Physiotherapy services fees and policy

  • Physiotherapy services fees

    Physiotherapy services 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:

    Item number

    Consultation

    Service Description

    Practitioner Contact Time

    Maximum payment rate

    At practitioners rooms
    PY100 Initial Consultation New Patient History, examination and treatment, including Physiotherapy Management Plan (PMP) to employer, Agent and medical practitioner AND > 20mins $101.50
    PY101 Brief Consultation Selective review, examination and treatment AND > 10 & < 15 mins $31.74
    PY102 Standard Consultation Individual consultation - History, examination and treatment Direct patient contact time ≥ = 15 mins $53.30
    PY105 Restricted Consultation History, examination and complex treatment for workers with specific injuries based on prior approval AND > 20 mins $82.29
    PY106 Restricted Consultation Application Completion of Restricted Consultation Application Form
    $49.15
    PY136 Group Consultation - Physiotherapist to supervise and attend planned session A maximum of 6 patients treated in a class or group session and in receipt of constant overall supervision and intermittent individual attention to each participant in the group from the physiotherapist. Constant overall supervision ≥ = 30 mins $23.31

    Item Number

    Consultation

    Service Description

    Practitioner Contact Time

    Maximum payment rate

    At hospital (involving travel from rooms)
    PY110 Initial Consultation New Patient History, examination and treatment, including PMP to employer, Agent and medical practitioner AND > 20 mins $101.52
    PY111 Brief Consultation Selective review, examination and treatment AND > 10 & < 15 mins $42.47
    PY112 Standard Consultation History, examination and treatment AND ≥15 mins $55.75
    PY113 Long Consultation History, examination and complex treatment or treatment of two distinct areas/conditions AND > 20 mins $79.01
    PY114 Extended Consultation History, examination and treatment of three distinct areas/conditions AND > 30 mins $100.76
    At home or work (involving travel from rooms)



    PY120 Initial Consultation New Patient History, examination and treatment, including PMP to employer, Agent and medical practitioner AND > 20 mins $101.52
    PY121 Brief Consultation Selective review, examination and treatment AND > 10 & < 15 mins $42.47
    PY122 Standard Consultation History, examination and treatment AND ≥ 15 mins $55.75
    PY123 Long Consultation History, examination and complex treatment or treatment of two distinct areas/conditions AND > 20 mins $79.01
    PY124 Extended Consultation History, examination and treatment of three distinct areas/conditions AND > 30 mins $100.76
    PY125 Group Consultation - Physiotherapist to supervise and attend planned session Maximum of 6 patients per session AND ≥ 30 mins (per patient) $24.65
    PY128 Workplace Assessment with approval of employer Workplace visit and assessment including report to employer/Agent
    $155.05 p/h maximum 3 hours

    Item Number

    Consultation

    Service Description

    Practitioner Contact Time

    Maximum payment rate

    Hydrotherapy Services
    PY130 Initial Consultation New Patient History, examination and treatment, including PMP to employer, Agent and medical practitioner AND > 20 mins $101.52
    PY132 Standard Consultation Individual consultation - History, examination and treatment Direct patient contact time ≥ = 15 mins $45.11
    PY133 Long Consultation History, examination and complex treatment or treatment of two distinct areas/conditions AND > 20 mins $68.32
    PY135 Group Consultation - Physiotherapist to supervise and attend planned session A maximum of 6 patients treated in a class or group session and in receipt of constant overall supervision and intermittent individual attention to each participant in the group from the physiotherapist, with patient in the pool for at least 20 minutes. Constant overall supervision ≥ = 30 mins $23.31
    Feldenkrais Services
    FK702 Individual Consultation

    $105.03
    FK802 Group Consultation

    $24.37
    Other
    PY0035Orthosis (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.

    Download physiotherapy services fees [PDF, 1.3mB]

    Download physiotherapy services fees [PDF, 1.3mB]

    View fee schedules from previous years

  • Physiotherapy services policy

    Guidelines for the provision of physiotherapy to injured workers

    The WorkSafe Agent (the Agent) can pay the reasonable costs of physiotherapy services when required as a result of a work-related injury or illness under Victorian workers' compensation legislation (the legislation). 

    The Agent will periodically review an injured worker's entitlement to physiotherapy services to ensure that the treatment and services remain reasonable for the workrelated injury and/or illness and are payable under the legislation. 

    Background 

    WorkSafe Victoria has developed the Clinical Framework for the Delivery of Health Services (Clinical Framework)to set out key principles for the delivery of services to injured workers. 

    The Clinical Framework is based on the following principles: 

    • Measurement and demonstration of the effectiveness of treatment 
    • Adoption of a biopsychosocial approach 
    • Empowering the injured worker to manage their injury 
    • Implementing goals focused on optimising function, participation and/or return to work/health 
    • Base treatments on best available research evidence. 

