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10.5.33 Physiotherapy

WorkSafe will only pay for physiotherapy services by health professionals who are:

The following section outlines the requirements of the legislation and WorkSafe’s policy regarding physiotherapy services.

See:

General information - Medical and Like Services

Clinical framework

Referral requirements for physiotherapy services

WorkSafe considers physiotherapy to be a primary contact service. A referral from a medical practitioner is therefore not required for the physiotherapy services.

A referral is required from a medical practitioner for the provision of any approved health service with the exception of medical, chiropractic, physiotherapy, osteopathy, optometry, dental and podiatry services.

Referrals to other health services

WorkSafe does not allow physiotherapists to provide a referral to other health services.

What WorkSafe will pay for

WorkSafe will pay for the reasonable costs of physiotherapy services that meet the following criteria:

WorkSafe will also consider the reasonable cost of Gym and swimming program.

What WorkSafe will not pay for

At the same time and for the same claim, WorkSafe will only pay for either:

However group physiotherapy sessions such as hydrotherapy, pilates and exercise programs may be allowed for limited periods of time.

Note: If a worker is receiving concurrent osteopathic, chiropractic and/or physiotherapy treatment the worker will be asked to select the treatment that they believe to be the most beneficial for their work injury.

Reporting requirements of physiotherapists

Information is required by the employer or agents / self insurers to assist in the injured worker’s return to function and work.

Physiotherapy Management Plan

Physiotherapists are required to complete the Physiotherapy Management Plan when providing treatment to workers with a work-related injury or illness by the fifth consultation.

This form must be forwarded to the workers agent and/or employer and medical practitioner to notify them of the commencement of physiotherapy services and the proposed management plan.

Further information on physiotherapy reporting requirements can be found at worksafe.vic.gov.au

Restricted consultations

Physiotherapists may apply to provide a restricted consultation (at the practitioners rooms) for workers with the following injuries:

Other complex injuries will be considered on merit.

A Restricted Consultation Application form must be completed by the physiotherapist to apply for approval to use the restricted consultation item number within their fee schedule.

Where to send the restricted consultation application form

The Restricted Consultation Application form must be faxed to the workers agent.

Charging for restricted consultations

It is recommended that physiotherapists do not use the restricted consultation item number until they have been advised in writing that their application has been accepted.

Fee for completing the restricted consultation form

A physiotherapist is able to invoice for the completion of the Restricted Consultation Application form using item number PY106.

Review of the restricted consultation application form

Restricted consultation application forms are reviewed by an IMA to ensure that the workers condition meets the restricted consultation diagnostic criteria.

Applications that do meets the criteria

If the IMA determines that the workers condition does meet the diagnostic criteria or may meet the ‘on merit’ criteria, the application is then forwarded to WorkSafe’s Clinical Panel who determines whether the proposed treatment is clinically justified.

Applications that do not meet the criteria

If the IMA determines that the workers condition does not meet the diagnostic criteria the agent will advise the treating physiotherapist in writing that their application has been unsuccessful.

Appealing an agent/WorkSafe decision

WorkSafe has instituted a process for physiotherapists to appeal decisions made by agents or WorkSafe for the use of restricted consultations. All appeals are considered by two members of WorkSafe Clinical Panel in consultation with the applicant, to determine the clinical justification of the treatment proposed. Appeals can be lodged by forwarding a copy of the original application, the reasons that a review is being requested and any other supporting documentation to:

WorkSafe Clinical Panel
GPO Box 4306
MELBOURNE VIC 3001

Fax: 9641 1927

email: clinical_panel@worksafe.vic.gov.au

Accessing the physiotherapy forms

The Physiotherapy Management Plan and Restricted Consultation Application Forms are available:

 

10.5.33.1 - Process for a physiotherapy management plan