100010000626.08.2024                    O  Y   Y
2026.08.202400101.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the
5026.08.2024treatment of work-related injuries or conditions. . The first six (6)
5026.08.2024consultations (including initial consultation) are pre-approved, provided the
5026.08.2024injuries or conditions have not previously been treated by an allied health
5026.08.2024provider. If additional treatment is required, submit a Provider Management
5026.08.2024Plan3 (PMP) by the 6th subsequent treatment consultation. The PMP should
5026.08.2024include a comprehensive treatment plan containing: expected functional gains,
5026.08.2024transition of care to self-management; and treatment timeframes. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services2. Subsequent consultation may include: ongoing assessment
5026.08.2024(subjective and objective) intervention/treatment setting expectations of
5026.08.2024recovery and return to work clinical recording communication with the insurer
5026.08.2024of any relevant information for the workers rehabilitation.
100010002126.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - A one-on-one initial consultation for the treatment of
5026.08.2024work-related injuries or conditions, or the first consultation in a new
5026.08.2024episode of care for the same work-related injuries or conditions. Please Note:
5026.08.2024A provider cannot bill for multiple initial consultations or multiple
5026.08.2024subsequent consultations for the same claimant on the same day. Services to be
5026.08.2024conducted in accordance with the Clinical Framework for the Delivery of Health
5026.08.2024Services. Initial consultation may include: subjective assessment objective
5026.08.2024assessment treatment/service tailored goal setting and treatment planning
5026.08.2024setting expectations of recovery and return to work clinical recording
5026.08.2024communication with the insurer of any relevant information for the workers
5026.08.2024rehabilitation.
100010010626.08.2024                    O  Y   Y
2026.08.202400055.0000000.0000000.00
5026.08.2024GROUP EXERCISE SESSIONS - Prior approval required before providing this
5026.08.2024service. A session where a common program is delivered to more than one
5026.08.2024individual at the same time. The group can consist of a maximum of eight (8)
5026.08.2024persons. The group session must be attended, conducted, and supervised by a
5026.08.2024physiotherapist.
100010022626.08.2024                    H  Y   Y
2026.08.202400271.0000000.0000000.00
5026.08.2024INDEPENDENT CASE REVIEW - An independent physiotherapy examination and report
5026.08.2024on a worker. It is not carried out by the treating physiotherapist. The review
5026.08.2024is requested by the insurer where progress of treatment and/or rehabilitation
5026.08.2024falls outside the plan or expected course of injury management. The
5026.08.2024examination and report provide the insurer with an assessment and
5026.08.2024recommendations for ongoing treatment and prognosis.
100010028726.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SPECIALISED HAND/UPPER LIMB CONSULTATION- PHYSIOTHERAPIST ONLY - Prior
5026.08.2024approval is required before providing this service, unless referred by a
5026.08.2024medical specialist, A one-on-one consultation and treatment for workers with
5026.08.2024hand and upper limb work-related injuries or conditions (below shoulder
5026.08.2024level). Treatment offered is considered specialist hand therapy provided by a
5026.08.2024qualified physiotherapist. Further details are provided below the tables.
5026.08.2024Consultations may include: ongoing assessment (subjective and objective)
5026.08.2024intervention/treatment setting expectations of recovery and return to work
5026.08.2024clinical recording communication with the insurer of any relevant information
5026.08.2024for the workers rehabilitation. A Provider Management Plan (PMP) is to be
5026.08.2024submitted following the initial assessment. The PMP should include an updated
5026.08.2024comprehensive treatment plan containing: expected functional gains, transition
5026.08.2024of care to self-management; and treatment timeframes. Maximum one (1) hour.
5026.08.2024Approval required for sessions exceeding 1 hr
100010031426.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - Prior
5026.08.2024approval is required before providing this service. Development and
5026.08.2024instruction of a gym/pool-based exercise program focused on improving function
5026.08.2024of the work-related injury or condition, relevant to the work role. The aim of
5026.08.2024this program is for a successful transition of the workers program to a
5026.08.2024gym/pool-based setting in order to meet their work specific functional goals.
5026.08.2024This service may only be charged once. Refer to Item Number 300228 for Gym and
5026.08.2024Pool Entry Fees. Services to be conducted in accordance with the Clinical
5026.08.2024Framework for the Delivery of Health Services. The entire consultation must be
5026.08.2024one-on-one with the worker. Maximum one (1) hour.
100010040226.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - Prior
5026.08.2024approval is required before providing this service. The insurer may request
5026.08.2024justification and will consider seeking an independent opinion if more than
5026.08.2024six (6) consultations are requested per episode of care. A one-on-one
5026.08.2024consultation with the worker for ongoing monitoring, review and progression of
5026.08.2024a gym/pool-based exercise program as developed during initial consultation
5026.08.2024(100314). The focus must be on improving function of the work-related injury
5026.08.2024or condition relevant to the work role and include education and progression
5026.08.2024to self-management. Services to be conducted in accordance with the Clinical
5026.08.2024Framework for the Delivery of Health Services. A Provider Management Plan
5026.08.2024(PMP) is to be submitted for approval following the initial consultation
5026.08.2024(100314) and before any treatment commences. The PMP should include a
5026.08.2024comprehensive treatment plan containing: expected functional gains, transition
5026.08.2024of care to self-management; and treatment timeframes. Maximum one (1) hour.
100010040626.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SPECIFIC PHYSIOTHERAPY ASSESSMENT - Prior approval is required before
5026.08.2024providing this service and justification may be requested by the insurer. A
5026.08.2024one-on-one assessment used for specific conditions that cannot be adequately
5026.08.2024assessed, due to the complexity of the condition, within an initial
5026.08.2024consultation (100021, 100313 for multiple injuries or conditions, and 100314
5026.08.2024for work specific functional exercise program). These may include, but are not
5026.08.2024limited to: extensive burns acquired brain injuries severe spinal cord
5026.08.2024injuries multiple orthopaedic fractures limb amputations crush injuries. This
5026.08.2024service can also be used for the assessment (only) of suitability for entry
5026.08.2024into a Multi-Disciplinary Program or Pain Management Program. The service may
5026.08.2024only be used once by the physiotherapist in the treatment of a work-related
5026.08.2024injury or condition, or the first consultation in a new episode of care for
5026.08.2024the same work-related injury or condition. Maximum one (1) hour.
100010040726.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SPECIFIC PHYSIOTHERAPY CONSULTATION - Prior approval is required before
5026.08.2024providing this service. The insurer may request justification and will
5026.08.2024consider seeking an independent opinion if more than six (6) consultations are
5026.08.2024requested per episode of care. A one-on-one consultation for recommended
5026.08.2024interventions identified during a Specific Physiotherapy Assessment (100406).
5026.08.2024These may include, but are not limited to: extensive burns acquired brain
5026.08.2024injuries severe spinal cord injuries multiple orthopaedic fractures limb
5026.08.2024amputations crush injuries. Please note: This service is not to be used for
5026.08.2024consultations within a Multi-Disciplinary Program or Pain Management Program
5026.08.2024and must not be already classified elsewhere in this table. A Provider
5026.08.2024Management Plan (PMP) is to be submitted following the initial assessment
5026.08.2024(100406). The PMP should include an updated comprehensive treatment plan
5026.08.2024containing: expected functional gains, transition of care to self-management;
5026.08.2024and treatment timeframes. Maximum one (1) hour.
100010050026.08.2024                    H  Y   Y
2026.08.202400350.0000000.0000000.00
5026.08.2024SPECIALIST PHYSIOTHERAPIST (TIER 3) INTERVENTION - Treatment provided by a
5026.08.2024Specialist Physiotherapist (Tier 3) must be aligned with their qualifications
5026.08.2024specific to the work-related injuries they are treating. A copy of these
5026.08.2024qualifications must be provided to the insurer prior to undertaking services.
5026.08.2024Specialist Physiotherapy consultations are approved at the Specialist
5026.08.2024Physiotherapist rate, except for specified services. The first six (6)
5026.08.2024consultations (including initial consultation) are pre-approved, provided the
5026.08.2024injuries or conditions have not previously been treated by an allied health
5026.08.2024provider.
100010055526.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024REASSESSMENT OR PROGRAM REVIEW - A one-on-one comprehensive assessment used
5026.08.2024when: the worker has been in active rehabilitation for at least six weeks and
5026.08.2024further treatment is likely; and/or there are new clinical findings that might
5026.08.2024affect ongoing treatment; and/or there is a rapid change in worker's status
5026.08.2024and/or there is no response to current therapeutic interventions. It should
5026.08.2024include: all components of initial consultation a review of the workers
5026.08.2024progress based on established objective measures a recommendation for future
5026.08.2024treatment and management strategies to assist the worker to return to work. It
5026.08.2024may include referral recommendations to other providers, a change in therapy
5026.08.2024or outcome direction requiring a new return to work goal. Following
5026.08.2024reassessment submit a Provider Management Plan (PMP) with an updated
5026.08.2024comprehensive treatment plan containing: expected functional gains, transition
5026.08.2024of care to self-management; and treatment timeframes.
100020001126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024COMPREHENSIVE ORAL EXAMINATION (ADA 011) - Insurer prior approval required. A
5026.08.2024comprehensive evaluation and recording of the current status of the dentition,
5026.08.2024mouth and associated structures performed on a patient. This applies to new
5026.08.2024patients, established patients who have had a significant change in health
5026.08.2024conditions, or established patients who have been absent from active treatment
5026.08.2024for two or more years. This may require interpretation of information acquired
5026.08.2024through additional diagnostic procedures reported and itemised separately.
5026.08.2024This evaluation includes recording an appropriate oral and medical history and
5026.08.2024any other relevant information. Usual practice fee applies.
100020001226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024PERIODIC ORAL EXAMINATION (ADA 012) - Insurer prior approval required. An
5026.08.2024evaluation of the dentition, mouth and associated structures performed on a
5026.08.2024patient of record to determine any changes in the patients oral and medical
5026.08.2024health status since a previous comprehensive or periodic examination. This may
5026.08.2024require interpretation of information acquired through additional diagnostic
5026.08.2024procedures reported and itemised separately. Usual practice fee applies.
100020001326.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024ORAL EXAMINATION - LIMITED (ADA 013) - Insurer prior approval required. A
5026.08.2024limited evaluation of the dentition, mouth and associated structures performed
5026.08.2024on a patient. This may be for a specific oral health problem or complaint.
5026.08.2024This may require interpretation of information acquired through additional
5026.08.2024diagnostic procedures reported and itemised separately. This evaluation
5026.08.2024includes recording an appropriate oral and medical history and any other
5026.08.2024relevant information. Usual practice fee applies.
100020001426.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024CONSULTATION (<30 MINUTES) (ADA 014) - Insurer prior approval required. A
5026.08.2024consultation to seek advice or discuss treatment options regarding a specific
5026.08.2024dental or oral condition. This consultation includes recording an appropriate
5026.08.2024medical history and any other relevant information. Usual practice fee
5026.08.2024applies.
100020001526.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024CONSULTATION - EXTENDED (30 MINUTES) (ADA 015) - Insurer prior approval
5026.08.2024required. An extended consultation to seek advice or discuss treatment options
5026.08.2024about a specific dental or oral complaint. This consultation includes
5026.08.2024recording an appropriate medical history and any other relevant information.
5026.08.2024Usual practice fee applies.
100020002226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024INTRAORAL PERIAPICAL OR BITEWING RADIOGRAPH (ADA 022) - Insurer prior approval
5026.08.2024required. Taking and interpreting a radiograph made with the film inside the
5026.08.2024mouth. Usual practice fee per exposure applies.
100020002526.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024INTRAORAL RADIOGRAPH - OCCLUSAL, MAXILLARY, MANDIBULAR (ADA 025) - Insurer
5026.08.2024prior approval required. Taking and interpreting a radiograph of the upper and
5026.08.2024or lower jaw using a film placed outside the mouth for example, oblique
5026.08.2024lateral radiograph. Usual practice fee per exposure applies.
