Prosthetic and orthotic fees

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Effective 1 July 2019

For Prosthetic and orthotic services provided on or after 1 July 2019
Service DescriptionTAC Item NumberMaximum Payment Rate
Initial Consultation PR600 $60.64
Standard Consultation  PR602 $48.52
Long Consultation  PR604 $72.51
Prolonged Consultation  PR606 $96.90
Manufacture
Time to manufacture (per hour) (Greater than 1 hour should be charged pro-rata at hourly rate) PR608 $105.25
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* $53.50
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
For Prosthetic and orthotic services provided between 1 July 2018 and 30 June 2019
Service DescriptionTAC Item NumberMaximum Payment Rate
Initial Consultation PR600 $59.42
Standard Consultation  PR602 $47.54
Long Consultation  PR604 $71.06
Prolonged Consultation  PR606 $94.96
Manufacture
Time to manufacture (per hour) (Greater than 1 hour should be charged pro-rata at hourly rate) PR608 $103.14
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* $52.43
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