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Physiotherapy policy

Policy

Comcare can fund the reasonable cost of physiotherapy treatment required as a result of work-related injuries, but the physiotherapist must be registered with the Physiotherapy Board of Australia.

Guidelines

What physiotherapy services can Comcare fund?

Comcare can fund the reasonable cost of physiotherapy services where:

  • there is clinical justification for treatment
  • the treatment is likely to be effective and achieve or maintain measurable functional improvement
  • the treatment helps the employee move towards functional independence, participation and self management.

Starting treatment

Comcare is able to fund an initial five sessions of physiotherapy for a new injured worker before a Treatment Notification Plan (TNP) has been submitted. You do not need a referral from a medical practitioner to start physiotherapy.

A TNP must be completed and submitted by the physiotherapist when:

  • physiotherapy is expected to exceed five treatment sessions
  • there has been a gap in treatment of greater than 12 months
  • the Comcare injured worker attends a new physiotherapy clinic.

Only one TNP is usually required during the life of the claim. All fields on the TNP must be completed.

If reasonable additional physiotherapy services are needed at the end of a treatment plan, the physiotherapist must contact the Claims Services Officer by phone to discuss the progress of the injured worker and the need for further services. Physiotherapists should not submit multiple TNPs, a report or review plans unless specifically requested by Comcare.

Significant gaps in treatment

For the purpose of this policy a gap in treatment is when no physiotherapy services have been sought for more than 12 months and treatment restarts after this period. Comcare is able to fund physiotherapy services after a gap in treatment via the following process:

  • completion of a TNP
  • confirmation that the treatment is related to the work-related injury.

Ongoing treatment

For injured workers receiving long-term physiotherapy services, Comcare may request a review of treatment goals and progress. Comcare will write to the physiotherapy service provider and request completion of a Review Treatment Plan (RTP) on a case-by-case basis. The RTP will be sent to the provider to complete at the time of the review.

Invoicing for physiotherapy services including a TNP

Comcare will fund the completion and submission of the TNP that includes a consultation through item number COMPHYST1—Consultation with TNP.

Typical billing may involve the following:

  • initial consultation x 1
  • consultation with TNP x 1
  • standard consultation x 3.

Total consultations = 5 consultations including a TNP.

Invoicing information required from physiotherapy providers

Comcare requires the actual provider of the service be identified on each invoice for payment. It is the responsibility of the registered provider to make sure invoices submitted to Comcare are correct, regardless of who has prepared the account. Invoices sent to Comcare must display the following information:

  • injured worker name
  • injured worker claim number
  • date of services
  • description of services
  • service location
  • amount billed for each service
  • name of the treating physiotherapist.

Relevant forms and notes

Provider use only

Page last updated: 04 Apr 2014