100020003726.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024PANORAMIC RADIOGRAPH (OPG) (ADA 037) - Insurer prior approval required. Taking
5026.08.2024and interpreting an extraoral radiograph presenting a panoramic view of part
5026.08.2024or all the mandible and/or the maxilla and/or adjacent structures. Usual
5026.08.2024practice fee per exposure applies.
100020007126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024DIAGNOSTIC MODEL (ADA 071) - Insurer prior approval required. The production
5026.08.2024of a model from an impression or digital data. The model is used for
5026.08.2024examination and treatment planning procedures. This item should not be used to
5026.08.2024describe a working model. Usual practice fee per model applies.
100020031126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024REMOVAL OF A TOOTH OR PART(S) THEREOF (ADA 311) - Insurer prior approval
5026.08.2024required. A procedure consisting of the removal of a tooth or part(s) thereof.
5026.08.2024Usual practice fee applies.
100020031426.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024SECTIONAL REMOVAL OF A TOOTH OR PART(S) THEREOF (ADA 314) - Insurer prior
5026.08.2024approval required The removal of a tooth or part(s) thereof in sections. Bone
5026.08.2024removal may be necessary. Usual practice fee applies.
100020032226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024SURGICAL REMOVAL OF A TOOTH OR FRAGMENT NOT REQUIRING REMOVAL OF BONE OR TOOTH
5026.08.2024DIVISION (ADA 322) - Insurer prior approval required. Removal of a tooth or
5026.08.2024tooth fragment where an incision and the raising of a mucoperiosteal flap are
5026.08.2024required, but where removal of bone or sectioning of the tooth is not
5026.08.2024necessary to remove the tooth. Usual practice fee applies.
100020032326.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024SURGICAL REMOVAL OF A TOOTH OR TOOTH FRAGMENT REQUIRING REMOVAL OF BONE (ADA
5026.08.2024323) - Insurer prior approval required. Removal of a tooth or tooth fragment
5026.08.2024where removal of bone and/or sectioning of the tooth after an incision and the
5026.08.2024raising of a mucoperiosteal flap. The tooth may be removed in sections. Usual
5026.08.2024practice fees applies.
100020035226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024FRACTURE OF MAXILLA OR MANDIBLE - NOT REQUIRING FIXATION (ADA 352) - Insurer
5026.08.2024prior approval required. Conservative treatment of a fracture of the maxilla
5026.08.2024or mandible where there is no marked displacement or mobility of the
5026.08.2024fragments. No physical reduction or fixation is required. Usual practice fee
5026.08.2024applies.
100020038726.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024REPLANTATION AND SPLINTING OF A TOOTH (ADA 387) - Insurer prior approval
5026.08.2024required. Replantation of a tooth that has been avulsed or intentionally
5026.08.2024removed. It may be held in the correct position by splinting. Usual practice
5026.08.2024fee applies per tooth.
100020039926.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024CONTROL OF REACTIONARY OR SECONDARY POST-OPERATIVE HAEMORRHAGE (ADA 399) -
5026.08.2024Insurer prior approval required. This procedure describes the control of
5026.08.2024reactionary or secondary post-operative haemorrhage. Usual practice fee
5026.08.2024applies.
100020041126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024DIRECT PULP CAPPING (ADA 411) - Insurer prior approval required. A procedure
5026.08.2024where an exposed pulp is directly covered with a protective dressing or
5026.08.2024cement. Usual practice fee applies.
100020041926.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024EXTIRPATION OF PULP OR DEBRIDEMENT OF ROOT CANAL(S) - EMERGENCY OR PALLIATIVE
5026.08.2024(ADA 419) - Insurer prior approval required. The partial removal of a tooth
5026.08.2024pulp for one or more of the following reasons: to relieve pain; to perform an
5026.08.2024assessment of root integrity; or to carry out an assessment of the tooth's
5026.08.2024suitability for restoration. Item numbers 415 and/or 416 should not be used at
5026.08.2024the same appointment as 419. Usual practice fee applies.
100020045526.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024ADDITIONAL VISIT FOR IRRIGATION AND/OR DRESSING OF THE ROOT CANAL SYSTEM (ADA
5026.08.2024455) - Insurer prior approval required. Separate appointment for additional
5026.08.2024irrigation of the root canal system and replacement of the intracanal
5026.08.2024dressing/medicament with therapeutic properties that facilitates
5026.08.2024healing/development of the root and periradicular tissues over time. This item
5026.08.2024is not to be used in conjunction with items 411421 or 451453 or 457. Usual
5026.08.2024practice fee applies per tooth.
100020051126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024METALLIC RESTORATION - ONE SURFACE - DIRECT (ADA 511) - Insurer prior approval
5026.08.2024required. Direct metallic restoration involving one surface of a tooth. Usual
5026.08.2024practice fee applies.
100020051226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024METALLIC RESTORATION - TWO SURFACES - DIRECT (ADA 512) - Insurer prior
5026.08.2024approval required. Direct metallic restoration involving two surfaces of a
5026.08.2024tooth. Usual practice fee applies.
100020051326.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024ANY PROSTHODONTIC SERVICE (ADA 611-ADA 779) - Insurer prior approval required.
5026.08.2024Provision of any service from the Prosthodontics chapter of The Australian
5026.08.2024Schedule of Dental Services and Glossary 13th edition. Usual practice fee
5026.08.2024applies.
100020071126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024COMPLETE MAXILLARY DENTURE (ADA 711) - Insurer prior approval required.
5026.08.2024Provision of a patient removable dental prosthesis replacing the natural teeth
5026.08.2024and adjacent tissues in the maxilla. Usual practice fee applies.
100020071226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024COMPLETE MANDIBULAR DENTURE (ADA 712) - Insurer prior approval required.
5026.08.2024Provision of a patient removable dental prosthesis replacing the natural teeth
5026.08.2024and adjacent tissues in the mandible. Usual practice fee applies.
100020072126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024PARTIAL MAXILLARY DENTURE - RESIN BASE (ADA 721) - Insurer prior approval
5026.08.2024required. Provision of a resin base for a patient removable dental prosthesis
5026.08.2024for the maxilla where some natural teeth remain. Other components of the
5026.08.2024denture such as teeth, rests, retainers, and immediate tooth replacements
5026.08.2024should be appropriately itemised. Usual practice fee applies.
100020072226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024PARTIAL MANDIBULAR DENTURE - RESIN BASE (ADA 722) - Insurer prior approval
5026.08.2024required. Provision of a resin base for a patient removable dental prosthesis
5026.08.2024for the mandible where some natural teeth remain. Other components of the
5026.08.2024denture such as teeth, rests, retainers, and immediate tooth replacements
5026.08.2024should be appropriately itemised. Usual practice fee applies.
100020072826.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024PARTIAL MANDIBULAR DENTURE - CAST METAL FRAMEWORK (ADA 728) - Insurer prior
5026.08.2024approval required Provision of the framework for a patient removable dental
5026.08.2024prosthesis made with a cast metal on which to replace teeth from the mandible
5026.08.2024where some natural teeth remain. Other components of the denture such as
5026.08.2024teeth, rests, retainers, and immediate tooth replacements should be
5026.08.2024appropriately itemised. Usual practice fee applies.
100020073126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024RETAINER (ADA 731) - Insurer prior approval required. A retainer or clasp that
5026.08.2024is attached to a partial denture that is adapted to an undercut in a tooth to
5026.08.2024aid retention. The number of retainers should be indicated. Usual practice fee
5026.08.2024per tooth applies.
100020073226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024OCCLUSAL REST (ADA 732) - Insurer prior approval required. A unit of partial
5026.08.2024denture that rests upon a tooth surface to provide support for the denture.
5026.08.2024The number of rests used should be indicated. Usual practice fee per rest
5026.08.2024applies.
100020073326.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024TOOTH/TEETH (PARTIAL DENTURE) (ADA 733) - Insurer prior approval required. An
5026.08.2024item to describe each tooth added to the base of new partial denture. The
5026.08.2024number of teeth should be indicated. Usual practice fee applies.
100020076426.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024REPAIRING BROKEN BASE OF A PARTIAL DENTURE (ADA 764) - Insurer prior approval
5026.08.2024required. Repair, insertion, and adjustment of a broken resin partial denture
5026.08.2024base. Usual practice fee applies.
100020076826.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024ADDING TOOTH TO PARTIAL DENTURE TO REPLACE AN EXTRACTED OR DECORONATED TOOTH
5026.08.2024(ADA 768) - Insurer prior approval required. Provision of a denture tooth on
5026.08.2024an existing partial denture to replace a natural tooth that has been removed
5026.08.2024or decoronated prior to or at the time of issue of the modified denture. Usual
5026.08.2024practice fee per tooth applies.
100020077626.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024IMPRESSION - DENTAL APPLIANCE REPAIR/ MODIFICATION (ADA 776) - Insurer prior
5026.08.2024approval required. An item to describe taking an impression where required for
5026.08.2024the repair or modification of a dental appliance. Usual practice fee applies.
100020091126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024PALLIATIVE CARE (ADA 911) - Insurer prior approval required. An item to
5026.08.2024describe interim care to relieve pain, infection, bleeding, or other problems
5026.08.2024not associated with other treatment, per appointment. Usual practice fee
5026.08.2024applies.
100020092726.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024PROVISION OF MEDICATION/MEDICAMENT (ADA 927) - Insurer prior approval
5026.08.2024required. The supply, or administration under professional supervision, of
5026.08.2024appropriate medications and medicaments required for dental treatments. Usual
5026.08.2024practice fee applies.
100021000126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024COMPLETE FORMS (SENT WITH REQUEST) - FOR TREATING DENTAL PRACTITIONERS TO
5026.08.2024PROVIDE BASIC INFORMATION - Complete forms (sent with request) for treating
5026.08.2024dental practitioners to provide basic information as set out in forms provided
5026.08.2024by the insurer. The treating dental practitioner is to indicate the need for
5026.08.2024phone contact or a full report if additional pertinent information is
5026.08.2024available. Basic fee payable for each form completed. Usual practice fee
5026.08.2024applies.
100021000226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024SHORT REPORT - A short report written in response to a request for specific
5026.08.2024information e.g. a statement of attendance, history, diagnosis, record of
5026.08.2024visits, including results of an investigation. These reports should only
5026.08.2024address the information requested but should include any comments necessary to
5026.08.2024make the position clear to a lay person. Expected length is half a page to one
5026.08.2024(1) page. Received by insurer within 10 working days. Usual practice fee
5026.08.2024applies.
100021000526.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024BASIC REPORT - A basic report includes summing up and an opinion helpful to
5026.08.2024the insurer. A basic report should include all of the relevant items listed in
5026.08.2024the outline for the short report and also a case summary. Details would only
5026.08.2024be given where this assists in determining the merits of a claim, establishing
5026.08.2024a need for a particular line of treatment or rehabilitation, understanding the
5026.08.2024development of the condition and the prognosis, or clarifying early treatment
5026.08.2024and return to work goals. Expected length is one (1) to two (2) pages.
5026.08.2024Received by insurer within 10 working days. Usual practice fee applies.
100021000826.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024SUBSTANTIAL REPORT - A substantial report includes extensive research or case
5026.08.2024discussion and opinion helpful to the insurer or assessment of impairment on
5026.08.2024request; or if the claim is rejected, to compensate for clinical input to the
5026.08.2024report. To qualify as substantial, a report must include, in addition to the
5026.08.2024case summary and comments required for a basic report, at least one of the
5026.08.2024following: - an assessment of impairment at the insurer's request - a report
5026.08.2024on a work-related injury or condition where the claim is subsequently rejected
5026.08.2024as a result of the report - evidence of extensive research into clinical,
5026.08.2024technical, or scientific papers - considerable case discussion outlining the
5026.08.2024merits of the claim - or advice on the future management of the case which
5026.08.2024assists the insurer and/or rehabilitation providers to manage the claim.
