100010000601.08.2025 O Y Y 2001.08.202500104.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the 5001.08.2025treatment of work-related injuries or conditions. The first five (5) 5001.08.2025consultations (including initial consultation) are pre-approved, provided the 5001.08.2025injuries or conditions have not previously been treated by an allied health 5001.08.2025provider. If additional treatment is required, submit a Provider Management 5001.08.2025Plan (PMP). Subsequent consultation may include: ongoing assessment 5001.08.2025(subjective and objective), intervention/treatment, setting expectations of 5001.08.2025recovery and return to work, clinical recording, communication with the 5001.08.2025insurer of any relevant information for the workers rehabilitation.Please 5001.08.2025Note: A provider cannot bill for multiple initial consultations or multiple 5001.08.2025subsequent consultations for the same injured worker on the same day. 100010002101.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - A one-on-one initial consultation for the treatment of 5001.08.2025work-related injuries or conditions, or the first consultation in a new 5001.08.2025episode of care for the same work-related injuries or conditions. Services to 5001.08.2025be conducted in accordance with the Clinical Framework for the Delivery of 5001.08.2025Health Services. Initial consultation may include: subjective 5001.08.2025assessment,objective assessment, treatment/service, tailored goal setting and 5001.08.2025treatment planning, setting expectations of recovery and return to work, 5001.08.2025clinical recording, communication with the insurer of any relevant information 5001.08.2025for the workers rehabilitation. Please Note: A provider cannot bill for 5001.08.2025multiple initial consultations or multiple subsequent consultations for the 5001.08.2025same claimant on the same day. 100010010601.08.2025 O Y Y 2001.08.202500056.0000000.0000000.00 5001.08.2025GROUP EXERCISE SESSIONS - A session where a common program is delivered to 5001.08.2025more than one individual at the same time. The group can consist of a maximum 5001.08.2025of eight (8) persons. The group session must be attended, conducted, and 5001.08.2025supervised by a physiotherapist. 100010022601.08.2025 H Y Y 2001.08.202500278.0000000.0000000.00 5001.08.2025INDEPENDENT CASE REVIEW - An independent physiotherapy examination and report 5001.08.2025on a worker. It is not carried out by the treating physiotherapist. The review 5001.08.2025is requested by the insurer where progress of treatment and/or rehabilitation 5001.08.2025falls outside the plan or expected course of injury management. The 5001.08.2025examination and report provide the insurer with an assessment and 5001.08.2025recommendations for ongoing treatment and prognosis. 100010028701.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SPECIALISED HAND/UPPER LIMB CONSULTATION- PHYSIOTHERAPIST ONLY - A one-on-one 5001.08.2025consultation and treatment for workers with hand and upper limb work-related 5001.08.2025injuries or conditions (below shoulder level). Treatment offered is considered 5001.08.2025hand therapy provided by a qualified hand therapist. Further details about 5001.08.2025qualifications are provided below the tables. The first five (5) consultations 5001.08.2025(including the initial consultation) are pre-approved, provided the injury or 5001.08.2025condition has not previously been treated by an allied health provider. 5001.08.2025Maximum one (1) hour. Prior insurer approval is required for sessions 5001.08.2025exceeding one (1) hour. The provider will be required to provide clinical 5001.08.2025justification and reasoning for sessions exceeding one (1) hour 100010031401.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - Prior 5001.08.2025approval is required before providing this service. Development and 5001.08.2025instruction of a gym/pool-based exercise program focused on improving function 5001.08.2025of the work-related injury or condition, relevant to the work role. The aim of 5001.08.2025this program is for a successful transition of the workers program to a 5001.08.2025gym/pool-based setting in order to meet their work specific functional goals. 5001.08.2025This service may only be charged once. Refer to Item Number 300228 for Gym and 5001.08.2025Pool Entry Fees. Services to be conducted in accordance with the Clinical 5001.08.2025Framework for the Delivery of Health Services. The entire consultation must be 5001.08.2025one-on-one with the worker. Maximum one (1) hour. 100010040201.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - The 5001.08.2025insurer may request justification and will consider seeking an independent 5001.08.2025opinion if more than six (6) consultations are requested per episode of care. 5001.08.2025A one-on-one consultation with the worker for ongoing monitoring, review and 5001.08.2025progression of a gym/pool-based exercise program as developed during initial 5001.08.2025consultation (100314). The focus must be on improving function of the 5001.08.2025work-related injury or condition relevant to the work role and include 5001.08.2025education and progression to self-management. Services to be conducted in 5001.08.2025accordance with the Clinical Framework for the Delivery of Health Services. A 5001.08.2025Provider Management Plan (PMP) is to be submitted for approval following the 5001.08.2025initial consultation (100314) and before any treatment commences. The PMP 5001.08.2025should include a comprehensive treatment plan containing: expected functional 5001.08.2025gains, transition of care to self-management; and treatment timeframes. 5001.08.2025Maximum one (1) hour. 100010040601.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SPECIFIC PHYSIOTHERAPY ASSESSMENT - A one-on-one assessment used for specific 5001.08.2025conditions that cannot be adequately assessed, due to the complexity of the 5001.08.2025condition, within an initial consultation (100021 and 100314 for work specific 5001.08.2025functional exercise program). These may include, but are not limited to: 5001.08.2025extensive burns, acquired brain injuries, severe spinal cord injuries, 5001.08.2025multiple orthopaedic fractures, limb amputations, crush injuries. This service 5001.08.2025can also be used for the assessment (only) of suitability for entry into a 5001.08.2025Multi-Disciplinary Program or Pain Management Program. The service may only be 5001.08.2025used once by the physiotherapist in the treatment of a work-related injury or 5001.08.2025condition, or the first consultation in a new episode of care for the same 5001.08.2025work-related injury or condition. Please note: A provider cannot bill for 5001.08.2025multiple initial consultations or multiple subsequent consultations for the 5001.08.2025same injured worker on the same day. Maximum one (1) hour. 100010040701.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SPECIFIC PHYSIOTHERAPY CONSULTATION - Prior approval is required before 5001.08.2025providing this service. The insurer may request justification and will 5001.08.2025consider seeking an independent opinion if more than six (6) consultations are 5001.08.2025requested per episode of care. A one-on-one consultation for recommended 5001.08.2025interventions identified during a Specific Physiotherapy Assessment (100406). 5001.08.2025These may include, but are not limited to: extensive burns acquired brain 5001.08.2025injuries severe spinal cord injuries multiple orthopaedic fractures limb 5001.08.2025amputations crush injuries. Please note: This service is not to be used for 5001.08.2025consultations within a Multi-Disciplinary Program or Pain Management Program 5001.08.2025and must not be already classified elsewhere in this table. A Provider 5001.08.2025Management Plan (PMP) is to be submitted following the initial assessment 5001.08.2025(100406). The PMP should include an updated comprehensive treatment plan 5001.08.2025containing: expected functional gains, transition of care to self-management; 5001.08.2025and treatment timeframes. Maximum one (1) hour. 100010050001.08.2025 H Y Y 2001.08.202500350.0000000.0000000.00 5001.08.2025SPECIALIST PHYSIOTHERAPIST (TIER 3) INTERVENTION - Treatment provided by a 5001.08.2025Specialist Physiotherapist (Tier 3) must be aligned with their qualifications 5001.08.2025specific to the work-related injuries they are treating. A copy of these 5001.08.2025qualifications must be provided to the insurer prior to undertaking services. 5001.08.2025Specialist Physiotherapy consultations are approved at the Specialist 5001.08.2025Physiotherapist rate, except for specified services. The first five (5) 5001.08.2025consultations (including initial consultation) are pre-approved, provided the 5001.08.2025injuries or conditions have not previously been treated by an allied health 5001.08.2025provider. 100010055501.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025REASSESSMENT OR PROGRAM REVIEW - A one-on-one comprehensive assessment used 5001.08.2025when: the worker has been in active rehabilitation for at least six (6) weeks 5001.08.2025and further treatment is likely; and/or there are new clinical findings that 5001.08.2025might affect ongoing treatment; and/or there is a rapid change in worker's 5001.08.2025status and/or there is no response to current therapeutic interventions.It 5001.08.2025should include: all components of initial consultation, a review of the 5001.08.2025workers progress based on established objective measures, a recommendation for 5001.08.2025future treatment and management strategies to assist the worker to return to 5001.08.2025work.It may include referral recommendations to other providers, a change in 5001.08.2025therapy or outcome direction requiring a new return to work goal. Following 5001.08.2025reassessment submit a Provider Management Plan (PMP) with an updated 5001.08.2025comprehensive treatment plan containing: expected functional gains, transition 5001.08.2025of care to self-management; and treatment timeframes. 100020001101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025COMPREHENSIVE ORAL EXAMINATION (ADA 011) - Insurer prior approval required. A 5001.08.2025comprehensive evaluation and recording of the current status of the dentition, 5001.08.2025mouth and associated structures performed on a patient. This applies to new 5001.08.2025patients, established patients who have had a significant change in health 5001.08.2025conditions, or established patients who have been absent from active treatment 5001.08.2025for two or more years. This may require interpretation of information acquired 5001.08.2025through additional diagnostic procedures reported and itemised separately. 5001.08.2025This evaluation includes recording an appropriate oral and medical history and 5001.08.2025any other relevant information. Usual practice fee applies. 100020001201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025PERIODIC ORAL EXAMINATION (ADA 012) - Insurer prior approval required. An 5001.08.2025evaluation of the dentition, mouth and associated structures performed on a 5001.08.2025patient of record to determine any changes in the patients oral and medical 5001.08.2025health status since a previous comprehensive or periodic examination. This may 5001.08.2025require interpretation of information acquired through additional diagnostic 5001.08.2025procedures reported and itemised separately. Usual practice fee applies. 100020001301.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025ORAL EXAMINATION - LIMITED (ADA 013) - Insurer prior approval required. A 5001.08.2025limited evaluation of the dentition, mouth and associated structures performed 5001.08.2025on a patient. This may be for a specific oral health problem or complaint. 5001.08.2025This may require interpretation of information acquired through additional 5001.08.2025diagnostic procedures reported and itemised separately. This evaluation 5001.08.2025includes recording an appropriate oral and medical history and any other 5001.08.2025relevant information. Usual practice fee applies. 100020001401.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025CONSULTATION (<30 MINUTES) (ADA 014) - Insurer prior approval required. A 5001.08.2025consultation to seek advice or discuss treatment options regarding a specific 5001.08.2025dental or oral condition. This consultation includes recording an appropriate 5001.08.2025medical history and any other relevant information. Usual practice fee 5001.08.2025applies. 100020001501.