Workers' Compensation and Injury Management (Scales of Fees) Amendment Regulations (No. 2) 2015 (WA)
!2015153GG!
WESTERN 4075 AUSTRALIAN GOVERNMENT
ISSN 1448-949X (print) ISSN 2204-4264 (online)
| PRINT POST APPROVED PP665002/00041 |
PERTH, FRIDAY, 16 OCTOBER 2015 No. 153 SPECIAL PUBLISHED BY AUTHORITY JOHN A. STRIJK, GOVERNMENT PRINTER AT 11.30 AM
© STATE OF WESTERN AUSTRALIA
Workers’ Compensation and Injury Management Act 1981
Workers’ Compensation and Injury
Management (Scales of Fees) Amendment
Regulations (No. 2) 2015
Made by the Governor in Executive Council on the recommendation of
WorkCover WA under section 292 of the Act.1. Citation
These regulations are the Workers’ Compensation and Injury
Management (Scales of Fees) Amendment Regulations
(No. 2) 2015.
2. Commencement
These regulations come into operation as follows —
(a) regulations 1 and 2 — on the day on which these regulations are published in the Gazette; (b) the rest of the regulations — on 1 November 2015.
3. Regulations amended
These regulations amend the Workers’ Compensation and Injury
Management (Scales of Fees) Regulations 1998.
4. Regulation 6 amended
In regulation 6(1) delete “$231.90” and insert:
$236.90
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5. Regulation 6A amended
In regulation 6A delete “$231.90” and insert:
$236.90
6. Regulation 7A amended
In regulation 7A delete “$73.35” and insert:
$74.95
7. Regulation 7C amended
In regulation 7C(2) delete “$71.60” and insert:
$73.15
8. Regulation 8 amended
In regulation 8 delete “$173.10” and insert:
$176.80
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9. Schedules 1 to 6 replaced
Delete Schedules 1, 2, 3, 4, 5, 5A and 6 and insert:
Schedule 1 — Scale of fees: medical specialists and
other medical practitioners
[r. 2]
Part 1 — Medical specialists and other medical practitioners
Type of service/by whom Fee $ GENERAL PRACTITIONER CONSULTATIONS Surgery Consultation in hours
Content based
Minor or Specific Service (Level A or B) $73.65 Extended Service (Level C) $134.60 Comprehensive Service (Level D) $206.75
Time based
up to 5 minutes $44.00 more than 5 minutes to 15 minutes $57.30 more than 15 minutes to 30 minutes $110.60 more than 30 minutes to 45 minutes $167.15 more than 45 minutes to 60 minutes $226.55
Surgery Consultations
out of hours
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For attendances between the hours of 6 p.m. and 8 a.m. on a weekday or between 12 noon on Saturday and 8 a.m. on the following Monday and Public Holiday.
Content based
Minor Service (Level A) $55.25 Specific Service (Level B) $110.60 Extended Service (Level C) $201.25 Comprehensive Service (Level D) $311.55
Time based
up to 5 minutes $87.50 more than 5 minutes to 15 minutes $94.95 more than 15 minutes to 30 minutes $147.15 more than 30 minutes $201.25
VISITS
Consultations at a place other than the Consulting Rooms
in hours
Minor Service (Level A) $92.20 Specific Service (Level B) $126.00 Extended Service (Level C) $186.95 Comprehensive Service (Level D) $260.55
out of hours
Minor Service (Level A) $110.60 Specific Service (Level B) $164.35 Extended Service (Level C) $252.15 Comprehensive Service (Level D) $368.20
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TELEPHONE CONSULTATIONS
Time based
up to 5 minutes $24.55 more than 5 minutes to 15 minutes $30.80 more than 15 minutes to 30 minutes $64.45 more than 30 minutes $96.55
CASE CONFERENCES, discussions with employers/insurers,
rehabilitation providers, workplace assessments, etc.
per hour $277.00 TRAVELLING FEES
Rate per kilometre $4.95 PHYSICIANS, OCCUPATIONAL & REHABILITATION
PHYSICIANS
PHYSICIANS
CONSULTATIONS
Professional attendance at consulting rooms and issue of certificate (if required) et al
first attendance $279.65 subsequent attendances $139.90 VISITS
Professional attendance at a place other than consulting rooms and issue of certificate (if required) et al
first attendance $334.85 subsequent attendances $193.20
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REHABILITATION PHYSICIANS
CONSULTATIONS
Professional attendance at consulting rooms and issue of certificate (if required) et al
first attendance $279.65 subsequent attendances $139.90 VISITS
Professional attendance at a place other than consulting rooms and issue of certificate (if required) et al
first attendance $334.85 subsequent attendances $193.20 OCCUPATIONAL PHYSICIANS
CONSULTATIONS
Professional attendance at consulting rooms and issue of certificate (if required) et al
first attendance $284.30 subsequent attendances $139.90 VISITS
Professional attendance at a place other than consulting rooms and issue of certificate (if required) et al
first attendance $334.85 subsequent attendances $193.20 TELEPHONE CONSULTATIONS
Time based
up to 5 minutes $36.75 more than 5 minutes to 15 minutes $45.20 more than 15 minutes to 30 minutes $94.60 more than 30 minutes $142.85
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CASE CONFERENCES, discussions with employers/insurers,
rehabilitation providers, workplace assessments, etc.
per hour $410.75 TRAVELLING FEES
Rate per kilometre $4.95 CONSULTANT PSYCHIATRISTS
CONSULTATIONS
Professional attendance at consulting rooms and issue of certificate (if required) et al
Time based
up to 15 minutes $82.00 more than 15 minutes to 30 minutes $163.65 more than 30 minutes to 45 minutes $245.10 more than 45 minutes to 60 minutes $327.95 more than 60 minutes to 75 minutes $371.10 more than 75 minutes $414.20
VISITS
Professional attendance at a place other than consulting visits
rooms and issue of certificate (if required) et al
Time based
up to 15 minutes $134.70 more than 15 minutes to 30 minutes $217.50 more than 30 minutes to 45 minutes $296.80 more than 45 minutes to 75 minutes $379.70 more than 75 minutes $457.55
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TELEPHONE CONSULTATIONS
Time based
up to 45 minutes $108.85 more than 45 minutes $237.55
CASE CONFERENCES, discussions with employers/insurers,
rehabilitation providers, workplace assessments, etc.
per hour $410.75 TRAVELLING FEES
Rate per kilometre $4.95 SPECIALISTS
SURGEONS
CONSULTATIONS
Professional attendance at consulting rooms and issue of certificate (if required) et al
first attendance $159.00 subsequent attendances $82.95 VISITS
Professional attendance at a place other than consulting rooms and issue of certificate (if required) et al
first attendance $214.25 subsequent attendances $136.65 DERMATOLOGISTS
CONSULTATIONS
Professional attendance at consulting rooms and issue of certificate (if required) et al
first attendance $159.00 subsequent attendances $82.95
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VISITS
Professional attendance at a place other than consulting rooms and issue of certificate (if required) et al
first attendance $213.95 subsequent attendances $136.35 TELEPHONE CONSULTATIONS
Time based
up to 5 minutes $36.75 more than 5 minutes to 15 minutes $45.20 more than 15 minutes to 30 minutes $94.60 more than 30 minutes $142.85
CASE CONFERENCES, discussions with employers/insurers,
rehabilitation providers, workplace assessments, etc.
per hour $410.75 TRAVELLING FEES
Rate per kilometre $4.95 ANAESTHETISTS
All anaesthesia fees are calculated by multiplying the units for the consultation, attendance, procedure or service by the $ value per unit allocated by this Schedule.
$ VALUE PER UNIT
$ value per unit $82.70 CONSULTATIONS AND ATTENDANCES Units Anaesthetist Consultation — an attendance of 15 minutes or less duration 2
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CONSULTATIONS AND ATTENDANCES Units — an attendance of more than 15 minutes but not more
than 30 minutes duration 4
— an attendance of more than 30 minutes but not more
than 45 minutes duration — an attendance of more than 45 minutes duration
6
8 Post anaesthesia patient care following a day procedure 2 EMERGENCY ATTENDANCES After hours — where immediate attendance is required after 6 p.m. and before 8 a.m. on any weekday, or at any time on a Saturday, Sunday or a public holiday 6 Note: No after hours loading applies to the above item Attendance on a patient in imminent danger of death requiring continuous life saving emergency treatment to the exclusion of all other patients 6 Call back from home, office or other distant location for the provision of emergency services 4 PROCEDURES AND SERVICES units for the procedure, the time units, and any modifying units and multiplying the result by the $ value per unit allocated by this Schedule.
All anaesthesia fees in relation to procedures and services are to be
charged on the relative value guide (RVG) system. In most cases, the
RVG system comprises 3 elements: base units (BUs), modifying units
(MUs) and time units (TUs).
(BUs + TUs + MUs) x $ value per unit = Fee
In Division 2, the fee for a therapeutic or diagnostic service only includes modifying units (MUs), and time units (TUs) if the item notes that service as including either or both.
