standard products require the prior approval of the TAC and are payable at cost.
Details of the products must be included on the invoice for payment. PR 610 As approved
Major Repair (Prosthesis) PR 614 As approved
Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers. (Major repairs are any repairs above $250 inclusive of consumables)
New prostheses or change of prescription. (Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers) PR 612 As approved
Prosthetic Management Review Form - lower extremity or upper extremity. (Total cost for completion of Form) PR 618* $51.31
Orthosis (purchase)- Providers to use when submitting invoice for payment for orthotic equipment, aids & appliances - not to be used for clinical or manufacturing services - use of PR codes to be used for these service types EQ 0035 As approved
Standard Consultation      - up to 30 minutes
Long Consultation             - >30 minutes < 45 minutes
Prolonged Consultation    - >45 minutes <60 minutes
Service DescriptionTAC Item Number2016/17 Maximum Payment Rate
Initial Consultation PR600 $57.30
Standard Consultation  PR602 $45.85
Long Consultation  PR604 $68.53
Prolonged Consultation  PR606 $91.57
Manufacture
Time to manufacture (per hour) (Greater than 1 hour should be charged pro-rata at hourly rate) PR608 $99.47
Purchase of Standard Products / Equipment
Standard products require the prior approval of the TAC and are payable at cost.
Details of the products must be included on the invoice for payment. PR 610 As approved
Major Repair (Prosthesis) PR 614 As approved
Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers. (Major repairs are any repairs above $250 inclusive of consumables)
New prostheses or change of prescription. (Total cost of consumables and materials only. Consultation and/or manufacturing time to be billed separately under corresponding item numbers) PR 612 As approved
Prosthetic Management Review Form - lower extremity or upper extremity. (Total cost for completion of Form) PR 618* $50.56
Orthosis (purchase)- Providers to use when submitting invoice for payment for orthotic equipment, aids & appliances - not to be used for clinical or manufacturing services - use of PR codes to be used for these service types EQ 0035 As approved
Standard Consultation      - up to 30 minutes
Long Consultation             - >30 minutes < 45 minutes
Prolonged Consultation    - >45 minutes <60 minutes

Forms and brochures

View Orthotics device request form

Orthotics device request form

Summary:

This form is used to request orthotic devices for TAC clients. It seeks details of the orthotic devices and associated clinical services being recommended to improve the function and mobility of the client.

Working with the TAC

Below you will find information relevant to all providers about working with TAC clients, including:

  • How to register
  • Approvals process
  • Travel
  • Compliance requirements
  • Medical excess (for accidents before 14th February 2018)
  • Requests for further information
  • Subsequent, pre-existing and non-accident related injuries
  • Treatment by a family member
  • How to get paid
  • What we cannot pay for

Click on the General Provider guideline below to find out more.

General Provider Guidelines

If you are a registered TAC provider, you can provide treatment and services to our clients when they:

  • Are required as a result of a transport accident injury.
  • Are safe and effective.
  • Promote recovery, functional independence or self-management.

How to register as a provider

To register, you may:

During the registration process you may be asked to provide evidence of your qualification or other documentation requested by us.

What we can pay for

Approved services

The following services are approved for all our clients:

  • ambulance
  • hospital (including surgery for the first three months from the date of accident)
  • medical  (including medical imaging)
  • pharmacy
  • allied health
  • mental health
  • domestic services and gardening
  • interpreting services
  • equipment under $1,000

We do not require requests, clinical notes or reports before we will pay for the above services.

Other services

We must approve in writing any services not listed above.

Requests for approval must be in writing from an appropriately qualified health professional and include the following information:

  • claim number
  • transport accident injury being treated
  • type of treatment or service being requested
  • rationale as to why it is required
  • proposed date of the service/treatment
  • number of services proposed or expected duration
  • date treatment will be reviewed
  • functional goals/outcome measure that will be used to evaluate the treatment
  • self-management strategies in place

We will consider the principles of the Clinical Framework when considering whether a treatment or service request is reasonable and appropriate. We will then respond to written treatment and service requests as set out in our TAC Service Charter.

Travel

We can pay the reasonable cost of travel without prior approval where:

  • It is clinically justified for you to conduct treatment in the community, or you are the most appropriate option in that locality, and
  • The treatment has an associated scheduled fee/item number.

The following requirements apply:

  • Travel time will only be paid for travel to and from your practice address and the patient’s residence or place of appointment.
  • Where you visit more than one TAC client in a single travel period, total travel costs should be split equally for each.
  • If you book multiple appointments on the same day, please organise them efficiently, as we cannot pay for down time between appointments.
  • When invoicing for travel, keep a record of travel details – points of origin, destination and duration of travel – in case we need it.

Other things to note

As providers, you are expected to:

Health professionals should also follow the principles of the Clinical Framework for the Delivery of Health Services (Clinical Framework) into their clinical practice. This is based on the following principles:

  • Measurement and demonstration of the effectiveness of treatment.
  • Adoption of a biopsychosocial approach.
  • Empowering the client to manage their injury.
  • Implementing goals focused on optimising function, participation and/or return to work/health.
  • Base treatment on best available research evidence.

