Implantable pain therapy guidelines

What WorkSafe will pay for

WorkSafe and its authorised agents can pay the reasonable costs of clinically justified implantable pain therapy (IPT) when required as a result of a work-related injury or illness under Victorian workers compensation legislation.

WorkSafe adopts the Medicare Benefits Schedule (MBS) items, explanations, definitions, rules and conditions for surgical services provided by medical practitioners.

This guideline must be read with the following:

Definitions

In this policy, Implantable Pain Therapy (IPT) is a procedure involving the use of an implantable prosthetic device to address persistent pain and may be considered when a range of alternatives for managing persistent pain have been fully explored. Many IPT procedures remain non- established or experimental.

There are three stages to IPT:

Stage 1: A trial of neurostimulation or a trial of intrathecal analgesia

Stage 2: Implantation of a permanent IPT device

Stage 3: IPT required for a technical purpose such as battery or device replacement

IPT incorporates:

• intrathecal morphine infusion and other analgesic infusions (also known as intraspinal pumps)
• neurostimulation/neuromodulation techniques such as:
  • spinal cord stimulation
  • subcutaneous electrical stimulation
  • peripheral nerve stimulation
  • deep brain stimulation
  • motor cortex stimulation
• other implanted neurostimulation devices for pain

Guidelines

What WorkSafe can pay for in relation to IPT

WorkSafe and its authorised agents can pay the reasonable costs of an IPT procedure where the following apply.

• The persistent pain condition has resulted from a work-related injury or illness.
• Alternative options for managing persistent pain have been fully explored and have not been successful.
• It is safe, effective and clinically justified, based on the worker's physical, psychological and functional status.
• The procedure has an item number in the MBS.
• The anticipated implantable prosthesis is listed on and provided in accordance with the Surgically Implanted Prostheses Guidelines.
• It is required for a technical purpose, such as a battery or device replacement, reprogramming or a refill, where the initial IPT was paid for by WorkSafe.

WorkSafe and its authorised agents can pay the reasonable costs of the following.

• A trial of neurostimulation of a minimum of one week duration and a maximum of 2 weeks duration in an outpatient setting and approved by WorkSafe or an intrathecal analgesia trial approved by WorkSafe.
• IPT approved by WorkSafe following an approved, successful trial of neurostimulation or intrathecal analgesia.
• Only one IPT unless a subsequent procedure is required for technical purposes and that procedure is approved by WorkSafe.
• Battery or device replacement approved by WorkSafe following approved IPT.
• Hospital services associated with IPT procedures.
• Prostheses in accordance with the Surgically Implanted Prostheses Guidelines.

When replacement or modification of a prosthesis used for IPT is required, and the prosthesis is covered by a supplier or manufacturer warranty, it is the responsibility of the manufacturer to replace or modify the prosthesis or its components.

Who can provide IPT

IPT is to be requested and performed by a registered medical practitioner with expertise in the area of IPT.

Information required

Information WorkSafe requires to consider paying for IPT

To consider paying for IPT, WorkSafe and its authorised agents require information from the treating medical practitioner and information from other health providers.

Information required from the treating medical practitioner

Prior approval is required in writing from WorkSafe or its authorised agent before any IPT procedure.

Prior approval is not required for the ongoing management, adjustment and reprogramming of a neurostimulator (item numbers 39131 and 39141) where WorkSafe or its authorised agent has approved the implantation of a permanent IPT device.

• WorkSafe and its authorised agent require a written request for IPT from the treating medical practitioner. IPT is to be requested and approved in stages and different information is required depending on the stage of treatment that is being requested.
• The following sections outline in detail the information required from the treating medical practitioner to request IPT, depending on the stage of the treatment. The information required is necessary for WorkSafe or its authorised agent to make an informed decision.
• Note: if an IPT request does not include all the information required it will not be reviewed.

Stage 1: A trial of neurostimulation or a trial of intrathecal analgesia

The request for a trial of either neurostimulation or intrathecal analgesia should include an assessment and written clinical rationale from the treating medical practitioner. This assessment should include the following.