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Base units
established and is set out in this Schedule.
[The number of base units for each procedure has been calculated so as to include
usual postoperative visits, the administration of fluids and/or blood incidental to theanaesthesia care and usual monitoring procedures.]
Time units
circumstances depending on factors such as the medical condition of the patient and unusual risk factors. These factors significantly affect the character of the anaesthetic services provided. Circumstances giving rise to additional modifying units are set out in this Schedule.
For the first 2 hours, each 15 minutes (or part thereof) of anaesthetic
time constitutes one time unit. After 2 hours, time units are calculated
at one per 10 minutes (or part thereof).
Modifying units
[Note: The modifying units are, in the main, derived from the modifying units set outin the AMA’s “List of Medical Services and Fees”.]
Description Units A normal healthy patient 0 A patient with a mild systemic disease 0 A patient with a severe systemic disease 1 A patient with a severe systemic disease that is a constant threat to life 4 A moribund patient who is not expected to survive for 24 hours with or without the operation 6 A patient who is morbidly obese (body mass index is more than 35) 2 A patient who is in the 3rd trimester of pregnancy 2 A patient declared brain-dead whose organs are being removed for donor purposes 0 Where the patient is aged under one year or over 70 years of age 1 Emergency surgery (i.e. when undue delay in treatment of the patient would lead to a significant increase in a threat to life or body part) 2
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Description Units Anaesthesia in the prone position (not applicable to lower intestinal endoscopic procedures) 3 is calculated using the “total relative value”. The 50% loading and the
Anaesthesia for after-hours emergencies
emergency surgery modifier should not be used together.
after-hours is defined as that period between 6.00 p.m. and the
following 8.00 a.m. on weekdays and between 8.00 a.m. and thefollowing 8.00 a.m. on weekend days and public holidays.
Division 1 — Procedures
Description of procedure, etc. Units Head Anaesthesia for all procedures on the skin and subcutaneous tissue, muscles, salivary glands and superficial blood vessels of the head, including biopsy, unless otherwise specified 5 — plastic repair of cleft lip 6 Anaesthesia for electroconvulsive therapy 4 Anaesthesia for all procedures on external, middle or inner ear, including biopsy, unless otherwise specified 5 — otoscopy 4 Anaesthesia for all procedures on eye unless otherwise specified 5 — lens surgery 6 — retinal surgery 6 — corneal transplant 8 — vitrectomy 8 — biopsy of conjunctiva 5 — ophthalmoscopy 4 Anaesthesia for all procedures on nose and accessory sinuses unless otherwise specified 6 — radical surgery 7
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Description of procedure, etc. Units — biopsy, soft tissue 4 Anaesthesia for all intraoral procedures, including biopsy, unless otherwise specified 6 — repair of cleft palate 7 — excision of retropharyngeal tumour 9 — radical intraoral surgery 10 Anaesthesia for all procedures on facial bones unless otherwise specified 5 — extensive surgery on facial bones (including prognathism and extensive facial bone
reconstruction) 10
Anaesthesia for all intracranial procedures unless
otherwise specified 15 — subdural taps 5 — burr holes 9 — intracranial vascular procedures including those for aneurysms and arterio-venous abnormalities — spinal fluid shunt procedures
20
10 — ablation of intracranial nerve 6 Anaesthesia for all cranial bone procedures 12 Neck Anaesthesia for all procedures on the skin or subcutaneous tissue of the neck unless otherwise specified 5 Anaesthesia for incision and drainage of large haematoma, large abscess, cellulitis, or similar lesion causing life threatening airway obstruction 15 Anaesthesia for all procedures on oesophagus, thyroid, larynx, trachea and lymphatic system muscles, nerves or other deep tissues of the neck unless otherwise specified 6 — for laryngectomy, hemi-laryngectomy, laryngopharyngectomy, or pharyngectomy Anaesthesia for laser surgery to the airway
10
8
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Description of procedure, etc. Units Anaesthesia for all procedures on major vessels of neck unless otherwise specified 10 — simple ligation 5 Thorax (chest wall/shoulder girdle) Anaesthesia for all procedures on the skin or subcutaneous tissue of the chest unless otherwise specified 3 Anaesthesia for all procedures on the breast unless otherwise specified 4 — reconstructive procedures on the breast (e.g.
reduction or augmentation, mammoplasty) 5
— removal of breast lump or for breast segmentectomy
where axillary node dissection is performed — mastectomy
5
6 — reconstructive procedures on the breast using
myocutaneous flaps 8
— radical or modified radical procedures on breast with
internal mammary node dissection — electrical conversion of arrhythmias
13
5 Anaesthesia for percutaneous bone marrow biopsy of the sternum 4 Anaesthesia for all procedures on the clavicle, scapula or sternum unless otherwise specified 5 — radical surgery 6 Anaesthesia for partial rib resection unless otherwise specified 6 — thoracoplasty 10 — extensive procedures (e.g. pectus excavatum) 13 Intrathoracic Anaesthesia for open procedures on the oesophagus 15 Anaesthesia for all closed chest procedures (including rigid oesophagoscopy or bronchoscopy) unless otherwise specified 6 — needle biopsy of pleura 4
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Description of procedure, etc. Units — pneumocentesis 4 — thoracoscopy 10 — mediastinoscopy 8 Anaesthesia for all thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum unless otherwise specified 13 — pulmonary decortication 15 — pulmonary resection with thoracoplasty 15 — intrathoracic repair of trauma to trachea and bronchi 15 Anaesthesia for all open procedures on the heart, pericardium, and great vessels of the chest 20 Anaesthesia for heart transplant 20 Anaesthesia for heart and lung transplant 20 Cadaver harvesting of heart and/or lungs 8 Spine and spinal cord Anaesthesia for all procedures on the cervical spine and/or cord unless otherwise specified (for myelography and discography see items in ‘Other Procedures’) 10 — posterior cervical laminectomy in sitting position 13 Anaesthesia for all procedures on the thoracic spine and/or cord unless otherwise specified 10 — thoracolumbar sympathectomy 13 Anaesthesia for all procedures in the lumbar region unless otherwise specified 8 — lumbar sympathectomy 7 — chemonucleolysis 10 Anaesthesia for extensive spine and spinal cord procedures 13 Anaesthesia for manipulation of spine 3 Anaesthesia for percutaneous spinal procedures 5
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Description of procedure, etc. Units Upper abdomen Anaesthesia for all procedures on the skin or subcutaneous tissue of the upper abdominal wall unless otherwise specified 3 Anaesthesia for all procedures on the nerves, muscles, tendons and fascia of the upper abdominal wall 4 Anaesthesia for diagnostic laparoscopy 6 Anaesthesia for laparoscopic procedures unless otherwise specified 7 Anaesthesia for extracorporeal shock wave lithotripsy 6 Anaesthesia for upper gastrointestinal endoscopic procedures 5 Anaesthesia for upper gastrointestinal endoscopic procedures in association with imaging techniques including fluoroscopy and ultrasound
6
Anaesthesia for upper gastrointestinal endoscopic procedures in association with acute gastrointestinal haemorrhage 6 Anaesthesia for all hernia repairs in upper abdomen unless otherwise specified 4 — repair of incisional hernia and/or wound dehiscence 6 — repair of omphalocele 7 — transabdominal repair of diaphragmatic hernia 9 Anaesthesia for all procedures on major abdominal blood vessels 15 Anaesthesia for all procedures within the peritoneal cavity in upper abdomen including cholecystectomy, gastrectomy, laparoscopic nephrectomy, bowel shunts and cadaver harvesting of organs unless otherwise specified 8 Anaesthesia for gastric reduction or gastroplasty for the treatment of morbid obesity 10 Anaesthesia for partial hepatectomy (excluding liver biopsy) 13
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Description of procedure, etc. Units Anaesthesia for extended or trisegmental hepatectomy 15 Anaesthesia for pancreatectomy, partial or total (e.g. Whipple procedure) 12 Anaesthesia for liver transplant (recipient) 30 Anaesthesia for neuro endocrine tumour removal (e.g. carcinoid) 10 Anaesthesia for percutaneous procedures on an intra-abdominal organ in the upper abdomen 6 Lower abdomen Anaesthesia for all procedures on the skin or subcutaneous tissue of the lower abdominal wall unless otherwise specified 3 — lipectomy 5 Anaesthesia for all procedures on the nerves, muscles, tendons and fascia of the lower abdominal wall (with the exception of abdominal lipectomy)
4
Anaesthesia for diagnostic laparoscopy 6 Anaesthesia for laparoscopic procedures 7 Anaesthesia for all lower intestinal endoscopic procedures (modifier for prone position is not applicable)
4
Anaesthesia for extracorporeal shock wave lithotripsy 6 Anaesthesia for all hernia repairs in lower abdomen unless otherwise specified 4 — repair of incisional hernia and/or wound dehiscence 6 Anaesthesia for all procedures within the peritoneal cavity in the lower abdomen (including appendicetomy) unless otherwise specified 6 Anaesthesia for bowel resection, including laparascopic bowel resection, unless otherwise specified 8 — amniocentesis 4 — abdominoperineal resection, including pull through procedures, ultra low anterior resection and
formation of bowel reservoir 10
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Description of procedure, etc. Units — radical prostatectomy 10 — radical hysterectomy 10 — radical ovarian surgery 10 — pelvic exenteration 10 — Caesarean section 10 — Caesarean hysterectomy or hysterectomy within
24 hours of delivery 15
Anaesthesia for all extraperitoneal procedures in lower
abdomen, including urinary tract, unless otherwise
specified 6 — renal procedures, including upper 1/3 or ureter 7 — total cystectomy 10 — adrenalectomy 10 — neuro endocrine tumour removal (e.g. carcinoid) 10 — renal transplant (donor or recipient) 10 Anaesthesia for all procedures on major lower abdominal vessels unless otherwise specified 15 — inferior vena cava ligation 10 — percutaneous umbrella insertion 5 Anaesthesia for percutaneous procedures on an intra-abdominal organ in the lower abdomen 6 Perineum Anaesthesia for all procedures on the skin or subcutaneous tissue of the perineum (including biopsy of male genital system) unless otherwise specified 3 — anorectal procedure (including endoscopy and/or
biopsy) 4
— radical perineal procedure including radical perineal
prostatectomy or radical vulvectomy — vulvectomy
7
4 Anaesthesia for all transurethral procedures (including urethrocystoscopy) unless otherwise specified 4 — transurethral resection of bladder tumour(s) 5
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Description of procedure, etc. Units — transurethral resection of prostate 7 — post-transurethral resection bleeding 7 Anaesthesia for all procedures on male external genitalia unless otherwise specified 3 — undescended testis, unilateral or bilateral 4 Anaesthesia for procedures on the cord and/or testes unless otherwise specified 4 — radical orchidectomy, inguinal approach 4 — radical orchidectomy, abdominal approach 6 — orchiopexy, unilateral or bilateral 4 — complete amputation of the penis 4 — complete amputation of the penis with bilateral
inguinal lymphadenectomy 6
— complete amputation of the penis with bilateral
inguinal and iliac lymphadenectomy — insertion of penile prosthesis (perianal approach)
8
4 Anaesthesia for all vaginal procedures (including biopsy of labia, vagina, cervix or endometrium) unless otherwise specified 4 — colpotomy, colpectomy, colporrhaphy 5 — transvaginal assisted reproductive services 4 — vaginal hysterectomy 6 — vaginal delivery 6 — purse string ligation of cervix 4 — culdoscopy 5 — hysteroscopy 4 Anaesthesia for endometrial ablation or resection in association with hysteroscopy 5 — correction of inverted uterus 8 Anaesthesia for evacuation of retained products of conception, as a complication of confinement 4 — for the manual removal of retained placenta or for
repair of vaginal or perineal tear following delivery 5
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Description of procedure, etc. Units — for vaginal procedures in the management of post
partum haemorrhage 7
Pelvis — except hip
Anaesthesia for all procedures on the skin and
subcutaneous tissue of the pelvic region, except external
genitalia 3 Anaesthesia for percutaneous bone marrow biopsy of the anterior iliac crest 4 — percutaneous bone marrow biopsy of the posterior
iliac crest 5
Anaesthesia for percutaneous bone marrow harvesting
from the pelvis 6 Anaesthesia for procedures on bony pelvis 6 Anaesthesia for body cast application or revision 3 Anaesthesia for interpelviabdominal (hind quarter) amputation 15 Anaesthesia for radical procedures for tumour of pelvis, except hind quarter amputation 10 Anaesthesia for closed procedures involving symphysis pubis or sacroiliac joint 4 Anaesthesia for open procedures involving symphysis pubis or sacroiliac joint 8 Upper leg — except knee Anaesthesia for all procedures on the skin or subcutaneous tissue of the upper leg 3 — on the nerves, muscles, tendons, fascia, or bursae of the upper leg Anaesthesia for all closed procedures involving hip joint
4
4 Anaesthesia for arthroscopic procedures of hip joint 4 Anaesthesia for all open procedures involving hip joint unless otherwise specified 6 — hip disarticulation 10 — total hip replacement or revision 10 Anaesthesia for bilateral total hip replacement 14
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Description of procedure, etc. Units Anaesthesia for all closed procedures involving upper 2/3 of femur 4 Anaesthesia for all open procedures involving upper 2/3 of femur unless otherwise specified 6 — amputation 5 — radical resection 8 Anaesthesia for all procedures involving veins of the upper leg including exploration 4 Anaesthesia for all procedures involving arteries of the upper leg, including bypass graft, unless otherwise specified 8 — femoral artery ligation 4 — femoral artery embolectomy 6 — for microsurgical reimplantation of upper leg 15 Knee and popliteal area Anaesthesia for all procedures on the skin and subcutaneous tissue of the knee and/or popliteal area 3 Anaesthesia for all procedures on nerves, muscles, tendons, fascia and bursae of the knee and/or popliteal area 4 Anaesthesia for all closed procedures on the lower 1/3 of femur 4 Anaesthesia for all open procedures on the lower 1/3 of femur 5 Anaesthesia for all closed procedures on the knee joint 3 Anaesthesia for arthroscopic procedures of the knee joint 4 Anaesthesia for all closed procedures on upper ends of the tibia and fibula, and/or patella 3 Anaesthesia for all open procedures on upper ends of the tibia and fibula, and/or patella 4 Anaesthesia for open procedures on the knee joint unless otherwise specified 4 — knee replacement 7
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Description of procedure, etc. Units — bilateral knee replacement 10 — disarticulation of knee 5 Anaesthesia for all cast applications, removal, or repair involving the knee joint 3 Anaesthesia for all procedures on the veins of the knee and popliteal area unless otherwise specified 4 — repair of arteriovenous fistula 5 Anaesthesia for all procedures on the arteries of the knee and popliteal area unless otherwise specified 8 Lower leg — below knee (includes ankle and foot) Anaesthesia for all procedures on the skin or subcutaneous tissue of the lower leg, ankle and foot 3 Anaesthesia for all procedures on the nerves, muscles, tendons and fascia of the lower leg, ankle, and foot unless otherwise specified 4 Anaesthesia for all closed procedures on the lower leg, ankle and foot 3 Anaesthesia for arthroscopic procedure of ankle joint 4 — gastrocnemius recession 5 Anaesthesia for all open procedures on the bones of the lower leg, ankle and foot, including amputation, unless otherwise specified
4
— radical resection 5 — osteotomy or osteoplasty of tibia and fibula 5 — total ankle replacement 7 Anaesthesia for lower leg cast application, removal or repair 3 Anaesthesia for all procedures on arteries of the lower leg, including bypass graft unless otherwise specified 8 — embolectomy 6 Anaesthesia for all procedures on the veins of the lower leg unless otherwise specified 4 — venous thrombectomy 5
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Description of procedure, etc. Units — for microsurgical reimplantation of the lower leg, ankle or foot — for microsurgical reimplantation of the toe
15
8 Shoulder and axilla (includes humeral head and neck, sternoclavicular joint, acromioclavicular joint and shoulder joint) Anaesthesia for all procedures on the skin or subcutaneous tissue of the shoulder or axilla 3 Anaesthesia for all procedures on nerves, muscles, tendons, fascia and bursae of shoulder and axilla, including axillary dissection 5 Anaesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint or the shoulder joint 4 Anaesthesia for all arthroscopic procedures of the shoulder joint 5 Anaesthesia for all open procedures on the humeral head and neck, sternoclavicular joint, acromioclavicular joint or the shoulder joint unless otherwise specified 5 — radical resection 6 — shoulder disarticulation 9 — interthoracoscapular (forequarter) amputation 15 — total shoulder replacement 10 Anaesthesia for all procedures on arteries of shoulder and axilla unless otherwise specified 8 — axillary-brachial aneurysm 10 — bypass graft 8 — axillary-femoral bypass graft 10 Anaesthesia for all procedures on veins of shoulder and axilla 4 Anaesthesia for all shoulder cast application, removal or repair unless otherwise specified 3 — shoulder spica 4
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Description of procedure, etc. Units Upper arm and elbow Anaesthesia for all procedures on the skin or subcutaneous tissue of the upper arm and elbow 3 Anaesthesia for all procedures on the nerves, muscles, tendons, fascia and bursae of upper arm and elbow, unless otherwise specified 4 — tenotomy, elbow to shoulder, open 5 — tenoplasty, elbow to shoulder 5 — tenodesis, rupture of long tendon of biceps 5 Anaesthesia for all closed procedures on the humerus and elbow 3 Anaesthesia for arthroscopic procedures of elbow joint 4 Anaesthesia for all open procedures on the humerus and elbow unless otherwise specified 5 — radical procedures 6 — total elbow replacement 7 Anaesthesia for all procedures on the arteries of the upper arm unless otherwise specified 8 — embolectomy 6 Anaesthesia for all procedures on the veins of the upper arm unless otherwise specified 4 — for microsurgical reimplantation of the upper arm 15 Forearm, wrist and hand Anaesthesia for all procedures on the skin or subcutaneous tissue of the forearm, wrist and hand 3 Anaesthesia for all procedures on the nerves, muscles, tendons, fascia and bursae of the forearm, wrist and hand 4 Anaesthesia for all closed procedures on radius, ulna, wrist, or hand bones 3 Anaesthesia for all open procedures on radius, ulna, wrist, or hand bones unless otherwise specified 4 — total wrist replacement 7
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Description of procedure, etc. Units Anaesthesia for arthroscopic procedures of the wrist joint 4 Anaesthesia for all procedures on the arteries of the forearm, wrist, and hand unless otherwise specified 8 — embolectomy 6 Anaesthesia for all procedures on the veins of the forearm, wrist, and hand unless otherwise specified 4 Anaesthesia for forearm, wrist, or hand cast application, removal or repair 3 — for microsurgical reimplantation of forearm, wrist or hand — for microsurgical reimplantation of a finger
15
8 Burns
Anaesthesia for excision of debridement of burns with
or without skin grafting
— where the burnt area involves not more than 3% of
total body surface 3
— where the burnt area involves more than 3% but less
than 10% of total body surface 5
— where the burnt area involves 10% or more but less
than 20% of total body surface 7
— where the burnt area involves 20% or more but less
than 30% of total body surface 9
— where the burnt area involves 30% or more but less
than 40% of total body surface 11
— where the burnt area involves 40% or more but less
than 50% of total body surface 13
— where the burnt area involves 50% or more but less
than 60% of total body surface 15
— where the burnt area involves 60% or more but less
than 70% of total body surface 17
— where the burnt area involves 70% or more but less
than 80% of total body surface 19
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Description of procedure, etc. Units — where the burnt area involves 80% or more of total
body surface 21
Other Procedures
Anaesthesia for injection procedure for myelography:
— lumbar or thoracic 5 — cervical 6 — posterior fossa 9 Anaesthesia for injection procedure for discography: — lumbar or thoracic 5 — cervical 6 Anaesthesia for peripheral arteriogram 5 Anaesthesia for arteriograms: — carotid, cerebral or vertebral 5 — retrograde, brachial or femoral 5 Anaesthesia for computerised axial tomography scanning, magnetic resonance scanning, ultrasound scanning or digital subtraction angiography scanning 7 Anaesthesia for radiology unless otherwise specified 4 Anaesthesia for retrograde cystography, retrograde urethrography or retrograde cystourethrography 4 Anaesthesia for flouroscopy 5 Anaesthesia for small bowel enema, barium or other opaque study of the small bowel 5 Anaesthesia for bronchography 6 Anaesthesia for phlebography 5 Anaesthesia for heart, 2 dimensional real time transoesophageal examination 6 Anaesthesia for peripheral venous cannulation 3 Anaesthesia for cardiac catheterisation including coronary arteriography, ventriculography, cardiac mapping, insertion of automatic defibrillator or
transvenous pacemaker 7
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Description of procedure, etc. Units Anaesthesia for cardiac electrophysiological procedures including radio frequency ablation 10 Anaesthesia for central vein catheterisation or insertion of right heart balloon catheter 5 Anaesthesia for lumbar puncture, cisternal puncture, or epidural injection 5 Anaesthesia for harvesting of bone marrow for the purpose of transplantation 5 Anaesthesia for muscle biopsy for malignant hyperpyrexia 10 Anaesthesia for electroencephalography 5 Anaesthesia for brain stem evoked audiometry 5 Anaesthesia for electrocochleography by extratympanic method or transtympanic membrane insertion method 5 Anaesthesia for a therapeutic procedure where it can be demonstrated that there is a clinical need for anaesthesia 5 Anaesthesia during hyperbaric therapy where the medical practitioner is not confined in the chamber (including the administration of oxygen) 8 Anaesthesia during hyperbaric therapy where the medical practitioner is confined in the chamber (including the administration of oxygen) 15 Anaesthesia for brachytherapy using radioactive sealed sources 5 Anaesthesia for therapeutic nuclear medicine 5 Anaesthesia for radiotherapy 7 Anaesthesia where no procedure ensues 3 Note — Unlisted anaesthetic procedures
The AMA recognise that in determining the number of units applicable, the anaesthetist shall have regard to equivalent procedures.
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Division 2 — Therapeutic and diagnostic services
Description of service, etc. MUs TUs BUs Collection of blood for autologous transfusion or when homologous blood is required for immediate transfusion in an emergency situation no no 3 Administration of blood or bone marrow already collected when performed in association with the
administration of anaesthesia no no 4 Venous cannulation and blood transfusion (or blood products) not associated with anaesthesia no no 5 Intubation, endotracheal,
emergency procedure, where the
patient’s airway is unsecured andat high risk of occlusion, (e.g. epiglottitis or haematoma post thyroidectomy) not associated with surgery
yes
yes
15
Intubation, endotracheal, not associated with anaesthesia, when subsequent management is not in an intensive care unit
yes
yes
4
Awake endotracheal intubation with flexible fibreoptic scope, associated with difficult airway, when performed in association with the administration of anaesthesia no no 4 Double lumen endobronchial tube or bronchial blocker, insertion of, when performed in association
with the administration of anaesthesia no no 4
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Description of service, etc. MUs TUs BUs Monitoring of depth of anaesthesia, incorporating continuous measurement of the EEG during anaesthesia for the diagnosis of awareness
no
no
3
Venous cannulation and commencement of intravenous infusion, under age of 3 years, not associated with anaesthesia no no 3 Venous cannulation, cutdown no no 5 Venous cannulation and commencement of intravenous infusion not associated with anaesthesia no no 2 Right heart balloon catheter, insertion of, including pulmonary wedge pressure and cardiac output measurement no no 7 Pulmonary artery pressure monitoring no no 3 Left atrial pressure monitoring via left atrial catheter no no 3 Invasive pressure monitoring, not otherwise listed no no 3
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Description of service, etc. MUs TUs BUs Measurement of the mechanical or gas exchange function of the respiration system, or of
respiratory muscle function, or of ventilatory control mechanisms, using measurements of parameters including pressures, volumes, flow, gas concentrations in inspired or expired air, alveolar gas or blood and incorporating
serial arterial blood gas analysis and a written record of the results, when performed in association with the
administration of anaesthesia no no 7 Central vein catheterisation, percutaneous via jugular, subclavian or femoral vein no no 3 Central vein catheterisation by cutdown no no 5 Central venous pressure monitoring no no 3 Arterial cannulation, percutaneous no no 3 Arterial puncture, withdrawal of blood for diagnosis no no 1 Arterial cannulation, by cutdown no no 5 Intra arterial pressure monitoring no no 3 Catheterisation, umbilical artery, newborn, for diagnosis, or therapy no no 5 Intra-arterial infusion or retrograde intravenous perfusion of a sympatholytic agent no no 4 Intravenous regional anaesthesia of limb by retrograde perfusion no no 4
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Description of service, etc. MUs TUs BUs Perfusion of limb or organ no no 12 Medical management of cardio-pulmonary bypass perfusion using heart/lung machine
yes
yes
20
Hypothermia, total body no no 5 Cardioplegia, blood or crystalloid, administration by any route no no 10 Deep hypothermia to a core temperature of less than 22 degrees in association with circulatory arrest
no
no
15
Standby medical management of cardio-pulmonary bypass perfusion using heart/lung machine
no
yes
5
Major nerve block (proximal to the elbow or knee), including intercostal nerve clock(s) or plexus block to provide post operative pain relief
no
no
4
Minor nerve block (specify type) to provide post operative pain relief (does not include subcutaneous infiltration) no no 2 Intrathecal or epidural injection (initial) of a therapeutic substance, with or without insertion of a catheter, in association with anaesthesia and surgery, for post operative pain management
no
no
5
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Description of service, etc. MUs TUs BUs Intrathecal or epidural injection (subsequent) of a therapeutic substance, in association with anaesthesia and surgery, for post
operative pain management no no 3 Subarachnoid puncture, lumbar, diagnostic no no 5 Insertion of subarachnoid drain no no 8 Intrathecal, or epidural or injection, (initial or commencement of infusion) of a therapeutic substance, including up to one hour of continuous
attendance by a medical practitioner no no 8 Intrathecal, or epidural or injection, (initial or commencement of infusion) of a therapeutic substance, where continuous attendance by a medical practitioner extends beyond the first hour. Derived fee being 8 units for the first hour plus one unit for each additional 15 minutes or part thereof no no 0 Intrathecal, or epidural or injection, (initial or commencement of infusion) of a therapeutic substance, including up to one hour of continuous
attendance by a medical practitioner after hours for a patient in labour no no 15
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Description of service, etc. MUs TUs BUs Intrathecal, or epidural or injection, (initial or commencement of infusion) of a therapeutic substance, where continuous after hours attendance by a medical practitioner extends beyond the first hour for a patient in labour. Derived fee being
15 units for the first hour plus one unit for each additional 15 minutes or part thereof no no 0 Subsequent injection (or revision of infusion) of a therapeutic substance to maintain regional anaesthesia or analgesia where the period of continuous medical
practitioner attendance is 15 minutes or less no no 3 Subsequent injection (or revision of infusion) of a therapeutic substance to maintain regional anaesthesia or analgesia where the period of continuous medical
practitioner attendance is more than 15 minutes no no 4 Interpleural block, initial injection or commencement of infusion of a therapeutic substance no no 5 Intrathecal, epidural or caudal injection of neurolytic substance no no 20 Intrathecal, epidural or caudal injection of substance other than anaesthetic, contrast or neurolytic solutions, not being a service to which another item in the Group applies
no
no
8
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Description of service, etc. MUs TUs BUs Epidural injection of blood for blood patch no no 8 Injection of an anaesthetic agent
— trigeminal nerve, primary
division of no no 10
— trigeminal nerve, peripheral
branch of no no 5
— facial nerve no no 3 — retrobulbar or peribulbar no no 5 — greater occipital nerve no no 3 — vagus nerve no no 8 — glossopharyngeal nerve no no 8 — phrenic nerve no no 7 — spinal accessory nerve no no 5 — cervical plexus no no 8 — brachial plexus no no 8 — suprascapular nerve no no 5 — intercostal nerve, single no no 5 — intercostal nerves, multiple no no 7 — ilioinguinal, iliohypogastric or genito femoral nerves,
one or more of — pudendal nerve
no
no
5
no no 8 — ulnar, radial or median nerve of main trunk, one or more of, not being associated with
a brachial plexus block — paracervical (uterine) nerve
no
no
5
no no 5 — obturator nerve no no 7 — femoral nerve no no 7 — saphenous, sural, popliteal or posterior tibial nerve of main trunk, one or more of
no
no
5
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Description of service, etc. MUs TUs BUs — paravertebral, cervical, thoracic, lumbar, sacral or
coccygeal nerves, single
vertebral level no no 7
— paravertebral nerves, multiple
levels — sciatic nerve
no
no
10
no no 7 — other peripheral nerve or branch — sphenopalatine ganglion
no
no
5
no no 10 — carotid sinus, as an independent percutaneous
procedure no no 8
— stellate ganglion (cervical
sympathetic block) no no 8
— lumbar or thoracic nerves
(paravertebral sympathetic
block) no no 8
— coeliac plexus or splanchnic
nerves no no 10
Cranial nerve other than
trigeminal, destruction by a neurolytic agent, not being a service associated with the
injection of botulinum toxin no no 20 Nerve branch, not covered by any other item in this Group, destruction by a neurolytic agent, not being a service associated with the injection of botulinum toxin no no 10 Coeliac plexus or splanchnic nerves, destruction by a neurolytic agent no no 20
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Description of service, etc. MUs TUs BUs Lumbar sympathetic chain, destruction by a neurolytic agent no no 15 Cervical or thoracic sympathetic chain, destruction by a neurolytic agent
no
no
20
Cardioversion, elective, electrical conversion of arrhythmia, external no no 4 Hyperbaric oxygen treatment when the specialist is inside the chamber yes yes 15 Hyperbaric oxygen treatment when the specialist is outside the chamber yes yes 8 Heart, 2-dimensional real time
transoesophageal examination of,
at least 2 oesophageal windows
performed using a mechanical
sector scanner or phased array
transducer with —
(a) measurement blood flow
velocities across the
cardiac valves using
pulsed wave and
continuous Doppler
techniques; and(b) real time colour flow mapping from at least 2 oesophageal windows; and
(c)
recording on video no no 10
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Description of service, etc. MUs TUs BUs Intra-operative 2-dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto
video, performed during cardiac surgery incorporating sequential assessment of cardiac function
before and after the surgical procedure no no 14 The use of 2-dimensional imaging ultrasound guidance to assist percutaneous major vascular access involving catheterisation of the jugular,
subclavian or femoral vein no no 3 The use of 2-dimensional imaging ultrasound guidance to assist percutaneous neural blockade involving the branchial plexus, or femoral and/or sciatic nerve no no 3 Skin testing for allergy to anaesthetic agents no yes 4 Assistance in the administration of an anaesthetic yes yes 5 Note — Unlisted services For an unlisted service, the number of units is to be determined by reference to the nearest listed anaesthetic procedure.
Part 2 — Medical procedures
Type of procedure Fee GENERAL Localised burns $61.40
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Type of procedure Fee Localised burns, including dressing of, under general anaesthetic $174.65 Extensive burns $105.95 Extensive burns, including dressing of, under general anaesthetic $369.70 Dressing of wounds, under general anaesthetic $174.65 Acupuncture, including consultation $81.45 DISLOCATIONS closed reduction means non-operative reduction
of the dislocation, and included percutaneous
fixation and/or external splintage by cast orsplint.
open reduction means treatment by either
closed reduction and intra-medullary fixation or
treatment by operative exposure of the
dislocation including internal or externalfixation.
other means treatment by any other method and
includes the use of external splintage.
[Where injuries are associated with a compound
(open) wound, an additional fee of 50% of the fee
listed is to apply.]
Elbow, by closed reduction $329.40 Elbow, by open reduction $436.85 Interphalangeal joint, by closed reduction $141.20 Interphalangeal joint, by open reduction $188.20 Mandible, by closed reduction $117.70 Clavicle, by closed reduction $139.65 Clavicle, by open reduction $282.30 Shoulder, not requiring general anaesthetic $157.05 Shoulder, by open reduction, with general anaesthetic $563.10 Shoulder, other, with general anaesthetic $278.85 Metacarpophalangeal joint, by closed reduction $188.20
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Type of procedure Fee Metacarpophalangeal joint, by open reduction $252.15 Patella, by closed reduction $211.60 Patella, by open reduction $282.30 Radioulnar joint, by closed reduction $329.40 Radioulnar joint, by open reduction $436.85 Toe, by closed reduction $117.70 Toe, by open reduction $156.30 REMOVAL OF FOREIGN BODIES
as independent procedure $51.25 superficial $228.50 deep tissue or muscle $638.65 ear, other than by syringing $164.60 nose, other than by simple probing $164.60 cornea or sclera, embedded $168.10
FRACTURES
closed reduction means non-operative reduction
of the fracture and included percutaneous
fixation and/or external splintage by cast orsplint.
open reduction means treatment by either
closed reduction and intra-medullary fixation or
treatment by operative exposure of the fractureincluding internal or external fixation.
other means treatment by any other method and
includes the use of external splintage.
[Where injuries are associated with a compound
(open) wound, an additional fee of 50% of the fee
listed is to apply.]Distal phalanx of finger or thumb
fracture, by closed reduction $211.60 fracture, intra-articular, by closed reduction $245.35 fracture, by open reduction $282.30 fracture, intra-articular, by open reduction $352.85
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Type of procedure Fee Middle phalanx of finger
fracture, by closed reduction $319.25 fracture, intra-articular, by closed reduction $361.20 fracture, by open reduction $420.05 fracture, intra-articular, by open reduction $529.30
Proximal phalanx of finger or thumb
fracture, by closed reduction $420.05 fracture, intra-articular, by closed reduction $495.65 fracture, by open reduction $563.10 fracture, intra-articular, by open reduction $705.75
Metacarpal
fracture, by closed reduction $420.05 fracture, intra-articular, by closed reduction $495.65 fracture, by open reduction $563.10 fracture, intra-articular, by open reduction $705.75
Carpal Scaphoid, by open reduction $941.00 Carpal Scaphoid, other $420.05 Carpus (excluding Scaphoid), by open reduction $588.10 Carpus (excluding Scaphoid), other $235.30 Radius
by closed management $470.35 by open management $941.00
Radius or Ulnar, distal end, (Colies’, Smith’s or
Barton’s)
by closed reduction $705.75 by open reduction $941.00
Ribs (1 or more), each attendance $107.65 Tibia, plateau of, medial or lateral
by closed reduction $848.60 by open reduction $1 125.80
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Type of procedure Fee Tibia, plateau of, medial and lateral
by closed reduction $1 411.45 by open reduction $1 890.40
SUTURES
face or neck, less than 7 cm, superficial $168.10 face or neck, less than 7 cm, deep $255.45 face or neck, more than 7 cm, superficial $255.45 face or neck, more than 7 cm, deep $436.85 except face or neck, less than 7 cm, superficial $127.70 except face or neck, less than 7 cm, deep $191.55 except face or neck, more than 7 cm, superficial $191.55 except face or neck, more than 7 cm, deep $420.05 AMPUTATIONS Hand, midcarpal or transmetacarpal $638.65 Hand, forearm or through arm $739.35 At shoulder $1 251.70 Interscapulothoracic $2 486.80 One digit of foot $335.95 Two digits of one foot $504.15 Three digits of one foot $680.50 Four digits of one foot $848.60 Five digits of one foot $1 016.60 Toe including metatarsal or part of metatarsal — each toe $396.75 Foot, at ankle $739.35 Foot, midtarsal or transmetatarsal $638.65 Through thigh, at knee or below knee $1 092.35 At hip $1 537.35
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Type of procedure Fee The fee for assistance at any operation (or series or
combination of operations) is to be related to the
fee listed for the operation (or series or combination
of operations) itself.
The fee is 20% of the total fee or the minimum sum
of $211.60, whichever is greater.
USE OF PRIVATE THEATRESASSISTANCE AT OPERATIONS practitioners for the use of their private theatre, but this fee may only be charged if the patient would otherwise have been sent to hospital.
Part 3 — Diagnostic Imaging Services
ULTRASOUND
MBS item number Fee (1 November 2009) 55028 $205.85 55029 $71.35 55030 $205.85 55031 $71.35 55032 $205.85 55033 $71.35 55036 $209.85 55037 $71.35 55038 $205.85 55039 $71.35 55044 $209.85 55045 $71.35 55048 $205.85 55049 $71.35 55054 $205.85 55070 $185.30
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MBS item number Fee (1 November 2009) 55073 $64.20 55076 $205.85 55079 $71.35 55084 $185.30 55085 $64.20 55113 $435.05 55114 $435.05 55115 $435.05 55116 $483.85 55117 $483.85 55118 $519.60 55130 $320.75 55135 $667.00 55238 $319.70 55244 $319.70 55246 $319.70 55248 $319.70 55252 $319.70 55274 $319.70 55276 $319.70 55278 $319.70 55280 $319.70 55282 $319.70 55284 $319.70 55292 $319.70 55294 $319.70 55296 $209.55 55600 $205.85 55603 $205.85 55700 $113.10
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MBS item number Fee (1 November 2009) 55703 $66.05 55704 $132.10 55705 $66.05 55706 $188.60 55707 $132.10 55708 $66.05 55709 $71.70 55712 $216.95 55715 $75.45 55718 $188.60 55721 $216.95 55723 $71.70 55725 $75.45 55729 $51.40 55731 $185.00 55733 $66.05 55736 $239.50 55739 $107.45 55759 $282.95 55762 $113.10 55764 $301.80 55766 $122.55 55768 $282.95 55770 $113.10 55772 $301.80 55774 $122.55 55800 $205.85 55802 $71.35 55804 $205.85 55806 $71.35
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MBS item number Fee (1 November 2009) 55808 $205.85 55810 $71.35 55812 $205.85 55814 $71.35 55816 $205.85 55818 $71.35 55820 $205.85 55822 $71.35 55824 $205.85 55826 $71.35 55828 $205.85 55830 $71.35 55832 $205.85 55834 $71.35 55836 $205.85 55838 $71.35 55840 $205.85 55842 $71.35 55844 $164.75 55846 $71.35 55848 $205.85 55850 $288.30 55852 $205.85 55854 $71.35 COMPUTED TOMOGRAPHY —
EXAMINATION AND REPORTMBS item number Fee (1 November 2009) 56001 $337.80 56007 $433.10
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MBS item number Fee (1 November 2009) 56010 $436.65 56013 $433.10 56016 $502.40 56022 $389.75 56028 $583.50 56030 $389.75 56036 $583.50 56041 $171.15 56047 $218.55 56050 $222.15 56053 $222.15 56056 $269.15 56062 $195.95 56068 $291.75 56070 $195.95 56076 $291.75 56101 $398.60 56107 $589.10 56141 $201.70 56147 $297.30 56219 $565.15 56220 $415.80 56221 $415.80 56223 $415.80 56224 $608.75 56225 $608.75 56226 $608.75 56227 $212.20 56228 $212.20 56229 $212.20
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MBS item number Fee (1 November 2009) 56230 $307.40 56231 $307.40 56232 $307.40 56233 $415.80 56234 $608.75 56235 $212.15 56236 $307.40 56237 $415.80 56238 $608.75 56239 $212.15 56240 $307.40 56259 $285.45 56301 $511.10 56307 $692.85 56341 $258.95 56347 $349.90 56401 $433.10 56407 $623.65 56409 $433.10 56412 $623.65 56441 $219.60 56447 $314.35 56449 $219.60 56452 $314.35 56501 $667.00 56507 $831.55 56541 $334.60 56547 $422.30 56549 $667.00 56551 $667.00
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MBS item number Fee (1 November 2009) 56619 $381.10 56625 $579.70 56659 $194.20 56665 $290.05 56801 $808.30 56807 $970.25 56841 $404.20 56847 $491.80 57001 $808.45 57007 $983.60 57041 $404.30 57047 $491.85 57201 $268.85 57247 $134.25 57341 $814.30 57345 $418.60 57350 $883.55 57351 $883.55 57355 $457.65 57356 $457.65 DIAGNOSTIC RADIOLOGY MBS item number Fee (1 November 2009) 57506 $59.50 57509 $79.50 57512 $81.05 57515 $108.00 57518 $64.95 57521 $86.80 57524 $98.95
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MBS item number Fee (1 November 2009) 57527 $131.60 57700 $81.05 57703 $108.00 57706 $64.95 57709 $86.80 57712 $94.35 57715 $121.90 57721 $198.55 57901 $129.00 57902 $129.00 57903 $94.60 57906 $129.00 57909 $129.00 57912 $94.35 57915 $94.35 57918 $94.35 57921 $94.35 57924 $94.35 57927 $99.20 57930 $65.80 57933 $156.55 57939 $129.00 57942 $99.20 57945 $86.80 57960 $94.90 57963 $94.90 57966 $94.90 57969 $94.90 58100 $134.25 58103 $110.25
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MBS item number Fee (1 November 2009) 58106 $154.00 58108 $265.85 58109 $94.10 58112 $194.55 58115 $265.85 58300 $80.30 58306 $178.75 58500 $70.75 58503 $94.35 58506 $121.70 58509 $79.50 58521 $86.80 58524 $113.05 58527 $138.80 58700 $92.25 58706 $315.90 58715 $303.20 58718 $252.40 58721 $276.60 58900 $71.35 58903 $95.15 58909 $179.90 58912 $220.60 58915 $157.90 58916 $277.05 58921 $270.60 58924 $168.20 58927 $152.95 58933 $411.40 58936 $392.10
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MBS item number Fee (1 November 2009) 58939 $278.70 59103 $42.70 59300 $179.10 59303 $107.90 59306 $200.70 59309 $401.20 59312 $174.10 59314 $105.00 59318 $94.15 59503 $178.75 59700 $193.15 59703 $151.90 59712 $227.55 59715 $287.20 59718 $269.40 59724 $453.10 59733 $215.50 59736 $124.05 59739 $147.75 59751 $278.45 59754 $438.80 59760 $230.40 59763 $267.95 59903 $229.20 59912 $610.60 59925 $725.10 59970 $336.80 59971 $114.65 59972 $305.20 59973 $362.55
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MBS item number Fee (1 November 2009) 59974 $168.40 60000 $1 128.45
60003 $1 654.85
60006 $2 353.05
60009 $2 753.70
60012 $1 128.45
60015 $1 654.85
60018 $2 353.05
60021 $2 753.70
60024 $1 128.45
60027 $1 654.85
60030 $2 353.05
60033 $2 753.70
60036 $1 128.45
60039 $1 654.85
60042 $2 353.05
60045 $2 753.70
60048 $1 128.45
60051 $1 654.85
60054 $2 353.05
60057 $2 753.70
60060 $1 128.45
60063 $1 654.85
60066 $2 353.05
60069 $2 753.70
60072 $96.35
60075 $192.30
60078 $288.50
60100 $121.70
60500 $86.80
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MBS item number Fee (1 November 2009) 60503 $59.50 60506 $127.60 60509 $197.80 60918 $94.35 60927 $76.15 61109 $517.95 NUCLEAR MEDICINE IMAGING MBS item number Fee (1 November 2009) 61302 $691.75 61303 $871.15 61306 $1 093.60
61307 $1 286.70
61310 $566.00
61313 $467.55
61314 $647.20
61316 $587.45
61317 $758.80
61320 $352.70
61328 $350.85
61340 $389.85
61348 $683.25
61352 $399.55
61353 $595.70
61356 $605.30
61360 $621.60
61361 $711.10
61364 $765.90
61368 $343.85
61369 $3 106.30
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MBS item number Fee (1 November 2009) 61372 $343.85 61373 $754.65 61376 $220.95 61381 $885.05 61383 $962.95 61384 $1 059.75
61386 $512.45
61387 $663.85
61389 $571.00
61390 $631.75
61393 $933.10
61397 $380.40
61401 $250.15
61402 $932.45
61405 $533.15
61409 $1 346.15
61413 $348.20
61417 $183.15
61421 $739.40
61425 $925.70
61426 $854.95
61429 $836.75
61430 $1 016.25
61433 $765.90
61434 $948.40
61437 $836.50
61438 $1 037.10
61441 $754.65
61442 $1 159.45
61445 $441.90
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MBS item number Fee (1 November 2009) 61446 $514.10 61449 $703.00 61450 $612.65 61453 $793.15 61454 $536.35 61457 $725.00 61458 $611.60 61461 $813.30 61462 $200.80 61465 $409.05 61469 $536.35 61473 $270.25 61480 $596.20 61484 $1 357.50
61485 $1 539.80
61495 $343.85
61499 $389.85
61650 $1 354.05
MAGNETIC RESONANCE IMAGING MBS item number Fee (1 November 2009) 63000-63200 $1 003.50 63201 $1 505.20 63202-63203 $1 003.50 63204 $1 505.20 63219-63243 $1 505.20 63271-63473 $1 003.50 63491-63494 $114.70 63497 $344.40
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Schedule 2 — Scale of fees: physiotherapists
[r. 3]
Part 1 — General
Service Code Service PA001
Initial Consultation Set Fee A consultation with the physiotherapist $82.00 including the following elements — Subjective assessment — of the following
points as required:
Major symptoms and lifestyle dysfunction;
current history and treatment; past history
and treatment; pain, 24-hour behaviour,
aggravating and relieving factors; general
health, medication, risk factors.Objective assessment — of the following
points as required:
Movement — active, passive, resisted,
repeated; muscle tone, spasm, weakness;
accessory movements, passive
intervertebral movements etc. Appropriate
procedures/tests as indicated.Appropriate initial management,
treatment or advice — based on
assessment findings that could include the
following as required:
Provisional diagnosis; goals of treatment;
treatment plan. Discussion with the patient
regarding working hypothesis and treatment
goals and expected outcomes; initial
treatment and response; advice regarding
home care including any exercise
programme to be followed.
16 October 2015 GOVERNMENT GAZETTE, WA 4131 Workers’ Compensation and Injury Management (Scales of Fees)
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Service Code Service Documentation of consultation — as
required that could include:
The assessment findings, physiotherapy
intervention(s), evaluation of
intervention(s), plan for future treatment
and results of other relevant tests and
warnings (if applicable).Includes:
• home or hospital; hydrotherapy
treatment; extended treatments; andIndividual services provided in rooms, business hours.
• Courtesy communication by the physiotherapist with the medical practitioner such as acknowledgment of referral.
• The physiotherapist’s notes of the consultation.
Does not include:
• Oral or written communication by the physiotherapist with a medical specialist, medical practitioner, employer, insurer or vocational
rehabilitation provider (other than a
courtesy communication with the
medical practitioner). Oral
communication has a specific item
number in this Table (PK001).• The physiotherapist’s involvement in case conferences. This service has a specific item number in this Table (PQ001).
4132 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Service Code Service PB001
Standard Consultation Set Fee Consultation for one body area or condition $65.85 including the following elements —
• subjective re-assessment; • objective re-assessment; • appropriate management,
intervention or advice;• documentation of consultation. Includes:
• Individual services provided in
rooms, home or hospital;
hydrotherapy treatment; extended
treatments; and services provided
outside of normal business hours.• Courtesy communication by the
physiotherapist such as brief oral or
written communication with the
medical practitioner.Does not include:
•
Oral or written communication by the physiotherapist with a medical specialist, medical practitioner,
employer, insurer or vocational
rehabilitation provider (other than a
courtesy communication with the
medical practitioner). Oral
communication has a specific itemnumber in this Table (PK001).
• The physiotherapist’s involvement in case conferences. This service has a specific item number in this Table (PQ001).
16 October 2015 GOVERNMENT GAZETTE, WA 4133 Workers’ Compensation and Injury Management (Scales of Fees)
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Service Code Service PC001
Two distinct areas of treatment per visit Set Fee Same description as PB001 except relates $83.30 to the treatment/management of 2 distinct
areas/conditions.PG001
Group Consultation — per person Cost per Includes non-individualised services participant provided to more than one individual $20.25 whether —
• in rooms, home or hospital; • hydrotherapy treatment; • extended treatments; • services provided outside of
normal business hours.PE001
Worksite Visit — prior approval from Hourly insurer required rate** Prior to a worksite evaluation, $187.05 consideration of details such as relevance to
injury; intended outcomes; likely duration
and reporting requirements should be made
and discussed with the insurer with a
suggested maximum duration of 2 hours.
Does not include reports or travel.PR001
Progress/Standard Report Set Fee A report relating to a specific worker that is $82.00 provided to a medical specialist, medical
practitioner, employer, insurer or vocational
rehabilitation provider that contains (where
applicable) —
• a summary of assessment findings; • treatment/management services
provided and results obtained;• recommendations for further
treatment/management;
4134 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Service Code Service
• functional and objective
improvements;• perceived treatment duration
required;• return to work recommendation; •
perceived barriers to return to work;
• questionnaire results and
implications.A maximum combined total of 3 reports or
Treatment Management Plans (PR003)
permitted without prior approval from
insurer. Additional reports require prior
approval from insurer.Does not include:
• Courtesy communication by the
physiotherapist such as brief oral or
written communication with the
medical practitioner.PR002
Comprehensive Report Hourly rate**
As above for progress/standard report and $187.05 contains information relating to more
detailed assessments and interventions
performed.The specific requirements for a
comprehensive report must be discussed
with the insurer prior to approval with a
suggested maximum duration of 2 hours.
PR003 Treatment Management Plan Set Fee Provision of a completed Treatment $82.00 Management Plan that must contain —
• clinical assessment of injured
worker and results of any
investigation;
16 October 2015 GOVERNMENT GAZETTE, WA 4135 Workers’ Compensation and Injury Management (Scales of Fees)
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Service Code Service
• injured worker’s current work
status and level of incapacity;
• proposed management plan
including —
1. the proposed work and
functional goals and estimated
timeframe in weeks;2. description and number of
proposed treatment methods;3.
the number of weeks treatment is to be conducted;
4. the injured worker’s expected fitness for work at the end of
the management plan;
5. other comments or
recommendations (including
barriers to recovery where
relevant).A maximum combined total of 3 Treatment
Management Plans or reports (PR001)
permitted without prior approval from
insurer. Additional Treatment ManagementPlans require prior approval from insurer.
PT001 Travel Hourly rate** Travel when the most appropriate $149.70 management of the patient requires the
provider to travel away from their normal
practice. The insurer must provide
pre-approval for travel in excess of one
hour.If services are provided to more than one worker before leaving a venue, the fee for the journey is to be apportioned equally
between workers.
4136 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Service Code Service PQ001 Case Conferences
Face-to-face or telephone communication $18.80 involving the physiotherapist with one or per 6 minute more of the following — block doctor, employer, insurer/claims manager,
rehabilitation providers and worker.The aim of the case conference is to plan,
implement, manage or review treatment
options and/or rehabilitation plan.PK001 Communication
Any required oral communication by the $18.80 physiotherapist with a medical specialist, per 6 minute medical practitioner, employer, insurer or block vocational rehabilitation provider (other than a courtesy communication with the medical practitioner) relating to the
treatment or rehabilitation of a specific
worker.The physiotherapist must keep a written
record of the details of the communication,
including its date, time and duration.Maximum duration per communication is
30 minutes.Maximum cumulative duration of
communications per claim is one hour.
When the maximum cumulative duration
has been reached, prior approval from
insurer for a minimum of 5 blocks of 6
minutes is required.
16 October 2015 GOVERNMENT GAZETTE, WA 4137 Workers’ Compensation and Injury Management (Scales of Fees)
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Service Code Service PS001
Specific Physiotherapy Assessment — Hourly prior approval from insurer required rate** Includes specific types of assessments not $187.05 classified elsewhere in these scales required
by the insurer which physiotherapists may
undertake (e.g. diagnostic ultrasound
imaging, Functional Capacity Assessments
(FCA’s), seating and wheelchairassessments). PW001
Specific Physiotherapy Intervention — Hourly prior approval from insurer required rate** (*replaces PD001).
Includes treatments not classified elsewhere $187.05 in these scales required by the insurer per hour to a which physiotherapists may undertake (e.g. maximum of treatment of severe multiple area trauma, 2 hours** burns, neurologically injured patients and
patients with severe spinal injuries,
ergonomic corrections of workplace,
specialised real-time ultrasound imaging,
short consultations).** Denotes that where the service provided is a fraction of one hour, the amount
chargeable is to be calculated as that fraction of the maximum amount.
Part 2 — Exercise-based programmes
Type of service Fee
EXE20 Initial Consultation/Assessment
Insurer approval must be obtained prior to $187.05 undertaking the service. per hour to Review of current medical and vocational a maximum status. of
2 hours**Communication/Liaison with relevant
parties.Physiological Assessment/testing.
4138 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Type of service Fee Screening questionnaires relating to
worker’s level of function.Programme design based on above. Exercise facility/equipment coordination
(pool or gym based).Provider to patient ratio must be 1:1 for the
duration of the consultation.