5026.08.2024Received by insurer within 10 working days. Usual practice fee applies.
100021001126.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024EXPERT SPECIALIST OPINION - An expert specialist opinion includes the above
5026.08.2024elements essential to the insurer in determining or managing claims. To
5026.08.2024attract the fee for an expert specialist report there should be evidence of
5026.08.2024two or more of the requirements for a substantial report, or the preparation
5026.08.2024of a report of a medico-legal standard for use by a medical assessment
5026.08.2024tribunal or a court. Expected length is three (3) or more pages. Note: only to
5026.08.2024be paid to specialists. Received by insurer within 10 working days. Usual
5026.08.2024practice fee applies.
100030000426.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - A one-on-one initial consultation for acupuncture in
5026.08.2024the treatment of work-related injuries or conditions, or the first
5026.08.2024consultation in a new episode of care for the same work-related injuries or
5026.08.2024conditions. Services to be conducted in accordance with the Clinical Framework
5026.08.2024for the Delivery of Health Services. Initial consultation may include:
5026.08.2024subjective assessment objective assessment treatment/service tailored goal
5026.08.2024setting and treatment planning setting expectations of recovery and return to
5026.08.2024work clinical recording communication (with referrer) any relevant information
5026.08.2024for the workers rehabilitation to the insurer.
100030000526.08.2024                    O  Y   Y
2026.08.202400101.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation for acupuncture
5026.08.2024in the treatment of work-related injuries or conditions. The first six (6)
5026.08.2024consultations (including initial consultation) are pre-approved, provided the
5026.08.2024injuries have not previously been treated by an allied health provider. If
5026.08.2024additional treatment is required, submit a Provider Management Plan (PMP) by
5026.08.2024the 6th subsequent treatment consultation. The PMP should include a
5026.08.2024comprehensive treatment plan containing: expected functional gains, transition
5026.08.2024of care to self-management; and treatment timeframes. Services to be conducted
5026.08.2024in accordance with the Clinical Framework for the Delivery of Health Services
5026.08.2024Subsequent consultation may include: ongoing assessment (subjective and
5026.08.2024objective) intervention/treatment setting expectations of recovery and return
5026.08.2024to work clinical recording communication with the insurer of any relevant
5026.08.2024information for the workers rehabilitation.
100030001426.08.2024                    H  Y   Y
2026.08.202400110.0000000.0000000.00
5026.08.2024HOME NURSING SERVICES BY A REGISTERED NURSE - Home Nursing Services by a
5026.08.2024Registered Nurse-Prior approval is required before providing this service.
5026.08.2024Home nursing services such as dressing of wounds and assistance with daily
5026.08.2024care. The insurer will not pay for home nursing services in excess of four (4)
5026.08.2024weeks without a treating medical practitioner review. NB: must be referred by
5026.08.2024a medical practitioner. Weekday evening rate: $125. Weekend rate: $175. Prior
5026.08.2024approval is required before providing this service.
100030005326.08.2024                    H  Y   Y
2026.08.202400090.0000000.0000000.00
5026.08.2024HOME NURSING SERVICES BY AN ENROLLED NURSE - Prior approval is required before
5026.08.2024providing this service. Home nursing services such as wound dressings and
5026.08.2024assistance with daily care. The insurer will not pay for home nursing services
5026.08.2024in excess of (4 weeks) without treating medical practitioner review. NB: must
5026.08.2024be referred by a medical practitioner. Weekday evening rate: $100 Weekend
5026.08.2024rate: $140
100030007926.08.2024                    O  Y   Y
2026.08.202400036.0000000.0000000.00
5026.08.2024COMMUNICATION - 3 TO 10 MINS - Communication-3 to 10 mins-Direct communication
5026.08.2024between treating provider and insurer, employer, insurer referred allied
5026.08.2024health provider and doctors to assist with faster and more effective
5026.08.2024rehabilitation and return to work for a worker. Excludes communication with a
5026.08.2024worker, and of a general administrative nature or conveying non-specific
5026.08.2024information. Must be more than three (3) minutes. Refer to details below the
5026.08.2024tables for a list of exclusions before using this item number. Treating
5026.08.2024providers are expected to keep a written record of the details of
5026.08.2024communication including date, time, and duration. The insurer may request
5026.08.2024evidence of communication at any time.
100030008126.08.2024                    O  Y   Y
2026.08.202400047.0000000.0000000.00
5026.08.2024GENERAL MEDICAL PROCEDURES - Payable where a patient is seen by an advanced
5026.08.2024practice registered nurse (i.e. a nurse practitioner or rural and isolated
5026.08.2024practice nurse) and performs straightforward medical procedures that would
5026.08.2024normally be payable as part of a doctor's MBS attendance fee i.e. suturing a
5026.08.2024wound or removal of a superficial foreign body. This also includes outpatient
5026.08.2024care in hospitals.
100030008226.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024CASE CONFERENCE - Prior approval is required before providing the service.
5026.08.2024Face-to-face or phone communication involving the treating provider, insurer
5026.08.2024and one or more of the following: treating medical practitioner or specialist
5026.08.2024employer or employee representative worker allied health providers; or other.
100030008426.08.2024                    O  Y   Y
2026.08.202400073.0000000.0000000.00
5026.08.2024UPDATED SUITABLE DUTIES PROGRAM (SDP) - Documentation of an updated or further
5026.08.2024suitable duties plan for a worker, detailing specific information necessary
5026.08.2024for a safe and effective return to the workplace. For WorkCover Queensland
5026.08.2024claims, only an approved RTW Services provider can provide this service.**
100030008626.08.2024                    O  Y   Y
2026.08.202400073.0000000.0000000.00
5026.08.2024PROGRESS REPORT - A written report providing a brief summary of the worker's
5026.08.2024progress towards recovery and return to work.
100030008726.08.2024                    O  Y   Y
2026.08.202400146.0000000.0000000.00
5026.08.2024PUBLIC HOSPITAL EMERGENCY NURSE SERVICES - To be billed where a worker
5026.08.2024receives primary emergency services provided by nursing staff only. This code
5026.08.2024is used if the care is of an emergency nature only and the hospital is not
5026.08.2024considered to have a recognised emergency department as per the Public Health
5026.08.2024Services Table of Costs.
100030008826.08.2024                    O  Y   Y
2026.08.202400184.0000000.0000000.00
5026.08.2024STANDARD REPORT - A written report used for conveying relevant information
5026.08.2024about a worker's work-related injury or condition where the case or treatment
5026.08.2024is not extremely complex or where responses to a limited number of questions
5026.08.2024have been requested by the insurer.
100030008926.08.2024                    O  Y   Y
2026.08.202400048.0000000.0000000.00
5026.08.2024ASSISTING DOCTOR IN MINOR SURGERY - This item will be payable only if the
5026.08.2024procedure attracts an MBS assistance fee and there is no other doctor
5026.08.2024available to assist.
100030009026.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024COMPREHENSIVE REPORT - A written report only used where the case and treatment
5026.08.2024is extremely complex. Hours to be negotiated with the insurer prior to
5026.08.2024providing the report.
100030009126.08.2024                    H  Y   Y
2026.08.202400167.0000000.0000000.00
5026.08.2024TRAVEL - RTW SERVICES ONLY - Travel charges are applicable when the provider
5026.08.2024is required to leave their normal place of practice to treat a worker at a:
5026.08.2024rehabilitation facility hospital workplace their place of residence, or
5026.08.2024community-based setting. Travel is not payable where: the travel is between
5026.08.2024clinics or facilities owned and/or operated by the provider or their employer.
5026.08.2024the travel is for services delivered at an external facility where treatment
5026.08.2024at these external facilities is a regular part of that providers approach and
5026.08.2024there exists a contractual arrangement and/or agreement to use that external
5026.08.2024facility. Please see explanatory notes for further information. For WorkCover
5026.08.2024Queensland claims, only an approved RTW Services provider can provide this
5026.08.2024service.**
100030009226.08.2024                    H  Y   Y
2026.08.202400161.0000000.0000000.00
5026.08.2024TRAVEL - TREATMENT - Travel - Prior approval is required for travel of more
5026.08.2024than one (1) hour. Travel charges are applicable when the provider is required
5026.08.2024to leave their normal place of practice to treat a worker at a: rehabilitation
5026.08.2024facility hospital workplace their place of residence, or community-based
5026.08.2024setting. Travel is not payable where: the travel is between clinics or
5026.08.2024facilities owned and/or operated by the provider or their employer. the travel
5026.08.2024is for services delivered at an external facility where treatment at these
5026.08.2024external facilities is a regular part of that providers approach and there
5026.08.2024exists a contractual arrangement and/or agreement to use that external
5026.08.2024facility. Please see explanatory notes for further information.
100030009326.08.2024                    O  Y   Y
2026.08.202400030.0000000.0000000.00
5026.08.2024COPIES OF PATIENT RECORDS RELATING TO CLAIM - Copies of patient records
5026.08.2024relating to the worker's compensation claim including file notes, results of
5026.08.2024relevant tests e.g. pathology, diagnostic imaging, and reports from
5026.08.2024specialists. Paid at $29 flat fee plus $1 per page.
100030009426.08.2024                    O  Y   Y
2026.08.202400083.0000000.0000000.00
5026.08.2024INCIDENTAL EXPENSES - Reasonable charges for incidental items required by the
5026.08.2024worker to assist in their recovery and which they take home with them
5026.08.2024following their treatment. Pharmacy items and consumables used by a provider
5026.08.2024during a consultation are not included. For further clarification refer to the
5026.08.2024information provided below the tables. * Payment will be made up to $80 in
5026.08.2024total for incidental expenses and up to $233 in total for supportive devices,
5026.08.2024per claim (not per consultation), without prior approval. Approval from the
5026.08.2024insurer must be obtained for items exceeding the pre-approved value. Hire of
5026.08.2024equipment to be negotiated with insurer. All expenses must be itemised on the
5026.08.2024invoice. Please note: This item number is not to be used for admission fees to
5026.08.2024external facilities such as gyms and pools.
100030010026.08.2024                    O  Y   Y
2026.08.202400073.0000000.0000000.00
5026.08.2024COMMUNICATION - 11 TO 20 MINS - Communication-11 to 20 mins-Direct
5026.08.2024communication between treating provider and insurer, employer, insurer
5026.08.2024referred allied health provider and doctors to assist with faster and more
5026.08.2024effective rehabilitation and return to work for a worker. Excludes
5026.08.2024communication with a worker, and of a general administrative nature or
5026.08.2024conveying non-specific information. Must be more than ten (10) minutes. Refer
5026.08.2024to details below the tables for a list of exclusions before using this item
5026.08.2024number. Treating providers are expected to keep a written record of the
5026.08.2024details of communication including date, time, and duration. The insurer may
5026.08.2024request evidence of communication at any time.
100030010226.08.2024                    O  Y   Y
2026.08.202400109.0000000.0000000.00
5026.08.2024INITIAL SUITABLE DUTIES PROGRAM (SDP) - Documentation of suitable duties for a
5026.08.2024worker, detailing specific information necessary for a safe and effective
5026.08.2024return to the workplace. For WorkCover Queensland claims, only an approved RTW
5026.08.2024Services provider can provide this service.**
100030015826.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024WORKPLACE EVALUATION/ASSESSMENT - Systematic process using the workplace to
5026.08.2024estimate work potential and work behaviour. Includes ergonomic assessments.
5026.08.2024For WorkCover Queensland claims, only an approved RTW Services provider can
5026.08.2024provide this service.**
100030015926.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024ACTIVITIES OF DAILY LIVING ASSESSMENT - A series of standardised tests and
5026.08.2024measures to assess a worker's activities of daily living and mobility
5026.08.2024(including Modified Barthel Index assessments for registered occupational
5026.08.2024therapy only). Service includes assessment and report, noting that WorkCover
5026.08.2024Queenslands template for Modified Barthel Index is to be used (for WorkCover
5026.08.2024claims).