• The condition(s) being treated.
• The relationship between the condition(s) being treated and the work-related injury or illness.
• A brief description of the IPT procedure with details of the prosthetic items to be used, in accordance with the Surgically Implanted Prostheses Guidelines.
• The clinical indication for the IPT procedure, including reasons why more conservative treatments that the worker has tried for pain management have not been effective.
• A list of all current medications taken by the worker, including any medication dependency issues.
• Anticipated effects the IPT procedure will have on the worker's:
  • participation in activities of daily living and work
  • mobility
  • pain levels and mood
  • medication use, such as expected reductions.
• Objective pre- and post-IPT outcome measures that will be used to measure the effectiveness of the procedure.
• Anticipated treatment plan following IPT procedure, including:
  • the medications expected to be required
  • who will be responsible for the worker’s short- and long-term care
  • who will be responsible for changing batteries, refills and reprogramming, where required
  • other therapists to be involved to maximise functional gains following IPT, for example, physiotherapist, occupational therapist, or return to work specialist
  • other treatments being considered if the procedure is not successful.

Stage 2: Implantation of a permanent IPT device, following an approved trial

If the outcome of an approved trial of neurostimulation or intrathecal analgesia supports the implantation of a permanent IPT device, WorkSafe and its authorised agent requires a request for a permanent IPT device from the requesting medical practitioner which includes the following.

• The objectively measured outcomes of the trial, in order to assess a request for a permanent IPT.
• A brief description of the IPT procedure with details of the prosthetic items to be used, in accordance with the Surgically Implanted Prostheses Guidelines.

Stage 3: IPT required for a technical purpose such as battery or device replacement

The request from the requesting medical practitioner must include the following.

• Justification of why the procedure or replacement is required.
• Evidence of the effectiveness of the IPT to date, including effect on the pain and function of the worker.
• A brief description of the IPT procedure with details of the prosthetic items to be used, in accordance with the Surgically Implanted Prostheses Guidelines.
• An indication of whether the replacement device parts are under warranty and, if not, when the warranty on the parts expired.
• An indication of the urgency of the request, or if the procedure or replacement has already occurred.

Information WorkSafe may obtain from other health providers

In addition to the information provided by the treating medical practitioner in the request for IPT, WorkSafe or its authorised agent may arrange for the worker to be assessed by an independent medical examiner with expertise in IPT.

They will also review information regarding a worker’s psychological suitability to undergo IPT. This information may be from:

• an independent medical examination with a psychiatrist, arranged by the agent
• the worker's treating psychologist or treating psychiatrist, but only at the request WorkSafe or its authorised agent.

WorkSafe information

Request review

To assist decision-making regarding a request for IPT, an IPT request will be reviewed by a WorkSafe Medical Advisor. The Medical Advisor may contact the requesting medical practitioner to seek further information and/or discuss the proposed treatment before making a recommendation. WorkSafe or its authorised agent will respond to the request when they have received the Medical Advisor's recommendation.

WorkSafe's invoicing requirements

From 1 July 2020 any hospital invoices that include prostheses from the Sub Category: 04.05 - Neurostimulation Therapies for Pain Management of the prescribed list of medical devices and human tissue products, need to include a copy of theatre records and prostheses stickers to support the prostheses invoiced.

In addition to these requirements, ensure invoices include, or are accompanied by, documentation in accordance with the following.

Fees payable for IPT

WorkSafe or its authorised agent can pay the reasonable costs of IPT in accordance with the following.

What WorkSafe will not pay for

WorkSafe and its authorised agents will not will not pay for the following.

• Treatment or services that are contra-indicated on physical, psychological or functional grounds.
• Treatment or services that form part of a clinical trial.
• Reports not requested by the agent.
• Services that are not in accordance with the MBS guidelines, unless otherwise specified.
• IPT where alternative options for managing persistent pain have not been fully explored.
• Modification or replacement of an IPT device that is covered by supplier or manufacturer warranty.
• Treatment or services for a person other than the worker.
• Fees associated with cancellation or non-attendance.
• Treatment or services provided outside Australia without prior written approval from WorkSafe.
• Invoices where the required supporting documentation has not been provided.
• Treatment or services provided by telephone or other mediums that do not align with WorkSafe's telehealth policy.
• The cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals.

More information

For more information about this guideline, contact the referring agent or email [email protected]. 

For more information about IPT, refer to the following.

• Implantable Pain Therapies: Intrathecal (IT) infusions Evidence Review, July 2011 by E. Donoghue and L. Piccenna, Transport Accident Commission and WorkSafe Victoria Evidence Service.
• Implantable Pain Therapies: Neurostimulation Evidence Review, October 2011 by E. Donoghue and L. Piccenna, Transport Accident Commission and WorkSafe Victoria Evidence Service.
• Journal of Clinical Neuroscience 18 (2011) 1295-1302, Recommendations for patient selection in spinal cord stimulation, L. Atkinson, S.R. Sundaraj, C.Brooker, J. O’Callaghan, P.Teddy, J. Salmon, T. Semple and P.M. Majedi.