Restricted Consultation
The following are frequently asked questions about restricted consultation.
- What is a restricted consultation?
- Who may be treated under restricted consultations?
- How do I make a restricted consultation application?
- Where do I find a restricted consultation application form?
- How do I invoice restricted consultation applications and services?
- How long is the restricted consultation item code valid?
- Who do I contact to check on the progress of my application?
- What if my application is unsuccessful?
- How do I appeal?
What is a restricted consultation?
Restricted consultations are in-rooms consultations with injured workers who require treatment beyond that of a standard consultation. Chiropractors, osteopaths and physiotherapists may apply to provide a restricted consultation for injured workers with severe injuries and complex treatment needs.
Payment for restricted consultations cannot be made unless prior approval is obtained from WorkSafe Victoria.
Who may be treated under restricted consultations?
Restricted consultations can only be provided following prior approval from the WorkSafe Clinical Panel and where a worker’s injury meets the diagnostic criteria. This includes moderate to severe acquired brain injuries, crush injuries, extensive burns, spinal cord injuries, multiple orthopaedic fractures, and/or limb amputations.
If a treating healthcare professional identifies a worker with severe injuries that are not covered under the diagnostic criteria listed above, an application can be made for the application to be assessed “on merit”.
WorkSafe expects that the restricted consultation is in line with the principles of the Clinical Framework for the Delivery of Healthcare Services to Injured Workers. The complexity of treatment, anticipated outcomes and justification supporting the request is also considered in reviewing a request for restricted consultations.
How do I make a restricted consultation application?
The treating healthcare professional must complete a Restricted Consultation application form and fax it to the managing WorkSafe Agent.
Download the application form and view Agent fax details.
Restricted consultation: application process flowchart (.ppt)
Restricted consultation applications are reviewed at the Agent by an Injury Management Advisor (IMA) who has a health background to ensure that the worker’s condition meets the restricted consultation diagnostic criteria.
If the IMA determines the worker’s condition does not meet the diagnostic criteria the Agent advises the treating healthcare professional in writing that their application has been unsuccessful.
If the IMA determines that the worker’s condition meets the criteria or may meet the “on merit” criteria the application is forwarded to the WorkSafe Clinical Panel for review. The WorkSafe Clinical Panel reviews the application and advises the treating healthcare professional in writing of the outcome.
WorkSafe and WorkSafe Agents aim to meet the following response times:
- 3 business days for notification of an unsuccessful application
- 5 business days for notification of a successful application
It is recommended that treating healthcare professionals do not use the restricted consultation item number until they have been advised in writing of the outcome of an application, as all restricted consultations services need to be approved by the WorkSafe Clinical Panel before payments can be made.
Where do I find a restricted consultation application form?
Click here to download the restricted consultation application form
How do I invoice restricted consultation applications and services?
Completion of the restricted consultation application form can be invoiced under the appropriate restricted consultation application item code:
- Chiropractic: CR106
- Osteopathy: OS106
- Physiotherapy: PY106
Once written approval is provided from the WorkSafe Clinical Panel, the treating healthcare professional can invoice consultations using the following codes within their fee schedules:
- Chiropractic: CR105
- Osteopathy: OS105
- Physiotherapy: PY105
Treatment for claims which do not meet the criteria for restricted consultations should be billed under the standard consultation item number.
How long is the restricted consultation item code valid?
Restricted consultations may be approved for a period of up to 6 months per application. If further restricted consultations are required after this period, the treating healthcare professional must re-apply to provide restricted consultations by completing an additional application form.
Who do I contact to check on the progress of my application?
If you would like to check on the status of your application, you should first contact the managing WorkSafe Agent. If the application form has been forwarded to the WorkSafe Clinical Panel, the progress of the application can be determined by phoning (03) 9641 1070 or fax (03) 9641 1927.
What if my application is unsuccessful?
Treating healthcare professionals are able to appeal decisions of denial, regardless of whether this decision was made by the managing WorkSafe Agent or the WorkSafe Clinical Panel. All appeals are considered by two members of the WorkSafe Clinical Panel.
The WorkSafe Clinical Panel members review whether the application meets the diagnostic criterion and reflects the principles of the Clinical Framework, and will contact the treating healthcare professional to discuss the application.
How do I appeal?
If you wish to lodge an appeal, please forward a copy of the original application, the reasons that you are requesting a review, and any other supporting documentation to:
WorkSafe Clinical Panel
Health Services Group
WorkSafe Victoria
Level 10, 222 Exhibition St
Melbourne 3000
Ph: (03) 9641 1070
Fax: (03) 9641 1927
clinical_panel@worksafe.vic.gov.au