100030016026.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024FUNCTIONAL CAPACITY EVALUATION (FCE) - Systematic assessment using a series of
5026.08.2024standardised tests and work specific simulation activities to assess a
5026.08.2024worker's functional capacity for work or potential to return to suitable work;
5026.08.2024includes assessment and report. For WorkCover Queensland claims, only an
5026.08.2024approved RTW Services provider can provide this service.**
100030016126.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024DRIVING ASSESSMENT - Off-road and on-road driving assessments of cognitive,
5026.08.2024psychological, and physical capacity to drive. Assessments must be conducted
5026.08.2024by a qualified driving assessor. Service includes assessment and report.
5026.08.2024Driving instructor is also required for on-road assessment component and fees
5026.08.2024are paid separately.
100030016226.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024VOCATIONAL ASSESSMENT AND REPORT* - Assessment of realistic vocational options
5026.08.2024in the current job market for a worker using integrated clinical and
5026.08.2024standardised assessment procedures and instruments; includes assessment and
5026.08.2024report. For WorkCover Queensland claims, only an approved RTW Services
5026.08.2024provider can provide this service.**
100030016426.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024RETURN TO WORK FACILITATION - Engaging with workers and employers for the
5026.08.2024purposes of establishing an updated suitable duties program or remove barriers
5026.08.2024preventing a workers participation in return to work where an alternative
5026.08.2024workplace rehabilitation service item number does not apply. This service may
5026.08.2024also be billed for face-to-face or electronic file reviews, or other services
5026.08.2024at the request from the insurer. For WorkCover Queensland claims, only an
5026.08.2024approved RTW Services provider can provide this service.**
100030016626.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024JOB SEEKING SKILLS ASSESSMENT - INITIAL* - Identify a worker's transferable
5026.08.2024skills and abilities for a new job/career or host placement; may involve the
5026.08.2024development of a vocational preparation action plan with the worker. For
5026.08.2024WorkCover Queensland claims, only an approved RTW Services provider can
5026.08.2024provide this service.**
100030016826.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024JOB PREPARATION SERVICES* - Prepare the worker to find suitable employment.
5026.08.2024Services will be based on the needs of the worker and may include development
5026.08.2024of or updating a resume and/or cover letter, interview preparation skills and
5026.08.2024career counselling. For WorkCover Queensland claims, only an approved RTW
5026.08.2024Services provider can provide this service.**
100030018626.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - Initial
5026.08.2024development and instruction of an exercise program focused on improving
5026.08.2024function of the work-related injuries or conditions, relevant to their work
5026.08.2024role. This service may only be charged once for development of an exercise
5026.08.2024program to meet the workers work specific functional goals. Refer item number
5026.08.2024300228 for Gym and Pool Entry Fees. The exercise physiologist is then expected
5026.08.2024to submit a Provider Management Plan (PMP) following the initial consultation
5026.08.2024for approval before any treatment commences. The PMP should include a
5026.08.2024comprehensive treatment plan containing: expected functional gains, transition
5026.08.2024of care to self-management; and treatment timeframes. The PMP form is
5026.08.2024available on the Workers Compensation Regulatory Services website
5026.08.2024(www.worksafe.qld.gov.au). The insurer will not pay for the preparation or
5026.08.2024completion of a Provider Management Plan. The entire consultation must be 1 on
5026.08.20241 with the worker. Maximum of one (1) hour.
100030018726.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - WORK SPECIFIC FUNCTIONAL EXERCISE PROGRAM - The
5026.08.2024first six (6) consultations (including initial consultation) are pre-approved,
5026.08.2024provided the injuries or conditions have not previously been treated by an
5026.08.2024allied health provider. If additional treatment is required, submit a Provider
5026.08.2024Management Plan3 (PMP) by the 6th subsequent treatment consultation. The PMP
5026.08.2024should include a comprehensive treatment plan containing: expected functional
5026.08.2024gains, transition of care to self-management; and treatment timeframes.
5026.08.2024Services to be conducted in accordance with the Clinical Framework for the
5026.08.2024Delivery of Health Services2. Subsequent consultation may include: ongoing
5026.08.2024assessment (subjective and objective) intervention/treatment setting
5026.08.2024expectations of recovery and return to work clinical recording communication
5026.08.2024with the insurer of any relevant information for the workers rehabilitation
5026.08.2024Maximum one (1) hour.
100030018826.08.2024                    H  Y   Y
2026.08.202400243.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - ADJUSTMENT COUNSELLING - Undertaken where possible to
5026.08.2024clarify the presence of possible adjustment to injury issues and set goals of
5026.08.2024therapy to optimise rehabilitation outcomes; performed where worker is
5026.08.2024displaying psychological, social, cognitive, emotional, and behavioural
5026.08.2024problems after a work-related incident or injury. The purpose of the
5026.08.2024consultation is to identify appropriate interventions/treatments to optimise
5026.08.2024rehabilitation outcomes. Services to be conducted in accordance with the
5026.08.2024Clinical Framework for the Delivery of Health Services. Initial consultation
5026.08.2024may include: history taking assessment diagnostic formulation
5026.08.2024treatment/service tailored goal setting and treatment planning setting
5026.08.2024expectations of recovery and return to work clinical recording communication
5026.08.2024with the insurer of any relevant information for the workers rehabilitation
5026.08.2024Maximum one (1) hour.
100030019026.08.2024                    O  Y   Y
2026.08.202400132.0000000.0000000.00
5026.08.2024DIETARY ASSESSMENT - Consultation to evaluate dietary issues and objective
5026.08.2024tests to formulate an intervention plan focused on a return to work goal.
5026.08.2024Prior approval required before providing service. Services must be provided by
5026.08.2024a person with a tertiary degree in dietetics.
100030019826.08.2024                    H  Y   Y
2026.08.202400058.0000000.0000000.00
5026.08.2024PERSONAL CARE ASSISTANCE - Prior approval is required before providing this
5026.08.2024service - generally a limited service. May need an Occupational Therapist
5026.08.2024Assessment. Provided through an agency - includes services for injury/wound
5026.08.2024care, personal hygiene and grooming etc. where the worker is living at home
5026.08.2024and has been assessed as incapable (for physical, cognitive or emotional
5026.08.2024reasons) of undertaking these tasks and has no family or other social support
5026.08.2024network. Day rate: $56 per hour. Weekend rate: $80 per hour.
100030020026.08.2024                    H  Y   Y
2026.08.202400052.0000000.0000000.00
5026.08.2024DIVERSIONAL THERAPY PROGRAM - Prior approval is required before providing this
5026.08.2024service Services to be provided by a diversional therapist at a nursing home
5026.08.2024including therapeutic activities. Services must be provided by a person with a
5026.08.2024minimum of an Associate Diploma in Diversional Therapy. The service should
5026.08.2024only be used under the supervision of an occupational therapist, who has
5026.08.2024recommended therapeutic activities as part of the overall treatment program.
100030020126.08.2024                    H  Y   Y
2026.08.202400055.0000000.0000000.00
5026.08.2024DOMESTIC ASSISTANCE - HOME CARE SERVICES - Prior approval is required before
5026.08.2024providing this service Provided through an agency - includes cleaning,
5026.08.2024shopping and washing etc. where the worker is living at home and has been
5026.08.2024assessed by an occupational therapist as incapable of undertaking these tasks
5026.08.2024(for physical, cognitive or emotional reasons) of undertaking these tasks, and
5026.08.2024has no family or other social support network. Usually limited timeframe of
5026.08.2024delivery. Note: weekend and public holiday rates may be negotiated with the
5026.08.2024insurer. - Attendant care and support services are generally services to help
5026.08.2024a worker with serious injuries and complex injuries to participate with
5026.08.2024everyday tasks.
100030020226.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024LITERACY SKILLS - Prior approval is required before providing this service
5026.08.2024Private tutoring by a qualified tutor to improve literacy skills for job
5026.08.2024placement prospects. Program should be limited to achieving a base level of
5026.08.2024competency up to four (4) to six (6) weeks. Typically, literacy services are
5026.08.2024provided through the local TAFE or appropriately qualified private literacy
5026.08.2024services.
100030021026.08.2024                    O  Y   Y
2026.08.202400036.0000000.0000000.00
5026.08.2024RTW COMMUNICATION - 3 TO 10 MINS - Communication by a RTW Services provider
5026.08.2024who has received a referral from an insurer for the following services:
5026.08.2024worksite assessment/evaluation development of suitable duties program or
5026.08.2024updated program monitoring of suitable duties programs communication with
5026.08.2024relevant stakeholders about a worker's progress or issues related to an
5026.08.2024existing suitable duties program functional capacity evaluation vocational
5026.08.2024assessment job seeking, job preparation or job placement services. Direct
5026.08.2024communication between a RTW Services provider and the following: insurer
5026.08.2024employer worker insurer referred providers; and treating providers to assist
5026.08.2024with faster, more effective rehabilitation and return to work for a worker.
5026.08.2024Refer to the exclusions listed below these tables before using this item
5026.08.2024number. For WorkCover Queensland claims, only an approved RTW Services
5026.08.2024provider can provide this service.**
100030021126.08.2024                    O  Y   Y
2026.08.202400073.0000000.0000000.00
5026.08.2024RTW COMMUNICATION - 11 TO 20 MINS - Communication by a RTW Services provider
5026.08.2024who has received a referral from an insurer for the following services:
5026.08.2024worksite assessment/evaluation development of suitable duties program or
5026.08.2024updated program monitoring of suitable duties programs communication with
5026.08.2024relevant stakeholders about a worker's progress or issues related to an
5026.08.2024existing suitable duties program functional capacity evaluation vocational
5026.08.2024assessment job seeking, job preparation or job placement services. Direct
5026.08.2024communication between a RTW Services provider and the following: insurer
5026.08.2024employer worker insurer referred providers; and treating providers to assist
5026.08.2024with faster, more effective rehabilitation and return to work for a worker.
5026.08.2024Must be more than ten (10) minutes. Refer to the exclusions listed below these
5026.08.2024tables before using this item number. For WorkCover Queensland claims, only an
5026.08.2024approved RTW Services provider can provide this service.**
100030021226.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024JOB PLACEMENT SERVICES - NEW EMPLOYER* - The process of actively sourcing and
5026.08.2024placing a worker in a host placement or for WorkCover also includes placing a
5026.08.2024worker in a Recover at Work program with a view to a durable return to work
5026.08.2024outcome. Also includes seeking new employment with/for the worker. Includes
5026.08.2024employer and worker liaison, job application and coaching. For WorkCover
5026.08.2024Queensland claims, only an approved RTW Services provider can provide this
5026.08.2024service.**
100030021326.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024JOB PREPARATION SERVICES - WORK HARDENING PROGRAM* - The process of actively
5026.08.2024sourcing and placing a worker in a host placement or for WorkCover also
5026.08.2024includes placing a worker in a Recover at Work program where the worker has a
5026.08.2024job to return to. Includes employer and worker liaison, job application and
5026.08.2024coaching. For WorkCover Queensland claims, only an approved RTW Services
5026.08.2024provider can provide this service.**
100030022826.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024GYM AND POOL ENTRY FEES - Prior approval is required before providing this
5026.08.2024service. The insurer may request justification and will consider seeking a
5026.08.2024second opinion if more than three (3) months facility membership is requested
5026.08.2024per episode of care. Entry fee for the worker to attend a gym or pool for
5026.08.2024assessment and treatment (up to a maximum three-month membership). Entry fees
5026.08.2024will be paid for the worker, only where the facility is not owned or operated
5026.08.2024by the provider, their employer, or where either party contracts their
5026.08.2024services to the facility. Entry fees will not be paid for providers. A
5026.08.2024Provider Management Plan3 (PMP) is expected to be submitted for approval
5026.08.2024before any treatment commences. The PMP should include a comprehensive
5026.08.2024treatment plan containing: expected functional gains, transition of care to
5026.08.2024self-management; and treatment timeframes. The provider is then expected to
5026.08.2024submit Provider Management Plan (PMP) for approval before any treatment
5026.08.2024commences.