    WorkSafe Victoria expects that all health professionals providing services to injured workers 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: 

    • Policy for Early Intervention Physiotherapy Framework 
    • Policy for Equipment and Related Services 
    • Policy for Gym and Swimming Programs 

    Guidelines 

    What can the Agent pay for in relation to physiotherapy services? 

    The Agent can pay the reasonable costs of physiotherapy services: 

    • required as a result of a work-related injury or illness 
    • registered by WorkSafe to provide physiotherapy services 
    • registered with the Physiotherapy Board of Australia 
    • that are clinically justified, safe and effective 
    • that have a clear rehabilitative purpose and are not for non-work-related injury rehabilitative purposes 
    • that are likely to achieve or maintain a measurable functional improvement 
    • that promote progress towards functional independence, participation and self management. 

    Please note that the Agent will not pay for more than one initial consultation by the same provider or clinic unless there are exceptional circumstances, for example following a hospital admission or surgery, or where a significant period of time has elapsed since the injured worker last received treatment. 

    Group consultations 

    The Agent can pay the reasonable cost of group consultations provided by a physiotherapist. 

    Group consultations involve two or more injured workers receiving constant overall supervision and intermittent attention. The maximum number of participants in a group should not exceed six. 

    Restricted consultations 

    • Restricted consultations require prior written approval from the Agent. The Agent can pay the reasonable costs of extended consultations where an injured worker requires treatment beyond that of a standard consultation including: 
    • moderate to severe acquired brain injury 
    • crush injuries 
    • extensive burns 
    • spinal cord injuries 
    • multiple orthopaedic fractures 
    • limb amputations. 

    The Restricted Consultation application form must be completed by a physiotherapist to apply for approval to use the restricted physiotherapy consultation item number. It is recommended that physiotherapists do not bill the restricted item consultation item number until they have been advised by the Agent in writing that their application has been accepted. 

    Physiotherapists can be reimbursed by the Agent for the completion of the Restricted Consultation application form. 

    Consultations in the community 

    • The Agent can pay the reasonable costs of a consultation undertaken in a community setting, such as at a hospital, at home or at an injured worker's workplace. 
    • The Agent expects the injured worker to seek treatment from a provider in their local area. Please refer to the WorkSafe Physiotherapy Fee Schedule for more information. 

    Subsequent (Continuing) Certificates of Capacity 

    • A physiotherapist may complete a subsequent certificate of capacity if the injured worker's capacity for work is impacted due to a work-related injury. 
    • A subsequent/continuing Certificate of Capacity can be issued by a physiotherapist for up to a maximum of 28 days, unless special reasons apply and express approval is obtained from the Agent. 
    • Please note that only a medical practitioner can complete an initial Certificate of Capacity. 
    • For more information about Certificates of Capacity please see www.worksafe.vic.gov.au. 

    Who can provide physiotherapy services? 

    • Physiotherapy services can be provided by a physiotherapist who is registered with the Physiotherapy Board of Australia to practice in the physiotherapy profession. 

    What information does the Agent require to consider paying for physiotherapy services? 

    • The Agent does not require any information from a physiotherapist before commencement of initial treatment for an injured worker's work-related injury. After initial treatment has commenced, the physiotherapist will be required to submit a Physiotherapy Management Plan to the Agent by the fifth consultation. 
    • For injured workers part of the Community Integration Program the request, approval and submission of outcome measures for services will form part of the independence planning process. 

    When will the Agent respond to a request? 

    Within 10 working days of receiving a request for physiotherapy services, 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 receipt of the additional information. To assist the Agent make a decision regarding a request for ongoing physiotherapy services, a request may be reviewed by a WorkSafe Medical Advisor/Clinical Panel. The Clinical Panel/Medical Advisor may contact the requesting physiotherapist to seek further information and/or discuss the proposed treatment prior to making a recommendation to the Agent regarding the request. The Agent will respond to the request when they have received the recommendations. 

    What are WorkSafe's invoicing requirements? 

    • Refer to the How to invoice WorkSafe guidelines. 

    What fees are payable for physiotherapy services? 

    Please refer to the WorkSafe Physiotherapy Fee Schedule. 

    In relation to physiotherapy 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 
    • the provision of multiple or concurrent physical treatments (for example 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 non-attendance 
    • 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 
    • consumable prosthetics, aides and appliances used in the course of the consultation – for further information please refer to the WorkSafe policy for Equipment and Related Services 
    • consultations 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, services, prostheses or equipment is safe and effective – refer to the WorkSafe policy for Non-Established, New or Emerging Treatments and Services. 

    Further information 

    Contact the referring Agent, email info@worksafe.vic.gov.au or refer to: 

    • How to Invoice WorkSafe 
    • WorkSafe's Online Claims Manual

    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.

    Download physiotherapy policy [PDF, 363kB]

    Download physiotherpay policy [PDF, 363kB]

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