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025CONSULTATION - EXTENDED (30 MINUTES) (ADA 015) - Insurer prior approval 5001.08.2025required. An extended consultation to seek advice or discuss treatment options 5001.08.2025about a specific dental or oral complaint. This consultation includes 5001.08.2025recording an appropriate medical history and any other relevant information. 5001.08.2025Usual practice fee applies. 100020002201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025INTRAORAL PERIAPICAL OR BITEWING RADIOGRAPH (ADA 022) - Insurer prior approval 5001.08.2025required. Taking and interpreting a radiograph made with the film inside the 5001.08.2025mouth. Usual practice fee per exposure applies. 100020002501.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025INTRAORAL RADIOGRAPH - OCCLUSAL, MAXILLARY, MANDIBULAR (ADA 025) - Insurer 5001.08.2025prior approval required. Taking and interpreting a radiograph of the upper and 5001.08.2025or lower jaw using a film placed outside the mouth for example, oblique 5001.08.2025lateral radiograph. Usual practice fee per exposure applies. 100020003701.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025PANORAMIC RADIOGRAPH (OPG) (ADA 037) - Insurer prior approval required. Taking 5001.08.2025and interpreting an extraoral radiograph presenting a panoramic view of part 5001.08.2025or all the mandible and/or the maxilla and/or adjacent structures. Usual 5001.08.2025practice fee per exposure applies. 100020007101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025DIAGNOSTIC MODEL (ADA 071) - Insurer prior approval required. The production 5001.08.2025of a model from an impression or digital data. The model is used for 5001.08.2025examination and treatment planning procedures. This item should not be used to 5001.08.2025describe a working model. Usual practice fee per model applies. 100020031101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025REMOVAL OF A TOOTH OR PART(S) THEREOF (ADA 311) - Insurer prior approval 5001.08.2025required. A procedure consisting of the removal of a tooth or part(s) thereof. 5001.08.2025Usual practice fee applies. 100020031401.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025SECTIONAL REMOVAL OF A TOOTH OR PART(S) THEREOF (ADA 314) - Insurer prior 5001.08.2025approval required The removal of a tooth or part(s) thereof in sections. Bone 5001.08.2025removal may be necessary. Usual practice fee applies. 100020032201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025SURGICAL REMOVAL OF A TOOTH OR FRAGMENT NOT REQUIRING REMOVAL OF BONE OR TOOTH 5001.08.2025DIVISION (ADA 322) - Insurer prior approval required. Removal of a tooth or 5001.08.2025tooth fragment where an incision and the raising of a mucoperiosteal flap are 5001.08.2025required, but where removal of bone or sectioning of the tooth is not 5001.08.2025necessary to remove the tooth. Usual practice fee applies. 100020032301.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025SURGICAL REMOVAL OF A TOOTH OR TOOTH FRAGMENT REQUIRING REMOVAL OF BONE (ADA 5001.08.2025323) - Insurer prior approval required. Removal of a tooth or tooth fragment 5001.08.2025where removal of bone and/or sectioning of the tooth after an incision and the 5001.08.2025raising of a mucoperiosteal flap. The tooth may be removed in sections. Usual 5001.08.2025practice fees applies. 100020035201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025FRACTURE OF MAXILLA OR MANDIBLE - NOT REQUIRING FIXATION (ADA 352) - Insurer 5001.08.2025prior approval required. Conservative treatment of a fracture of the maxilla 5001.08.2025or mandible where there is no marked displacement or mobility of the 5001.08.2025fragments. No physical reduction or fixation is required. Usual practice fee 5001.08.2025applies. 100020038701.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025REPLANTATION AND SPLINTING OF A TOOTH (ADA 387) - Insurer prior approval 5001.08.2025required. Replantation of a tooth that has been avulsed or intentionally 5001.08.2025removed. It may be held in the correct position by splinting. Usual practice 5001.08.2025fee applies per tooth. 100020039901.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025CONTROL OF REACTIONARY OR SECONDARY POST-OPERATIVE HAEMORRHAGE (ADA 399) - 5001.08.2025Insurer prior approval required. This procedure describes the control of 5001.08.2025reactionary or secondary post-operative haemorrhage. Usual practice fee 5001.08.2025applies. 100020041101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025DIRECT PULP CAPPING (ADA 411) - Insurer prior approval required. A procedure 5001.08.2025where an exposed pulp is directly covered with a protective dressing or 5001.08.2025cement. Usual practice fee applies. 100020041901.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025EXTIRPATION OF PULP OR DEBRIDEMENT OF ROOT CANAL(S) - EMERGENCY OR PALLIATIVE 5001.08.2025(ADA 419) - Insurer prior approval required. The partial removal of a tooth 5001.08.2025pulp for one or more of the following reasons: to relieve pain; to perform an 5001.08.2025assessment of root integrity; or to carry out an assessment of the tooth's 5001.08.2025suitability for restoration. Item numbers 415 and/or 416 should not be used at 5001.08.2025the same appointment as 419. Usual practice fee applies. 100020045501.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025ADDITIONAL VISIT FOR IRRIGATION AND/OR DRESSING OF THE ROOT CANAL SYSTEM (ADA 5001.08.2025455) - Insurer prior approval required. Separate appointment for additional 5001.08.2025irrigation of the root canal system and replacement of the intracanal 5001.08.2025dressing/medicament with therapeutic properties that facilitates 5001.08.2025healing/development of the root and periradicular tissues over time. This item 5001.08.2025is not to be used in conjunction with items 411421 or 451453 or 457. Usual 5001.08.2025practice fee applies per tooth. 100020051101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025METALLIC RESTORATION - ONE SURFACE - DIRECT (ADA 511) - Insurer prior approval 5001.08.2025required. Direct metallic restoration involving one surface of a tooth. Usual 5001.08.2025practice fee applies. 100020051201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025METALLIC RESTORATION - TWO SURFACES - DIRECT (ADA 512) - Insurer prior 5001.08.2025approval required. Direct metallic restoration involving two surfaces of a 5001.08.2025tooth. Usual practice fee applies. 100020051301.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025ANY PROSTHODONTIC SERVICE (ADA 611-ADA 779) - Insurer prior approval required. 5001.08.2025Provision of any service from the Prosthodontics chapter of The Australian 5001.08.2025Schedule of Dental Services and Glossary 13th edition. Usual practice fee 5001.08.2025applies. 100020071101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025COMPLETE MAXILLARY DENTURE (ADA 711) - Insurer prior approval required. 5001.08.2025Provision of a patient removable dental prosthesis replacing the natural teeth 5001.08.2025and adjacent tissues in the maxilla. Usual practice fee applies. 100020071201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025COMPLETE MANDIBULAR DENTURE (ADA 712) - Insurer prior approval required. 5001.08.2025Provision of a patient removable dental prosthesis replacing the natural teeth 5001.08.2025and adjacent tissues in the mandible. Usual practice fee applies. 100020072101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025PARTIAL MAXILLARY DENTURE - RESIN BASE (ADA 721) - Insurer prior approval 5001.08.2025required. Provision of a resin base for a patient removable dental prosthesis 5001.08.2025for the maxilla where some natural teeth remain. Other components of the 5001.08.2025denture such as teeth, rests, retainers, and immediate tooth replacements 5001.08.2025should be appropriately itemised. Usual practice fee applies. 100020072201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025PARTIAL MANDIBULAR DENTURE - RESIN BASE (ADA 722) - Insurer prior approval 5001.08.2025required. Provision of a resin base for a patient removable dental prosthesis 5001.08.2025for the mandible where some natural teeth remain. Other components of the 5001.08.2025denture such as teeth, rests, retainers, and immediate tooth replacements 5001.08.2025should be appropriately itemised. Usual practice fee applies. 100020072801.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025PARTIAL MANDIBULAR DENTURE - CAST METAL FRAMEWORK (ADA 728) - Insurer prior 5001.08.2025approval required Provision of the framework for a patient removable dental 5001.08.2025prosthesis made with a cast metal on which to replace teeth from the mandible 5001.08.2025where some natural teeth remain. Other components of the denture such as 5001.08.2025teeth, rests, retainers, and immediate tooth replacements should be 5001.08.2025appropriately itemised. Usual practice fee applies. 100020073101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025RETAINER (ADA 731) - Insurer prior approval required. A retainer or clasp that 5001.08.2025is attached to a partial denture that is adapted to an undercut in a tooth to 5001.08.2025aid retention. The number of retainers should be indicated. Usual practice fee 5001.08.2025per tooth applies. 100020073201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025OCCLUSAL REST (ADA 732) - Insurer prior approval required. A unit of partial 5001.08.2025denture that rests upon a tooth surface to provide support for the denture. 5001.08.2025The number of rests used should be indicated. Usual practice fee per rest 5001.08.2025applies. 100020073301.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025TOOTH/TEETH (PARTIAL DENTURE) (ADA 733) - Insurer prior approval required. An 5001.08.2025item to describe each tooth added to the base of new partial denture. The 5001.08.2025number of teeth should be indicated. Usual practice fee applies. 100020076401.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025REPAIRING BROKEN BASE OF A PARTIAL DENTURE (ADA 764) - Insurer prior approval 5001.08.2025required. Repair, insertion, and adjustment of a broken resin partial denture 5001.08.2025base. Usual practice fee applies. 100020076801.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025ADDING TOOTH TO PARTIAL DENTURE TO REPLACE AN EXTRACTED OR DECORONATED TOOTH 5001.08.2025(ADA 768) - Insurer prior approval required. Provision of a denture tooth on 5001.08.2025an existing partial denture to replace a natural tooth that has been removed 5001.08.2025or decoronated prior to or at the time of issue of the modified denture. Usual 5001.08.2025practice fee per tooth applies. 100020077601.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025IMPRESSION - DENTAL APPLIANCE REPAIR/ MODIFICATION (ADA 776) - Insurer prior 5001.08.2025approval required. An item to describe taking an impression where required for 5001.08.2025the repair or modification of a dental appliance. Usual practice fee applies. 100020091101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025PALLIATIVE CARE (ADA 911) - Insurer prior approval required. An item to 5001.08.2025describe interim care to relieve pain, infection, bleeding, or other problems 5001.08.2025not associated with other treatment, per appointment. Usual practice fee 5001.08.2025applies. 100020092701.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025PROVISION OF MEDICATION/MEDICAMENT (ADA 927) - Insurer prior approval 5001.08.2025required. The supply, or administration under professional supervision, of 5001.08.2025appropriate medications and medicaments required for dental treatments. Usual 5001.08.2025practice fee applies. 100021000101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025COMPLETE FORMS (SENT WITH REQUEST) - FOR TREATING DENTAL PRACTITIONERS TO 5001.08.2025PROVIDE BASIC INFORMATION - Complete forms (sent with request) for treating 5001.08.2025dental practitioners to provide basic information as set out in forms provided 5001.08.2025by the insurer. The treating dental practitioner is to indicate the need for 5001.08.2025phone contact or a full report if additional pertinent information is 5001.08.2025available. Basic fee payable for each form completed. Usual practice fee 5001.08.2025applies. 100021000201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025SHORT REPORT - A short report written in response to a request for specific 5001.08.2025information e.g. a statement of attendance, history, diagnosis, record of 5001.08.2025visits, including results of an investigation. These reports should only 5001.08.2025address the information requested but should include any comments necessary to 5001.08.2025make the position clear to a lay person. Expected length is half a page to one 5001.08.2025(1) page. Received by insurer within 10 working days. Usual practice fee 5001.08.2025applies. 100021000501.