Medical excess (applies to accidents before 14th February 2018)

Client's whose accidents occurred prior to 14th February 2018 are required to pay the first $629 of treatment costs for medical services (excluding hospital and ambulance) before the TAC can fund their ongoing treatment unless:

  • the client or an immediate family member were admitted to hospital as an inpatient; or
  • an immediate family member dies as a result of the transport accident.

If a TAC client hasn't reached the medical excess, you need to invoice them directly for any medical treatment and services they receive. Bulk billed services can be used to reach the medical excess amount.

Once the client has provided a declaration to the TAC that they have reached their medical excess, you can begin invoicing the TAC directly.

You can find out if a client is subject to medical excess by:

  • using the medical excess tool
  • checking if they are available to invoice using Lantern Pay
  • checking client correspondence via the client’s letter or myTAC app

When further information is needed

In some cases we may contact your patient or yourself to seek further information about the treatment or service. We will send in writing any requests for reports or information.

We can release a treatment report to the client, another health practitioner or the client's legal representative upon receipt of a verbal or written request from a client or their legal representative.

If you are a health practitioner, clinical notes will be paid for in accordance with Schedule 2 of the Health Records Regulations 2012 and under the guidelines set out in the Health Records Act 2001.

See the relevant provider guideline or policy for information relevant to these services.

Subsequent, pre-existing and non-accident related injuries

Notify us if your patient has sustained a subsequent or exacerbation of an existing injury.

  • Where a pre-existing injury has become aggravated as a result of a transport accident, we will fund treatment for the exacerbation of that injury.
  • When a patient is being treated for non-accident related injuries at the same time as accident related injuries, you may only invoice us for the treatment relating to the patient’s accident related injury.
  • We will only accept liability for an injury sustained after the transport accident if it is established that a patient’s subsequent injury is a direct result of the injury or injuries originally sustained in the transport accident.

Treatment by an immediate family member

We cannot pay for treatment or services provided by a member of a client’s immediate family, unless exceptional circumstances exist such as:

  • Treatment was provided in an emergency situation.
  • A client resides in a remote area and the distance to access an alternative health care professional is excessive.

When the TAC client has been treated by a family member, care should be transferred to another suitably qualified healthcare professional as soon as practicable.

How to get paid

Use LanternPay

If you’re an eligible provider, LanternPay lets you:

  • check if your patient or client has a TAC approved claim.
  • submit invoices online.
  • view payment decisions immediately.
  • receive payment the next business day.

To find out more about LanternPay and to register, watch our short video or visit www.lanternpay.com/TAC.

Mail your invoice

You may also invoice us by mail. Services subject to GST must be submitted on a GST compliant invoice. Your invoice must include:

payee details

  • group/company/agency
  • ABN
  • TAC payee number (if you have one)
  • billing address and practice/clinic address

client details

  • given and family names
  • TAC claim number

service details

  • name of service provider and Medicare number (if applicable)
  • date of service and time of service (if applicable)
  • TAC item number as per the TAC fee schedule
  • duration of service
  • itemised fee
  • service location (if different to practice address)
  • total charge for invoiced items

If multiple providers are required on one invoice, you must clearly identify the service listed under each service provider. Duplicate accounts, such as statements, photocopies or facsimiles will not be processed for payment.

Send your invoice to:

Transport Accident Commission (TAC)
GPO Box 2751
MELBOURNE   VIC   3001

Payment dates

We process invoices each week. Payment will be made to your bank account.

Is this your first TAC invoice?

In order to receive payment in your bank account, please complete an EFT/Direct Deposit Authority form.

Note:

Invoices you submit to us should accurately reflect the goods and/or services that have been provided. Inaccurate, inappropriate or fraudulent invoicing may result in requests for supporting documentation, prosecution, recovery of inappropriately paid funds or other actions.

If you become aware of an error in your invoicing for services provided to our clients, or where there is a concern over the accuracy of the payments that we have made, contact us on 1300 654 329 to rectify the situation.

What we cannot pay for

Services

We cannot pay for:

  • Services for a person other than the client (except for family counselling where applicable).
  • Services subcontracted to, or provided by, a non-registered provider.
  • Services provided outside the Commonwealth of Australia.
  • Services where there is no National Health and Medical Research Council level 1 or 2 evidence that they are safe and effective. See: Non-established, new or emerging treatments and services policy.

Expenses and travel

We cannot pay for:

  • The cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals. The exception is GPs coordinating return to work programs approved by us.
  • Downtime between appointments or travel expenses unrelated to a consultation.

Invoices

We cannot pay for:

Reports

We cannot pay for:

  • The same medical report provided more than once – for example, a re-issue of a previous report or multiple copies.
  • A consultation used for the purposes of preparing a medical report. When we request a report, please complete it using your existing clinical notes.

Other guidelines that may be relevant for P&Os include: