Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2003 (SA)

South Australia

Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2003

under the Workers Rehabilitation and Compensation Act 1986

Contents

Part 1—Preliminary

1. Short title

2. Commencement

3. Variation provisions

Part 2—Variation of Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Regulations 1999 (Gazette 14.1.1999 p 58) as varied

1. Substitution of heading to Schedule A

2. Revocation of Schedule B

   Schedule B—Workers compensation services

Part 1—Preliminary

1—Short title

These regulations may be cited as the Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2003.

2—Commencement

These regulations will come into operation on 14 April 2003.

3—Variation provisions

In these regulations, a provision under a heading referring to the variation of specified regulations varies the regulations so specified.

Part 2—Variation of Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Regulations 1999 (Gazette 14.1.1999 p 58) as varied

4—Substitution of heading to Schedule A

Heading to Schedule A—delete the heading and substitute:

Schedule A—Clinical medical services

5—Revocation of Schedule B

Schedule B—delete the Schedule and substitute:

Schedule B—Workers compensation services

Medical report—treating doctor

Item No.	Group	Description	Maximum Fee
WMG16	General Practitioners	Treating doctor medical report—provided within 10 business days of receipt of the initial request.	$150.40
WMG17	General Practitioners	Treating doctor medical report—provided between 10 and 30 business days after receipt of the initial request.	$117.00
WMG18	General Practitioners	Treating doctor medical report—provided 30 or more business days after receipt of the initial request.	$89.10
WMS16	Specialists in a surgical discipline	Treating doctor medical report—provided within 10 business days of receipt of the initial request.	$239.60
WMS17	Specialists in a surgical discipline	Treating doctor medical report—provided between 10 and 30 business days after receipt of the initial request.	$206.20
WMS18	Specialists in a surgical discipline	Treating doctor medical report—provided 30 or more business days after receipt of the initial request.	$167.20
WMP16	Consultant Physicians	Treating doctor medical report—provided within 10 business days of receipt of the initial request.	$239.60
WMP17	Consultant Physicians	Treating doctor medical report—provided between 10 and 30 business days after receipt of the initial request.	$206.20
WMP18	Consultant Physicians	Treating doctor medical report—provided 30 or more business days after receipt of the initial request.	$167.20

Notes—

Note 1A medical report must be requested in writing and may be requested by—

•a claims agent, self-managed or exempt employer; or

•a worker's representative or advocate.

(Refer to the report preparation guidelines on page 1 of the explanatory booklet "Schedule B—Workers Compensation".)

Note 2The date of request is taken to be 2 business days after the date the letter of request is posted, or 1 business day after the request is faxed. A business day is any day, excluding Saturday, Sunday and public holidays.

Note 3Most reports are expected to be completed on the basis of the medical practitioner's clinical notes, therefore a consultation is not necessarily a pre-requisite for the preparation of a report. However, if required in the judgement of the medical practitioner, the consultation is billed in the usual manner.

Note 4Reading time for treating doctor medical reports is not normally chargeable. However, an appropriate fee for reading time for treating doctor medical reports will be authorised by the claims agent, self-managed or exempt employer if the costs are reasonable; for example, if the medical practitioner believes he or she has been asked to read an unusually large amount of material supplied by the requestor.

Note 5A report clarification fee may be charged for clarification of a report if it is considered reasonable and not sought as a result of failure by the provider to address the original request. The claims agent, self-managed or exempt employer will authorise the cost if it is considered reasonable.

Note 6Payment for reports will not be made in advance.

Short report—treating doctor

Item No.	Group	Description	Maximum Fee
WMG37	General Practitioners	Short report—provided within 72 hours of receipt of the initial request.	$70.00
WMG38	General Practitioners	Short report—provided more than 72 hours after receipt of the initial request.	$20.00
WMS37	Specialists in a surgical discipline	Short report—provided within 72 hours of receipt of the initial request.	$70.00
WMS38	Specialists in a surgical discipline	Short report—provided more than 72 hours after receipt of the initial request.	$20.00
WMP37	Consultant Physicians	Short report—provided within 72 hours of receipt of the initial request.	$70.00
WMP38	Consultant Physicians	Short report—provided more than 72 hours after receipt of the initial request.	$20.00

Notes—

Note 1The requestor must specify in the request that he or she is seeking a short report.

Note 2A medical report must be requested in writing and may be requested by—

•a claims agent, self-managed or exempt employer; or

•a worker's representative or advocate.

Note 3The date of request is taken to be 2 business days after the date the letter of request is posted, or 1 business day after the request is faxed. A business day is any day, excluding Saturday, Sunday and public holidays.

Note 4Reports should be concise and focused. The anticipated length of a short report is approximately half an A4 page.

(Refer to the report preparation guidelines on page 1 of the explanatory booklet "Schedule B—Workers Compensation".)

Note 5A short report should be based on the medical practitioner's notes and should not require a consultation with the patient. There may be occasions where a consultation is deemed appropriate; for example, if the practitioner has not seen the patient for some time or detailed information is required about the range of duties being considered, a consultation fee may be billed in the usual manner.

Note 6Short reports may be faxed to the requestor with the relevant account.

Note 7A report clarification fee may be charged for clarification of a report if it is considered reasonable and not sought as a result of failure by the provider to address the original request. The claims agent, self-managed or exempt employer will authorise the cost if it is considered reasonable.

Note 8Payment for reports will not be made in advance.

Telephone calls (excluding calls made to or received from workers)

Item No.	Group	Description	Maximum Fee
WMG19	General Practitioners	Telephone calls—of up to and including 10 minutes duration.	$22.50
WMG20	General Practitioners	Telephone calls—of more than 10 minutes duration.	$51.00
WMS19	Specialists in a surgical discipline	Telephone calls—of up to and including 10 minutes duration.	$30.00
WMS20	Specialists in a surgical discipline	Telephone calls—of more than 10 minutes duration.	$67.50
WMP19	Consultant Physicians	Telephone calls—of up to and including 10 minutes duration.	$30.00
WMP20	Consultant Physicians	Telephone calls—of more than 10 minutes duration.	$67.50

Notes—

Note 1Telephone calls are chargeable if of a case specific nature, made to or received from—

•a claims agent, self-managed or exempt employer; or

•an employer; or

•a worker's representative or advocate; or

•a WorkCover Corporation medical consultant; or

•a provider of return to work services registered by WorkCover Corporation.

Note 2Telephone contact between treating / referring medical providers which forms part of the clinical management of the case is not chargeable.

Note 3A fee is payable if the telephone contact occurs during a consultation with the worker provided that the consultation duration excludes the duration of the telephone call. For example, if the consultation and telephone call duration is 40 minutes and the call duration alone is 10 minutes, the consultation should be billed as a 30 minute consultation.

Note 4Invoices for telephone calls in accordance with this item must record the name of the other party.

Worksite assessment

Item No.	Group	Description	Maximum Fee
WMG08	General Practitioners	Worksite assessment—for the purpose of assessing and reporting the duties that are or can be made available, and the capacity of the worker to undertake these duties.	$142.60 per hour
WMS08	Specialists in a surgical discipline	Worksite assessment—for the purpose of assessing and reporting the duties that are or can be made available, and the capacity of the worker to undertake these duties.	$183.90 per hour
WMP08	Consultant Physicians	Worksite assessment—for the purpose of assessing and reporting the duties that are or can be made available, and the capacity of the worker to undertake these duties.	$183.90 per hour

Notes—

Note 1A worksite assessment may be requested by—

•a claims agent, self-managed or exempt employer; or

•a worker, worker's representative or advocate.

Note 2The claims agent, self-managed or exempt employer will authorise the fee if it is considered reasonable.

Note 3At worksite visits it is expected that the employer, worker or worker's representative, claims agent or self-managed or exempt employer representative should be present.

Note 4The claims agent, self-managed or exempt employer should contact the employer to ensure appropriate access to the worksite and to arrange for an employer representative to be available to help maximise the value of time spent in the workplace.

Note 5The worksite assessment must include an assessment of the physical environment, mental work demands, human behaviour, working conditions, educational requirements and other conditions.

Note 6The report of a worksite assessment is to be completed and distributed to relevant parties in attendance during the worksite assessment. A copy must also be provided to the case manager, treating doctor and worker (if not present) within 1 week of the assessment. No additional fee is payable for completion of the form.

Proformas can be obtained from WorkCover Corporation on [phone].

Case conference

Item No.	Group	Description	Maximum Fee
WMG09	General Practitioners	Case conference—to determine details of limitations to work, recommendations facilitating a return to work and options for management of the worker's recovery, including medical treatment strategies.	$142.60 per hour
WMS09	Specialists in a surgical discipline	Case conference—to determine details of limitations to work, recommendations facilitating a return to work and options for management of the worker's recovery, including medical treatment strategies.	$183.90 per hour
WMP09	Consultant Physicians	Case conference—to determine details of limitations to work, recommendations facilitating a return to work and options for management of the worker's recovery, including medical treatment strategies.	$183.90 per hour

Notes—

Note 1This service must be authorised by the claims agent, self-managed or exempt employer.

Note 2A case conference may be requested by—

•a treating medical expert; or

•an employer; or

•a worker or worker's advocate; or

•a claims agent, self-managed or exempt employer; or

•a provider of return to work services registered by WorkCover Corporation.

Note 3The claims agent, self-managed or exempt employer must be represented at the case conference. The worker, or worker's advocate or representative must always be invited to attend the case conference.

Note 4It is the responsibility of the claims agent, self-managed or exempt employer to make a written and signed record of the case conference that is to be distributed to all attendees. Differences of opinion should be noted in the record. No fee is payable for records made by any medical practitioner during the case conference.

Travel—worksite assessments, case conferences and dispute resolution

Item No.	Group	Description	Maximum Fee
WMG10	General Practitioners	Travel time—worksite assessment, case conference or dispute resolution.	$142.60 per hour
WMS10	Specialists in a surgical discipline	Travel time—worksite assessment, case conference or dispute resolution.	$183.90 per hour
WMP10	Consultant Physicians	Travel time—worksite assessment, case conference or dispute resolution.	$183.90 per hour

Notes—

Note 1Travel must be authorised by the claims agent, self-managed or exempt employer.

Note 2All accounts must include the total time spent travelling plus the distance travelled.

Note 3The case manager may choose to contain costs by requesting the service from an appropriate practitioner based in the worker's locality.

Note 4Where more than 1 worksite assessment, case conference or dispute resolution is conducted, the travel fee is to be apportioned accordingly.

Third party consultation

Item No.	Group	Description	Maximum Fee
WMG14	General Practitioners	Third party consultation—at the doctor's rooms where the worker is usually not present.	$142.60 per hour
WMS14	Specialists in a surgical discipline	Third party consultation—at the doctor's rooms where the worker is usually not present.	$183.90 per hour
WMP14	Consultant Physicians	Third party consultation—at the doctor's rooms where the worker is usually not present.	$183.90 per hour

Notes—

Note 1This service must be authorised by the claims agent, self-managed or exempt employer.

Note 2This service should involve 1 of the following:

•an employer; or

•a claims agent, self-managed or exempt employer; or

•a worker's representative or advocate; or

•a provider of return to work services registered by WorkCover Corporation.

Note 3This service may include a video viewing of a worker's normal duties, alternative duties or other activities.

Note 4It is the responsibility of the claims agent, self-managed or exempt employer to ensure a written and signed record is made of the third party consultation that is to be distributed to all attendees. No fee is payable for records made by a medical practitioner during the third party consultation.

Note 5If, as a result of the third party consultation, the medical practitioner has amended details regarding the injured worker's limitations to work, capacity, recommendations for facilitating a return to work and/or options for management of the worker, the medical practitioner must consider the worker's input into this decision.

Attendance for the purpose of dispute resolution

Item No.	Group	Description	Maximum Fee
WMG15	General Practitioners	Attendance for the purpose of dispute resolution.	$142.60 per hour
WMS15	Specialists in a surgical discipline	Attendance for the purpose of dispute resolution.	$183.90 per hour
WMP15	Consultant Physicians	Attendance for the purpose of dispute resolution.	$183.90 per hour

Notes—

Note 1Attendance for the purpose of dispute resolution must be at the request of—

•a claims agent, self-managed or exempt employer; or

•a worker or worker's representative; or

•an employer or employer's representative.

Note 2A witness at a dispute resolution proceeding is entitled to reimbursement of any expense that the dispute resolution authority certifies has been, or is likely to be, reasonably incurred by the witness as a consequence of appearing before the authority.

Cancellation of an attendance for the purpose of a dispute resolution

Item No.	Group	Description	Maximum Fee
WMG36	General Practitioners	Cancellation for the purpose of dispute resolution.	$142.60 per hour
WMS36	Specialists in a surgical discipline	Cancellation for the purpose of dispute resolution.	$183.90 per hour
WMP36	Consultant Physicians	Cancellation for the purpose of dispute resolution.	$183.90 per hour

Notes—

Note 1Payment for cancellation of an attendance for the purpose of dispute resolution will only be made when the attendance was at the request of—

•a claims agent, self-managed or exempt employer; or

•a worker or worker's representative; or

•an employer or employer's representative.

Note 2A cancellation fee is payable only if the cancellation occurs less than 24 hours before the time of the proposed attendance.

Independent medical examiners—medical report

Item No.	Group	Description	Maximum Fee
WMS29	Specialists in a surgical discipline	Independent medical examiner report—provided within 10 business days of receipt of the initial request.	$222.90
WMS30	Specialists in a surgical discipline	Independent medical examiner report—provided between 10 and 30 business days after receipt of the initial request.	$200.50
WMS31	Specialists in a surgical discipline	Independent medical examiner report—provided 30 or more business days after receipt of the initial request.	$167.20
WMP29	Consultant Physicians	Independent medical examiner report—provided within 10 business days of receipt of the initial request.	$222.90
WMP30	Consultant Physicians	Independent medical examiner report—provided between 10 and 30 business days after receipt of the initial request.	$200.50
WMP31	Consultant Physicians	Independent medical examiner report—provided 30 or more business days after receipt of the initial request.	$167.20

Notes—

Note 1A medical report must be requested in writing and may be requested by—

•a claims agent, self-managed or exempt employer; or

•a worker, worker's representative or advocate.

(Refer to the report preparation guidelines on page 1 of the explanatory booklet "Schedule B—Workers Compensation".)

Note 2The date of request is taken to be 2 business days after the date the letter of request is posted, or 1 business day after the request is faxed. A business day is any day, excluding Saturday, Sunday and public holidays.

Note 3There is an expectation that a consultation will be required for the preparation of a report and should be billed in the usual manner.

Note 4Independent Medical Examiners on WorkCover Corporation's Register of Independent Medical Examiner Providers have a separate service and fee schedule. Please contact WorkCover Corporation on [phone] for details.

Note 5A report clarification fee may be charged for clarification of a report if it is considered reasonable and not sought as a result of failure by the provider to address the original request. The claims agent, self-managed or exempt employer will authorise the cost if it is considered reasonable.

Note 6Payment for reports will not be made in advance.

Independent medical examiners—reading time

Item No.	Group	Description	Maximum Fee
WMS32	Specialists in a surgical discipline	Reading time—payable to an independent medical examiner for reading prior reports or other information forwarded by the requestor.	$27.90
WMP32	Consultant Physicians	Reading time—payable to an independent medical examiner for reading prior reports or other information forwarded by the requestor.	$27.90

Independent medical examiners—short report

Item No.	Group	Description	Maximum Fee
WMSA1	Specialists in a surgical discipline	Independent medical examiner short report—provided within 72 hours of receipt of the initial request.	$70.00
WMSA2	Specialists in a surgical discipline	Independent medical examiner short report—provided more than 72 hours after receipt of the initial request.	$20.00
WMPA1	Consultant Physicians	Independent medical examiner short report—provided within 72 hours of receipt of the initial request.	$70.00
WMPA2	Consultant Physicians	Independent medical examiner short report—provided more than 72 hours after receipt of the initial request.	$20.00

Notes—

Note 1The requestor must specify in the request that he or she is seeking a short report.

Note 2A medical report must be requested in writing and may be requested by—

•a claims agent, self-managed or exempt employer; or

•a worker, a worker's representative or advocate.

Note 3The date of request is taken to be 2 business days after the date the letter of request is posted, or 1 business day after the request is faxed. A business day is any day, excluding Saturday, Sunday and public holidays.

Note 4Reports should be concise and focused. The anticipated length of a short report is approximately half an A4 page. (Refer to the report preparation guidelines on page 1 of the explanatory booklet "Schedule B—Workers Compensation".)

Note 5The intention of this fee is to provide a facility for follow up questions or issues relating to prior independent medical examinations and additional consultations may not be required. The decision to undertake a further consultation is at the discretion of the medical practitioner.

Note 6Short reports may be faxed to the requestor with the relevant account.

Note 7A report clarification fee may be charged for clarification of a report if it is considered reasonable and not sought as a result of failure by the provider to address the original request. The claims agent, self-managed or exempt employer will authorise the cost if it is considered reasonable.

Note 8Payment for reports will not be made in advance.

Independent medical examiners—travel

Item No.	Group	Description	Maximum Fee
MS940	Specialists in a surgical discipline	Travel time—worksite assessment, case conference or dispute resolution.	$183.90 per hour
MP940	Consultant Physicians	Travel time—worksite assessment, case conference or dispute resolution.	$183.90 per hour

Notes—

Note 1Travel will be approved for independent medical examiner services requested by—

•a claims agent, self-managed or exempt employer; or

•the worker or worker's representative.

Travel must be authorised by the claims agent, self-managed or exempt employer. The cost will be authorised if it is considered reasonable.

Note 2All accounts must include the total time spent travelling as well as the distance travelled.

Note 3When the service is requested by the case manager, he or she may choose to contain costs by requesting the service from an appropriately based practitioner in the worker's locality.