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025BASIC REPORT - A basic report includes summing up and an opinion helpful to 5001.08.2025the insurer. A basic report should include all of the relevant items listed in 5001.08.2025the outline for the short report and also a case summary. Details would only 5001.08.2025be given where this assists in determining the merits of a claim, establishing 5001.08.2025a need for a particular line of treatment or rehabilitation, understanding the 5001.08.2025development of the condition and the prognosis, or clarifying early treatment 5001.08.2025and return to work goals. Expected length is one (1) to two (2) pages. 5001.08.2025Received by insurer within 10 working days. Usual practice fee applies. 100021000801.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025SUBSTANTIAL REPORT - A substantial report includes extensive research or case 5001.08.2025discussion and opinion helpful to the insurer or assessment of impairment on 5001.08.2025request; or if the claim is rejected, to compensate for clinical input to the 5001.08.2025report. To qualify as substantial, a report must include, in addition to the 5001.08.2025case summary and comments required for a basic report, at least one of the 5001.08.2025following: - an assessment of impairment at the insurer's request - a report 5001.08.2025on a work-related injury or condition where the claim is subsequently rejected 5001.08.2025as a result of the report - evidence of extensive research into clinical, 5001.08.2025technical, or scientific papers - considerable case discussion outlining the 5001.08.2025merits of the claim - or advice on the future management of the case which 5001.08.2025assists the insurer and/or rehabilitation providers to manage the claim. 5001.08.2025Received by insurer within 10 working days. Usual practice fee applies. 100021001101.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025EXPERT SPECIALIST OPINION - An expert specialist opinion includes the above 5001.08.2025elements essential to the insurer in determining or managing claims. To 5001.08.2025attract the fee for an expert specialist report there should be evidence of 5001.08.2025two or more of the requirements for a substantial report, or the preparation 5001.08.2025of a report of a medico-legal standard for use by a medical assessment 5001.08.2025tribunal or a court. Expected length is three (3) or more pages. Note: only to 5001.08.2025be paid to specialists. Received by insurer within 10 working days. Usual 5001.08.2025practice fee applies. 100030000401.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - A one-on-one initial consultation for acupuncture in 5001.08.2025the treatment of work-related injuries or conditions, or the first 5001.08.2025consultation in a new episode of care for the same work-related injuries or 5001.08.2025conditions. Services to be conducted in accordance with the Clinical Framework 5001.08.2025for the Delivery of Health Services. Initial consultation may include: 5001.08.2025subjective assessment objective assessment treatment/service tailored goal 5001.08.2025setting and treatment planning setting expectations of recovery and return to 5001.08.2025work clinical recording communication (with referrer) any relevant information 5001.08.2025for the workers rehabilitation to the insurer. 100030000501.08.2025 O Y Y 2001.08.202500104.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation for acupuncture 5001.08.2025in the treatment of work-related injuries or conditions. The first five (5) 5001.08.2025consultations (including initial consultation) are pre-approved, provided the 5001.08.2025injuries have not previously been treated by an allied health provider. 5001.08.2025Subsequent consultation may include: ongoing assessment (subjective and 5001.08.2025objective), intervention/treatment, setting expectations of recovery and 5001.08.2025return to work, clinical recording, communication with the insurer of any 5001.08.2025relevant information for the workers rehabilitation. 100030000601.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025PSYCHOLOGY TREATMENT PROGRESS REPORT - This report is for cases where the 5001.08.2025insurer has requested specific information and/or where the insurer has 5001.08.2025requested specific information and/or a limited set of questions.Reports must 5001.08.2025be submitted within 10 business days of the request.Maximum billable time: 1.5 5001.08.2025hours.This report is only to be prepared at the request of the insurer. 100030001401.08.2025 H Y Y 2001.08.202500113.0000000.0000000.00 5001.08.2025HOME NURSING SERVICES BY A REGISTERED NURSE - Home Nursing Services by a 5001.08.2025Registered Nurse-Prior approval is required before providing this service. 5001.08.2025Home nursing services such as dressing of wounds and assistance with daily 5001.08.2025care. The insurer will not pay for home nursing services in excess of four (4) 5001.08.2025weeks without a treating medical practitioner review. NB: must be referred by 5001.08.2025a medical practitioner. Weekday evening rate: $128. Weekend rate: $180. Prior 5001.08.2025approval is required before providing this service. 100030005301.08.2025 H Y Y 2001.08.202500092.0000000.0000000.00 5001.08.2025HOME NURSING SERVICES BY AN ENROLLED NURSE - Prior approval is required before 5001.08.2025providing this service. Home nursing services such as wound dressings and 5001.08.2025assistance with daily care. The insurer will not pay for home nursing services 5001.08.2025in excess of (4 weeks) without treating medical practitioner review. NB: must 5001.08.2025be referred by a medical practitioner. Weekday evening rate: $103 Weekend 5001.08.2025rate: $144 100030007901.08.2025 O Y Y 2001.08.202500037.0000000.0000000.00 5001.08.2025COMMUNICATION - 3 TO 10 MINS - Communication-3 to 10 mins- Direct 5001.08.2025communication between the treating provider, insurer, employer, 5001.08.2025insurer-referred allied health providers, and doctors is essential for 5001.08.2025facilitating faster and more effective rehabilitation and return to work 5001.08.2025outcomes for workers. Communications must involve the insurer.This excludes 5001.08.2025communication with the worker of a general administrative nature, the exchange 5001.08.2025of non-specific information, and communication between or among internal and 5001.08.2025external medical or allied health providers unless the communication 5001.08.2025specifically involves WorkCover the insurer. Communication must last longer 5001.08.2025than three (3) minutes. Treating providers are required to maintain a written 5001.08.2025record of the communication, including the date, time, and duration. The 5001.08.2025insurer may request evidence of communication at any time 100030008101.08.2025 O Y Y 2001.08.202500048.0000000.0000000.00 5001.08.2025GENERAL MEDICAL PROCEDURES - Payable where a patient is seen by an advanced 5001.08.2025practice registered nurse (i.e. a nurse practitioner or rural and isolated 5001.08.2025practice nurse) and performs straightforward medical procedures that would 5001.08.2025normally be payable as part of a doctor's MBS attendance fee i.e. suturing a 5001.08.2025wound or removal of a superficial foreign body. This also includes outpatient 5001.08.2025care in hospitals. 100030008201.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025CASE CONFERENCE - Prior approval is required before providing this 5001.08.2025service.Face-to-face or phone communication involving the treating provider, 5001.08.2025insurer and one or more of the following: treating medical practitioner or 5001.08.2025specialist, employer or employee representative, worker, allied health 5001.08.2025provider; or other. Communication must involve the insurer. 100030008401.08.2025 O Y Y 2001.08.202500075.0000000.0000000.00 5001.08.2025UPDATED SUITABLE DUTIES PROGRAM (SDP) - Documentation of an updated or further 5001.08.2025suitable duties plan for a worker, detailing specific information necessary 5001.08.2025for a safe and effective return to the workplace. For WorkCover Queensland 5001.08.2025claims, only an approved RTW Services provider can provide this service.** 100030008601.08.2025 O Y Y 2001.08.202500075.0000000.0000000.00 5001.08.2025PROGRESS REPORT - A written report providing a brief summary of the worker's 5001.08.2025progress towards recovery and return to work. 100030008701.08.2025 O Y Y 2001.08.202500150.0000000.0000000.00 5001.08.2025PUBLIC HOSPITAL EMERGENCY NURSE SERVICES - To be invoiced where a worker 5001.08.2025receives primary emergency services provided by nursing staff only. This code 5001.08.2025is used if the care is of an emergency nature only and the hospital is not 5001.08.2025considered to have a recognised emergency department as per the Public Health 5001.08.2025Services Table of Costs. 100030008801.08.2025 O Y Y 2001.08.202500189.0000000.0000000.00 5001.08.2025STANDARD REPORT - A written report that conveys relevant information relating 5001.08.2025to a workers recovery and return to work including functional and return to 5001.08.2025work status, treatment plan, interventions to date, any changes in prognosis 5001.08.2025along with the reasons for those changes, barriers, recommendations, goals, 5001.08.2025and timeframes. Also includes responses to a limited number of questions 5001.08.2025raised by an insurer. 100030008901.08.2025 O Y Y 2001.08.202500049.0000000.0000000.00 5001.08.2025ASSISTING DOCTOR IN MINOR SURGERY - This item will be payable only if the 5001.08.2025procedure attracts an MBS assistance fee and there is no other doctor 5001.08.2025available to assist. 100030009001.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025COMPREHENSIVE REPORT - A written report that conveys all the information 5001.08.2025included in a standard report however would only be relevant where questions 5001.08.2025raised by the insurer are extensive. Maximum billable time: 3 to 5 hours 100030009101.08.2025 H Y Y 2001.08.202500172.0000000.0000000.00 5001.08.2025TRAVEL - RTW SERVICES ONLY - Travel charges are applicable when the provider 5001.08.2025is required to leave their normal place of practice to treat a worker at a: 5001.08.2025rehabilitation facility hospital workplace their place of residence, or 5001.08.2025community-based setting. Travel is not payable where: the travel is between 5001.08.2025clinics or facilities owned and/or operated by the provider or their employer. 5001.08.2025the travel is for services delivered at an external facility where treatment 5001.08.2025at these external facilities is a regular part of that providers approach and 5001.08.2025there exists a contractual arrangement and/or agreement to use that external 5001.08.2025facility. Please see explanatory notes for further information. For WorkCover 5001.08.2025Queensland claims, only an approved RTW Services provider can provide this 5001.08.2025service.** 100030009201.08.2025 H Y Y 2001.08.202500165.0000000.0000000.00 5001.08.2025TRAVEL - TREATMENT - Travel - Prior approval is required for travel of more 5001.08.2025than one (1) hour. Travel charges are applicable when the provider is required 5001.08.2025to leave their normal place of practice to treat a worker at a: rehabilitation 5001.08.2025facility hospital workplace their place of residence, or community-based 5001.08.2025setting. Travel is not payable where: the travel is between clinics or 5001.08.2025facilities owned and/or operated by the provider or their employer. the travel 5001.08.2025is for services delivered at an external facility where treatment at these 5001.08.2025external facilities is a regular part of that providers approach and there 5001.08.2025exists a contractual arrangement and/or agreement to use that external 5001.08.2025facility. Please see explanatory notes for further information. 100030009301.08.2025 O Y Y 2001.08.202500031.0000000.0000000.00 5001.08.2025COPIES OF PATIENT RECORDS RELATING TO CLAIM - Copies of patient records 5001.08.2025relating to the worker's compensation claim including file notes, results of 5001.08.2025relevant tests e.g. pathology, diagnostic imaging, and reports from 5001.08.2025specialists. Paid at $31 flat fee plus $1 per page. 100030009401.08.2025 O Y Y 2001.08.202500085.0000000.0000000.00 5001.08.2025INCIDENTAL EXPENSES - Reasonable charges for incidental items required by the 5001.08.2025worker to assist in their recovery and which they take home with them 5001.08.2025following their treatment. Pharmacy items and consumables used by a provider 5001.08.2025during a consultation are not included. For further clarification refer to the 5001.08.2025information provided below the tables. * Payment will be made up to $85 in 5001.08.2025total for incidental expenses and up to $249 in total for supportive devices, 5001.08.2025per claim (not per consultation), without prior approval. Approval from the 5001.08.2025insurer must be obtained for items exceeding the pre-approved value. Hire of 5001.08.2025equipment to be negotiated with insurer. All expenses must be itemised on the 5001.08.2025invoice. Please note: This item number is not to be used for admission fees to 5001.08.2025external facilities such as gyms and pools. 100030010001.08.2025 O Y Y 2001.08.202500075.0000000.0000000.00 5001.08.2025COMMUNICATION - 11 TO 20 MINS - Communication-11 to 20 mins- Direct 5001.08.2025communication between the treating provider, insurer, employer, 5001.08.2025insurer-referred allied health providers, and doctors is essential for 5001.08.2025facilitating faster and more effective rehabilitation and return to work 5001.08.2025outcomes for workers. Communications must involve the insurer. This excludes 5001.08.2025communication with the worker of a general administrative nature, the exchange 5001.08.2025of non-specific information, and communication between or among internal and 5001.08.2025external medical or allied health providers -unless the communication 5001.08.2025specifically involves the insurer. Communication must last longer than ten 5001.08.2025(10) minutes. Please refer to the exclusions listed below in the table before 5001.08.2025using this item number.Treating providers are required to maintain a written 5001.08.2025record of the communication, including the date, time, and duration. The 5001.08.2025insurer may request evidence of communication at any time. 100030010201.08.2025 O Y Y 2001.08.202500112.0000000.0000000.00 5001.08.2025INITIAL SUITABLE DUTIES PROGRAM (SDP) - Documentation of suitable duties for a 5001.08.2025worker, detailing specific information necessary for a safe and effective 5001.08.2025return to the workplace. For WorkCover Queensland claims, only an approved RTW 5001.08.2025Services provider can provide this service.** 100030015801.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025WORKPLACE EVALUATION/ASSESSMENT - Systematic process using the workplace to 5001.08.2025estimate work potential and work behaviour. Includes ergonomic assessments. 5001.08.2025For WorkCover Queensland claims, only an approved RTW Services provider can 5001.08.2025provide this service.** 100030015901.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025ACTIVITIES OF DAILY LIVING ASSESSMENT - A series of standardised tests and 5001.08.2025measures to assess a worker's activities of daily living and mobility 5001.08.2025(including Modified Barthel Index assessments for registered occupational 5001.08.2025therapists only). Service includes assessment and report, noting that 5001.08.2025WorkCover Queenslands template for Modified Barthel Index is to be used (for 5001.08.2025WorkCover claims). 100030016001.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025FUNCTIONAL CAPACITY EVALUATION (FCE) - Systematic assessment using a series of 5001.08.2025standardised tests and work specific simulation activities to assess a 5001.08.2025worker's functional capacity for work or potential to return to suitable work; 5001.08.2025includes assessment and report. For WorkCover Queensland claims, only an 5001.08.2025approved RTW Services provider can provide this service.** 100030016101.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025DRIVING ASSESSMENT - Off-road and on-road driving assessments of cognitive, 5001.08.2025psychological, and physical capacity to drive. Assessments must be conducted 5001.08.2025by a qualified driving assessor. Service includes assessment and report. 5001.08.2025Driving instructor is also required for on-road assessment component and fees 5001.08.2025are paid separately. 100030016201.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025VOCATIONAL ASSESSMENT AND REPORT* - Assessment of realistic vocational options 5001.08.2025in the current job market for a worker using integrated clinical and 5001.08.2025standardised assessment procedures and instruments; includes assessment and 5001.08.2025report. For WorkCover Queensland claims, only an approved RTW Services 5001.08.2025provider can provide this service.** 100030016401.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025RETURN TO WORK FACILITATION - Engaging with workers and employers for the 5001.08.2025purposes of establishing an updated suitable duties program or remove barriers 5001.08.2025preventing a workers participation in return to work where an alternative 5001.08.2025workplace rehabilitation service item number does not apply. This service may 5001.08.2025also be billed for face-to-face or electronic file reviews, or other services 5001.08.2025at the request from the insurer. For WorkCover Queensland claims, only an 5001.08.2025approved RTW Services provider can provide this service.** 100030016601.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025JOB SEEKING SKILLS ASSESSMENT - INITIAL* - Identify a worker's transferable 5001.08.2025skills and abilities for a new job/career or host placement; may involve the 5001.08.2025development of a vocational preparation action plan with the worker. For 5001.08.2025WorkCover Queensland claims, only an approved RTW Services provider can 5001.08.2025provide this service.** 100030016801.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025JOB PREPARATION SERVICES* - Prepare the worker to find suitable employment. 5001.08.2025Services will be based on the needs of the worker and may include development 5001.08.2025of or updating a resume and/or cover letter, interview preparation skills and 5001.08.2025career counselling. For WorkCover Queensland claims, only an approved RTW 5001.08.2025Services provider can provide this service.** 100030018601.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - Initial 5001.08.2025development and instruction of an exercise program focused on improving 5001.08.2025function of the work-related injuries or conditions, relevant to their work 5001.08.2025role. This service may only be charged once for development of an exercise 5001.08.2025program to meet the workers work specific functional goals. Refer item number 5001.08.2025300228 for Gym and Pool Entry Fees. Initial consultation may include: 5001.08.2025subjective assessment, objective assessment, treatment/service, tailored goal 5001.08.2025setting and treatment planning, setting expectations of recovery and return to 5001.08.2025work, clinical recording, communication with the insurer of any relevant 5001.08.2025information for the workers rehabilitation. The entire consultation must be 5001.08.2025one-on-one with the worker. Maximum one (1) hour. 100030018701.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - Prior 5001.08.2025approval is required before providing this service. A one-on-one consultation 5001.08.2025with the worker for ongoing monitoring, review and progression of a 5001.08.2025work-specific functional exercise program as developed during initial 5001.08.2025consultation (300186). The focus must be on improving function of the 5001.08.2025work-related injury or condition relevant to the work role and include 5001.08.2025education and progression to self-management. Any additional treatment 5001.08.2025required beyond the initial consultation (300186) will require the submission 5001.08.2025of a Provider Management Plan3 (PMP). Maximum 45 minutes per consultation. 100030018801.08.2025 H Y Y 2001.08.202500250.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - ADJUSTMENT COUNSELLING - A one-on-one initial 5001.08.2025consultation undertaken where possible to clarify the presence of possible 5001.08.2025adjustment to injury issues and set goals of therapy to optimise 5001.08.2025rehabilitation outcomes; performed where worker is displaying psychological, 5001.08.2025social, cognitive, emotional, and behavioural problems after a work-related 5001.08.2025incident or injury. The purpose of the consultation is to identify appropriate 5001.08.2025interventions/treatments to optimise rehabilitation outcomes.Initial 5001.08.2025consultation may include: history taking, assessment, diagnostic formulation, 5001.08.2025treatment/service, tailored goal setting and treatment planning, setting 5001.08.2025expectations of recovery and return to work, clinical recording, communication 5001.08.2025with the insurer of any relevant information for the workers rehabilitation. 5001.08.2025Maximum one (1) hour on any one day. 100030019001.08.2025 O Y Y 2001.08.202500136.0000000.0000000.00 5001.08.2025DIETARY ASSESSMENT - Consultation to evaluate dietary issues and objective 5001.08.2025tests to formulate an intervention plan focused on a return to work goal. 5001.08.2025Prior approval required before providing service. Services must be provided by 5001.08.2025a person with a tertiary degree in dietetics. 100030019801.08.2025 H Y Y 2001.08.202500060.0000000.0000000.00 5001.08.2025PERSONAL CARE ASSISTANCE - Prior approval is required before providing this 5001.08.2025service - generally a limited service. May need an Occupational Therapist 5001.08.2025Assessment. Provided through an agency - includes services for injury/wound 5001.08.2025care, personal hygiene and grooming etc. where the worker is living at home 5001.08.2025and has been assessed as incapable (for physical, cognitive or emotional 5001.08.2025reasons) of undertaking these tasks and has no family or other social support 5001.08.2025network. Day rate: $56 per hour. Weekend rate: $80 per hour. 100030020001.08.2025 H Y Y 2001.08.202500053.0000000.0000000.00 5001.08.2025DIVERSIONAL THERAPY PROGRAM - Prior approval is required before providing this 5001.08.2025service Services to be provided by a diversional therapist at a nursing home 5001.08.2025including therapeutic activities. Services must be provided by a person with a 5001.08.2025minimum of an Associate Diploma in Diversional Therapy. The service should 5001.08.2025only be used under the supervision of an occupational therapist, who has 5001.08.2025recommended therapeutic activities as part of the overall treatment program. 100030020101.08.2025 H Y Y 2001.08.202500056.0000000.0000000.00 5001.08.2025DOMESTIC ASSISTANCE - HOME CARE SERVICES - Prior approval is required before 5001.08.2025providing this service Provided through an agency - includes cleaning, 5001.08.2025shopping and washing etc. where the worker is living at home and has been 5001.08.2025assessed by an occupational therapist as incapable of undertaking these tasks 5001.08.2025(for physical, cognitive or emotional reasons) of undertaking these tasks, and 5001.08.2025has no family or other social support network. Usually limited timeframe of 5001.08.2025delivery. Note: weekend and public holiday rates may be negotiated with the 5001.08.2025insurer. - Attendant care and support services are generally services to help 5001.08.2025a worker with serious injuries and complex injuries to participate with 5001.08.2025everyday tasks. 100030020201.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025LITERACY SKILLS - Prior approval is required before providing this service 5001.08.2025Private tutoring by a qualified tutor to improve literacy skills for job 5001.08.2025placement prospects. Program should be limited to achieving a base level of 5001.08.2025competency up to four (4) to six (6) weeks. Typically, literacy services are 5001.08.2025provided through the local TAFE or appropriately qualified private literacy 5001.08.2025services. 100030021001.08.2025 O Y Y 2001.08.202500037.0000000.0000000.00 5001.08.2025RTW COMMUNICATION - 3 TO 10 MINS - Communication by a RTW Services provider 5001.08.2025who has received a referral from an insurer for the following services: 5001.08.2025worksite assessment/evaluation development of suitable duties program or 5001.08.2025updated program monitoring of suitable duties programs communication with 5001.08.2025relevant stakeholders about a worker's progress or issues related to an 5001.08.2025existing suitable duties program functional capacity evaluation vocational 5001.08.2025assessment job seeking, job preparation or job placement services. Direct 5001.08.2025communication between a RTW Services provider and the following: insurer 5001.08.2025employer worker insurer referred providers; and treating providers to assist 5001.08.2025with faster, more effective rehabilitation and return to work for a worker. 5001.08.2025Refer to the exclusions listed below these tables before using this item 5001.08.2025number. For WorkCover Queensland claims, only an approved RTW Services 5001.08.2025provider can provide this service.