Early intervention physiotherapy framework fees and policy
- Early intervention physiotherapy fees
Early Intervention Physiotherapy Framework fees effective from 1 July 2017
Effective as at 1 July 2017, WorkSafe Victoria (WorkSafe) will pay up to a maximum amount for the following categories of the service:
Maximum payment rate
( > 20mins) History, examination and treatment of a new patient. Includes PMP to employer, Agent and Medical practitioner.
EPA100 Initial Consultation < 7 months from date of injury $101.50 EPB100 Initial Consultation > 7 months from date of injury $101.50
( ≥ 15mins
EPA102 Standard Consultation < 7 months from date of injury $67.01 EPB102 Standard Consultation > 7 months from date of injury $53.30
( ≥15mins) See guidance material for eligible surgery types*. Can be billed for a maximum of 3 months of treatment following surgery (from first post-op physio session). Surgery must occur within 30 months of date of injury
EIP001 Post-operative Consultation : max. of 3 months treatment $67.01
Employer approval required – includes travel
PY128 Workplace Assessment and report $155.05 per hr (max.$465.15)
Prior approval required – refer to policy for eligibility criteria.
EPA107 Extended Consultation (31-40 mins) < 9 months from first community treatment $89.33 EPB107 Extended Consultation (31-40 mins) > 9 months from first community treatment $66.40 EPA108 Extended Consultation (+40 mins) < 9 months from first community treatment $111.68 EPB108 Extended Consultation (+40 mins) > 9 months from first community treatment $106.60
Prior approval required – refer to the policy for eligibility criteria. Cannot be billed where service rate includes travel.
EPA131 Melbourne Metropolitan $2.72 per km EPA132 Regional / Rural $1.84 per km
Hydrotherapy & Group Consultation:
Hydrotherapy rates include travel
PY130 Initial Consultation History, examination and treatment of a new patient. Includes PMP to employer, Agent and Medical practitioner $101.52 PY132 Standard Consultation $45.11 PY133 Long Consultation $68.32 PY135 Group Consultation (≥ = 30 mins) Maximum of 6 patients receiving constant overall supervision and intermittent individual attention from a physiotherapist $23.31 PY0035 Orthosis (purchase) Providers to use when submitting invoice for payment for orthoses provided in accordance with the External Prostheses and Orthoses Policy. As approved
GST Amounts published have not taken into account that GST may apply to certain services. Where deemed appropriate by WorkSafe, an amount taking into account GST will be added to the listed amount.
- Early Intervention Physiotherapy Services policy
Early Intervention Physiotherapy Framework policy effective from June 2013
Guidelines for physiotherapists who provide services to injured workers under the framework
The WorkSafe Agent (the Agent) can pay the reasonable costs of services delivered under the Early Intervention Physiotherapy Framework where required as a result of a work-related injury or illness under Victorian workers compensation legislation (the legislation).
The Agent will periodically review a worker's entitlement to physiotherapy services to ensure that they remain reasonable for the work-related injury or illness and are payable under the legislation.
The Early Intervention Physiotherapy Framework is a service model that recognises the importance of early treatment in facilitating return to work and return to health outcomes.
Any physiotherapist can enroll in the Early Intervention Physiotherapy Framework by completing the required training and signing a declaration to provide services in line with the Clinical Framework.
The WorkSafe have developed the Clinical Framework for the Delivery of Health Services which is a set of guiding principles intended to support healthcare professionals in their treatment of an injury through:
- Measurement and demonstration of the effectiveness of treatment
- Adoption of a biopsychosocial approach
- Empower the injured person to manage their injury
- Implementing goals focused on optimising function, participation and return to work
- Base treatment on best available research evidence.
The WorkSafe expects that all health professionals providing services to workers will integrate the principles of the Clinical Framework into their daily practice.
Further information about the Clinical Framework can be found at www.worksafe.vic.gov.au.
This policy must be read in conjunction with the following documents:
- WorkSafe policy for Physiotherapy
- WorkSafe policy for Medical Excess
- WorkSafe policy for Equipment and Related Services
- WorkSafe policy for Gym and Swimming Programs
- WorkSafe Restricted Consultation Fact Sheet
What can the Agent pay for in relation to Early Intervention Physiotherapy Framework services?
The Agent can pay the reasonable costs of services:
- required as a result of a work-related injury or illness
- provided by WorkSafe enrolled physiotherapists
- that are clinically justified
- that promote progress towards functional independence, participation and selfmanagement
- that are proven to be effective and achieve or maintain a measurable functional improvement
- that are focused on achieving health and return to work outcomes
- that are reasonable, necessary or appropriate in the circumstances
- that are safe and effective
- in accordance with the WorkSafe policies and guidelines
Once a physiotherapist agrees to the declaration and is enrolled by WorkSafe as a physiotherapist providing EIPF services, they may no longer bill traditional physiotherapy item numbers.