EXE21 Subsequent Exercise Consultation/Assessment
Includes — $187.05 programme implementation — prescription per hour to and provision of exercises (land or pool a maximum based); of one programme monitoring; hour** post programme screening questionnaire
relating to worker’s level of function;psychosocial reassessment;
communication/liaison with relevant
parties.EXE02 Initial report
Includes — $187.05 initial assessment report outlining results per hour to (self-reported and objective), a maximum recommendations and exercise of one rehabilitation plan; hour** current status as per medical certification
and proposed outcome status;detailed cost plan outlining proposed
outcome, services required and proposed
costs for insurer approval.
16 October 2015 GOVERNMENT GAZETTE, WA 4139 Workers’ Compensation and Injury Management (Scales of Fees)
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Type of service Fee
EXE03 Subsequent reports
Progress report to be provided at the request $187.05 of the referrer.
per hour to a maximum of
30 minutes
**
EXE04 Final report
Comprehensive report to be provided at the $187.05 end of the service delivery detailing — per hour to physiological testing results pre and post a maximum programme; of
30 minutesworker attendance/programme compliance. ** EXE05 Gym membership/Entry fees
Includes direct cost of membership (pool or Market gym). rates Prior approval from insurer required. EXE06 Travel
Travel when the most appropriate $149.70 management of the patient requires the per hour** practice.
The insurer must provide pre-approval for
travel in excess of one hour.provider to travel away from their normal worker before leaving a venue, the fee for the journey is to be apportioned equally between workers.
4140 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Type of service Fee
EXE08 Communication
Any requested or required oral $18.80 communication with relevant parties per (treating medical practitioners, employers 6 minute and insurers) relating to the treatment of a block specific worker.
Excludes courtesy communication such as
acknowledgment of referral and brief
updates to the medical practitioner.
Maximum time allowable per
communication of 30 minutes.EXE09 Attendance at Medical Case Conferences
Insurer approval must be obtained prior to $187.05 undertaking the service. per hour** ** Denotes that where the service provided is a fraction of one hour, the amount
chargeable is to be calculated as that fraction of the maximum amount.Schedule 3 — Scale of fees: chiropractors
[r. 3]
Type of service Fee
1. Initial consultation and examination $64.85 2. Subsequent consultation $54.10 3. Spinal x-ray, one region $128.85 4. Spinal x-ray, 2 or more regions $193.50 5. Travel (per kilometre) $1.00 Schedule 4 — Scale of fees: occupational therapists
[r. 5]
Type of service Fee
1. Brief consultation (< 15 minutes) $27.95 2. Short consultation (15 minutes to < 30 minutes) $56.10 3. Standard consultation (30 minutes to < 45 minutes) $92.50
16 October 2015 GOVERNMENT GAZETTE, WA 4141 Workers’ Compensation and Injury Management (Scales of Fees)
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Type of service Fee
4. Extended consultation (45 minutes to < one hour) $138.70 5. Extended consultation (≥ one hour) $185.10 6. Standard group consultation (30 minutes) per person $60.75 7.
Travel costs are to be calculated at the hourly rate by the length of time spent travelling
Schedule 5 — Scale of fees: speech pathologists
[r. 7]
Type of service Fee
1. Initial consultation/assessment (up to and including
one hour) $171.00 2.
Initial consultation/assessment (exceeding one hour) $221.45 3.
Subsequent consultation (< 30 minutes) $74.60 4.
Subsequent consultation (30 minutes — one hour) $96.85 5.
Subsequent consultation (> one hour) $130.70 Schedule 5A — Scale of fees: exercise physiologists
[r. 7B]
Exercise-based programmes
Type of service Fee
EXE20 Initial Consultation/Assessment
Insurer approval must be obtained prior to $187.05 undertaking the service.
per hour to a maximum of
2 hours**
Review of current medical and vocational status.
Communication/Liaison with relevant parties.
Physiological Assessment/testing.Screening questionnaires relating to worker’s
level of function.
4142 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Type of service Fee Programme design based on above. Exercise facility/equipment coordination (pool
or gym based).Provider to patient ratio must be 1:1 for the
duration of the consultation.
EXE21 Subsequent Exercise Consultation/Assessment
Includes — $187.05 programme implementation — prescription and per hour to provision of exercises (land or pool based); a maximum
of oneprogramme monitoring; hour** post programme screening questionnaire relating
to worker’s level of function;psychosocial reassessment;
communication/liaison with relevant parties.EXE02 Initial report
Includes — $187.05 initial assessment report outlining results per hour to (self-reported and objective), recommendations a maximum and exercise rehabilitation plan;
of one hour**
current status as per medical certification and
proposed outcome status;detailed cost plan outlining proposed outcome, services required and proposed costs for insurer approval.
EXE03 Subsequent reports
Progress report to be provided at the request of $187.05 the referrer.
per hour to a maximum of
30 minutes
**
16 October 2015 GOVERNMENT GAZETTE, WA 4143 Workers’ Compensation and Injury Management (Scales of Fees)
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Type of service Fee
EXE04 Final report
Comprehensive report to be provided at the end $187.05 of the service delivery detailing — per hour to physiological testing results pre and post a maximum programme; of
30 minutesworker attendance/programme compliance. ** EXE05 Gym membership/Entry fees
Includes direct cost of membership (pool or Market gym). rates Prior approval from insurer required. EXE06 Travel
Travel when the most appropriate management $149.70 of the patient requires the provider to travel per hour** The insurer must provide pre-approval for travel
in excess of one hour.away from their normal practice. before leaving a venue, the fee for the journey is to be apportioned equally between workers.
EXE08 Communication
Any requested or required oral communication $18.80 with relevant parties (treating medical per practitioners, employers and insurers) relating to 6 minute the treatment of a specific worker. block Excludes courtesy communication such as
acknowledgment of referral and brief updates to
the medical practitioner.
Maximum time allowable per communication of
30 minutes.EXE09 Attendance at Medical Case Conferences
Insurer approval must be obtained prior to $187.05 undertaking the service. per hour**
** Denotes that where the service provided is a fraction of one hour, the amount
chargeable is to be calculated as that fraction of the maximum amount.
4144 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Schedule 6 — Scale of maximum fees: approved
medical specialists
[r. 9]
Part 1 — Assessments
Description of assessment Maximum fee**
1. Examination and provision of report and $1 261.65 (or, if an certificate — straightforward assessment — interpreter is present at other than a service mentioned in item 4, 5, the examination, 6 or 8. $1 577.10 excluding
any fee payable to the
interpreter)2. Examination and provision of report and $1 577.10 (or, if an certificate — moderately complex interpreter is present at assessment (e.g. reviewing multiple the examination, questions and reports; impairment $1 892.50 excluding involving more complex assessments; more any fee payable to the than one body system involved) — other interpreter) than a service mentioned in item 4, 5, 6
or 8.3. Examination and provision of report and $1 892.50 (or, if an certificate — complex assessment interpreter is present at (e.g. multiple injuries; severe impairment the examination, such as spinal cord injury or head injury) — $2 207.80 excluding other than a service mentioned in item 4, 5, any fee payable to the 6 or 8. interpreter) 4. Examination of any ear, nose and throat $1 261.65 (or, if an only, including audiometric testing and interpreter is present at provision of report and certificate — other the examination, than a service mentioned in item 8. $1 577.10 excluding
any fee payable to the
interpreter)
16 October 2015 GOVERNMENT GAZETTE, WA 4145 Workers’ Compensation and Injury Management (Scales of Fees)
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Description of assessment Maximum fee**
5. Examination and provision of report and $1 892.50 (or, if an certificate — psychiatric — standard interpreter is present at assessment — other than a service the examination, mentioned in item 8. $2 207.80 excluding
any fee payable to the
interpreter)6. Examination and provision of report and $3 154.00 (or, if an certificate — psychiatric — complex interpreter is present at assessment (e.g. reviewing significant the examination, documented prior psychiatric history) — $3 469.40 excluding other than a service mentioned in item 8. any fee payable to the
interpreter)7. Consolidation of written assessments from $630.85 multiple assessors. 8. Re-examination and provision of report and $946.20 (or, if an certificate. interpreter is present at
the examination,
$1 261.65 excluding
any fee payable to the
interpreter)9. Provision of supplementary report and $315.45 certificate. Part 2 — Attempted assessments
Description of circumstances Maximum fee**
1. If a worker who is required under Part VII $630.85 Division 2 of the Act to submit to an examination by an approved medical specialist does not attend, in a case in which —
(a)
no prior arrangements to cancel the examination are made; or
4146 GOVERNMENT GAZETTE, WA 16 October 2015 Workers’ Compensation and Injury Management (Scales of Fees)
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Description of circumstances Maximum fee** (b) the examination is cancelled,
otherwise than at the request of the
approved medical specialist, with
less than one working day’s notice.
** Denotes that where the service provided is a fraction of one hour, the amount
chargeable is to be calculated as that fraction of the maximum amount.N. HAGLEY, Clerk of the Executive Council.
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