100030028526.08.2024                    H  Y   Y
2026.08.202400243.0000000.0000000.00
5026.08.2024ADJUSTMENT COUNSELLING - SUBSEQUENT CONSULTATION - Ongoing treatment of
5026.08.2024work-related components of presenting adjustment to injury issues;
5026.08.2024intervention would be based on treatment formulated from the initial
5026.08.2024consultation (300188). The first six (6) hours (including initial
5026.08.2024consultation) are pre-approved, provided this issue has not previously been
5026.08.2024treated by an allied health provider, with a maximum of one (1) hours on any
5026.08.2024one day. If additional treatment is required, submit a Provider Management
5026.08.2024Plan (PMP) within six (6) hours of consultations which includes a
5026.08.2024comprehensive treatment plan containing: expected functional gains, transition
5026.08.2024to self-care management; and treatment timeframes. Services to be conducted in
5026.08.2024accordance with the Clinical Framework for the Delivery of Health Services.
5026.08.2024Subsequent consultation may include: ongoing assessment intervention/treatment
5026.08.2024setting expectations of recovery and return to work clinical recording
5026.08.2024communication with the insurer of any relevant information for the workers
5026.08.2024rehabilitation
100030029526.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024EXTERNAL CASE MANAGEMENT - Includes an initial needs assessment and report;
5026.08.2024should outline a case management plan indicating the goals of the program,
5026.08.2024services required, timeframes and costs. Insurer request only.
100030030926.08.2024                    O  Y   Y
5026.08.2024AMBULANCE TRANSPORT - NON QAS - INITIAL TRANSPORTATION - Transport provided
5026.08.2024immediately after the work-related injury or condition is sustained.
100030031026.08.2024                    O  Y   Y
2026.08.202400000.0000000.0000000.00
5026.08.2024AMBULANCE TRANSPORT - NON QAS - SUBSEQUENT TRANSPORTATION - Subsequent
5026.08.2024transport must be certified in writing by a doctor as necessary because of the
5026.08.2024worker's physical condition resulting from a work-related injury or condition.
100030040126.08.2024                    O  Y   Y
2026.08.202400055.0000000.0000000.00
5026.08.2024GROUP EXERCISE SESSIONS - Prior approval is required before providing this
5026.08.2024service. A group session where a common exercise programs is delivered to more
5026.08.2024than one individual at the same time. The group can consist of a maximum of
5026.08.2024eight (8) persons. The group session must be attended, conducted, and
5026.08.2024supervised by an exercise physiologist.
100030041326.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024WORKPLACE FACILITATED DISCUSSIONS - Workplace facilitated discussion is a
5026.08.2024meeting conducted by a return-to-work services provider to resolve significant
5026.08.2024barriers in the workplace and support workers and employers in their
5026.08.2024return-to-work efforts. This includes: Engaging in discussions in a supported
5026.08.2024environment, identifying an appropriate Suitable Duties or Return to Work
5026.08.2024(RTW) plan for recovery at work, assisting the worker to reach a workable
5026.08.2024agreement for recovery at work, assisting employers in identifying suitable
5026.08.2024duties through discussions, resolving issues raised by the worker and/or the
5026.08.2024employer, resetting expectations of involved parties. For WorkCover Queensland
5026.08.2024claims, only an approved, suitably qualified, and accredited RTW Services
5026.08.2024provider can provide this service.
100040008826.08.2024                    H  Y   Y
2026.08.202400260.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION- PSYCHOLOGIST ONLY - The initial consultation in the
5026.08.2024treatment of possible psychological, social, cognitive, emotional, and
5026.08.2024behavioural problems occurring after a work-related injury or condition. The
5026.08.2024purpose of the assessment is to identify appropriate interventions/treatments
5026.08.2024to optimise rehabilitation outcomes (maximum two (2) hours direct contact and
5026.08.2024test scoring time). Services to be conducted in accordance with the Clinical
5026.08.2024Framework for the Delivery of Health Services. Initial consultation may
5026.08.2024include: history taking assessment diagnostic formulation treatment/service
5026.08.2024tailored goal setting and treatment planning setting expectations of recovery
5026.08.2024and return to work clinical recording communication with the insurer of any
5026.08.2024relevant information for the workers rehabilitation. The entire consultation
5026.08.2024must be one-on-one with the worker.
100040009126.08.2024                    H  Y   Y
2026.08.202400260.0000000.0000000.00
5026.08.2024NEUROPSYCHOLOGICAL ASSESSMENT - An assessment to clarify the presence of
5026.08.2024possible acquired brain injury or brain dysfunction where possible
5026.08.2024psychological, social, cognitive, emotional, and behavioural problems are
5026.08.2024occurring after a work-related injury or condition (four to five (4-5) hours
5026.08.2024direct contact and test scoring time). This does not include a report. Prior
5026.08.2024approval required for this assessment.
100040009526.08.2024                    H  Y   Y
2026.08.202400260.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - PSYCHOLOGIST ONLY - A one-on-one subsequent
5026.08.2024consultation with the worker in the ongoing management and treatment of their
5026.08.2024work-related psychological issues. Intervention is based on treatment
5026.08.2024formulated in the initial consultation. The first six (6) hours (including
5026.08.2024initial consultation) are preapproved provided this condition has not
5026.08.2024previously been treated by an allied health provider. If additional treatment
5026.08.2024is required, submit a Provider Management Plan3 (PMP) within six (6) hours of
5026.08.2024consultations, which includes a comprehensive treatment plan containing:
5026.08.2024expected functional gains, transition to self-care management; and treatment
5026.08.2024timeframes. Services to be conducted in accordance with the Clinical Framework
5026.08.2024for the Delivery of Health Services2 Max two (2) hours on any one day.
100040010126.08.2024                    H  Y   Y
2026.08.202400192.0000000.0000000.00
5026.08.2024INITIAL ASSESSMENT COUNSELLING SERVICES ONLY - A one-on-one initial
5026.08.2024consultation where possible psychological, social, cognitive, emotional, and
5026.08.2024behavioural problems are occurring after a work-related injury or condition.
5026.08.2024The purpose of the assessment is to identify appropriate
5026.08.2024interventions/treatments to optimise rehabilitation outcomes (maximum two (2)
5026.08.2024hours direct contact and test scoring time). Services to be conducted in
5026.08.2024accordance with the Clinical Framework for the Delivery of Health Services.
5026.08.2024Initial consultation may include: history taking assessment diagnostic
5026.08.2024formulation treatment/service tailored goal setting and treatment planning
5026.08.2024setting expectations of recovery and return to work clinical recording
5026.08.2024communication with the insurer of any relevant information for the workers
5026.08.2024rehabilitation.
100040010226.08.2024                    H  Y   Y
2026.08.202400192.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION COUNSELLING SERVICES ONLY - A one-on-one subsequent
5026.08.2024consultation with the worker in their ongoing management and treatment.
5026.08.2024Intervention is based on treatment formulated in the initial consultation. The
5026.08.2024first six (6) hours (including initial consultation) are pre-approved,
5026.08.2024provided this issue has not previously been treated by an allied health
5026.08.2024provider, with a maximum of two (2) hours on any one day. If additional
5026.08.2024treatment is required, submit a Provider Management Plan (PMP) within six (6)
5026.08.2024hours of consultations which includes a comprehensive treatment plan
5026.08.2024containing: expected functional gains, transition to self-care management; and
5026.08.2024treatment timeframes. Services to be conducted in accordance with the Clinical
5026.08.2024Framework for the Delivery of Health Services. Subsequent consultation may
5026.08.2024include: ongoing assessment intervention/treatment setting expectations of
5026.08.2024recovery and return to work clinical recording communication with the insurer
5026.08.2024of any relevant information for the workers rehabilitation.
100040018426.08.2024                    H  Y   Y
2026.08.202400260.0000000.0000000.00
5026.08.2024CRITICAL INCIDENT DEBRIEFING SESSIONS - A process where, following exposure to
5026.08.2024a critical incident, an individual or group of workers are debriefed by a
5026.08.2024psychologist to assist them to deal more effectively with their experience.
5026.08.2024Approval required after the first two (2) pre-approved sessions.
100040022626.08.2024                    H  Y   Y
2026.08.202400271.0000000.0000000.00
5026.08.2024INDEPENDENT CASE REVIEW - An independent psychologist examination and report
5026.08.2024of a worker (not by the treating psychologist). Only provided following a
5026.08.2024request from the insurer. The review is requested by the insurer where
5026.08.2024progress of treatment and/or rehabilitation falls outside the plan or expected
5026.08.2024course of injury management. The examination and report provide the insurer
5026.08.2024with an assessment and recommendations for ongoing treatment and prognosis.
100050000626.08.2024                    O  Y   Y
2026.08.202400101.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the
5026.08.2024treatment of work-related injuries or conditions. The first six (6)
5026.08.2024consultations (including initial consultation) are pre-approved, provided the
5026.08.2024injuries or conditions have not previously been treated by an allied health
5026.08.2024provider. If additional treatment is required, submit a Provider Management
5026.08.2024Plan (PMP) by the 6th subsequent treatment consultation. The PMP should
5026.08.2024include a comprehensive treatment plan containing: expected functional gains,
5026.08.2024transition of care to self-management; and treatment timeframes. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services. Subsequent consultation may include: ongoing assessment
5026.08.2024(subjective and objective) intervention/treatment setting expectations of
5026.08.2024recovery and return to work clinical recording communication with the insurer
5026.08.2024of any relevant information for the workers rehabilitation.
100050002126.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of
5026.08.2024work-related injuries or conditions, or the first consultation in a new
5026.08.2024episode of care for the same work-related injuries or conditions. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services. Initial consultation may include: subjective assessment
5026.08.2024objective assessment treatment/service tailored goal setting and treatment
5026.08.2024planning setting expectations of recovery and return to work clinical
5026.08.2024recording communication with the insurer of any relevant information for the
5026.08.2024workers rehabilitation.
100050005526.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024REASSESSMENT OR PROGRAM REVIEW - A comprehensive assessment used when: the
5026.08.2024worker has been in active rehabilitation for at least six weeks and further
5026.08.2024treatment is likely; and/or there are new clinical findings that might affect
5026.08.2024ongoing treatment; and/or there is a rapid change in worker's status and/or
5026.08.2024there is no response to current therapeutic interventions. It should include:
5026.08.2024all components of initial consultation a review of the workers progress based
5026.08.2024on established objective measures a recommendation for future treatment and
5026.08.2024management strategies to assist the worker to return to work. It may include
5026.08.2024referral recommendations to other providers, a change in therapy or outcome
5026.08.2024direction requiring a new return to work goal. Following reassessment submit a
5026.08.2024Provider Management Plan3 (PMP) with an updated comprehensive treatment plan
5026.08.2024containing: expected functional gains, transition of care to self-management;
5026.08.2024and treatment timeframes.
100050022626.08.2024                    H  Y   Y
2026.08.202400272.0000000.0000000.00
5026.08.2024INDEPENDENT CASE REVIEW - An independent chiropractic examination and report
5026.08.2024on a worker and is not carried out by the treating chiropractor. The review is
5026.08.2024requested by the insurer where progress of treatment and/or rehabilitation
5026.08.2024falls outside the plan or expected course of injury management. The
5026.08.2024examination and report provide the insurer with an assessment and
5026.08.2024recommendations for ongoing treatment and prognosis.
100055810026.08.2024                    O  Y   Y
2026.08.202400138.0000000.0000000.00
5026.08.2024X-RAY - CERVICAL SPINE - X-Ray - Cervical Spine. Must be clinically
5026.08.2024justifiable.