All services must be billed in accordance with the Early Intervention Physiotherapy Framework Fee Schedule.
Initial and standard consultations
The Early Intervention Physiotherapy Framework model has been developed to facilitate return to work and return to health outcomes.
The initial consultation is recognised as an important opportunity for the EIPF provider to influence return to work and recovery outcomes.
Accordingly, the initial consultation is paid at a higher rate than the standard consultation.
Attached to this higher fee is the expectation that, when appropriate, the physiotherapist makes contact with any other key parties in the return to work / return to health process, such as the Employer or GP. In addition, the initial consultation fee includes the completion of the WorkSafe Physiotherapy Management Plan (PMP) within the first five visits.
Consistent with a focus on early intervention and safe and sustainable return to work and return to health outcomes, standard consultations are also reimbursed at a higher rate for a period of seven months from the worker's date of injury.
For more information please refer to the Early Intervention Physiotherapy Framework Fee Schedule.
Physiotherapists providing services under the Early Intervention Physiotherapy Framework are eligible to be paid a higher rate for treatment occurring after certain specific endorsed surgical and procedural interventions. This post-operative rate recognises that certain procedures return the injury to an acute state, and that more intensive treatment and greater communication between stakeholders is required to achieve optimal rehabilitation and return to work outcomes.
The post-operative item number can be billed for a maximum of 3 months of treatment following an endorsed procedure, provided the procedure occurs within 2 ½ years of the date of workrelated/traffic accident injury.
The 3 month eligibility period commences from the first treatment by the physiotherapist following an endorsed procedure. For a list of approved procedures, please refer to the EIPF Post-operative endorsed procedure list. For further information, see the WorkSafe Postoperative Physiotherapy Question and Answer fact sheet.
Workplace Assessment & Report
Physiotherapists can play a key role in safe and sustainable return to work and health. Accordingly, WorkSafe encourages physiotherapists providing services under the EIPF to consider whether conducting a Workplace Assessment would help an injured worker.
A Workplace Assessment is a proactive intervention that can be used to facilitate better return to work and health outcomes for injured workers. Some general guidelines for when a workplace assessment may be appropriate include:
- As an early intervention tool to initiate a return to work
- To confirm the availability and/or suitability of modified or alternative duties
- To confirm time-frames for an injured worker to return to work if certified totally/partially unfit for work
- To discuss suitable work duties and hours to support a return to work plan
- If the worker has reported difficulties in sustaining employment
- To discuss and address any identified return to work barriers
WorkSafe recognises that workplace environments and conditions vary greatly. Accordingly workplace assessment reports submitted to WorkSafe will differ according to the individual circumstances of the injured worker workplace.
A workplace assessment report completed by an EIPF provider should contain the following basic information:
- Worker details (name, claim number, Employer, DOB, date of injury, nature of injury / diagnosis)
- Workplace Assessment details (date of visit, location, attendees)
- Pre-injury duties and hours (brief description)
- Current status of Worker (including certified capacity, work status, and RTW goals)
- Identified barriers and proposed solutions / alternatives
- Suitable duties identified
- Conclusions (duties and positions identified, current capacity and how this relates to identified duties, recommendations for future RTW supports)
- Other (follow-up discussions with GP, Worker, Employer, other stakeholders)
The Workplace Assessment and Report item is billed on an hourly basis, to a maximum of 3.5 hours. The fee for a Workplace Assessment and Report includes:
- time spent arranging the assessment;
- travel time to the injured worker's workplace;
- time spent undertaking the assessment; and
- report writing.
Prior approval from the injured worker's Employer is required before a Workplace Assessment is conducted on premises.
- The WorkSafe can pay for extended consultations where the physiotherapist, using the appropriate request form, has submitted written clinical justification of the need for direct patient contact time of greater than 30 minutes per session for workers who have:
- a significant acquired brain injury
- a spinal cord injury
- severe burns
- complex and multisite orthopaedic injuries
- limb amputations; or
- crush injuries.
Physiotherapists treating a worker who meets the above criteria are eligible to be paid a higher extended consultation fee for the period of nine months from the worker's initial physiotherapy consultation. Prior written approval is required for all extended consultations and consultations can only be billed as a single consultation on any one day.
Extended consultations can be for periods of either:
- 31-40 minutes
- greater than 40 minutes
For more information refer to the Early Intervention Physiotherapy Framework Fee Schedule. For further information on when WorkSafe can approve extended consultations refer to the WorkSafe Restricted Consultation Fact Sheet.
The Agent can pay the reasonable costs of travel on a per kilometre basis for physiotherapists providing treatment outside their clinic other than when conducting a Workplace Assessment and Report. Travel is defined as the physiotherapist driving a registered motor vehicle from their clinic address to an approved community consultation.
