Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Regulations 1995 (SA)
South Australia
Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Regulations 1995
under the Workers Rehabilitation and Compensation Act 1986
Contents
Short title
Interpretation
3AScales of charges—public hospitals
Scales of charges—private hospitals and day surgery facilities
Scales of charges—physiotherapy services
Scales of charges—psychology services
Scales of charges—speech pathologists
Scales of charges—occupational therapists
8AScales of charges—chiropractors
Increase in charges for GST
WorkCover may issue guidelines
Schedule 1—Scales of charges—private hospitals and day surgery facilities
Part 1—Preliminary
Interpretation
Part 2—Private hospital services
Rehabilitation, psychiatric and pain assessment or management services by a private hospital
Other private hospital services
Part 3—Day surgery facility services
Day surgery facility services
Part 4—Tables
Schedule 2—Scales of charges—physiotherapy services
Schedule 3—Scales of charges—psychology services
Schedule 4—Scales of charges—speech pathologists
Schedule 5—Scales of charges—occupational therapists
Schedule 6—Scales of charges—chiropractors
Legislative history
1—Short title
This regulation may be cited as the Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Regulations 1995.
3—Interpretation
In these regulations—
Act means the Workers Rehabilitation and Compensation Act 1986;
chiropractor means a person registered as a chiropractor under the law of this State;
claims agent means a private sector body that is a party to an authorised contract or arrangement under section 14 of the WorkCover Corporation Act 1994 involving the conferral of powers to manage and determine claims;
day surgery facility means a facility (other than a private hospital or facility of a private hospital) designed for the provision of medical, surgical or related treatment or care on a same day basis that is declared by WorkCover by notice in the Gazette to be a day surgery facility for the purposes of these regulations;
GST means the tax payable under the GST law;
GST law means—
(a)A New Tax System (Goods and Services Tax) Act 1999 (Commonwealth); and
(b)the related legislation of the Commonwealth dealing with the imposition of a tax on the supply of goods, services and other things;
occupational therapist means a person registered as an occupational therapist under the law of this State;
physiotherapist means a person registered as a physiotherapist under the law of this State;
private hospital means a private hospital within the meaning of the South Australian Health Commission Act 1976;
psychologist means a person registered as a psychologist under the law of this State;
same day, in relation to a service, means a service that is provided on a single calendar day;
self-insured employer means exempt employer;
WorkCover is the Corporation.
A reference in these regulations to specified schedule guidelines is a reference to the guidelines of the specified name issued by WorkCover, as in force from time to time.
If a charge prescribed in a scale of charges is expressed as an amount per hour—
(a)a charge is payable for services provided for less than or more than an hour; and
(b)the amount payable is to be determined by multiplying the amount per hour by the proportion that the number of minutes for which the services are provided rounded to the nearest 5 minutes bears to 60 minutes.
Note—
These regulations apply for the purposes of section 127A of the Motor Vehicles Act 1959 subject to modifications specified by that section and modifications specified by notice in the Gazette under that section.
3A—Scales of charges—public hospitals
Pursuant to section 32(11) of the Act, the scales of charges determined for the purposes of this regulation by the Corporation by notice in the Gazette are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 of the Act for the provision of services in hospitals and other facilities established or provided under the South Australian Health Commission Act 1976.
4—Scales of charges—private hospitals and day surgery facilities
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 1 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services in private hospitals and day surgery facilities.
5—Scales of charges—physiotherapy services
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 2 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of physiotherapy services.
6—Scales of charges—psychology services
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 3 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services by a psychologist.
7—Scales of charges—speech pathologists
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 4 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services by speech pathologists.
8—Scales of charges—occupational therapists
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 5 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services by occupational therapists.
8A—Scales of charges—chiropractors
Pursuant to section 32(11) of the Act, the scales of charges set out in Schedule 6 are, subject to modification under regulation 9, prescribed as scales of charges for the purposes of section 32 for the provision of services by a chiropractor.
9—Increase in charges for GST
If a service for which a charge is prescribed in a scale of charges is subject to GST, the amount prescribed as the charge is increased by the amount of the GST.
10—WorkCover may issue guidelines
WorkCover may issue guidelines from time to time for the purposes of these regulations.
Schedule 1—Scales of charges—private hospitals and day surgery facilities
Part 1—Preliminary
1—Interpretation
In this Schedule, unless the contrary intention appears—
admission means the formal administrative process of a private hospital or day surgery facility by which the hospital or facility commences the provision of treatment, care, accommodation and other services to a patient;
admitted, in relation to a patient in a private hospital or day surgery facility, means that the patient has undergone the formal admission process of the hospital or facility and has not been discharged;
AR‑DRG means Australian Refined Diagnosis Related Group;
criteria for admission—see subclause (5);
day means a calendar day;
Day Only Procedures Manual means the Day Only Procedures Manual published in 1999 by the Commonwealth Department of Health and Aged Care, as in force on 1 January 2008;
discharge means the formal administrative process of a private hospital or day surgery facility by which the hospital or facility ceases the provision of treatment, care, accommodation and other services to a patient;
discharged, in relation to a person who has been a patient in a private hospital or day surgery facility, means that the person has undergone the formal discharge process of the hospital or facility;
inlier patient means an admitted patient whose length of stay in a private hospital for a service identified in columns 1 and 2 of Table 2—
(a)is equal to or greater than the Lower Trim Point specified in column 5 of the table corresponding to that service (or, where the Lower Trim Point is zero, is greater than the Lower Trim Point); and
(b)is equal to or less than the Upper Trim Point specified in column 4 of the table corresponding to that service;
inpatient, in relation to a private hospital, means an admitted patient who, following a clinical decision, requires or is expected to require overnight treatment for a minimum of 1 night;
length of stay, in relation to an admitted patient in a private hospital, means the number of days between the day of admission of the patient to the hospital and the day of discharge of the patient from the hospital—
(a)counting the day of admission as 1 day; and
(b)excluding the day of discharge (unless it is also the day of admission);
long stay outlier patient means an admitted patient whose length of stay in a private hospital for a service identified in columns 1 and 2 of Table 2 is greater than the Upper Trim Point specified in column 4 of the table corresponding to that service;
Manual means the Australian Refined Diagnosis Related Groups, Version 4.2, Addendum to Definitions Manual, Volume 4, produced in 2000 by the Commonwealth Department of Health and Aged Care (read with the Australian Refined Diagnosis Related Groups, Version 4.1, Definitions Manual, Volumes 1—3, produced in 1998 by the Commonwealth Department of Health and Aged Care);
short stay outlier patient means an admitted patient whose length of stay in a private hospital for a service identified in columns 1 and 2 of Table 2 for which the Lower Trim Point specified in column 5 of the table corresponding to that service is 2 or more, is less than that Lower Trim Point but greater than zero.
A reference in this Schedule to a Table of a specified number is a reference to the Table of that number in Part 4.
For the purposes of this Schedule—
(a)AR‑DRG reference numbers or descriptions are as set out in the Manual; and
(b)terms and abbreviations used in AR‑DRG descriptions have the meanings given by the Manual.
For the purposes of this Schedule—
(a)a charge determined in accordance with Part 2 or 3 for a service includes (where applicable) the cost of the following:
(i)accommodation;
(ii)intensive care unit;
(iii)theatre;
(iv)common use theatre items;
(v)pharmaceutical items directly related to the condition being treated;
(vi)television;
(vii)newspapers;
(viii)local telephone calls;
(ix)all hotel services (eg meals etc);
(x)consumable items;
(b)a charge determined in accordance with Part 2 or 3 for a service does not include the following costs:
(i)the cost of prostheses;
(ii)a 5% handling charge for prostheses (to a maximum of $200);
(iii)the cost of substituted high cost single use items not commonly used in Australian clinical practice for delivery of the service where the substitution for the usual item can be demonstrated to have been necessary for the treatment of the patient;
(iv)the cost of allied health treatment (such as physiotherapy, dietetics, podiatry, psychology, social work, speech pathology etc);
(v)the cost of pharmaceutical items provided on discharge of a patient;
(vi)the cost of pharmaceutical items required for a patient for maintenance of an unrelated condition;
(vii)the cost of splints and braces required for the discharge of a patient;
(viii)transfer costs;
(ix)boarder fees.
For the purposes of this Schedule, a patient qualifies for admission to a private hospital or day surgery facility if he or she satisfies 1 of the following criteria:
(a)the patient is to receive day only Band 1, 2, 3, or 4 services (excluding uncertified Type C professional attention procedures) as specified in the Day Only Procedures Manual;
(b)the patient is to receive a Type C professional attention procedure as specified in the Day Only Procedures Manual and there is an accompanying certification by a medical practitioner that an admission is necessary on the grounds of the medical condition of the patient or other special circumstances relating to the patient;
(c)the patient, following a clinical decision, is expected to require overnight treatment for a minimum of 1 night;
(d)the patient is to receive a Type B professional attention procedure as specified in the Day Only Procedures Manual and there is an accompanying certification by a medical practitioner that an overnight admission is necessary on the grounds of the medical condition of the patient or other special circumstances relating to the patient.
Part 2—Private hospital services
2—Rehabilitation, psychiatric and pain assessment or management services by a private hospital
The charges for the provision to a patient by a private hospital of the rehabilitation, psychiatric and pain assessment or management services specified in Table 1 are as specified in that table.
3—Other private hospital services
Subject to clause 2, the charges for the provision to an admitted patient by a private hospital of the services specified in columns 1 and 2 of Table 2 are as determined in accordance with this clause.
Subject to subclause (5), the maximum charge for a service identified in columns 1 and 2 of Table 2 for an inlier patient is the Schedule Charge specified in column 3 of the table corresponding to that service.
Subject to subclause (5), the maximum charge for a service identified in columns 1 and 2 of Table 2 for a short stay outlier patient is the charge calculated as follows:
where—
(a)the Rate per Day is the rate per day specified in column 6 of the table corresponding to the service; and
(b)LOS is the length of stay of the patient in the hospital.
Subject to subclause (5), the maximum charge for a service identified in columns 1 and 2 of Table 2 for a long stay outlier patient is the charge calculated as follows:
where—
(a)the Schedule Charge is the charge specified in column 3 of the table corresponding to the service; and
(b)the Rate per Day is the rate per day specified in column 6 of the table corresponding to the service; and
(c)LOS is the length of stay of the patient in the hospital; and
(d)the Upper Trim Point is the Upper Trim Point specified in column 4 of the table corresponding to the service.
Where the patient is transferred from the private hospital to another hospital, the maximum charge for the service provided by the transferring hospital is 80% of the charge determined in accordance with subclause (2), (3) or (4).
Part 3—Day surgery facility services
4—Day surgery facility services
The charges for the provision to an admitted patient by a day surgery facility of same day services included in Table 3 are the accommodation and theatre charges determined in accordance with the table.
Part 4—Tables
| Table 1 | ||||
| Item No | Service description | Maximum charge (excl GST) | ||
| A charge applicable to an admitted patient is not payable unless the patient is admitted in accordance with the criteria for admission (see clause 1(5)). Private rooms are allocated on the basis of clinical need and the cost of such rooms is, unless otherwise stated, included in the per day charges specified. Where a patient requests a private room, WorkCover will not be responsible for or accept any surcharge. In this table— length of stay, in relation to an inpatient in a private hospital, means the number of days between the day of admission of the patient to the hospital and the day of discharge of the patient from the hospital— (a) counting the day of admission as 1 day (unless it is also the day of discharge); and (b) excluding the day of discharge. | ||||
| HOSPITAL REHABILITATION SERVICES | ||||
| Rehabilitation orthopaedic program for inpatients An orthopaedic program involves referral and assessment by the rehabilitation coordinator of the program. It is a defined program with intense service provision. Rapid improvement is expected and there are specific outcome goals. The program includes physiotherapy, aquatic therapy, occupational therapy, case conferences and discharge planning. | ||||
| PR600 | Length of stay 1 or more days but not more than 21 days | $485.30 per day | ||
| PR605 | 22 or more days | $406.80 per day | ||
| Rehabilitation trauma program for inpatients A trauma program involves referral and assessment by the rehabilitation coordinator of the program. It is a defined program with intense service provision. Rapid improvement is expected and there are specific outcome goals. The program includes physiotherapy, aquatic therapy, occupational therapy, speech therapy, case conferences and discharge planning. | ||||
| PR610 | Length of stay 1 or more days but not more than 50 days | $578.70 per day | ||
| PR615 | 51 or more days | $522.30 per day | ||
| PSYCHIATRIC SERVICES | ||||
| Inpatient services | ||||
| PR800 | Length of stay 1 or more days but not more than 14 days | $495.30 per day | ||
| PR803 | 15 or more days | $381.10 per day | ||
| PR822 | Electro‑convulsive therapy (ECT) | $212.00 per day | ||
| PR850 | Private room allocated on basis of clinical need | $12.45 per day (additional charge) | ||
| Drug and alcohol program for inpatients This program provides specialised treatment and care for patients with alcohol or drug dependencies (including analgesics/narcotics/opiates and Benzodiazepine). The program is managed by a multi‑disciplinary team including a Medical Director and consultant psychiatrists. Where required, the program involves a medically controlled, safe withdrawal of drugs or alcohol. | ||||
| PR990 | Length of stay 1 or more days but not more than 14 days | $527.80 per day | ||
| PR991 | 15 or more days | $386.20 per day | ||
| Same day psychiatric services A day program is usually available to provide ongoing support and care to patients after discharge from treatment as inpatients. It is managed by a multi‑disciplinary team of health care professionals, and is tailored to the individual needs of the patient. It can include specialised therapy modules including cognitive behavioural therapy, relaxation, assertiveness skills and anxiety management. Outreach is treatment or care provided by the hospital to a non‑admitted patient at a location outside the hospital premises (being treatment or care provided as a direct substitute for treatment or care that would normally be provided on the hospital premises). For billing purposes, the 'O' in item numbers for same day services is an alphabetical letter not the number zero. | ||||
| PRO81 | Group session | $63.50 | ||
| PRO82 | Electro‑convulsive therapy day program | $331.00 | ||
| PRO83 | Half‑day program | $169.40 | ||
| PRO84 | Day program | $268.20 | ||
| PRO95 | Outreach | $153.00 | ||
| OTHER SERVICES | ||||
| Inpatient pain assessment/management | ||||
| PR700 | Length of stay 1 or more days but not more than 7 days | $425.80 per day | ||
| PR705 | 8 or more days but not more than 14 days | $400.00 per day | ||
| PR710 | 15 or more days | $260.00 per day | ||
| Table 3 | ||||
| Item No | Service description | Maximum charge (excl GST) | ||
| A charge applicable to an admitted patient is not payable unless the patient is admitted in accordance with the criteria for admission (see clause 1(5)). SAME DAY SERVICES FOR DAY SURGERY FACILITIES | ||||
| Accommodation The band into which services fall will be determined in accordance with the Day Only Procedures Manual. | ||||
| PR410 | Band 1: including gastrointestinal endoscopy, some minor surgical and non‑surgical procedures not normally requiring anaesthetic. | $270.50 | ||
| PR420 | Band 2: procedures other than Band 1 performed under local anaesthetic with no sedation. Theatre time less than 1 hour. | $322.05 | ||
| PR430 | Band 3: procedures other than Band 1 performed under general or regional anaesthesia or intravenous sedation. Theatre time less than 1 hour. | $376.30 | ||
| PR440 | Band 4: procedures other than Band 1 performed under general or regional anaesthesia or intravenous sedation. Theatre time 1 hour or more. | $398.90 | ||
| Theatre The band into which services fall will be determined in accordance with the Group Accommodation and Theatre Banding Schedule produced by the Commonwealth Department of Veterans' Affairs, November 2007. Where more than 1 service is provided in a single theatre session, the theatre charge is— (a) the theatre charge for the service with the highest theatre charge; plus (b) 50% of the theatre charge for the service with the next highest theatre charge; plus (c) 30% of the theatre charge for each of the other services so provided. | ||||
| PRT1A | Band 1A | $155.40 | ||
| PRT01 | Band 1 | $310.75 | ||
| PRT02 | Band 2 | $396.65 | ||
| PRT03 | Band 3 | $551.45 | ||
| PRT04 | Band 4 | $797.80 | ||
| PRT05 | Band 5 | $1 023.80 | ||
| PRT06 | Band 6 | $1 348.10 | ||
| PRT07 | Band 7 | $1 844.15 | ||
| PRT08 | Band 8 | $1 968.45 | ||
| PRT9A | Band 9A | $2 289.40 | ||
| PRT09 | Band 9 | $2 626.10 | ||
| PRT10 | Band 10 | $3 437.45 | ||
| PRT11 | Band 11 | $4 878.20 | ||
| PRT12 | Band 12 | $5 237.55 | ||
| PRT13 | Band 13 | $4 952.80 | ||
| PRT50 | Dental minor | $293.80 | ||
| PRT55 | Dental major | $529.95 | ||
Schedule 2—Scales of charges—physiotherapy services
This Schedule must be read in conjunction with the Physiotherapy Fee Schedule Guidelines.
| Item No | Service description | Maximum charge (excl GST) |
| Consultations | ||
| Initial consultation An initial consultation by a treating physiotherapist involving some or all of the following elements (although the extent of the consultation is at the discretion of the physiotherapist): | ||
| • Subjective reporting Consideration by the physiotherapist of 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 Assessment by the physiotherapist of movement (eg, active, passive, resisted, repeated; muscle tone, spasm, weakness; accessory movements, passive intervertebral movements etc) and the carrying out of appropriate procedures and tests. | ||
| • Assessment results Provisional diagnosis; the setting of the goals of treatment, and the development of a treatment plan, by the physiotherapist. | ||
| • Treatment Discussion between the physiotherapist and the worker regarding working hypothesis, treatment goals and expected outcomes; initial treatment and response and the provision of advice by the physiotherapist regarding home care, including any exercise programs to be followed. | ||
| • Clinical records Recording of information by the physiotherapist in the worker's clinical records, including the results of procedures and tests carried out. | ||
| • Communication Communication by the physiotherapist of information relevant to the rehabilitation and return to work of the worker to the claims agent or self‑insured employer, the worker's employer (if not self‑insured) and the worker's referring/treating medical expert. | ||
| PT107 | Short initial consultation of not more than 20 minutes duration. | $36.90 |
| PT108 | Initial consultation of more than 20 minutes duration. | $61.60 |
| Subsequent consultation A subsequent consultation by a treating physiotherapist involving assessment and treatment of a worker's condition and some or all of the other elements listed below (although the extent of the consultation is at the discretion of the physiotherapist): | ||
| • History taking/assessment Consideration by the physiotherapist of the clinical records of the worker relating to the condition and the worker's progress since the previous consultation. | ||
| • Examination Examination by the physiotherapist of the condition. | ||
| • Treatment Appropriate treatment of the condition by the physiotherapist. | ||
| • Reassessment and management Reassessment of the goals of treatment, the treatment plan and the management program by both the worker and the physiotherapist; counselling by the physiotherapist regarding further treatment (if any), care and preventative measures. | ||
| • Communication Communication by the physiotherapist of information relevant to the rehabilitation and return to work of the worker to the claims agent or self‑insured employer, worker's employer (if not self‑insured) and the worker's referring/treating medical expert. | ||
| • Physiotherapy treatment form If treatment is expected to extend for longer than 6 weeks, completion by the physiotherapist of a physiotherapy treatment form (in a form approved by the Corporation) and forwarding of the form to the claims agent or self‑insured employer. No additional fee is payable for completion of this form. | ||
| • Clinical records Recording of information by the physiotherapist in the worker's clinical records, including the results of any procedures and tests carried out. | ||
| PT205 | Brief subsequent consultation of not more than 15 minutes duration. The consultation will involve minimal physiotherapist contact time. | $30.70 |
| PT210 | Standard subsequent consultation of more than 15 minutes duration but not more than 20 minutes duration. | $43.00 |
| PT215 | Long subsequent consultation of more than 20 minutes duration but not more than 30 minutes duration. The consultation will involve all of the elements of a subsequent consultation, and, because of the complexity of the injury, will require extra time for history taking, examination, treatment, documentation and liaison. For example, this type of consultation may be expected in cases of injuries following major trauma or major surgery requiring intensive post‑operative treatment. | $61.60 |
| PT220 | Prolonged subsequent consultation of more than 30 minutes duration. The consultation will involve all of the elements of a subsequent consultation and, because of the extreme complexity of the injury or treatment, will require extra time for history taking, examination, treatment, documentation and liaison. This type of consultation is expected in only a limited number of cases, for example, in cases of injuries following extensive burns, multi‑trauma, major surgery requiring intensive post‑operative treatment such as complicated hand injuries or joint reconstruction and some neurological conditions. | $86.20 |
| Corrective/serial splinting | ||
| PT300 | Fabrication/fitting/adjustment of splint | $147.70 per hour |
| Aquatic physiotherapy | ||
| PT415 | Individual aquatic physiotherapy session An aquatic physiotherapy session requiring significant planning, supervision and monitoring of individual workers by a physiotherapist. The prior approval of a claims manager or self‑insured employer is required for a session other than— • the initial session; • 2 subsequent individual sessions following the initial session; • a review session at week 4 to 6 of the aquatic physiotherapy program. | $51.80 |
| PT420 | Subsequent individual or group aquatic physiotherapy session An aquatic physiotherapy session not referred to in PT415. If the session is a group session— • the group will be comprised of not more than 6 workers; and • the session will involve programs that are unique and individualised to particular workers. | $21.60 per worker |
| Exercise | ||
| PT455 | Individual exercise session Exercise session (other than an aquatic physiotherapy session) planned by a physiotherapist where an individual worker is constantly and directly supervised and assessed by the physiotherapist. The session will involve all or some of the elements of a subsequent consultation (but a subsequent consultation cannot be separately charged). | $51.80 |
| PT460 | Group exercise session Group exercise session (other than an aquatic physiotherapy session) planned and supervised by a physiotherapist for a group of not more than 8 workers. The session will involve all or some of the elements of a subsequent consultation (but a subsequent consultation cannot be separately charged). | $15.30 per worker |
| Telephone calls | ||
| PT552 | Telephone call greater than 3 minutes | $20.50 |
| Calls of a case specific nature made by a physiotherapist to, or received by a physiotherapist from, the worker’s referring/treating medical expert, rehabilitation provider contracted by WorkCover, claims agent or self‑insured employer, employer (if not self‑insured), WorkCover provider consultant or the worker's representative, excluding— (a) calls made during a consultation; and (b) calls of a duration of 3 minutes or less. | ||
| There is no charge for a telephone call to or from a worker. | ||
| Functional capacity evaluation | ||
| PT700 | Functional capacity evaluation The maximum time chargeable is 7 hours. | $147.70 per hour |
| Assessment by a physiotherapist of a worker's work capacity, including— (a) a series of standardised tests of the worker's physical capabilities focussed on selected work tolerances (ie, the observed and measured physical capabilities that affect a worker's ability to perform the physical demands of specified work tasks); and (b) an analysis of the results of the tests to infer the worker's capacity to sustain a given work effort (ie, the worker's capacity to undertake specified work at a prescribed frequency over a given period of time, taking into account the pace compatible with such work); and (c) preparation of a report with an executive summary outlining the major components of the service and relevant findings. | ||
| Worksite assessment | ||
| PT730 | Worksite assessment | $147.70 per hour |
| Attendance by a physiotherapist at a worker's workplace in order to obtain an overview of the workplace and determine the availability of suitable duties. | ||
| Job analysis | ||
| PT740 | Job analysis | $147.70 per hour |
| Job analysis by a physiotherapist, including— (a) an analysis of the critical physical demands of occupational tasks; and (b) determining the worker's capacity to undertake the tasks or giving consideration to available medical guidelines and the physiotherapist's knowledge of the worker's diagnosis, pathology and prognosis; and (c) making recommendations for— (i) modifying the tasks or the way in which the tasks are undertaken; or (ii) providing aids or equipment; or (iii) introducing work practice guidelines to ensure that the worker utilises appropriate body mechanics; and (d) preparation of a report with an executive summary outlining the major components of the service and relevant findings. | ||
| Graduated return to work program | ||
| PT750 | Graduated return to work program | $147.70 per hour |
| A program of work duties and work practice guidelines for a worker designed by a physiotherapist to increase the worker’s tolerance for the physical demands of work. | ||
| The purpose of the program is to assist the worker to maintain his or her employment while undertaking rehabilitation. The program will involve actual and productive work duties identified by the physiotherapist as being within the worker's capacity and work practice guidelines relevant to the nature of the worker's injury and the performance of the particular duties. | ||
| Activities of daily living assessment | ||
| PT760 | Activities of daily living assessment | $147.70 per hour |
| Assessment by a physiotherapist, usually conducted in a worker's home environment, of the worker's level of functioning in relation to personal care, household tasks and recreational and social activities. | ||
| The purpose of the assessment is to facilitate the reduction of the adverse impact of the injury on the worker and the early return of the worker to normal activity, and to provide an indicator of functional tolerances for determining work capacity. | ||
| Independent clinical assessment | ||
| PT780 | Independent clinical assessment and report | $147.70 per hour |
| Service provided by a physiotherapist other than the treating physiotherapist comprising— (a) a review of the worker's medical history; and (b) a clinical assessment; and (c) a review of the worker's activity and functional capacity; and (d) preparation of a report, for the purpose of providing a different diagnosis or making recommendations in relation to ongoing treatment goals, the worker's return to work and any other relevant matters. | ||
| The report will have been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | ||
| Functional notification form | ||
| PT785 | Functional notification form | $20.50 |
| Completion by a physiotherapist of a functional notification form (in a form approved by the Corporation) and provision of the form to a worker's referring/treating medical expert. The form is completed when information directly affecting the worker's capacity to return to work or the process of the worker returning to work is identified by the physiotherapist. | ||
| Reports | ||
| PT810 | Comprehensive report | $221.50 |
| A report by a treating physiotherapist, relating to the status of a claim and comprising a clinical opinion or statement or a response to specific questions, that has been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | ||
| A report will be taken to be comprehensive when re‑examination of the worker is a prerequisite for preparation of the report. The consultation should be charged in accordance with the appropriate item. | ||
| PT820 | Standard report | $147.70 |
| A report by a treating physiotherapist, relating to the status of a claim and comprising a clinical opinion or statement or a response to specific questions, that has been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | ||
| A report will be taken to be standard when re‑examination of the worker is not required and the report is based on a transcription of existing clinical records. | ||
| Case conference | ||
| PT870 | Case conference | $147.70 per hour |
| Case conference, attended by a physiotherapist and authorised by a claims agent or self‑insured employer, for the purpose of determining— • details of limitations/recommendations relating to a sustainable return to work; • options for management of a worker’s recovery; • other related information. | ||
| A case conference may be requested by— • a treating medical expert; • a worker or worker's representative; • a claims agent or self‑insured employer; • an employer (if not self‑insured); • a rehabilitation provider contracted by WorkCover. | ||
| The hourly rate excludes travelling time from rooms or other appropriate departure point to the venue and return. Travel may be charged separately. | ||
| Travel | ||
| PT905 | Travel time | $125.50 per hour |
| Travel, authorised by a claims agent or self‑insured employer, by a treating physiotherapist for the purposes of— (a) a case conference; or (b) a home, hospital or worksite visit; or (c) consultation where the worker is otherwise unable to attend the physiotherapist's clinic or rooms. | ||
| There is no charge for travel from 1 clinic or rooms to another clinic or rooms. | ||
| Non‑scheduled services | ||
| PT999 | Non‑scheduled services | $147.70 per hour |
| A service of a kind not listed above, provided by a physiotherapist and authorised by a claims agent or self‑insured employer prior to the delivery of the service as being necessary, appropriate and reasonably required. | ||
Schedule 3—Scales of charges—psychology services
This Schedule supersedes the scale of charges for medical services delivered by a registered psychologist fixed by notice under section 32 of the Act and published in the Gazette on 10 March 1994 at page 709.
This Schedule must be read in conjunction with the Psychology Fee Schedule Guidelines.
| Item No | Service description | Maximum charge (excl GST) | |||||||||||
| Psychological assessment | |||||||||||||
| Assessment by a psychologist involving the psychologist's attendance on the client. | |||||||||||||
| W0111 | An attendance of not more than 15 minutes duration | $39.00 | |||||||||||
| W0112 | An attendance of more than 15 minutes duration but not more than 30 minutes duration | $58.50 | |||||||||||
| W0113 | An attendance of more than 30 minutes duration but not more than 45 minutes duration | $97.50 | |||||||||||
| W0114 | An attendance of more than 45 minutes duration but not more than 75 minutes duration | $156.00 | |||||||||||
| W0115 | An attendance of more than 75 minutes duration but not more than 105 minutes duration | $234.00 | |||||||||||
| W0116 | An attendance of more than 105 minutes duration but not more than 135 minutes duration | $312.00 | |||||||||||
| W0117 | An attendance of more than 135 minutes duration | $353.60 | |||||||||||
| Consultations | |||||||||||||
| Treatment and intervention by a psychologist involving the psychologist's attendance on the client. | |||||||||||||
| Initial attendance | |||||||||||||
| W0101 | An attendance of not more than 15 minutes duration | $39.00 | |||||||||||
| W0102 | An attendance of more than 15 minutes duration but not more than 30 minutes duration | $58.50 | |||||||||||
| W0103 | An attendance of more than 30 minutes duration but not more than 45 minutes duration | $97.50 | |||||||||||
| W0104 | An attendance of more than 45 minutes duration but not more than 75 minutes duration | $156.00 | |||||||||||
| W0105 | An attendance of more than 75 minutes duration | $195.00 | |||||||||||
| Subsequent attendance | |||||||||||||
| W0121 | An attendance of not more than 15 minutes duration | $39.00 | |||||||||||
| W0122 | An attendance of more than 15 minutes duration but not more than 30 minutes duration | $58.50 | |||||||||||
| W0123 | An attendance of more than 30 minutes duration but not more than 45 minutes duration | $97.50 | |||||||||||
| W0124 | An attendance of more than 45 minutes duration but not more than 75 minutes duration | $156.00 | |||||||||||
| W0125 | An attendance of more than 75 minutes duration | $195.00 | |||||||||||
| Group therapy | |||||||||||||
| Group therapy under the continuous direct supervision of a psychologist. | |||||||||||||
| Group therapy (minimum of 2 clients, maximum of 9 clients) | |||||||||||||
| W1704 | Group therapy of more than 45 minutes duration and not more than 75 minutes duration | $30.75 (each client) | |||||||||||
| W1705 | Group therapy of more than 75 minutes duration and not more than 105 minutes duration | $47.25 (each client) | |||||||||||
| W1706 | Group therapy of more than 105 minutes duration and not more than 135 minutes duration | $62.65 (each client) | |||||||||||
| W1707 | Group therapy of more than 135 minutes duration | $69.75 (each client) | |||||||||||
| Family group therapy (2 clients) | |||||||||||||
| W1724 | Family group therapy of more than 45 minutes duration and not more than 75 minutes duration | $78.00 (each client) | |||||||||||
| W1725 | Family group therapy of more than 75 minutes duration and not more than 105 minutes duration | $117.00 (each client) | |||||||||||
| W1726 | Family group therapy of more than 105 minutes duration and not more than 135 minutes duration | $156.00 (each client) | |||||||||||
| W1727 | Family group therapy of more than 135 minutes | $176.10 (each client) | |||||||||||
| Family group therapy (3 or more clients) | |||||||||||||
| W1714 | Family group therapy of more than 45 minutes duration and not more than 75 minutes duration | $52.00 (each client) | |||||||||||
| W1715 | Family group therapy of more than 75 minutes duration and not more than 105 minutes duration | $78.00 (each client) | |||||||||||
| W1716 | Family group therapy of more than 105 minutes duration and not more than 135 minutes duration | $104.00 (each client) | |||||||||||
| W1717 | Family group therapy of more than 135 minutes duration | $117.00 (each client) | |||||||||||
| Interview of a person other than a client | |||||||||||||
| Interview by a psychologist of a person other than a client (eg spouse, employer, supervisor) for the purposes of obtaining information crucial to the treatment and management of the injury. The psychologist must be able to provide clear justification for this service, if requested. | |||||||||||||
| W0131 | Interview of a person other than a client, not more than 15 minutes duration | $39.00 | |||||||||||
| W0132 | Interview of a person other than a client, more than 15 minutes duration but not more than 30 minutes duration | $58.50 | |||||||||||
| W0133 | Interview of a person other than a client, more than 30 minutes duration but not more than 45 minutes duration | $97.50 | |||||||||||
| W0134 | Interview of a person other than a client, more than 45 minutes duration but not more than 75 minutes duration | $156.00 | |||||||||||
| W0135 | Interview of a person other than a client, more than 75 minutes duration | $195.00 | |||||||||||
| Independent clinical assessment | |||||||||||||
| Services provided by a psychologist other than the treating psychologist comprising— • a review of the worker's psychological/medical history; and • clinical assessment of the worker; and • preparation of a report, for the purpose of clarifying the worker's current psychological/psychosocial status and barriers to return to work, and providing advice on appropriate treatment or management. The report may be requested in writing by— • a claims agent or self-insured employer; or • a worker or worker's representative. | |||||||||||||
| W0780 | Independent clinical assessment | $156.00 per hour | |||||||||||
| Vocational assessment | |||||||||||||
| A vocational assessment of a worker by a psychologist to identify potential and alternative career and employment options carried out by means of integrated clinical and standardised assessment procedures and instruments. | |||||||||||||
| WV111 | Vocational assessment, an attendance of not more than 15 minutes duration | $39.00 | |||||||||||
| WV112 | Vocational assessment, an attendance of more than 15 minutes duration but not more than 30 minutes duration | $58.50 | |||||||||||
| WV113 | Vocational assessment, an attendance of more than 30 minutes duration but not more than 45 minutes duration | $97.50 | |||||||||||
| WV114 | Vocational assessment, an attendance of more than 45 minutes duration but not more than 75 minutes duration | $156.00 | |||||||||||
| WV115 | Vocational assessment, an attendance of more than 75 minutes duration but not more than 105 minutes duration | $234.00 | |||||||||||
| WV116 | Vocational assessment, an attendance of more than 105 minutes duration but not more than 135 minutes duration | $312.00 | |||||||||||
| WV117 | Vocational assessment, an attendance of more than 135 minutes duration | $353.60 | |||||||||||
| Reports | |||||||||||||
| Vocational report A vocational report by a psychologist providing advice on factors affecting occupational options following a vocational assessment. These factors may include— • psychosocial factors such as beliefs, motivation, attitude and personality • skills and abilities • cultural, religious or ethnic factors • socio-economic context • medical status • education • advice on strategies to assist in the return to work process. The report may include responses to specific questions asked by the claims agent or self-insured employer. | |||||||||||||
| WRV20 | Vocational report, to provide advice on factors affecting occupational options following vocational assessment—First page | $125.00 | |||||||||||
| Second and subsequent pages | $62.00 | ||||||||||||
| Other reports Report by a psychologist, other than a report of an independent clinical assessment or a vocational report, requested by a claims agent, self-insured employer, worker or worker's representative. | |||||||||||||
| Comprehensive report A report will be taken to be comprehensive when re-examination of the patient is a prerequisite for the preparation of the report. | |||||||||||||
| WR020 | Comprehensive report—first page | $125.00 | |||||||||||
| Second and subsequent pages | $62.00 | ||||||||||||
| Standard report A report will be taken to be standard when re-examination of the worker is not required and the report is based on a transcription of existing clinical records. | |||||||||||||
| WRT20 | Standard report—first page | $93.00 | |||||||||||
| Second and subsequent pages | $47.00 | ||||||||||||
| For the purposes of the charges for vocational and other reports— (a) a page means a page of A4 paper that complies with the following: (i) a top margin of no more than 2 centimetres; (ii) a bottom margin of no more than 2 centimetres; (iii) side margins of no more than 2.5 centimetres; (iv) line spacing of no more than 1.5 centimetres; (v) more than 75% of the lines on the page contain text; and (b) if a page complies with (a) except (a)(v), the charge will be reduced as follows: (i) if 25% or less of the lines on the page contain text, the charge is 25% of the charge otherwise payable; (ii) if more than 25% but not more than 50% of the lines on the page contain text, the charge is 50% of the charge otherwise payable; (iii) if more than 50% but not more than 75% of the lines on the page contain text, the charge is 75% of the charge otherwise payable. | |||||||||||||
| Telephone calls | |||||||||||||
| Calls of a case specific nature made by a psychologist to, or received by a psychologist from, the worker's referring/treating medical expert, worker's employer, rehabilitation provider, claims agent or self-insured employer, WorkCover provider consultant or worker's representative, excluding— (a) calls made during a consultation; and (b) calls of a duration of 3 minutes or less. There is no charge for a telephone call to or from a worker. | |||||||||||||
| W0180 | Telephone calls greater than 3 minutes | $2.60 per minute | |||||||||||
| Travel | |||||||||||||
| A return trip approved by a claims agent or self-insured employer by a treating psychologist from the treating psychologist's rooms to another place for the purpose of a home, hospital or worksite visit or case conference. | |||||||||||||
| WT001 | Travel time | $156.00 per hour | |||||||||||
| Case conference | |||||||||||||
| Case conference, attended by a psychologist and authorised by a claims agent or self-insured employer, for the purpose of determining— • details of limitations/recommendations relating to a sustainable return to work • options for management of a worker's recovery • other related information A case conference may be requested by— • a treating medical expert • an employer • a worker or worker's representative • a claims agent or self-insured employer • a rehabilitation provider contracted by WorkCover. | |||||||||||||
| W0130 | Case Conference | $156.00 per hour | |||||||||||
| The hourly rate excludes travelling time from rooms or other appropriate departure point to the venue and return. Travel may be charged separately. | |||||||||||||
| Non-scheduled services | |||||||||||||
| A service of a kind not listed above provided by a psychologist and authorised by a claims agent or self-insured employer prior to the delivery of the service as being necessary, appropriate and reasonably required. | |||||||||||||
| W9999 | Non scheduled services | $156.00 per hour | |||||||||||
Schedule 4—Scales of charges—speech pathologists
This Schedule must be read in conjunction with the Speech Pathology Fee Schedule Guidelines.
| Item No | Service description | Maximum charge (excl GST) | |||
| Consultations | |||||
| Initial consultation | |||||
| An initial consultation by a speech pathologist involving some or all of the following elements: | |||||
| • the taking of a detailed case history; • counselling (according to the worker's emotional needs); • determination of options for ongoing management following assessment; • consideration and implementation of appropriate treatment; • administration of a standardised clinical assessment or an empirical clinical assessment; • assessment of the ability of the worker to communicate at the worker's workplace; • evaluation and analysis of assessment results. | |||||
| The initial consultation will be designed to form the basis of the diagnosis and assist in prognostic indications and treatment planning. | |||||
| E0149 | Standard initial consultation of up to 1.5 hours duration. | $137.70 per hour | |||
| E0151 | Extended initial consultation of more than 1.5 hours duration (up to a maximum time chargeable of 2.5 hours). | $137.70 per hour | |||
| Subsequent consultation | |||||
| A subsequent consultation by a speech pathologist involving treatment and intervention designed to restore the worker's function to optimal levels. The consultation may involve— (a) tasks specifically related to skill development; (b) counselling to facilitate adjustment and transfer of restored skill to everyday communicative situations. | |||||
| E0249 | Subsequent consultation of up to 1 hours duration. | $137.70 per hour | |||
| Reports | |||||
| E0810 | Comprehensive report | $275.40 | |||
| A report by a treating speech pathologist, relating to the status of a claim and comprising a clinical opinion or statement or a response to specific questions, that has been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | |||||
| A report will be taken to be comprehensive when re‑examination of the worker is a prerequisite for the preparation of the report. The consultation should be charged in accordance with the appropriate item. | |||||
| E0820 | Standard report | $206.60 | |||
| A report by a treating speech pathologist, relating to the status of a claim and comprising a clinical opinion or statement or a response to specific questions, that has been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | |||||
| A report will be taken to be standard when re‑examination of the worker is not required and the report is based on a transcription of existing clinical records. | |||||
| Telephone calls | |||||
| E0850 | Telephone call greater than 3 minutes | $2.30 per minute | |||
| Calls of a case specific nature made by a speech pathologist to, or received by a speech pathologist from, the worker’s referring/treating medical expert, rehabilitation provider contracted by WorkCover, claims agent or self‑insured employer, employer (if not self‑insured), WorkCover provider consultant or the worker's representative excluding— (a) calls made during a consultation; and (b) calls of a duration of 3 minutes or less. | |||||
| There is no charge for a telephone call to or from a worker. | |||||
| Case conference | |||||
| E0870 | Case conference | $137.70 per hour | |||
| Case conference, attended by a speech pathologist and authorised by a claims agent or self‑insured employer, for the purpose of determining— • details of limitations/recommendations relating to a sustainable return to work; • options for management of a worker's recovery; • other related information. | |||||
| A case conference may be requested by— • a treating medical expert; • a worker or worker's representative; • a claims agent or self‑insured employer; • an employer (if not self‑insured); • a rehabilitation provider contracted by WorkCover. | |||||
| The hourly rate excludes travelling time from rooms or other appropriate departure point to the venue and return. Travel may be charged separately. | |||||
| Travel | |||||
| E0910 | Travel time | $117.10 per hour | |||
| Travel, authorised by a claims agent or self‑insured employer, by a treating speech pathologist for the purposes of— • a case conference; or • a home, hospital or worksite visit; or • a consultation where the worker is otherwise unable to attend the speech pathologist's clinic or rooms. | |||||
| There is no charge for travel from 1 clinic or rooms to another clinic or rooms. | |||||
| Non-scheduled services | |||||
| E0999 | Non‑scheduled services | $137.70 per hour | |||
| A service of a kind not listed above, provided by a speech pathologist and authorised by a claims agent or self‑insured employer prior to the delivery of the service as being necessary, appropriate and reasonably required. | |||||
Schedule 5—Scales of charges—occupational therapists
This Schedule must be read in conjunction with the Occupational Therapy Fee Schedule Guidelines.
| Item No | Service description | Maximum charge (excl GST) | ||
| Consultation (individual worker) | ||||
| OT105 | Initial consultation (history, examination and treatment) | $147.70 per hour | ||
| OT205 | Subsequent consultation and treatment A consultation by an occupational therapist involving some or all of the following elements: • clinical assessment; • clinical treatment; • graded activity/exercise; • pain management; • stress management; • relaxation training; • biomechanical education; • independent living skills training. | $147.70 per hour | ||
| Corrective/serial splinting | ||||
| OT300 | Fabrication/fitting/adjustment of splint | $147.70 per hour | ||
| Work simulation (group program) | ||||
| OT502 | Work simulation, group program | $41.20 per hour, per worker | ||
| A graduated program of activities planned and supervised by an occupational therapist used to simulate work conditions and the physical demands of duties. The program will involve at least 2, and not more than 5, workers and will take place at the occupational therapist's rooms. The program will be highly structured, goal orientated and individualised for each worker. | ||||
| The purpose of the program is to maximise the worker's ability to return to work. The program will usually be agreed to by the worker to encourage attendance and appropriate behaviour at work. | ||||
| Telephone calls | ||||
| OT552 | Telephone call greater than 3 minutes | $20.50 | ||
| Calls of a case specific nature made by an occupational therapist to, or received by an occupational therapist from, the worker’s referring/treating medical expert, rehabilitation provider contracted by WorkCover, claims agent or self‑insured employer, employer (if not self‑insured), WorkCover provider consultant or the worker's representative, excluding— (a) calls made during a consultation; and (b) calls of a duration of 3 minutes or less. | ||||
| There is no charge for a telephone call to or from a worker. | ||||
| Pain management group program | ||||
| OT602 | Pain management, group program | $41.20 per hour, per worker | ||
| Pain management by way of a group program planned and supervised by an occupational therapist involving at least 2, but not more than 5, workers. | ||||
| Functional capacity evaluation | ||||
| OT700 | Functional capacity evaluation The maximum time chargeable is 7 hours. | $147.70 per hour | ||
| Assessment by an occupational therapist of a worker's work capacity, including— (a) a series of standardised tests of the worker's physical capabilities focussed on selected work tolerances (ie, the observed and measured physical capabilities that affect a worker's ability to perform the physical demands of specified work tasks); and (b) an analysis of the results of the tests to infer the worker's capacity to sustain a given work effort (ie, the worker's capacity to undertake specified work at a prescribed frequency over a given period of time, taking into account the pace compatible with such work); and (c) preparation of a report with an executive summary outlining the major components of the service and relevant findings. | ||||
| Worksite assessment | ||||
| OT730 | Worksite assessment | $147.70 per hour | ||
| Attendance by an occupational therapist at a worker's workplace in order to obtain an overview of the workplace and determine the availability of suitable duties. | ||||
| Job analysis | ||||
| OT740 | Job analysis | $147.70 per hour | ||
| Job analysis by an occupational therapist, including— (a) an analysis of the critical physical demands of occupational tasks; and (b) determining the worker's capacity to undertake the tasks or giving consideration to available medical guidelines and the occupational therapist's knowledge of the worker's diagnosis, pathology and prognosis; and | ||||
| (c) making recommendations for— (i) modifying the tasks or the way in which the tasks are undertaken; or (ii) providing aids or equipment; or (iii) introducing work practice guidelines to ensure that the worker utilises appropriate body mechanics; and (d) preparation of a report with an executive summary outlining the major components of the service and relevant findings. | ||||
| Graduated return to work program | ||||
| OT750 | Graduated return to work program | $147.70 per hour | ||
| A program of work duties and work practice guidelines for a worker designed by an occupational therapist to increase the worker’s tolerance for the physical demands of work. | ||||
| The purpose of the program is to assist the worker to maintain his or her employment while undertaking rehabilitation. The program will involve actual and productive work duties identified by the occupational therapist as being within the worker's capacity and work practice guidelines relevant to the nature of the worker's injury and the performance of the particular duties. | ||||
| Activities of daily living assessment | ||||
| OT760 | Activities of daily living assessment | $147.70 per hour | ||
| Assessment by an occupational therapist, usually conducted in a worker's home environment, of the worker's level of functioning in relation to personal care, household tasks and recreational and social activities. | ||||
| The purpose of the assessment is to facilitate the reduction of the adverse impact of the injury on the worker and the early return of the worker to normal activity, and to provide an indicator of functional tolerances for determining work capacity. | ||||
| Independent clinical assessment | ||||
| OT780 | Independent clinical assessment and report | $147.70 per hour | ||
| Service provided by an occupational therapist other than the treating occupational therapist comprising— (a) a review of the worker's medical history; and (b) a clinical assessment; and (c) a review of the worker's activity and functional capacity; and (d) preparation of a report, for the purpose of providing a different diagnosis or making recommendations in relation to ongoing treatment goals, the worker's return to work and any other relevant matters. | ||||
| The report will have been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | ||||
| This service is NOT to be performed by the treating occupational therapist. | ||||
| Functional estimation form | ||||
| OT785 | Functional estimation form | $20.50 | ||
| Completion by an occupational therapist of a functional estimation form (in a form approved by the Corporation) and provision of the form to a worker's referring/treating medical expert. The form is completed when information directly affecting the worker's capacity to return to work or the process of the worker returning to work is identified by the occupational therapist. | ||||
| Reports | ||||
| OT810 | Comprehensive report | $221.50 | ||
| A report by a treating occupational therapist, relating to the status of a claim and comprising a clinical opinion or statement or a response to specific questions, that has been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | ||||
| A report will be taken to be comprehensive when re‑examination of the worker is a prerequisite for the preparation of the report. The consultation should be charged in accordance with the appropriate item. | ||||
| OT820 | Standard report | $147.70 | ||
| A report by a treating occupational therapist, relating to the status of a claim and comprising a clinical opinion or statement or a response to specific questions, that has been requested in writing by— (a) a claims agent or self‑insured employer; or (b) a worker or worker's representative. | ||||
| A report will be taken to be standard when re‑examination of the worker is not required and the report is based on a transcription of existing clinical records. | ||||
| Case conference | ||||
| OT870 | Case conference | $147.70 per hour | ||
| Case conference, attended by an occupational therapist and authorised by a claims agent or self‑insured employer, for the purpose of determining— • details of limitations/recommendations relating to a sustainable return to work; • options for management of a worker's recovery; • other related information. | ||||
| A case conference may be requested by— • a treating medical expert; • a worker or worker's representative; • a claims agent or self‑insured employer; • an employer (if not self‑insured); • a rehabilitation provider contracted by WorkCover. | ||||
| The hourly rate excludes travelling time from rooms or other appropriate departure point to the venue and return. Travel may be charged separately. | ||||
| Travel | ||||
| OT905 | Travel time | $125.50 per hour | ||
| Travel, authorised by a claims agent or self‑insured employer, by a treating occupational therapist for the purposes of— (a) a case conference; or (b) a home, hospital or worksite visit; or (c) consultation where the worker is otherwise unable to attend the occupational therapist's clinic or rooms. | ||||
| There is no charge for travel from 1 clinic or rooms to another clinic or rooms. | ||||
| Non-scheduled services | ||||
| OT999 | Non‑scheduled services | $147.70 per hour | ||
| A service of a kind not listed above provided by an occupational therapist and authorised by a claims agent or self‑insured employer prior to the delivery of the service as being necessary, appropriate and reasonably required. | ||||
Schedule 6—Scales of charges—chiropractors
This Schedule supersedes the scale of charges for medical services delivered by a registered chiropractor fixed by notice under section 32 of the Act and published in the Gazette on 29 September 1994 at pages 887 to 895.
This Schedule must be read in conjunction with the Chiropractic Fee Schedule Guidelines.
| Item No | Service description | Maximum charge (excl GST) | ||||||||||||||||
| Consultations | ||||||||||||||||||
| Consultation by a chiropractor involving the chiropractor's attendance on the client. The initial consultation may involve 2 separate attendances on the same day. For example, a second attendance might be required for the interpretation of test data (such as x-rays). | ||||||||||||||||||
| Initial consultation | ||||||||||||||||||
| C0001 | Initial consultation, involving review of medical history and examination but no treatment, of more than 15 minutes duration but not more than 30 minutes duration | $50.00 | ||||||||||||||||
| C0002 | Initial consultation, involving review of medical history, examination and treatment, of more than 15 minutes duration but not more than 30 minutes duration | $60.00 | ||||||||||||||||
| Subsequent consultation | ||||||||||||||||||
| C0005 | Subsequent consultation and treatment, of not more than 15 minutes duration | $36.50 | ||||||||||||||||
| C0006 | Subsequent consultation and treatment, of more than 15 minutes duration but not more than 30 minutes duration | $50.00 | ||||||||||||||||
| C0007 | Subsequent consultation and treatment involving re-examination with treatment, of more than 30 minutes duration but not more than 45 minutes duration | $83.35 | ||||||||||||||||
| After hours consultation If a consultation takes place on a public holiday, a Sunday, a Saturday before 8am or after 1pm, or on any other day before 8am or after 8pm, the following charge applies instead of the charges listed above. | ||||||||||||||||||
| C0008 | After hours consultation of more than 15 minutes duration but not more than 30 minutes duration | $66.65 | ||||||||||||||||
| Independent clinical assessment | ||||||||||||||||||
| Services provided by a chiropractor other than the treating chiropractor comprising— (a) a review of the worker's medical history; and (b) a clinical assessment; and (c) an evaluation of the worker's functional capacity; and (d) preparation of a report, for the purpose of providing a different diagnosis or making recommendations in relation to treatment goals, the worker's return to work or any other relevant matters. The report may be requested in writing by— (a) a claims agent or self-insured employer; or (b) a worker or worker's representative. | ||||||||||||||||||
| C0078 | Independent clinical assessment | $146.00 per hour | ||||||||||||||||
| Travel | ||||||||||||||||||
| Travel authorised by a claims agent or self-insured employer by a treating chiropractor for the purposes of— (a) a case conference; or (b) a home, hospital or worksite visit; or (c) a consultation where the client is otherwise unable to attend the chiropractor's clinic or rooms. There is no charge for travel from 1 clinic or rooms to another clinic or rooms. | ||||||||||||||||||
| C0900 | Travel time | $146.00 per hour | ||||||||||||||||
| Telephone calls | ||||||||||||||||||
| Calls of a case specific nature made by a chiropractor to, or received by a chiropractor from, the worker's referring/treating medical expert, worker's employer, rehabilitation provider, claims agent or self-insured employer, WorkCover provider consultant or worker's representative, excluding— (a) calls made during a consultation; and (b) calls of a duration of 3 minutes or less. There is no charge for a telephone call to or from a worker. | ||||||||||||||||||
| C00R3 | Telephone calls greater than 3 minutes | $2.43 per minute | ||||||||||||||||
| Reports | ||||||||||||||||||
| Report by chiropractor, other than a report of an independent clinical assessment, requested by a claims agent, self-insured employer, worker or worker's representative. | ||||||||||||||||||
| Comprehensive reports A report will be taken to be comprehensive when re-examination of the patient is a prerequisite for the preparation of the report. The consultation should be charged in accordance with the appropriate item. A comprehensive report is chargeable on an hourly basis with a maximum time chargeable of 1.5 hours. | ||||||||||||||||||
| C00R4 | Comprehensive reports | $146.00 per hour | ||||||||||||||||
| Standard reports A report will be taken to be standard when re-examination of the worker is not required and the report is based on a transcription of existing clinical records. A standard report is chargeable on an hourly basis with a maximum time chargeable of 1 hour. | ||||||||||||||||||
| C00R5 | Standard reports | $146.00 per hour | ||||||||||||||||
| Case conference | ||||||||||||||||||
| Case conference, attended by a chiropractor and authorised by a claims agent or self-insured employer, for the purpose of determining— • details of limitations/recommendations relating to a sustainable return to work • options for management of a worker’s recovery • other related information. A case conference may be requested by— • a treating medical expert • an employer • a worker or worker’s representative • a claims agent or self-insured employer • a rehabilitation provider contracted by WorkCover. | ||||||||||||||||||
| C00R6 | Case conference | $146.00 per hour | ||||||||||||||||
| The hourly rate excludes travelling time from rooms or other appropriate departure point to the venue and return. Travel may be charged separately. | ||||||||||||||||||
| Radiological services (including interpretation by chiropractor) | ||||||||||||||||||
| C0011 | Cervical spine | 2 views | $113.30 | |||||||||||||||
| C0013 | Thoracic spine | 2 views | $96.30 | |||||||||||||||
| C0015 | Lumbo-sacral spine | 3-6 views | $132.90 | |||||||||||||||
| C0016 | Sacro-coccygeal area | 2 views | $80.30 | |||||||||||||||
| C0027 | Hip joint | $86.50 | ||||||||||||||||
| C0028 | Pelvic girdle | $109.20 | ||||||||||||||||
| Non-scheduled services | ||||||||||||||||||
| A service (other than a radiological service) of a kind not listed above provided by a chiropractor and authorised by a claims agent or self-insured employer prior to the delivery of the service as being necessary, appropriate and reasonably required. | ||||||||||||||||||
| C9999 | Non-scheduled services | $146.00 per hour | ||||||||||||||||
Legislative history
Notes
•Please note—References in the legislation to other legislation or instruments or to titles of bodies or offices are not automatically updated as part of the program for the revision and publication of legislation and therefore may be obsolete.
•Earlier versions of these regulations (historical versions) are listed at the end of the legislative history.
•For further information relating to the Act and subordinate legislation made under the Act see the Index of South Australian Statutes or of regulations
The Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Regulations 1995 were revoked by r 3 of the Workers Rehabilitation and Compensation (Scales of Medical and Other Charges) Revocation Regulations 2009 on 1.7.2009.
Principal regulations and variations
Year No Reference Commencement 1995 206 Gazette 16.11.1995 p1370 16.11.1995: r 2 1995 226 Gazette 14.12.1995 p1687 14.12.1995: r 2 1996 247 Gazette 28.11.1996 p1777 28.11.1996: r 2 1997 48 Gazette 24.4.1997 p1645 24.4.1997: r 2 1997 133 Gazette 15.5.1997 p2293 15.5.1997: r 2 1997 230 Gazette 27.11.1997 p1456 29.11.1997: r 2 1999 9 Gazette 4.2.1999 p855 4.2.1999: r 2 1999 269 Gazette 23.12.1999 p3835 23.12.1999: r 2 2000 4 Gazette 20.1.2000 p458 7.2.2000: r 2 2000 25 Gazette 30.3.2000 p1933 31.3.2000: r 2 2000 141 Gazette 22.6.2000 p3370 22.6.2000: r 2 2002 184 Gazette 26.9.2002 p3540 1.10.2002: r 2 2004 32 Gazette 20.5.2004 p1331 20.6.2004: r 2 2004 237 Gazette 11.11.2004 p4312 11.11.2004: r 2 2005 276 Gazette 15.12.2005 p4347 16.1.2006: r 2 2006 2 Gazette 12.1.2006 p57 23.1.2006: r 2 2006 227 Gazette 28.9.2006 p3374 28.10.2006: r 2 2007 55 Gazette 3.5.2007 p1462 1.7.2007: r 2 2008 13 Gazette 7.2.2008 p404 7.2.2008: r 2 2008 43 Gazette 1.5.2008 p1541 1.5.2008: r 2 2008 185 Gazette 26.6.2008 p2660 1.7.2008: r 2 Provisions varied
Entries that relate to provisions that have been deleted appear in italics.
Provision How varied Commencement r 2 omitted under the Legislation Revision and Publication Act 2002 20.6.2004 r 3 r 3(1) r 3 redesignated as r 3(1) by 237/2004 r 4 11.11.2004 chiropractor inserted by 2/2006 r 4 23.1.2006 Claims Agent deleted by 276/2005 r 4(1) 16.1.2006 claims agent inserted by 276/2005 r 4(1) 16.1.2006 day surgery facility inserted by 13/2008 r 4(1) 7.2.2008 GST inserted by 141/2000 r 3 22.6.2000 GST law inserted by 141/2000 r 3 22.6.2000 occupational therapist inserted by 276/2005 r 4(2) 16.1.2006 physiotherapist inserted by 276/2005 r 4(2) 16.1.2006 private hospital inserted by 13/2008 r 4(2) 7.2.2008 psychologist inserted by 276/2005 r 4(2) 16.1.2006 same day inserted by 13/2008 r 4(3) 7.2.2008 self-insured employer inserted by 276/2005 r 4(2) 16.1.2006 Self-Managed Employer deleted by 276/2005 r 4(2) 16.1.2006 r 3(2) inserted by 237/2004 r 4 11.11.2004 r 3(3) inserted by 227/2006 r 4 28.10.2006 r 3A inserted by 276/2005 r 5 16.1.2006 varied by 43/2008 r 4 1.5.2008 substituted by 185/2008 r 4 1.7.2008 r 4 before substitution by 276/2005 r 4(1) r 4 amended and redesignated as r 4(1) by 247/1996 r 3 28.11.1996 varied by 141/2000 r 4(a) 22.6.2000 r 4(2) inserted by 247/1996 r 3(b) 28.11.1996 varied by 141/2000 r 4(b) 22.6.2000 r 4 substituted by 276/2005 r 5 16.1.2006 varied by 13/2008 r 5 7.2.2008 r 5 varied by 141/2000 r 5 22.6.2000 varied by 276/2005 r 6(1)—(3) 16.1.2006 r 6 inserted by 226/1995 r 3 14.12.1995 varied by 141/2000 r 6 22.6.2000 substituted by 276/2005 r 7 16.1.2006 r 7 inserted by 133/1997 r 3 15.5.1997 varied by 141/2000 r 7 22.6.2000 varied by 276/2005 r 8(1)—(3) 16.1.2006 r 8 inserted by 25/2000 r 3 31.3.2000 varied by 141/2000 r 8 22.6.2000 varied by 276/2005 r 9(1)—(4) 16.1.2006 r 8A inserted by 2/2006 r 5 23.1.2006 r 9 inserted by 141/2000 r 9 22.6.2000 substitution by 276/2005 r 10 16.1.2006 r 10 inserted by 237/2004 r 5 11.11.2004 Sch 1 substituted by 247/1996 r 4 28.11.1996 substituted by 230/1997 r 3 29.11.1997 substituted by 9/1999 r 3 4.2.1999 substituted by 269/1999 r 3 23.12.1999 substituted by 184/2002 r 3 1.10.2002 substituted by 276/2005 r 11 16.1.2006 substituted by 13/2008 r 6 7.2.2008 Sch 1A inserted by 247/1996 r 4 28.11.1996 varied by 48/1997 r 3 24.4.1997 substituted by 230/1997 r 3 29.11.1997 substituted by 9/1999 r 3 4.2.1999 substituted by 269/1999 r 3 23.12.1999 substituted by 184/2002 r 3 1.10.2002 deleted by 276/2005 r 11 16.1.2006 Sch 2 substituted by 4/2000 r 3 7.2.2000 substituted by 32/2004 r 4 (Sch 1) 20.6.2004 varied by 276/2005 r 12(1)—(3) 16.1.2006 substituted by 227/2006 r 5 28.10.2006 substituted by 55/2007 r 4 1.7.2007 substituted by 185/2008 r 5 1.7.2008 Sch 3 inserted by 226/1995 r 4 14.12.1995 substituted by 276/2005 r 13 16.1.2006 Sch 4 inserted by 133/1997 r 4 15.5.1997 varied by 276/2005 r 14(1)—(4) 16.1.2006 substituted by 227/2006 r 6 28.10.2006 substituted by 55/2007 r 5 1.7.2007 substituted by 185/2008 r 6 1.7.2008 Sch 5 inserted by 25/2000 r 4 31.3.2000 substituted by 237/2004 r 6 11.11.2004 heading varied by 276/2005 r 15 16.1.2006 substituted by 227/2006 r 6 28.10.2006 substituted by 55/2007 r 5 1.7.2007 substituted by 185/2008 r 6 1.7.2008 Sch 6 inserted by 2/2006 r 6 23.1.2006 varied by 227/2006 r 7 28.10.2006 Historical versions
Reprint No 1—14.12.1995 Reprint No 2—28.11.1996 Reprint No 3—24.4.1997 Reprint No 4—15.5.1997 Reprint No 5—29.11.1997 Reprint No 6—4.2.1999 Reprint No 7—23.12.1999 Reprint No 8—7.2.2000 Reprint No 9—30.3.2000 Reprint No 10—22.6.2000 Reprint No 11—1.10.2002 20.6.2004 11.11.2004 16.1.2006 23.1.2006 28.10.2006 1.7.2007 7.2.2008 1.5.2008
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