** 100030021101.08.2025 O Y Y 2001.08.202500075.0000000.0000000.00 5001.08.2025RTW COMMUNICATION - 11 TO 20 MINS - Communication by a RTW Services provider 5001.08.2025who has received a referral from an insurer for the following services: 5001.08.2025worksite assessment/evaluation development of suitable duties program or 5001.08.2025updated program monitoring of suitable duties programs communication with 5001.08.2025relevant stakeholders about a worker's progress or issues related to an 5001.08.2025existing suitable duties program functional capacity evaluation vocational 5001.08.2025assessment job seeking, job preparation or job placement services. Direct 5001.08.2025communication between a RTW Services provider and the following: insurer 5001.08.2025employer worker insurer referred providers; and treating providers to assist 5001.08.2025with faster, more effective rehabilitation and return to work for a worker. 5001.08.2025Must be more than ten (10) minutes. Refer to the exclusions listed below these 5001.08.2025tables before using this item number. For WorkCover Queensland claims, only an 5001.08.2025approved RTW Services provider can provide this service.** 100030021201.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025JOB PLACEMENT SERVICES - NEW EMPLOYER* - The process of actively sourcing and 5001.08.2025placing a worker in a host placement or for WorkCover also includes placing a 5001.08.2025worker in a Recover at Work program with a view to a durable return to work 5001.08.2025outcome. Also includes seeking new employment with/for the worker. Includes 5001.08.2025employer and worker liaison, job application and coaching. For WorkCover 5001.08.2025Queensland claims, only an approved RTW Services provider can provide this 5001.08.2025service.** 100030021301.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025JOB PREPARATION SERVICES - WORK HARDENING PROGRAM* - The process of actively 5001.08.2025sourcing and placing a worker in a host placement or for WorkCover also 5001.08.2025includes placing a worker in a Recover at Work program where the worker has a 5001.08.2025job to return to. Includes employer and worker liaison, job application and 5001.08.2025coaching. For WorkCover Queensland claims, only an approved RTW Services 5001.08.2025provider can provide this service.** 100030022801.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025GYM AND POOL ENTRY FEES - Prior approval is required before providing this 5001.08.2025service. The insurer may request justification and will consider seeking a 5001.08.2025second opinion if more than three (3) months facility membership is requested 5001.08.2025per episode of care. Entry fee for the worker to attend a gym or pool for 5001.08.2025assessment and treatment (up to a maximum three-month membership). Entry fees 5001.08.2025will be paid for the worker, only where the facility is not owned or operated 5001.08.2025by the provider, their employer, or where either party contracts their 5001.08.2025services to the facility. Entry fees will not be paid for providers. A 5001.08.2025Provider Management Plan3 (PMP) is expected to be submitted for approval 5001.08.2025before any treatment commences. The PMP should include a comprehensive 5001.08.2025treatment plan containing: expected functional gains, transition of care to 5001.08.2025self-management; and treatment timeframes. The provider is then expected to 5001.08.2025submit Provider Management Plan (PMP) for approval before any treatment 5001.08.2025commences. 100030028501.08.2025 H Y Y 2001.08.202500250.0000000.0000000.00 5001.08.2025ADJUSTMENT COUNSELLING - SUBSEQUENT CONSULTATION - A one-on-one subsequent 5001.08.2025consultation for ongoing treatment of work-related components of presenting 5001.08.2025adjustment to injury issues; intervention would be based on treatment 5001.08.2025formulated from the initial consultation (300188). The first six (6) hours 5001.08.2025(including initial consultation) are pre-approved, provided this issue has not 5001.08.2025previously been treated by an allied health provider, with a maximum of one 5001.08.2025(1) hours on any one day. If additional treatment is required, submit a 5001.08.2025Provider Management Plan (PMP). Subsequent consultation may include: ongoing 5001.08.2025assessment, intervention/treatment, setting expectations of recovery and 5001.08.2025return to work, clinical recording, communication with the insurer of any 5001.08.2025relevant information for the workers rehabilitation. Maximum one (1) hour on 5001.08.2025any one day. 100030029501.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025EXTERNAL CASE MANAGEMENT - Includes an initial needs assessment and report; 5001.08.2025should outline a case management plan indicating the goals of the program, 5001.08.2025services required, timeframes and costs. Insurer request only. 100030030901.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025AMBULANCE TRANSPORT - NON QAS - INITIAL TRANSPORTATION - Transport provided 5001.08.2025immediately after the work-related injury or condition is sustained. 100030031001.08.2025 O Y Y 2001.08.202500000.0000000.0000000.00 5001.08.2025AMBULANCE TRANSPORT - NON QAS - SUBSEQUENT TRANSPORTATION - Subsequent 5001.08.2025transport must be certified in writing by a doctor as necessary because of the 5001.08.2025worker's physical condition resulting from a work-related injury or condition. 100030040101.08.2025 O Y Y 2001.08.202500056.0000000.0000000.00 5001.08.2025GROUP EXERCISE SESSIONS - Prior approval is required before providing this 5001.08.2025service. A group session where a common exercise programs is delivered to more 5001.08.2025than one individual at the same time. The group can consist of a maximum of 5001.08.2025eight (8) persons. The group session must be attended, conducted, and 5001.08.2025supervised by an exercise physiologist. 100030041301.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025WORKPLACE FACILITATED DISCUSSIONS - Workplace facilitated discussion is a 5001.08.2025meeting conducted by a return-to-work services provider to resolve significant 5001.08.2025barriers in the workplace and support workers and employers in their 5001.08.2025return-to-work efforts. This includes: Engaging in discussions in a supported 5001.08.2025environment, identifying an appropriate Suitable Duties or Return to Work 5001.08.2025(RTW) plan for recovery at work, assisting the worker to reach a workable 5001.08.2025agreement for recovery at work, assisting employers in identifying suitable 5001.08.2025duties through discussions, resolving issues raised by the worker and/or the 5001.08.2025employer, resetting expectations of involved parties. For WorkCover Queensland 5001.08.2025claims, only an approved, suitably qualified, and accredited RTW Services 5001.08.2025provider can provide this service. 100040008801.08.2025 H Y Y 2001.08.202500267.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION- PSYCHOLOGIST ONLY - The initial consultation in the 5001.08.2025treatment of possible psychological, social, cognitive, emotional, and 5001.08.2025behavioural problems occurring after a work-related injury or condition. The 5001.08.2025purpose of the assessment is to identify appropriate interventions/treatments 5001.08.2025to optimise rehabilitation outcomes (maximum two (2) hours direct contact and 5001.08.2025test scoring time). Services to be conducted in accordance with the Clinical 5001.08.2025Framework for the Delivery of Health Services. Initial consultation may 5001.08.2025include: history taking assessment diagnostic formulation treatment/service 5001.08.2025tailored goal setting and treatment planning setting expectations of recovery 5001.08.2025and return to work clinical recording communication with the insurer of any 5001.08.2025relevant information for the workers rehabilitation. 100040009101.08.2025 H Y Y 2001.08.202500267.0000000.0000000.00 5001.08.2025NEUROPSYCHOLOGICAL ASSESSMENT - An assessment to clarify the presence of 5001.08.2025possible acquired brain injury or brain dysfunction where possible 5001.08.2025psychological, social, cognitive, emotional, and behavioural problems are 5001.08.2025occurring after a work-related injury or condition (four to five (4-5) hours 5001.08.2025direct contact and test scoring time). This does not include a report. Prior 5001.08.2025approval required for this assessment. 100040009501.08.2025 H Y Y 2001.08.202500267.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - PSYCHOLOGIST ONLY - A one-on-one subsequent 5001.08.2025consultation with the worker in the ongoing management and treatment of their 5001.08.2025work-related psychological issues. Intervention is based on treatment 5001.08.2025formulated in the initial consultation.The first six (6) hours (including 5001.08.2025initial consultation) are preapproved provided this condition has not 5001.08.2025previously been treated by an allied health provider. If additional treatment 5001.08.2025is required, submit a Provider Management Plan (PMP). Max two (2) hours on any 5001.08.2025one day. 100040010101.08.2025 H Y Y 2001.08.202500197.0000000.0000000.00 5001.08.2025INITIAL ASSESSMENT COUNSELLING SERVICES ONLY - A one-on-one initial 5001.08.2025consultation where possible psychological, social, cognitive, emotional, and 5001.08.2025behavioural problems are occurring after a work-related injury or condition. 5001.08.2025The purpose of the assessment is to identify appropriate 5001.08.2025interventions/treatments to optimise rehabilitation outcomes (maximum two (2) 5001.08.2025hours direct contact and test scoring time). Services to be conducted in 5001.08.2025accordance with the Clinical Framework for the Delivery of Health Services. 5001.08.2025Initial consultation may include: history taking assessment diagnostic 5001.08.2025formulation treatment/service tailored goal setting and treatment planning 5001.08.2025setting expectations of recovery and return to work clinical recording 5001.08.2025communication with the insurer of any relevant information for the workers 5001.08.2025rehabilitation. 100040010201.08.2025 H Y Y 2001.08.202500197.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION COUNSELLING SERVICES ONLY - A one-on-one subsequent 5001.08.2025consultation with the worker in their ongoing management and treatment. 5001.08.2025Intervention is based on treatment formulated in the initial consultation. The 5001.08.2025first six (6) hours (including initial consultation) are pre-approved, 5001.08.2025provided this issue has not previously been treated by an allied health 5001.08.2025provider. If additional treatment is required, submit a Provider Management 5001.08.2025Plan (PMP). Subsequent consultation may include: ongoing assessment, 5001.08.2025intervention/treatment, setting expectations of recovery and return to work 5001.08.2025clinical recording, communication with the insurer of any relevant information 5001.08.2025for the workers rehabilitation.Maximum one (1) hour on any one day. 100040018401.08.2025 H Y Y 2001.08.202500267.0000000.0000000.00 5001.08.2025CRITICAL INCIDENT DEBRIEFING SESSIONS - A process where, following exposure to 5001.08.2025a critical incident, an individual or group of workers are debriefed by a 5001.08.2025psychologist to assist them to deal more effectively with their experience. 5001.08.2025Approval required after the first two (2) pre-approved sessions. 100040022601.08.2025 H Y Y 2001.08.202500278.0000000.0000000.00 5001.08.2025INDEPENDENT CASE REVIEW - An independent psychologist examination and report 5001.08.2025of a worker (not by the treating psychologist). Only provided following a 5001.08.2025request from the insurer. The review is requested by the insurer where 5001.08.2025progress of treatment and/or rehabilitation falls outside the plan or expected 5001.08.2025course of injury management. The examination and report provide the insurer 5001.08.2025with an assessment and recommendations for ongoing treatment and prognosis. 100050000601.08.2025 O Y Y 2001.08.202500104.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the 5001.08.2025treatment of work-related injuries or conditions. The first five (5) 5001.08.2025consultations (including initial consultation) are pre-approved, provided the 5001.08.2025injuries or conditions have not previously been treated by an allied health 5001.08.2025provider. If additional treatment is required, submit a Provider Management 5001.08.2025Plan (PMP). Subsequent consultation may include: ongoing assessment 5001.08.2025(subjective and objective), intervention/treatment, setting expectations of 5001.08.2025recovery and return to work, clinical recording, communication with the 5001.08.2025insurer of any relevant information for the workers rehabilitation. 