Note 4Where more than 1 examination and report is conducted, the travel fee is to be apportioned accordingly.

Independent medical examiners—cancellation of an appointment

Item No.	Group	Description	Maximum Fee
WMS34	Specialists in a surgical discipline	Cancellation of an appointment—less than 24 hours before the time of the scheduled appointment.	$47.90
WMP34	Consultant Physicians	Cancellation of an appointment—less than 24 hours before the time of the scheduled appointment.	$84.70

Note—

Note 1Fees apply only to the cancellation of medical appointments arranged by—

•a claims agent, self-managed or exempt employer; or

•a worker, a worker's representative or advocate.

Specified duties form (SDF)

Item No.	Group	Description	Maximum Fee
WMG23	General Practitioners	Completion of a specified duties form (SDF).	$16.70
WMS23	Specialists in a surgical discipline	Completion of a specified duties form (SDF).	$16.70
WMP23	Consultant Physicians	Completion of a specified duties form (SDF).	$16.70

Notes—

Note 1This form is to be completed at the request of the worker, worker's advocate or representative, claims agent, self-managed or exempt employer.

Note 2A fee is not payable if the form is completed during a consultation with the worker.

Note 3SDFs may be obtained by contacting WorkCover Corporation on 13 18 55.

Emergency retrieval teams—travel time

Item No.	Group	Description	Maximum Fee
WMS51	Specialists	Travel time—by a retrieval team doctor in association with a professional attendance relating to Medicare Benefits Schedule item numbers 00160, 00161, 00162, 00163 and 00164, other than 'out of hours' travel (refer to item number WMS52).	$183.90 per hour
WMS52	Specialists	Travel time—by a retrieval team doctor between 11pm and 7am any day of the week or on a public holiday in association with a professional attendance relating to Medicare Benefits Schedule item numbers 00160, 00161, 00162, 00163 and 00164.	$267.40 per hour

Note—

Where more than 1 worker is treated at the site of the emergency, the travel fee is to be apportioned accordingly.

Extra-Corporeal Shock Wave Therapy

Item No.	Group	Description	Maximum Fee
WMI11	Specialists	For the initial treatment of Extra-Corporeal Shock Wave Therapy provided by a specialist radiology practice.	$110.00
WMI12	Specialists	For subsequent treatments of Extra-Corporeal Shock Wave Therapy provided by a specialist radiology practice.	$90.00
WMI13	Specialists	For double treatments (bilateral or multiple) of Extra-Corporeal Shock Wave Therapy provided by a specialist radiology practice.	$150.00

Notes—

Note 1The I in prefix WMI item numbers represents the letter "I", not the numeral "1".

Note 2This treatment has been approved by WorkCover Corporation for use in the following conditions:

•heel pain/plantar fasciitis; or

•calcific tendonitis of shoulder; or

•lateral epicondylitis (tennis elbow); or

•medial epicondylitis; or

•non-united fractures.

Note 3Extra-corporeal Shock Wave Therapy for any other conditions must be authorised by the claims agent, self-managed or exempt employer prior to treatment.

Services delivered by ear, nose and throat surgeons

Item No.	Group	Description	Maximum Fee
WME24	Otorhinolaryngologists	Cortical Evoked Response Audiometry—verification.	$256.30
WME2A	Otorhinolaryngologists	Cortical Evoked Response Audiometry—quantification.	$256.30
WME25	Otorhinolaryngologists	Sensonics Smell Identification Test.	$111.40

Services delivered by medical practitioners

Item No.	Group	Description	Maximum Fee
WMG26	Medical Practitioners	Fluids, intravenous drip infusion of—percutaneous.	$44.00
WMG27	Medical Practitioners	Fluids, intravenous drip infusion of—open exposure.	$73.00

Note—

Item WMG26 is only payable where the service is not in association with a surgical procedure.

Services delivered by medical practitioners in the practice of hypnotherapy

Item No.	Group	Description	Maximum Fee
WMG31	Medical Practitioners	At consulting rooms—not more than 15 minutes.	$37.70
WMG28	Medical Practitioners	At consulting rooms—16–30 minutes.	$65.70
WMG29	Medical Practitioners	At consulting rooms—31–45 minutes.	$98.60
WMG30	Medical Practitioners	At consulting rooms—more than 46 minutes.	$134.30

Note—

As required by section 10AA(2) of the Subordinate Legislation Act 1978, the Minister has certified that, in the Minister's opinion, it is necessary or appropriate that these regulations come into operation as set out in these regulations.

Made by the Governor

with the advice and consent of the Executive Council

on 20 March 2003

No 26 of 2003

02/WCK003CS