Occupational therapy guidelines

These guidelines should be read in conjunction with our General provider guidelines.

Who can provide occupational therapy services?

You can provide services if you are registered under the Health Practitioner Regulation National Law (e.g. AHPRA) to practice in the occupational therapy profession (other than as a student) and registered with the Occupational Therapy Board of Australia.

The TAC is in partnership with the State-Wide Equipment Program (SWEP). We use this partnership to manage occupational therapist credentialing. This enables us to find suitably experienced and skilled occupational therapists to provide services for TAC clients in their local areas.

Where possible, the TAC will refer to providers who are registered and credentialed in line with the standards outlined in the SWEP registration and credentialing framework available on the SWEP website.

What we can pay for

Within the first 90 days of a client’s accident, we can help pay for the reasonable costs of an initial occupational therapy assessment and report without the need for you or the client to contact us for approval first. Our client may access services independently or following a referral from a medical practitioner or on discharge from hospital.

Following the initial assessment and report, we may help pay for the reasonable costs of the services listed below, after a review of the treatment plan.

Treatments or services must be recommended by a health professional, related to the client’s accident injuries and delivered in line with the Clinical Framework.

If you intend to continue treating a TAC client beyond 90 days after their transport accident you will need to send us a request in writing or a copy of their treatment plan. We will review our client’s treatment to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. We will assess your request and let you and the client know our decision about what we can help pay for and for how long.

If our client has not received treatment in 6 months they will need to seek approval from us before we will pay for further treatment. Ask our client for a copy of their approval if you haven’t seen them in 6 months.

For details see What we can pay for and How to seek TAC approval.

Treatment and services

We can help pay for:

  • Attending multidisciplinary consultation and team meetings.
  • Hand Therapy via Accredited Hand Therapists.

Assessments and recommendations

We can help pay for assessments and recommendations related to:

  • Home services.
  • Activities of daily living.
  • Home modifications.
  • Vehicle modifications.
  • Driving programs/lessons.
  • Vocational and return to work plans.
  • Transport and travel training.
  • Attendant care programs, including carer training, community access guidelines for a client and Functional Independence Reviews.
  • Support and monitoring for clients engaged in community group programs.
  • Disability support services.
  • Multiple and Complex Needs Model (MACNM).
  • Neurobehavioural rehabilitation services.

Travel

We can help pay for:

  • Travel to conduct treatment in the community, where this is clinically justified.

Travel time can be paid for travel to and from your practice address and your client's residence. Where more than one client is visited in a single travel period, total travel costs should be apportioned equally between clients. Travel should be a reasonable distance from your practice and invoiced in 15-minute increments.

Equipment and orthoses

We can help pay for:

  • Provision of basic equipment, including the supply of splints, supports and orthoses. Please read our Equipment guidelines for details on equipment prescription and what we can pay for.

For specialised equipment, use the Equipment Prescription Form to submit written requests for specialised items such as wheelchairs and bathroom equipment.

Driving assessments

We can help pay for:

  • Driving assessments performed by a VicRoads-authorised occupational therapist in cases where the transport accident injury imposes physical, psychological or cognitive restrictions on driving.

Other things to note

Certificates of Capacity

As part of the client’s treatment, you can complete Certificates of Capacity to assess and certify the client’s capacity for work.

Concurrent treatments

Concurrent allied health treatments are not generally recommended to treat the same injury. This is line with the principles of the Clinical Framework. There can be some exceptions, such as group exercise.

If you or your patient believe concurrent allied health treatments are necessary, please contact us to discuss their needs.

Medical excess

For accidents that occurred prior to 14 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.

Clients with a severe injury

If the client has a severe injury, the discussion, referral and approval of services will form part of the independence planning process between the client's treating team and one of the TAC's support coordinators.

If the client already has an individualised funding package, occupational therapy services may be included as part of that.

How much we can pay

Occupational therapists who are credentialed at red level (as defined by the SWEP Framework) are eligible to invoice in line with the occupational therapy fee schedule for red level providers.

All other occupational therapists will be paid in line with our Occupational therapy fees.

If your fee is higher than our fee, you may choose to charge the client the difference in the form of a gap payment.

What we cannot pay for

We cannot pay for services that are included as part of a hospital inpatient bed fee.

For more information

Access our policy for Occupational therapy.