100050002101.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of 5001.08.2025work-related injuries or conditions, or the first consultation in a new 5001.08.2025episode of care for the same work-related injuries or conditions. Services to 5001.08.2025be conducted in accordance with the Clinical Framework for the Delivery of 5001.08.2025Health Services. Initial consultation may include: subjective assessment 5001.08.2025objective assessment treatment/service tailored goal setting and treatment 5001.08.2025planning setting expectations of recovery and return to work clinical 5001.08.2025recording communication with the insurer of any relevant information for the 5001.08.2025workers rehabilitation. 100050005501.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025REASSESSMENT OR PROGRAM REVIEW - A one-on-one comprehensive assessment used 5001.08.2025when: the worker has been in active rehabilitation for at least six (6) weeks 5001.08.2025and further treatment is likely and/or, there are new clinical findings that 5001.08.2025might affect ongoing treatment and/or, there is a rapid change in worker's 5001.08.2025status and/or, there is no response to current therapeutic interventions. It 5001.08.2025should include: all components of initial consultation, a review of the 5001.08.2025workers progress based on established objective measures, a recommendation for 5001.08.2025future treatment and management strategies to assist the worker to return to 5001.08.2025work. It may include referral recommendations to other providers, a change in 5001.08.2025therapy or outcome direction requiring a new return to work goal. Following 5001.08.2025reassessment submit a Provider Management Plan (PMP). Please note: A provider 5001.08.2025cannot bill for multiple initial consultations or multiple subsequent 5001.08.2025consultations for the same injured worker on the same day. 100050022601.08.2025 H Y Y 2001.08.202500279.0000000.0000000.00 5001.08.2025INDEPENDENT CASE REVIEW - An independent chiropractic examination and report 5001.08.2025on a worker and is not carried out by the treating chiropractor. The review is 5001.08.2025requested by the insurer where progress of treatment and/or rehabilitation 5001.08.2025falls outside the plan or expected course of injury management. The 5001.08.2025examination and report provide the insurer with an assessment and 5001.08.2025recommendations for ongoing treatment and prognosis. 100055810001.08.2025 O Y Y 2001.08.202500141.0000000.0000000.00 5001.08.2025X-RAY - CERVICAL SPINE - X-Ray - Cervical Spine. Must be clinically 5001.08.2025justifiable. 100055810301.08.2025 O Y Y 2001.08.202500116.0000000.0000000.00 5001.08.2025X-RAY - THORACIC SPINE - X-Ray - Thoracic Spine. Must be clinically 5001.08.2025justifiable. 100055810601.08.2025 O Y Y 2001.08.202500162.0000000.0000000.00 5001.08.2025X-RAY - LUMBOSACRAL SPINE - X-Ray - Lumbosacral Spine. Must be clinically 5001.08.2025justifiable. 100055811201.08.2025 O Y Y 2001.08.202500204.0000000.0000000.00 5001.08.2025X-RAY - ANY TWO REGIONS OF THE SPINE - X-Ray - Any two regions of the spine. 5001.08.2025Must be clinically justifiable. 100055811501.08.2025 O Y Y 2001.08.202500231.0000000.0000000.00 5001.08.2025X-RAY - ANY THREE REGIONS OF THE SPINE - X-Ray - Any three regions of the 5001.08.2025spine. Must be clinically justifiable. 100060001501.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of 5001.08.2025work-related injuries or conditions, or the first consultation in a new 5001.08.2025episode of care for the same work-related injuries or conditions. Services to 5001.08.2025be conducted in accordance with the Clinical Framework for the Delivery of 5001.08.2025Health Services. Initial consultation may include: subjective assessment 5001.08.2025objective assessment treatment/service tailored goal setting and treatment 5001.08.2025planning setting expectations of recovery and return to work clinical 5001.08.2025recording communication (with referrer) any relevant information for the 5001.08.2025workers rehabilitation to the insurer. 100060001601.08.2025 O Y Y 2001.08.202500104.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the 5001.08.2025treatment of work-related injuries or conditions. The first five (5) 5001.08.2025consultations (including initial consultation) are pre-approved, provided the 5001.08.2025injury has not previously been treated by an allied health provider.If 5001.08.2025additional treatment is required, the provider is expected to submit a 5001.08.2025Provider Management Plan (PMP). Subsequent consultation may include: ongoing 5001.08.2025assessment (subjective and objective) intervention/treatment setting 5001.08.2025expectations of recovery and return to work clinical recording communication 5001.08.2025with the insurer of any relevant information for the workers rehabilitation. 100060005501.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025REASSESSMENT OR PROGRAM REVIEW - A one-on-one comprehensive assessment used 5001.08.2025when: the worker has been in active rehabilitation for at least six (6) weeks 5001.08.2025and further treatment is likely, there are new clinical findings that might 5001.08.2025affect ongoing treatment, there is a rapid change in worker's status, there is 5001.08.2025no response to current therapeutic interventions. It should include: all 5001.08.2025components of initial consultation, a review of the workers progress based on 5001.08.2025established objective measures, a recommendation for future treatment and 5001.08.2025management strategies to assist the worker to return to work. It may include 5001.08.2025referral recommendations to other providers, a change in therapy or outcome 5001.08.2025direction requiring a new return to work goal. Following reassessment, submit 5001.08.2025a Provider Management Plan (PMP). 100060017001.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SPECIFIC OCCUPATIONAL THERAPY ASSESSMENT - Prior approval is required before 5001.08.2025providing this service and justification may be requested by the insurer. A 5001.08.2025one-on-one assessment used for assessing specific conditions that cannot be 5001.08.2025adequately assessed, due to the complexity of the condition, within an initial 5001.08.2025consultation 600015. These may include, but are not limited to: extensive 5001.08.2025burns, acquired brain injuries severe spinal cord injuries, multiple 5001.08.2025orthopaedic fractures, limb amputations, crush injuries. This service can also 5001.08.2025be used for the assessment (only) of suitability for entry into a 5001.08.2025Multi-Disciplinary Program or Pain Management Program.The service may only be 5001.08.2025used once by the occupational therapist in the treatment of a work-related 5001.08.2025injury or condition, or the first consultation in a new episode of care for 5001.08.2025the same work-related injury or condition. Maximum one (1) hour. 100060022601.08.2025 H Y Y 2001.08.202500278.0000000.0000000.00 5001.08.2025INDEPENDENT CASE REVIEW - An independent occupational therapist examination 5001.08.2025and report on a worker and is not carried out by the treating occupational 5001.08.2025therapist. The review is requested by the insurer where progress of treatment 5001.08.2025and/or rehabilitation falls outside the plan or expected course of injury 5001.08.2025management. The examination and report provide the insurer with an assessment 5001.08.2025and recommendations for ongoing treatment and prognosis. 100060028701.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SPECIALISED HAND/UPPER LIMB THERAPY CONSULTATION- OCCUPATIONAL THERAPIST ONLY 5001.08.2025- A one-on-one consultation and treatment for workers with hand and upper limb 5001.08.2025work-related injuries or conditions (below shoulder level). Treatment offered 5001.08.2025is considered hand therapy provided by a qualified hand therapist. Further 5001.08.2025details about qualifications are provided below the tables. The first five (5) 5001.08.2025consultations (including the initial consultation) are pre-approved, provided 5001.08.2025the injury or condition has not previously been treated by an allied health 5001.08.2025provider. Maximum one (1) hour. Prior insurer approval is required for 5001.08.2025sessions exceeding one (1) hour. The provider will be required to provide 5001.08.2025clinical justification and reasoning for sessions exceeding one (1) hour 100060029201.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SPECIFIC OCCUPATIONAL THERAPY CONSULTATION - Prior approval is required before 5001.08.2025providing this service. The insurer may request justification and will 5001.08.2025consider seeking an independent opinion if more than six (6) consultations are 5001.08.2025requested per episode of care. A one-on-one consultation for recommended 5001.08.2025interventions identified during a Specific Occupational Therapist Assessment 5001.08.2025(600170). These may include, but are not limited to: extensive burns acquired 5001.08.2025brain injuries severe spinal cord injuries multiple orthopaedic fractures limb 5001.08.2025amputations crush injuries. Please note: This service is not to be used for 5001.08.2025ongoing consultations within a Multi-Disciplinary Program and/or Pain 5001.08.2025Management Program. This service must not be already classified elsewhere in 5001.08.2025this table of costs. A Provider Management Plan (PMP) is to be submitted 5001.08.2025following the initial assessment (600170). Maximum one (1) hour. 100070005101.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of 5001.08.2025work-related injuries or conditions, or the first consultation in a new 5001.08.2025episode of care for the same work-related injuries or conditions. Initial 5001.08.2025consultation may include: subjective assessment, objective assessment, 5001.08.2025treatment/service, tailored goal setting and treatment planning, setting 5001.08.2025expectations of recovery and return to work, clinical recording communication 5001.08.2025with the insurer of any relevant information for the workers 5001.08.2025rehabilitation.Maximum one (1) hour. 100070005301.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the 5001.08.2025treatment of work-related injuries or conditions. If additional treatment is 5001.08.2025required, the provider must submit a Provider Management Plan (PMP) after the 5001.08.2025initial consultation and before commencing any treatment consultations. The 5001.08.2025PMP should include a comprehensive treatment plan containing: expected 5001.08.2025functional gains, transition of care to self-management; and treatment 5001.08.2025timeframes. Subsequent consultation may include: ongoing assessment 5001.08.2025(subjective and objective) intervention/treatment setting expectations of 5001.08.2025recovery and return to work clinical recording communication with the insurer 5001.08.2025of any relevant information for the workers rehabilitation. Maximum one (1) 5001.08.2025hour. 100070022601.08.2025 H Y Y 2001.08.202500278.0000000.0000000.00 5001.08.2025INDEPENDENT CASE REVIEW - An independent speech pathologist examination and 5001.08.2025report on a worker and is not carried out by the treating speech pathologist. 5001.08.2025The review is requested by the insurer where progress of treatment and/or 5001.08.2025rehabilitation falls outside the plan or expected course of injury management. 5001.08.2025The examination and report provide the insurer with an assessment and 5001.08.2025recommendations for ongoing treatment and prognosis. 100080002801.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - A one-one-one initial consultation in the treatment of 5001.08.2025work-related injuries or conditions, or the first consultation in a new 5001.08.2025episode of care for the same work-related injuries or conditions. Services to 5001.08.2025be conducted in accordance with the Clinical Framework for the Delivery of 5001.08.2025Health Services. Initial consultation may include: subjective assessment 5001.08.2025objective assessment treatment/service tailored goal setting and treatment 5001.08.2025planning setting expectations of recovery and return to work clinical 5001.08.2025recording communication (with referrer) any relevant information for the 5001.08.2025workers rehabilitation to the insurer. 100080002901.08.2025 O Y Y 2001.08.202500104.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the 5001.08.2025treatment of work-related injuries or conditions. The first five (5) 5001.08.2025consultations (including initial consultation) are pre-approved, provided the 5001.08.2025injuries have not previously been treated by an allied health provider. If 5001.08.2025additional treatment is required, submit a Provider Management Plan (PMP). 