Approved consultations in a community setting are paid at the standard or extended consultation rate, inclusive of the higher fee rate where applicable. The cost of travel is paid on a per kilometre basis.
For more information refer to the Early Intervention Physiotherapy Framework Fee Schedule. The WorkSafe expects a worker to seek treatment from a physiotherapist within their local area. Travel can only be paid where:
- no other physiotherapist offering an equivalent service is situated within a 30 kilometre round trip of the worker ; and
- travel to the worker is clinically justified.
A request for travel must be accompanied by a WorkSafe Request for Early Intervention Framework Physiotherapy Travel Request Form detailing:
- the worker name and claim number
- the specific conditions and injuries to be treated
- the clinical justification as to why travel is required
- whether or not there are other reasonable transport options available to the worker
- the approximate distance and cost per episode of travel (round-trip); and
- the number of travel episodes requested.
Travel is only payable with prior written approval from the Agent.
The per kilometre rate paid for travel is different for regional and metropolitan areas. Travel is paid at the applicable rate where most of the travel occurred. For example, 10km in a regional area and 20km in a metropolitan area would result in payment for 30km of travel at the metropolitan rate. Metropolitan and regional areas are as defined by the Victorian Department of Health.
Travel must be recorded from the rooms nearest to the worker's location where a physiotherapist has more than one practice address.
The physiotherapist must record the distance from one appointment to the next when workers are treated consecutively, not from each appointment to the practice.
When invoicing for travel, the physiotherapist must record the:
- number of metropolitan and/or regional kilometres travelled
- applicable metropolitan or regional rate; and
- item number
Please refer to the Early Intervention Physiotherapy Fee Schedule for further information.
The Agent can also reimburse the reasonable travel expenses of a worker attending a physiotherapist. Please refer to the WorkSafe Travel Expenses for Medical and Hospital Services policy for information regarding reimbursement of travel expenses.
Who may provide services under the Early Intervention Physiotherapy Framework?
Services must be delivered by a physiotherapist who:
- is registered with the Physiotherapy Board of Australia
- has satisfactorily completed the WorkSafe training modules
- has signed a declaration committing to provide services in line with the Clinical Framework and related Service Standards; and
- has received confirmation of enrolment from the WorkSafe.
What information does the Agent require to consider paying for Early Intervention Physiotherapy Framework services?
Workers can access physiotherapy services for a work-related injury or illness without prior approval from the Agent or a referral from a medical practitioner.
WorkSafe does not require any information from a physiotherapist before commencement of initial treatment for a worker's work related injury or illness.
The physiotherapist must submit a WorkSafe Physiotherapy Management Plan including baseline measures after initial treatment has commenced:
- within the first five sessions; or
- if the worker has previously attended a different physiotherapy clinic.
The Agent may request a report from the physiotherapist if a worker requires additional services after the approved management plan.
The Agent will decide whether the additional services are reasonable in the circumstances of the worker's claim.
When will the Agent respond to a request?
(If Within 10 working days of receiving the request,) the Agent will advise whether:
- the request has been approved * the request has been denied, or
- further information is required to make a decision.
Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information .
The WorkSafe Clinical Panel may contact the physiotherapist to discuss the proposed treatment.
The Agent will decide on the treatment requested after receiving the Clinical Panel recommendation.
What are the WorkSafe's invoice requirements?
Please refer to How to Invoice WorkSafe guidelines
What fees are payable for Early Intervention Physiotherapy Framework services?
Please refer to the WorkSafe Early Intervention Physiotherapy Framework Fee Schedule
In relation to Early Intervention Physiotherapy Framework services, what won't the Agent pay for?
The Agent will not pay for:
- treatment or services for a person other than the worker
- treatment or services provided by a health professional not registered and approved by WorkSafe under Victorian workers' compensation legislation
- more than one initial consultation by the same provider or clinic
- items that are not charged under the Early Intervention Physiotherapy Framework Fee Schedule
- the provision of multiple or concurrent physical treatments (for example early intervention physiotherapy, physiotherapy, chiropractic, osteopathy or acupuncture) with exceptions such as group exercise or group hydrotherapy
- pharmacy items such as creams and gels supplied by health professionals
- treatment or services subcontracted to, or provided by a non-registered provider
- fees associated with cancellation or nonattendance
- treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent
- treatment or services provided by telephone or other non-face to face mediums
- telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals
- multiple claims for travel to and from the practice for community consultations provided consecutively
- consumable prosthetics, aides and appliances used in the course of the consultation – for further information please refer to the Equipment and Related Services Policy
- provided more than once on the same day to the same worker
- treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1 or level 2 evidence that the treatment, service, prostheses or equipment is safe and effective - refer to the Non-Established, New or Emerging Treatments and Services Policy
Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services, and services for which approval should be sought from the WorkSafe Agent or self-insurer (as the case may be) before the services are provided.