100055810326.08.2024                    O  Y   Y
2026.08.202400113.0000000.0000000.00
5026.08.2024X-RAY - THORACIC SPINE - X-Ray - Thoracic Spine. Must be clinically
5026.08.2024justifiable.
100055810626.08.2024                    O  Y   Y
2026.08.202400158.0000000.0000000.00
5026.08.2024X-RAY - LUMBOSACRAL SPINE - X-Ray - Lumbosacral Spine. Must be clinically
5026.08.2024justifiable.
100055811226.08.2024                    O  Y   Y
2026.08.202400199.0000000.0000000.00
5026.08.2024X-RAY - ANY TWO REGIONS OF THE SPINE - X-Ray - Any two regions of the spine.
5026.08.2024Must be clinically justifiable.
100055811526.08.2024                    O  Y   Y
2026.08.202400225.0000000.0000000.00
5026.08.2024X-RAY - ANY THREE REGIONS OF THE SPINE - X-Ray - Any three regions of the
5026.08.2024spine. Must be clinically justifiable.
100060001526.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of
5026.08.2024work-related injuries or conditions, or the first consultation in a new
5026.08.2024episode of care for the same work-related injuries or conditions. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services. Initial consultation may include: subjective assessment
5026.08.2024objective assessment treatment/service tailored goal setting and treatment
5026.08.2024planning setting expectations of recovery and return to work clinical
5026.08.2024recording communication (with referrer) any relevant information for the
5026.08.2024workers rehabilitation to the insurer.
100060001626.08.2024                    O  Y   Y
2026.08.202400101.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the
5026.08.2024treatment of work-related injuries or conditions. The first six (6)
5026.08.2024consultations (including initial consultation) are pre-approved, provided the
5026.08.2024injury has not previously been treated by an allied health provider. If
5026.08.2024additional treatment is required, the provider is expected to submit a
5026.08.2024Provider Management Plan (PMP) by the 6th subsequent treatment consultation.
5026.08.2024The PMP should include a comprehensive treatment plan containing: expected
5026.08.2024functional gains, transition of care to self-management; and treatment
5026.08.2024timeframes. Services to be conducted in accordance with the Clinical Framework
5026.08.2024for the Delivery of Health Services. Subsequent consultation may include:
5026.08.2024ongoing assessment (subjective and objective) intervention/treatment setting
5026.08.2024expectations of recovery and return to work clinical recording communication
5026.08.2024with the insurer of any relevant information for the workers rehabilitation.
100060005526.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024REASSESSMENT OR PROGRAM REVIEW - This reassessment or program review is
5026.08.2024indicated when: the worker has been in active rehabilitation for at least six
5026.08.2024weeks and further treatment is likely; and/or there are new clinical findings
5026.08.2024that might affect ongoing treatment; and/or there is a rapid change in
5026.08.2024worker's status and/or there is no response to current therapeutic
5026.08.2024interventions. A reassessment or program review is a comprehensive assessment
5026.08.2024including: all components of initial consultation a review of the workers
5026.08.2024progress based on established objective measures a recommendation for future
5026.08.2024treatment and management strategies to assist the worker to return to work. A
5026.08.2024reassessment or program review may include referral recommendations to other
5026.08.2024providers, a change in therapy direction or a change on outcome direction
5026.08.2024requiring a new return to work goal. The occupational therapist is expected to
5026.08.2024submit a Provider Management Plan (PMP) following the reassessment.
100060017026.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SPECIFIC OCCUPATIONAL THERAPY ASSESSMENT - Prior approval is required before
5026.08.2024providing this service and justification may be requested by the insurer. This
5026.08.2024service is to be used for assessing specific conditions that cannot be
5026.08.2024adequately assessed, due to the complexity of the condition, within an initial
5026.08.2024consultation 600015 and 600020 for multiple injuries or conditions. The entire
5026.08.2024consultation must be one-on-one with the worker. These may include, but are
5026.08.2024not limited to: extensive burns acquired brain injuries severe spinal cord
5026.08.2024injuries multiple orthopaedic fractures limb amputations crush injuries. This
5026.08.2024service can also be used for the assessment (only) of suitability for entry
5026.08.2024into a Multi-Disciplinary Program or Pain Management Program. The service may
5026.08.2024only be used once by the occupational therapist in the treatment of a
5026.08.2024work-related injury or condition, or the first consultation in a new episode
5026.08.2024of care for the same work-related injury or condition. Maximum one (1) hour.
100060022626.08.2024                    H  Y   Y
2026.08.202400271.0000000.0000000.00
5026.08.2024INDEPENDENT CASE REVIEW - An independent occupational therapist examination
5026.08.2024and report on a worker and is not carried out by the treating occupational
5026.08.2024therapist. The review is requested by the insurer where progress of treatment
5026.08.2024and/or rehabilitation falls outside the plan or expected course of injury
5026.08.2024management. The examination and report provide the insurer with an assessment
5026.08.2024and recommendations for ongoing treatment and prognosis.
100060028726.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SPECIALISED HAND/UPPER LIMB THERAPY CONSULTATION- OCCUPATIONAL THERAPIST ONLY
5026.08.2024- Prior approval is required before providing this service, unless referred by
5026.08.2024a medical specialist, then the first six (6) consultations are pre-approved.
5026.08.2024Prior approval for sessions exceeding 1 hr. A one-on-one consultation and
5026.08.2024treatment for workers with hand and upper limb work-related injuries or
5026.08.2024conditions (below shoulder level). Treatment offered is considered specialist
5026.08.2024hand therapy provided by a qualified occupational therapist. Further details
5026.08.2024are provided below the tables. Consultations may include: ongoing assessment
5026.08.2024(subjective and objective) intervention/treatment setting expectations of
5026.08.2024recovery and return to work clinical recording communication with the insurer
5026.08.2024of any relevant information for the workers rehabilitation. The occupational
5026.08.2024therapist is expected to submit a Provider Management Plan (PMP) following the
5026.08.2024initial assessment. Maximum one (1) hour.
100060029226.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SPECIFIC OCCUPATIONAL THERAPY CONSULTATION - Prior approval is required before
5026.08.2024providing this service. The insurer may request justification and will
5026.08.2024consider seeking an independent opinion if more than six (6) consultations are
5026.08.2024requested per episode of care. A one-on-one consultation for recommended
5026.08.2024interventions identified during a Specific Occupational Therapist Assessment
5026.08.2024(600170). These may include, but are not limited to: extensive burns acquired
5026.08.2024brain injuries severe spinal cord injuries multiple orthopaedic fractures limb
5026.08.2024amputations crush injuries. Please note: This service is not to be used for
5026.08.2024ongoing consultations within a Multi-Disciplinary Program and/or Pain
5026.08.2024Management Program. This service must not be already classified elsewhere in
5026.08.2024this table of costs. A Provider Management Plan (PMP) is to be submitted
5026.08.2024following the initial assessment (600170). Maximum one (1) hour.
100070005126.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of
5026.08.2024work-related injuries or conditions, or the first consultation in a new
5026.08.2024episode of care for the same work-related injuries or conditions. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services. Initial consultation may include: subjective assessment
5026.08.2024objective assessment treatment/service tailored goal setting and treatment
5026.08.2024planning setting expectations of recovery and return to work clinical
5026.08.2024recording communication with the insurer of any relevant information for the
5026.08.2024workers rehabilitation.
100070005326.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the
5026.08.2024treatment of work-related injuries or conditions. If additional treatment is
5026.08.2024required, the provider must submit a Provider Management Plan (PMP) after the
5026.08.2024initial consultation and before commencing any treatment consultations. The
5026.08.2024PMP should include a comprehensive treatment plan containing: expected
5026.08.2024functional gains, transition of care to self-management; and treatment
5026.08.2024timeframes. Services to be conducted in accordance with the Clinical Framework
5026.08.2024for the Delivery of Health Services. Subsequent consultation may include:
5026.08.2024ongoing assessment (subjective and objective) intervention/treatment setting
5026.08.2024expectations of recovery and return to work clinical recording communication
5026.08.2024with the insurer of any relevant information for the workers rehabilitation.
5026.08.2024Maximum one (1) hour.
100070022626.08.2024                    H  Y   Y
2026.08.202400271.0000000.0000000.00
5026.08.2024INDEPENDENT CASE REVIEW - An independent speech pathologist examination and
5026.08.2024report on a worker and is not carried out by the treating speech pathologist.
5026.08.2024The review is requested by the insurer where progress of treatment and/or
5026.08.2024rehabilitation falls outside the plan or expected course of injury management.
5026.08.2024The examination and report provide the insurer with an assessment and
5026.08.2024recommendations for ongoing treatment and prognosis.
100080002826.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - A one-one-one initial consultation in the treatment of
5026.08.2024work-related injuries or conditions, or the first consultation in a new
5026.08.2024episode of care for the same work-related injuries or conditions. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services. Initial consultation may include: subjective assessment
5026.08.2024objective assessment treatment/service tailored goal setting and treatment
5026.08.2024planning setting expectations of recovery and return to work clinical
5026.08.2024recording communication (with referrer) any relevant information for the
5026.08.2024workers rehabilitation to the insurer.
100080002926.08.2024                    O  Y   Y
2026.08.202400101.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the
5026.08.2024treatment of work-related injuries or conditions. The first six (6)
5026.08.2024consultations (including initial consultation) are pre-approved, provided the
5026.08.2024injuries have not previously been treated by an allied health provider. If
5026.08.2024additional treatment is required, submit a Provider Management Plan (PMP) by
5026.08.2024the 6th subsequent treatment consultation. The PMP should include a
5026.08.2024comprehensive treatment plan containing: expected functional gains, transition
5026.08.2024of care to self-management; and treatment timeframes. Services to be conducted
5026.08.2024in accordance with the Clinical Framework for the Delivery of Health Services.
5026.08.2024Subsequent consultation may include: ongoing assessment (subjective and
5026.08.2024objective) intervention/treatment setting expectations of recovery and return
5026.08.2024to work clinical recording communication with the insurer of any relevant
5026.08.2024information for the workers rehabilitation.
100080003726.08.2024                    O  Y   Y
2026.08.202400251.0000000.0000000.00
5026.08.2024ORTHOSES - Thermoplastic shell - Intrinsic fore/rearfoot post - single. Prior
5026.08.2024insurer approval is required.
100080003826.08.2024                    O  Y   Y
2026.08.202400489.0000000.0000000.00
5026.08.2024ORTHOSES - Thermoplastic shell - Intrinsic fore/rearfoot post - pair. Prior
5026.08.2024approval from the insurer is required.
100080003926.08.2024                    O  Y   Y
2026.08.202400042.0000000.0000000.00
5026.08.2024INSOLES - Plain - single. Prior insurer approval is required.
100080004026.08.2024                    O  Y   Y
2026.08.202400076.0000000.0000000.00
5026.08.2024INSOLES - Plain - pair. Prior insurer approval is required.
100080004126.08.2024                    O  Y   Y
2026.08.202400088.0000000.0000000.00
5026.08.2024INSOLES - Padded insole - single. Prior insurer approval is required.
100080004226.08.2024                    O  Y   Y
2026.08.202400168.0000000.0000000.00
5026.08.2024INSOLES - Padded insole - pair. Prior insurer approval is required.
100080004326.08.2024                    O  Y   Y
2026.08.202400214.0000000.0000000.00
5026.08.2024INSOLES - Balance inlay - single custom. Prior insurer approval is required.
100080004426.08.2024                    O  Y   Y
2026.08.202400407.0000000.0000000.00
5026.08.2024INSOLES - Balance inlay - pair custom. Prior insurer approval is required.
100080004526.08.2024                    O  Y   Y
2026.08.202400147.0000000.0000000.00
5026.08.2024INSOLES - Balance inlay - Thermo non-cast single. Prior insurer approval is
5026.08.2024required.
100080004626.08.2024                    O  Y   Y
2026.08.202400235.0000000.0000000.00
5026.08.2024INSOLES - Balance inlay - Thermo non-cast pair. Prior insurer approval is
5026.08.2024required.
100080004726.08.2024                    O  Y   Y
2026.08.202400036.0000000.0000000.00
5026.08.2024ORTHOSES - Heel lift - single. Prior insurer approval is required.
100080004826.08.2024                    O  Y   Y
2026.08.202400033.0000000.0000000.00
5026.08.2024ORTHOSES - Extrinsic fore/rear foot post - single. Prior approval from the
5026.08.2024insurer is required.
100080004926.08.2024                    O  Y   Y
2026.08.202400100.0000000.0000000.00
5026.08.2024CAST - Negative impression- single. Prior insurer approval is required.
100080005026.08.2024                    O  Y   Y
2026.08.202400138.0000000.0000000.00
5026.08.2024CAST - Negative impression - pair. Prior insurer approval is required.
100080008426.08.2024                    O  Y   Y
2026.08.202400080.0000000.0000000.00
5026.08.2024INSOLES - Soft tissue supplement - pair. Prior insurer approval is required.
100080022626.08.2024                    H  Y   Y
2026.08.202400271.0000000.0000000.00
5026.08.2024INDEPENDENT CASE REVIEW - This is an independent podiatrist examination and
5026.08.2024report on a worker and is not carried out by the treating podiatrist. The
5026.08.2024review is requested by the insurer where progress of treatment and/or
5026.08.2024rehabilitation falls outside the plan or expected course of injury management.
5026.08.2024The examination and report provide the insurer with an assessment and
5026.08.2024recommendations for ongoing treatment and prognosis.
100080023226.08.2024                    O  Y   Y
2026.08.202400063.0000000.0000000.00
5026.08.2024ORTHOSES - Extrinsic fore/rear foot post - pair. Prior insurer approval is
5026.08.2024required.
100080028326.08.2024                    O  Y   Y
2026.08.202400043.0000000.0000000.00
5026.08.2024INSOLES - Covers - plain. Prior insurer approval is required.
100080028426.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024NAIL REMOVAL - Nail removal under local anaesthetic. Prior insurer approval is
5026.08.2024required.
100090000626.08.2024                    O  Y   Y
2026.08.202400101.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION - A one-on-one subsequent consultation in the
5026.08.2024treatment of work-related injuries or conditions. The first six (6)
5026.08.2024consultations (including initial consultation) are pre-approved, provided the
5026.08.2024injuries or conditions have not previously been treated by an allied health
5026.08.2024provider. If additional treatment is required, submit a Provider Management
5026.08.2024Plan (PMP) by the 6th subsequent treatment consultation. The PMP should
5026.08.2024include a comprehensive treatment plan containing: expected functional gains,
5026.08.2024transition of care to self-management; and treatment timeframes. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services. Subsequent consultation may include: ongoing assessment
5026.08.2024(subjective and objective) intervention/treatment setting expectations of
5026.08.2024recovery and return to work clinical recording communication with the insurer
5026.08.2024of any relevant information for the workers rehabilitation.
100090002126.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION - A one-on-one initial consultation in the treatment of
5026.08.2024work-related injuries or conditions, or the first consultation in a new
5026.08.2024episode of care for the same work-related injuries or conditions. Services to
5026.08.2024be conducted in accordance with the Clinical Framework for the Delivery of
5026.08.2024Health Services. Initial consultation may include: subjective assessment
5026.08.2024objective assessment treatment/service tailored goal setting and treatment
5026.08.2024planning setting expectations of recovery and return to work clinical
5026.08.2024recording communication (with referrer) any relevant information for the
5026.08.2024workers rehabilitation to the insurer.
100090005526.08.2024                    O  Y   Y
2026.08.202400129.0000000.0000000.00
5026.08.2024REASSESSMENT OR PROGRAM REVIEW - A one-one-one comprehensive assessment used
5026.08.2024when: the worker has been in active rehabilitation for at least six weeks and
5026.08.2024further treatment is likely; and/or there are new clinical findings that might
5026.08.2024affect ongoing treatment; and/or there is a rapid change in worker's status
5026.08.2024and/or there is no response to current therapeutic interventions. It should
5026.08.2024include: all components of initial consultation a review of the workers
5026.08.2024progress based on established objective measures a recommendation for future
5026.08.2024treatment and management strategies to assist the worker to return to work. It
5026.08.2024may include referral recommendations to other providers, a change in therapy
5026.08.2024or outcome direction requiring a new return to work goal. Following
5026.08.2024reassessment submit a Provider Management Plan3 (PMP) which should include an
5026.08.2024updated comprehensive treatment plan containing: expected functional gains,
5026.08.2024transition of care to self-management; and treatment timeframes.
100090022626.08.2024                    H  Y   Y
2026.08.202400271.0000000.0000000.00
5026.08.2024INDEPENDENT CASE REVIEW - An independent osteopathy examination and report on
5026.08.2024a worker and is not carried out by the treating osteopath. The review is
5026.08.2024requested by the insurer where progress of treatment and/or rehabilitation
5026.08.2024falls outside the plan or expected course of injury management. The
5026.08.2024examination and report provide the insurer with an assessment and
5026.08.2024recommendations for ongoing treatment and prognosis.
100100023526.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION MENTAL HEALTH OCCUPATIONAL THERAPIST SERVICES - Mental
5026.08.2024Health Occupational Therapist Services Undertaken where possible
5026.08.2024psychological, social, cognitive, emotional, and behavioural problems are
5026.08.2024occurring after a work-related incident or injury. The purpose of the
5026.08.2024assessment is to identify appropriate interventions/treatments to optimise
5026.08.2024rehabilitation outcomes (maximum 2 hours direct contact and test scoring
5026.08.2024time). Services to be conducted in accordance with the Clinical Framework for
5026.08.2024the Delivery of Health Services. Initial consultation may include: History
5026.08.2024taking Assessment Diagnostic formulation Treatment/service Tailored goal
5026.08.2024setting and treatment planning Setting expectations of recovery and return to
5026.08.2024work Clinical recording Maximum one (1) hour.
100100023626.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION MENTAL HEALTH OCCUPATIONAL THERAPIST - Mental Health
5026.08.2024Occupational Therapist A one-on-one subsequent consultation in the treatment
5026.08.2024of work-related injuries or conditions. The first six (6) hours (including
5026.08.2024initial consultation) are pre-approved, provided the injuries or conditions
5026.08.2024have not previously been treated by an allied health provider. If additional
5026.08.2024treatment is required, submit a Provider Management Plan3 (PMP) by the 6th
5026.08.2024subsequent treatment consultation. The PMP should include a comprehensive
5026.08.2024treatment plan containing: expected functional gains, transition of care to
5026.08.2024self-management; and treatment timeframes. Subsequent consultation may
5026.08.2024include: ongoing assessment (subjective and objective) intervention/treatment
5026.08.2024setting expectations of recovery and return to work clinical recording
5026.08.2024communication with the insurer of any relevant information for the workers
5026.08.2024rehabilitation.
100100023726.08.2024                    O  Y   Y
2026.08.202400184.0000000.0000000.00
5026.08.2024STANDARD REPORT (ITEM CODE FOR PSYCHOLOGY ONLY) - A written report used for
5026.08.2024conveying relevant information about a worker's work-related injury or
5026.08.2024condition where the case or treatment is not extremely complex or where
5026.08.2024responses to a limited number of questions have been requested by the insurer.
100100023826.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024COMPREHENSIVE REPORT (ITEM CODE FOR PSYCHOLOGY ONLY) - Comprehensive Report
5026.08.2024(Item Code for Psychology only) A written report only used where the case and
5026.08.2024treatment are extremely complex. Hours to be negotiated with the insurer prior
5026.08.2024to providing the report.
100100023926.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024INITIAL NEEDS ASSESSMENT (INA) AND REPORT - Max 2-4 hrs. Assessment with a
5026.08.2024worker completed prior to commencement of return to work services to establish
5026.08.2024injuries and formulate recovery process and develop goals for return to work
5026.08.2024and/or reengagement with workplace based on expectation from all parties.
5026.08.2024Includes worksite assessment, interview with the employer and worker and
5026.08.2024liaison with relevant treating medical/allied health providers. Includes
5026.08.2024report. Assists with claims with complex diagnosis, secondary diagnosis or
5026.08.2024flags raised by worker and/or employer. Leads to development of rehabilitation
5026.08.2024program for return to work outcomes. For WorkCover Queensland claims, only an
5026.08.2024approved RTW Services provider can provide this service.**
100100024026.08.2024                    H  Y   Y
2026.08.202400217.0000000.0000000.00
5026.08.2024PSYCHOLOGICAL FUNCTIONAL CAPACITY EVALUATION (PFCE) - Max 3-5 hrs. Assessment
5026.08.2024of a workers capacity to perform cognitive tasks, offering a baseline
5026.08.2024measurement of current symptoms and fitness for work. Determines capacity for
5026.08.2024return to work program, assists in graduation of duties in psychological
5026.08.2024claims or where cognitive deficits are identified by treating team. Assists
5026.08.2024with claims with delayed return to work in psychological or
5026.08.2024significant/complex physical injury claims, secondary psychological claims,
5026.08.2024minimal progression in return to work capacity despite ongoing treatment For
5026.08.2024WorkCover Queensland claims, only an approved RTW Services provider can
5026.08.2024provide this service.** (Psychologists, Rehabilitation Counsellors and
5026.08.2024Occupational Therapists to perform this service.
100100024126.08.2024                    H  Y   Y
2026.08.202400243.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION MENTAL HEALTH SOCIAL WORKER - Undertaken where possible
5026.08.2024to clarify the presence of possible adjustment to injury issues and set goals
5026.08.2024of therapy to optimise rehabilitation outcomes; performed where worker is
5026.08.2024displaying psychological, social, cognitive, emotional, and behavioural
5026.08.2024problems after a work-related incident or injury. The purpose of the
5026.08.2024consultation is to identify appropriate interventions/treatments to optimise
5026.08.2024rehabilitation outcomes. Services to be conducted in accordance with the
5026.08.2024Clinical Framework for the Delivery of Health Services. Initial consultation
5026.08.2024may include: history taking assessment diagnostic formulation
5026.08.2024treatment/service tailored goal setting and treatment planning setting
5026.08.2024expectations of recovery and return to work clinical recording communication
5026.08.2024with the insurer of any relevant information for the workers rehabilitation
5026.08.2024Maximum one (1) hour.
100100024226.08.2024                    H  Y   Y
2026.08.202400243.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION MENTAL HEALTH SOCIAL WORKER - Subsequent Consultation
5026.08.2024A one-on-one subsequent consultation in the treatment of work-related injuries
5026.08.2024or conditions. The first six (6) consultations (including initial
5026.08.2024consultation) are pre-approved, provided the injuries or conditions have not
5026.08.2024previously been treated by an allied health provider. If additional treatment
5026.08.2024is required, submit a Provider Management Plan3 (PMP) by the 6th subsequent
5026.08.2024treatment consultation. The PMP should include a comprehensive treatment plan
5026.08.2024containing: expected functional gains, transition of care to self-management;
5026.08.2024and treatment timeframes. Services to be conducted in accordance with the
5026.08.2024Clinical Framework for the Delivery of Health Services2. Subsequent
5026.08.2024consultation may include: ongoing assessment (subjective and objective)
5026.08.2024intervention/treatment setting expectations of recovery and return to work
5026.08.2024clinical recording communication with the insurer of any relevant information
5026.08.2024for the workers rehabilitation.