5001.08.2025Subsequent consultation may include: ongoing assessment (subjective and 5001.08.2025objective), intervention/treatment, setting expectations of recovery and 5001.08.2025return to work, clinical recording, communication with the insurer of any 5001.08.2025relevant information for the workers rehabilitation. 100080003701.08.2025 O Y Y 2001.08.202500258.0000000.0000000.00 5001.08.2025ORTHOSES - Thermoplastic shell - Intrinsic fore/rearfoot post - single. Prior 5001.08.2025insurer approval is required. 100080003801.08.2025 O Y Y 2001.08.202500502.0000000.0000000.00 5001.08.2025ORTHOSES - Thermoplastic shell - Intrinsic fore/rearfoot post - pair. Prior 5001.08.2025approval from the insurer is required. 100080003901.08.2025 O Y Y 2001.08.202500043.0000000.0000000.00 5001.08.2025INSOLES - Plain - single. Prior insurer approval is required. 100080004001.08.2025 O Y Y 2001.08.202500078.0000000.0000000.00 5001.08.2025INSOLES - Plain - pair. Prior insurer approval is required. 100080004101.08.2025 O Y Y 2001.08.202500090.0000000.0000000.00 5001.08.2025INSOLES - Padded insole - single. Prior insurer approval is required. 100080004201.08.2025 O Y Y 2001.08.202500173.0000000.0000000.00 5001.08.2025INSOLES - Padded insole - pair. Prior insurer approval is required. 100080004301.08.2025 O Y Y 2001.08.202500220.0000000.0000000.00 5001.08.2025INSOLES - Balance inlay - single custom. Prior insurer approval is required. 100080004401.08.2025 O Y Y 2001.08.202500418.0000000.0000000.00 5001.08.2025INSOLES - Balance inlay - pair custom. Prior insurer approval is required. 100080004501.08.2025 O Y Y 2001.08.202500151.0000000.0000000.00 5001.08.2025INSOLES - Balance inlay - Thermo non-cast single. Prior insurer approval is 5001.08.2025required. 100080004601.08.2025 O Y Y 2001.08.202500241.0000000.0000000.00 5001.08.2025INSOLES - Balance inlay - Thermo non-cast pair. Prior insurer approval is 5001.08.2025required. 100080004701.08.2025 O Y Y 2001.08.202500037.0000000.0000000.00 5001.08.2025ORTHOSES - Heel lift - single. Prior insurer approval is required. 100080004801.08.2025 O Y Y 2001.08.202500034.0000000.0000000.00 5001.08.2025ORTHOSES - Extrinsic fore/rear foot post - single. Prior approval from the 5001.08.2025insurer is required. 100080004901.08.2025 O Y Y 2001.08.202500103.0000000.0000000.00 5001.08.2025CAST - Negative impression- single. Prior insurer approval is required. 100080005001.08.2025 O Y Y 2001.08.202500142.0000000.0000000.00 5001.08.2025CAST - Negative impression - pair. Prior insurer approval is required. 100080008401.08.2025 O Y Y 2001.08.202500082.0000000.0000000.00 5001.08.2025INSOLES - Soft tissue supplement - pair. Prior insurer approval is required. 100080022601.08.2025 H Y Y 2001.08.202500278.0000000.0000000.00 5001.08.2025INDEPENDENT CASE REVIEW - This is an independent podiatrist examination and 5001.08.2025report on a worker and is not carried out by the treating podiatrist. The 5001.08.2025review is requested by the insurer where progress of treatment and/or 5001.08.2025rehabilitation falls outside the plan or expected course of injury management. 5001.08.2025The examination and report provide the insurer with an assessment and 5001.08.2025recommendations for ongoing treatment and prognosis. 100080023201.08.2025 O Y Y 2001.08.202500065.0000000.0000000.00 5001.08.2025ORTHOSES - Extrinsic fore/rear foot post - pair. Prior insurer approval is 5001.08.2025required. 100080028301.08.2025 O Y Y 2001.08.202500044.0000000.0000000.00 5001.08.2025INSOLES - Covers - plain. Prior insurer approval is required. 100080028401.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025NAIL REMOVAL - Nail removal under local anaesthetic. Prior insurer approval is 5001.08.2025required. 100090000601.08.2025 O Y Y 2001.08.202500104.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the 5001.08.2025treatment of work-related injuries or conditions. The first five (5) 5001.08.2025consultations (including initial consultation) are pre-approved, provided the 5001.08.2025injuries or conditions have not previously been treated by an allied health 5001.08.2025provider. If additional treatment is required, submit a Provider Management 5001.08.2025Plan (PMP). Subsequent consultation may include: ongoing assessment 5001.08.2025(subjective and objective) intervention/treatment setting expectations of 5001.08.2025recovery and return to work clinical recording communication with the insurer 5001.08.2025of any relevant information for the workers rehabilitation. 100090002101.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of 5001.08.2025work-related injuries or conditions, or the first consultation in a new 5001.08.2025episode of care for the same work-related injuries or conditions. Services to 5001.08.2025be conducted in accordance with the Clinical Framework for the Delivery of 5001.08.2025Health Services. Initial consultation may include: subjective assessment 5001.08.2025objective assessment treatment/service tailored goal setting and treatment 5001.08.2025planning setting expectations of recovery and return to work clinical 5001.08.2025recording communication (with referrer) any relevant information for the 5001.08.2025workers rehabilitation to the insurer. 100090005501.08.2025 O Y Y 2001.08.202500132.0000000.0000000.00 5001.08.2025REASSESSMENT OR PROGRAM REVIEW - A one-one-one comprehensive assessment used 5001.08.2025when: the worker has been in active rehabilitation for at least six weeks and 5001.08.2025further treatment is likely; and/or there are new clinical findings that might 5001.08.2025affect ongoing treatment; and/or there is a rapid change in worker's status 5001.08.2025and/or there is no response to current therapeutic interventions. It should 5001.08.2025include: all components of initial consultation a review of the workers 5001.08.2025progress based on established objective measures a recommendation for future 5001.08.2025treatment and management strategies to assist the worker to return to work. It 5001.08.2025may include referral recommendations to other providers, a change in therapy 5001.08.2025or outcome direction requiring a new return to work goal. Following 5001.08.2025reassessment submit a Provider Management Plan3 (PMP) which should include an 5001.08.2025updated comprehensive treatment plan containing: expected functional gains, 5001.08.2025transition of care to self-management; and treatment timeframes. 100090022601.08.2025 H Y Y 2001.08.202500278.0000000.0000000.00 5001.08.2025INDEPENDENT CASE REVIEW - An independent osteopathy examination and report on 5001.08.2025a worker and is not carried out by the treating osteopath. The review is 5001.08.2025requested by the insurer where progress of treatment and/or rehabilitation 5001.08.2025falls outside the plan or expected course of injury management. The 5001.08.2025examination and report provide the insurer with an assessment and 5001.08.2025recommendations for ongoing treatment and prognosis. 100100023501.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION MENTAL HEALTH OCCUPATIONAL THERAPIST SERVICES - A 5001.08.2025one-on-one initial consultation for the treatment of possible psychological, 5001.08.2025social, cognitive, emotional, and behavioural problems occurring after a 5001.08.2025work-related injury or condition. The purpose of the consultation is to 5001.08.2025identify appropriate interventions/treatments to optimise rehabilitation 5001.08.2025outcomes (maximum two (2) hours direct contact and test scoring time). Initial 5001.08.2025consultation may include: history taking, assessment, diagnostic formulation, 5001.08.2025treatment/service, tailored goal setting and treatment planning, setting 5001.08.2025expectations of recovery and return to work, clinical recording, communication 5001.08.2025with the insurer of any relevant information for the workers rehabilitation. 5001.08.2025Please note: A provider cannot bill for multiple initial consultations or 5001.08.2025multiple subsequent consultations for the same injured worker on the same day. 100100023601.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION MENTAL HEALTH OCCUPATIONAL THERAPIST - A one-on-one 5001.08.2025subsequent consultation with the worker in the ongoing management and 5001.08.2025treatment of their work-related psychological issues. Intervention is based on 5001.08.2025treatment formulated in the initial consultation (1000235). The first six (6) 5001.08.2025hours (including initial consultation) are pre-approved provided this 5001.08.2025condition has not previously been treated by an allied health provider. If 5001.08.2025additional treatment is required, submit a Provider Management Plan (PMP). 5001.08.2025Subsequent consultation may include: ongoing assessment, 5001.08.2025intervention/treatment, setting expectations of recovery and return to work, 5001.08.2025clinical recording, communication with the insurer of any relevant information 5001.08.2025for the workers rehabilitation. Please note: A provider cannot bill for 5001.08.2025multiple initial consultations or multiple subsequent consultations for the 5001.08.2025same injured worker on the same day. Maximum one (1) hour on any one day. 100100023801.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025COMPREHENSIVE REPORT (ITEM CODE FOR PSYCHOLOGY ONLY) - A comprehensive 5001.08.2025psychological report prepared to assess diagnostic clarification, workplace 5001.08.2025functioning, or educational needs.Maximum billable hours: 35 hours.Reports 5001.08.2025must be provided within 10 business days of the insurers request.This report 5001.08.2025is only to be prepared at the request of the insurer. 100100023901.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025INITIAL NEEDS ASSESSMENT (INA) AND REPORT - Max 2-4 hrs. Assessment with a 5001.08.2025worker completed prior to commencement of return to work services to establish 5001.08.2025injuries and formulate recovery process and develop goals for return to work 5001.08.2025and/or reengagement with workplace based on expectation from all parties. 5001.08.2025Includes worksite assessment, interview with the employer and worker and 5001.08.2025liaison with relevant treating medical/allied health providers. Includes 5001.08.2025report. Assists with claims with complex diagnosis, secondary diagnosis or 5001.08.2025flags raised by worker and/or employer. Leads to development of rehabilitation 5001.08.2025program for return to work outcomes. For WorkCover Queensland claims, only an 5001.08.2025approved RTW Services provider can provide this service.** 100100024001.08.2025 H Y Y 2001.08.202500223.0000000.0000000.00 5001.08.2025PSYCHOLOGICAL FUNCTIONAL CAPACITY EVALUATION (PFCE) - Max 3-5 hrs. Assessment 5001.08.2025of a workers capacity to perform cognitive tasks, offering a baseline 5001.08.2025measurement of current symptoms and fitness for work. Determines capacity for 5001.08.2025return to work program, assists in graduation of duties in psychological 5001.08.2025claims or where cognitive deficits are identified by treating team. Assists 5001.08.2025with claims with delayed return to work in psychological or 5001.08.2025significant/complex physical injury claims, secondary psychological claims, 5001.08.2025minimal progression in return to work capacity despite ongoing treatment For 5001.08.2025WorkCover Queensland claims, only an approved RTW Services provider can 5001.08.2025provide this service.** (Psychologists, Rehabilitation Counsellors and 5001.08.2025Occupational Therapists to perform this service. 100100024101.08.2025 H Y Y 2001.08.202500250.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION MENTAL HEALTH SOCIAL WORKER - A one-on-one initial 5001.08.2025consultation undertaken where possible to clarify the presence of possible 5001.08.2025adjustment to injury issues and set goals of therapy to optimise 5001.08.2025rehabilitation outcomes; performed where worker is displaying psychological, 5001.08.2025social, cognitive, emotional, and behavioural problems after a work-related 5001.08.2025incident or injury. The purpose of the consultation is to identify appropriate 5001.08.2025interventions/treatments to optimise rehabilitation outcomes. Services to be 5001.08.2025conducted in accordance with the Clinical Framework for the Delivery of Health 5001.08.2025Services. Initial consultation may include: history taking assessment 5001.08.2025diagnostic formulation treatment/service tailored goal setting and treatment 5001.08.2025planning setting expectations of recovery and return to work clinical 5001.08.2025recording communication with the insurer of any relevant information for the 5001.08.2025workers rehabilitation Maximum one (1) hour on any one day 100100024201.08.2025 H Y Y 2001.08.202500250.