100100024326.08.2024                    H  Y   Y
2026.08.202400192.0000000.0000000.00
5026.08.2024INITIAL CONSULTATION PSYCHOTHERAPY SERVICES ONLY - Initial Consultation
5026.08.2024Psychotherapy Services Undertaken where possible psychological, social,
5026.08.2024cognitive, emotional, and behavioural problems are occurring after a
5026.08.2024work-related incident or injury. The purpose of the assessment is to identify
5026.08.2024appropriate interventions/treatments to optimise rehabilitation outcomes
5026.08.2024(maximum 2 hours direct contact and test scoring time). Services to be
5026.08.2024conducted in accordance with the Clinical Framework for the Delivery of Health
5026.08.2024Services. Initial consultation may include: History taking Assessment
5026.08.2024Diagnostic formulation Treatment/service Tailored goal setting and treatment
5026.08.2024planning Setting expectations of recovery and return to work Clinical
5026.08.2024recording Communication with referrer, insurer, and other relevant parties.
5026.08.2024The entire consultation must be 1 on 1 with the worker.
100100024426.08.2024                    H  Y   Y
2026.08.202400192.0000000.0000000.00
5026.08.2024SUBSEQUENT CONSULTATION PSYCHOTHERAPY SERVICES ONLY - A one-on-one subsequent
5026.08.2024consultation with the worker in their ongoing management and treatment.
5026.08.2024Intervention is based on treatment formulated in the initial consultation. The
5026.08.2024first six (6) hours (including initial consultation) are pre-approved,
5026.08.2024provided this issue has not previously been treated by an allied health
5026.08.2024provider, with a maximum of two (2) hours on any one day. If additional
5026.08.2024treatment is required, submit a Provider Management Plan (PMP) within six (6)
5026.08.2024hours of consultations which includes a comprehensive treatment plan
5026.08.2024containing: expected functional gains, transition to self-care management; and
5026.08.2024treatment timeframes. Services to be conducted in accordance with the Clinical
5026.08.2024Framework for the Delivery of Health Services. Subsequent consultation may
5026.08.2024include: ongoing assessment intervention/treatment setting expectations of
5026.08.2024recovery and return to work clinical recording communication with the insurer
5026.08.2024of any relevant information for the workers rehabilitation.
100100024526.08.2024                    H  Y   Y
2026.08.202400066.0000000.0000000.00
5026.08.2024ATTENDANT CARE STANDARD WEEKDAY- DAYTIME - Weekday Daytime Support is any
5026.08.2024support to a participant that starts at or after 6:00 am and ends before or at
5026.08.20248:00 pm on a single weekday (unless it is a Public Holiday or Night-time
5026.08.2024Sleepover Support). - Attendant care and support services are generally
5026.08.2024services to help a worker with serious injuries and complex injuries to
5026.08.2024participate with everyday tasks. - Please Note: Prior approval required before
5026.08.2024approving these services. Prior approval required before approving this
5026.08.2024service.
100100024626.08.2024                    H  Y   Y
2026.08.202400072.0000000.0000000.00
5026.08.2024ATTENDANT CARE -STANDARD - WEEKDAY EVENING - Weekday Evening Support is any
5026.08.2024support to a participant that starts after 8:00 pm and finishes at or before
5026.08.2024midnight on a single weekday (unless it is a Public Holiday or Night-time
5026.08.2024Sleepover Support). - Attendant care and support services are generally
5026.08.2024services to help a worker with serious injuries and complex injuries to
5026.08.2024participate with everyday tasks. - Please Note: Prior approval required before
5026.08.2024approving these services.
100100024726.08.2024                    H  Y   Y
2026.08.202400073.0000000.0000000.00
5026.08.2024ATTENDANT CARE - STANDARD - WEEKDAY NIGHT - Weekday Night Support is any
5026.08.2024support to a participant that commences at or before midnight on a weekday and
5026.08.2024finishes after midnight on that weekday or commences before 6:00 am on a
5026.08.2024weekday and finishes on that weekday (unless it is a Public Holiday, Saturday,
5026.08.2024Sunday, or Night-time Sleepover Support). - Attendant care and support
5026.08.2024services are generally services to help a worker with serious injuries and
5026.08.2024complex injuries to participate with everyday tasks. - Please Note: Prior
5026.08.2024approval required before approving these services.
100100024826.08.2024                    H  Y   Y
2026.08.202400092.0000000.0000000.00
5026.08.2024ATTENDANT CARE - STANDARD - SATURDAY - Saturday Support is any support to a
5026.08.2024participant that starts at or after midnight on the night prior to a Saturday
5026.08.2024and ends before or at midnight of that Saturday (unless it is a Public Holiday
5026.08.2024or Night-time Sleepover Support). - Attendant care and support services are
5026.08.2024generally services to help a worker with serious injuries and complex injuries
5026.08.2024to participate with everyday tasks. - Please Note: Prior approval required
5026.08.2024before approving these services.
100100024926.08.2024                    H  Y   Y
2026.08.202400118.0000000.0000000.00
5026.08.2024ATTENDANT CARE - STANDARD - SUNDAY - Sunday Support is any support to a
5026.08.2024participant that starts at or after midnight on the night prior to a Sunday
5026.08.2024and ends before or at midnight of that Sunday (unless it is a Public Holiday
5026.08.2024or Night-time Sleepover Support). - Attendant care and support services are
5026.08.2024generally services to help a worker with serious injuries and complex injuries
5026.08.2024to participate with everyday tasks. - Please Note: Prior approval required
5026.08.2024before approving these services.
100100025026.08.2024                    H  Y   Y
2026.08.202400145.0000000.0000000.00
5026.08.2024ATTENDANT CARE - STANDARD - PUBLIC HOLIDAY - Public Holiday Support is any
5026.08.2024support to a participant that starts at or after midnight on the night prior
5026.08.2024to a Public Holiday and ends before or at midnight of that Public Holiday
5026.08.2024(unless it is a Night-time Sleepover Support). - Attendant care and support
5026.08.2024services are generally services to help a worker with serious injuries and
5026.08.2024complex injuries to participate with everyday tasks. - Please Note: Prior
5026.08.2024approval required before approving these services.
100100025126.08.2024                    O  Y   Y
2026.08.202400272.0000000.0000000.00
5026.08.2024ATTENDANT CARE - ASSISTANCE WITH SELF-CARE ACTIVITIES - NIGHT-TIME SLEEPOVER -
5026.08.2024Night-time Sleepover Support is any support to a participant delivered on a
5026.08.2024weekday, a Saturday, a Sunday, or a Public Holiday that: o Commences before
5026.08.2024midnight on a day and finishes after midnight on that day; and o Is for a
5026.08.2024continuous period of eight (8) hours or more; and o The worker is allowed to
5026.08.2024sleep when they are not providing support. - Attendant care and support
5026.08.2024services are generally services to help a worker with serious injuries and
5026.08.2024complex injuries to participate with everyday tasks. - Please Note: Prior
5026.08.2024approval required before approving these services.
100100025226.08.2024                    O  Y   Y
2026.08.202401352.0000000.0000000.00
5026.08.2024ATTENDANT CARE PROGRAM ESTABLISHMENT FEE - Establishment fee- One off set up
5026.08.2024fee for complex attendant care program of ongoing support services. (Where
5026.08.2024more than 20hrs of care per week is required for more than 3 months).
100100025326.08.2024                    H  Y   Y
2026.08.202400055.0000000.0000000.00
5026.08.2024GARDEN MAINTENANCE - HOME CARE SERVICES - Provided through an agency -
5026.08.2024includes basic gardening assistance. where the worker is living at home and
5026.08.2024has been assessed by an occupational therapist as incapable of undertaking
5026.08.2024these tasks (for physical, cognitive, or emotional reasons) of undertaking
5026.08.2024these tasks, and Note: Prior approval is required before providing this
5026.08.2024service NOTE: Yard maintenance (lawn mowing, light pruning, and rubbish
5026.08.2024removal) is limited to work ordinarily required for an average residence and
5026.08.2024excludes excessive or high frequency maintenance work. See further information
5026.08.2024below has no family or other social support network.
100100025426.08.2024                    H  Y   Y
2026.08.202400055.0000000.0000000.00
5026.08.2024HOME MAINTENANCE- HOME CARE SERVICES - Provided through an agency - includes
5026.08.2024basic home maintenance. where the worker is living at home and has been
5026.08.2024assessed by an occupational therapist as incapable of undertaking these tasks
5026.08.2024(for physical, cognitive, or emotional reasons) of undertaking these tasks,
5026.08.2024and has no family or other social support network. Prior approval is required
5026.08.2024before providing this service Note: Home and garden maintenance services
5026.08.2024exclude services or works that are ordinarily undertaken by a skilled
5026.08.2024tradesperson (for example carpentry services for home repairs, painting
5026.08.2024services, electrical and plumbing services, roofing repair services). See
5026.08.2024Further information below.
100100025526.08.2024                    O  Y   Y
2026.08.202400031.0000000.0000000.00
5026.08.2024BASIC DRESSING PACK SIMPLE - Basic wound dressings e.g. Primapore Opsite
5026.08.2024Mepilex lite Melolite Hypafix Steri-strips transparent Opsite Simple
5026.08.2024post-operative wound dressings Disposable Wound Management Kit Sterile field
5026.08.2024(sterile pack incl. gauze) Sterile instruments (scissors and tweezers) Stitch
5026.08.2024cutters (for suture removal) Saline solution (for wound irrigation) Peroxide
5026.08.2024Betadine Chlorohexidine (for wound irrigation)
100100025626.08.2024                    O  Y   Y
2026.08.202400052.0000000.0000000.00
5026.08.2024BASIC DRESSING PACK COMPLEX - Complex wound dressings Multiple basic wound
5026.08.2024dressings e.g. Primapore Opsite Mepilex lite Mepitel Mepilex border lite
5026.08.2024Melolite Hypafix Steri-strips transparent Opsite Crepe bandaging Multiple
5026.08.2024wounds, infected wounds, specialised dressings, wounds requiring healing with
5026.08.2024secondary intention Disposable Wound Management Kit Sterile field (sterile
5026.08.2024pack incl. gauze) Sterile instruments (scissors and tweezers) Stitch cutters
5026.08.2024(for suture removal) Saline solution (for wound irrigation) Peroxide Betadine
5026.08.2024Chlorohexidine (for wound irrigation)
100100025726.08.2024                    O  Y   Y
2026.08.202400073.0000000.0000000.00
5026.08.2024MULTI TRAUMA DRESSINGS - Variety of basic and complex wound dressings for
5026.08.2024multiple or large wounds e.g. Mepitel Mepilex border lite Primapore Opsite
5026.08.2024Mepilex lite Melolite Hypafix Steri-strips transparent Opsite Large wound
5026.08.2024margins requiring multiple dressings and large dressings, specialised
5026.08.2024dressings, burns, wound debridement isposable Wound Management Kit Sterile
5026.08.2024field (sterile pack incl. gauze) Sterile instruments (scissors and tweezers)
5026.08.2024Stitch cutters (for suture removal) Saline solution (for wound irrigation)
5026.08.2024Peroxide Betadine Chlorohexidine (for wound irrigation)
100100025826.08.2024                    O  Y   Y
2026.08.202400166.0000000.0000000.00
5026.08.2024INCIDENTAL EXPENSES HAND THERAPY - Reasonable charges for incidental items
5026.08.2024required by the worker to assist in their recovery and which they take home
5026.08.2024with them following their treatment. Pharmacy items and consumables used by a
5026.08.2024provider during a consultation are not included. For further clarification
5026.08.2024refer to the information provided below the tables. * Payment will be made up
5026.08.2024to $160 in total for incidental expenses and up to $265 in total for
5026.08.2024supportive devices, per claim (not per consultation), without prior approval.
5026.08.2024Approval from the insurer must be obtained for items exceeding the
5026.08.2024pre-approved value. Hire of equipment to be negotiated with insurer. All
5026.08.2024expenses must be itemised on the invoice. Please note: This item number is not
5026.08.2024to be used for admission fees to external facilities such as gyms and pools.