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION MENTAL HEALTH SOCIAL WORKER - A one-on-one subsequent 5001.08.2025consultation for ongoing treatment of work-related components of presenting 5001.08.2025adjustment to injury conditions; intervention would be based on treatment 5001.08.2025formulated from the initial consultation (1000241) The first six (6) hours 5001.08.2025(including initial consultation) are pre-approved provided this condition has 5001.08.2025not previously been treated by an allied health provider. If additional 5001.08.2025treatment is required, submit a Provider Management Plan (PMP). Subsequent 5001.08.2025consultation may include: ongoing assessment, intervention/treatment, setting 5001.08.2025expectations of recovery and return to work, clinical recording, communication 5001.08.2025with the insurer of any relevant information for the workers rehabilitation. 5001.08.2025Maximum one (1) hour on any one day. 100100024301.08.2025 H Y Y 2001.08.202500197.0000000.0000000.00 5001.08.2025INITIAL CONSULTATION PSYCHOTHERAPY SERVICES ONLY - Initial Consultation 5001.08.2025Psychotherapy Services Undertaken where possible psychological, social, 5001.08.2025cognitive, emotional, and behavioural problems are occurring after a 5001.08.2025work-related incident or injury. The purpose of the assessment is to identify 5001.08.2025appropriate interventions/treatments to optimise rehabilitation outcomes 5001.08.2025(maximum 2 hours direct contact and test scoring time). Services to be 5001.08.2025conducted in accordance with the Clinical Framework for the Delivery of Health 5001.08.2025Services. Initial consultation may include: History taking Assessment 5001.08.2025Diagnostic formulation Treatment/service Tailored goal setting and treatment 5001.08.2025planning Setting expectations of recovery and return to work Clinical 5001.08.2025recording Communication with referrer, insurer, and other relevant parties. 100100024401.08.2025 H Y Y 2001.08.202500197.0000000.0000000.00 5001.08.2025SUBSEQUENT CONSULTATION PSYCHOTHERAPY SERVICES ONLY - A one-on-one subsequent 5001.08.2025consultation with the worker in their ongoing management and treatment. 5001.08.2025Intervention is based on treatment formulated in the initial consultation. The 5001.08.2025first six (6) hours (including initial consultation) are pre-approved, 5001.08.2025provided this issue has not previously been treated by an allied health 5001.08.2025provider. If additional treatment is required, submit a Provider Management 5001.08.2025Plan (PMP). Subsequent consultation may include: ongoing assessment, 5001.08.2025intervention/treatment, setting expectations of recovery and return to work 5001.08.2025clinical recording, communication with the insurer of any relevant information 5001.08.2025for the workers rehabilitation. 100100024501.08.2025 H Y Y 2001.08.202500068.0000000.0000000.00 5001.08.2025ATTENDANT CARE STANDARD WEEKDAY- DAYTIME - Weekday Daytime Support is any 5001.08.2025support to a participant that starts at or after 6:00 am and ends before or at 5001.08.20258:00 pm on a single weekday (unless it is a Public Holiday or Night-time 5001.08.2025Sleepover Support). - Attendant care and support services are generally 5001.08.2025services to help a worker with serious injuries and complex injuries to 5001.08.2025participate with everyday tasks. - Please Note: Prior approval required before 5001.08.2025approving these services. Prior approval required before approving this 5001.08.2025service. 100100024601.08.2025 H Y Y 2001.08.202500074.0000000.0000000.00 5001.08.2025ATTENDANT CARE -STANDARD - WEEKDAY EVENING - Weekday Evening Support is any 5001.08.2025support to a participant that starts after 8:00 pm and finishes at or before 5001.08.2025midnight on a single weekday (unless it is a Public Holiday or Night-time 5001.08.2025Sleepover Support). - Attendant care and support services are generally 5001.08.2025services to help a worker with serious injuries and complex injuries to 5001.08.2025participate with everyday tasks. - Please Note: Prior approval required before 5001.08.2025approving these services. 100100024701.08.2025 H Y Y 2001.08.202500075.0000000.0000000.00 5001.08.2025ATTENDANT CARE - STANDARD - WEEKDAY NIGHT - Weekday Night Support is any 5001.08.2025support to a participant that commences at or before midnight on a weekday and 5001.08.2025finishes after midnight on that weekday or commences before 6:00 am on a 5001.08.2025weekday and finishes on that weekday (unless it is a Public Holiday, Saturday, 5001.08.2025Sunday, or Night-time Sleepover Support). - Attendant care and support 5001.08.2025services are generally services to help a worker with serious injuries and 5001.08.2025complex injuries to participate with everyday tasks. - Please Note: Prior 5001.08.2025approval required before approving these services. 100100024801.08.2025 H Y Y 2001.08.202500094.0000000.0000000.00 5001.08.2025ATTENDANT CARE - STANDARD - SATURDAY - Saturday Support is any support to a 5001.08.2025participant that starts at or after midnight on the night prior to a Saturday 5001.08.2025and ends before or at midnight of that Saturday (unless it is a Public Holiday 5001.08.2025or Night-time Sleepover Support). - Attendant care and support services are 5001.08.2025generally services to help a worker with serious injuries and complex injuries 5001.08.2025to participate with everyday tasks. - Please Note: Prior approval required 5001.08.2025before approving these services. 100100024901.08.2025 H Y Y 2001.08.202500121.0000000.0000000.00 5001.08.2025ATTENDANT CARE - STANDARD - SUNDAY - Sunday Support is any support to a 5001.08.2025participant that starts at or after midnight on the night prior to a Sunday 5001.08.2025and ends before or at midnight of that Sunday (unless it is a Public Holiday 5001.08.2025or Night-time Sleepover Support). - Attendant care and support services are 5001.08.2025generally services to help a worker with serious injuries and complex injuries 5001.08.2025to participate with everyday tasks. - Please Note: Prior approval required 5001.08.2025before approving these services. 100100025001.08.2025 H Y Y 2001.08.202500149.0000000.0000000.00 5001.08.2025ATTENDANT CARE - STANDARD - PUBLIC HOLIDAY - Public Holiday Support is any 5001.08.2025support to a participant that starts at or after midnight on the night prior 5001.08.2025to a Public Holiday and ends before or at midnight of that Public Holiday 5001.08.2025(unless it is a Night-time Sleepover Support). - Attendant care and support 5001.08.2025services are generally services to help a worker with serious injuries and 5001.08.2025complex injuries to participate with everyday tasks. - Please Note: Prior 5001.08.2025approval required before approving these services. 100100025101.08.2025 O Y Y 2001.08.202500279.0000000.0000000.00 5001.08.2025ATTENDANT CARE - ASSISTANCE WITH SELF-CARE ACTIVITIES - NIGHT-TIME SLEEPOVER - 5001.08.2025Night-time Sleepover Support is any support to a participant delivered on a 5001.08.2025weekday, a Saturday, a Sunday, or a Public Holiday that: o Commences before 5001.08.2025midnight on a day and finishes after midnight on that day; and o Is for a 5001.08.2025continuous period of eight (8) hours or more; and o The worker is allowed to 5001.08.2025sleep when they are not providing support. - Attendant care and support 5001.08.2025services are generally services to help a worker with serious injuries and 5001.08.2025complex injuries to participate with everyday tasks. - Please Note: Prior 5001.08.2025approval required before approving these services. 100100025201.08.2025 O Y Y 2001.08.202501389.0000000.0000000.00 5001.08.2025ATTENDANT CARE PROGRAM ESTABLISHMENT FEE - Establishment fee- One off set up 5001.08.2025fee for complex attendant care program of ongoing support services. (Where 5001.08.2025more than 20hrs of care per week is required for more than 3 months). 100100025301.08.2025 H Y Y 2001.08.202500056.0000000.0000000.00 5001.08.2025GARDEN MAINTENANCE - HOME CARE SERVICES - Provided through an agency - 5001.08.2025includes basic gardening assistance. where the worker is living at home and 5001.08.2025has been assessed by an occupational therapist as incapable of undertaking 5001.08.2025these tasks (for physical, cognitive, or emotional reasons) of undertaking 5001.08.2025these tasks, and Note: Prior approval is required before providing this 5001.08.2025service NOTE: Yard maintenance (lawn mowing, light pruning, and rubbish 5001.08.2025removal) is limited to work ordinarily required for an average residence and 5001.08.2025excludes excessive or high frequency maintenance work. See further information 5001.08.2025below has no family or other social support network. 100100025401.08.2025 H Y Y 2001.08.202500056.0000000.0000000.00 5001.08.2025HOME MAINTENANCE- HOME CARE SERVICES - Provided through an agency - includes 5001.08.2025basic home maintenance. where the worker is living at home and has been 5001.08.2025assessed by an occupational therapist as incapable of undertaking these tasks 5001.08.2025(for physical, cognitive, or emotional reasons) of undertaking these tasks, 5001.08.2025and has no family or other social support network. Prior approval is required 5001.08.2025before providing this service Note: Home and garden maintenance services 5001.08.2025exclude services or works that are ordinarily undertaken by a skilled 5001.08.2025tradesperson (for example carpentry services for home repairs, painting 5001.08.2025services, electrical and plumbing services, roofing repair services). See 5001.08.2025Further information below. 100100025501.08.2025 O Y Y 2001.08.202500032.0000000.0000000.00 5001.08.2025BASIC DRESSING PACK SIMPLE - Basic wound dressings e.g. Primapore Opsite 5001.08.2025Mepilex lite Melolite Hypafix Steri-strips transparent Opsite Simple 5001.08.2025post-operative wound dressings Disposable Wound Management Kit Sterile field 5001.08.2025(sterile pack incl. gauze) Sterile instruments (scissors and tweezers) Stitch 5001.08.2025cutters (for suture removal) Saline solution (for wound irrigation) Peroxide 5001.08.2025Betadine Chlorohexidine (for wound irrigation) 100100025601.08.2025 O Y Y 2001.08.202500053.0000000.0000000.00 5001.08.2025BASIC DRESSING PACK COMPLEX - Complex wound dressings Multiple basic wound 5001.08.2025dressings e.g. Primapore Opsite Mepilex lite Mepitel Mepilex border lite 5001.08.2025Melolite Hypafix Steri-strips transparent Opsite Crepe bandaging Multiple 5001.08.2025wounds, infected wounds, specialised dressings, wounds requiring healing with 5001.08.2025secondary intention Disposable Wound Management Kit Sterile field (sterile 5001.08.2025pack incl. gauze) Sterile instruments (scissors and tweezers) Stitch cutters 5001.08.2025(for suture removal) Saline solution (for wound irrigation) Peroxide Betadine 5001.08.2025Chlorohexidine (for wound irrigation) 100100025701.08.2025 O Y Y 2001.08.202500075.0000000.0000000.00 5001.08.2025MULTI TRAUMA DRESSINGS - Variety of basic and complex wound dressings for 5001.08.2025multiple or large wounds e.g. Mepitel Mepilex border lite Primapore Opsite 5001.08.2025Mepilex lite Melolite Hypafix Steri-strips transparent Opsite Large wound 5001.08.2025margins requiring multiple dressings and large dressings, specialised 5001.08.2025dressings, burns, wound debridement isposable Wound Management Kit Sterile 5001.08.2025field (sterile pack incl. gauze) Sterile instruments (scissors and tweezers) 5001.08.2025Stitch cutters (for suture removal) Saline solution (for wound irrigation) 5001.08.2025Peroxide Betadine Chlorohexidine (for wound irrigation) 100100025801.08.2025 O Y Y 2001.08.202500170.0000000.0000000.00 5001.08.2025INCIDENTAL EXPENSES HAND THERAPY - Reasonable charges for incidental items 5001.08.2025required by the worker to assist in their recovery and which they take home 5001.08.2025with them following their treatment. Pharmacy items and consumables used by a 5001.08.2025provider during a consultation are not included. For further clarification 5001.08.2025refer to the information provided below the tables. * Payment will be made up 5001.08.2025to $170 in total for incidental expenses and up to $283 in total for 5001.08.2025supportive devices, per claim (not per consultation), without prior approval. 5001.08.2025Approval from the insurer must be obtained for items exceeding the 5001.08.2025pre-approved value. Hire of equipment to be negotiated with insurer. All 5001.08.2025expenses must be itemised on the invoice. Please note: This item number is not 5001.08.2025to be used for admission fees to external facilities such as gyms and pools.