Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers - 2021Physiotherapist Gazette 2021Tariff of Fees in respect of Physiotherapy Services from 1 April 2021 |
| 001. | Unless timely steps are taken to cancel an appointment, the relevant fee may be charged to the employee. |
Each case shall be considered on merit and if the circumstances warrant, no fee shall be charged.
| 002. | In exceptional cases where the tariff fee is disproportionately low in relation to the actual services rendered by a physiotherapist, a higher fee may be negotiated. Conversely, if the fee is disproportionately high in relation to the actual services rendered, a lower fee than that in the tariff should be charged. |
| 003. | Newly hospitalised patients will be allowed up 20 sessions without pre-authorisation. After a series of 20 treatment sessions in hospital, the treating practitioner must submit motivation with a treatment plan to the Compensation Fund for authorisation. |
| 004. | AM and PM treatment sessions, applicable only to hospitalised patients, should be specified and medically motivated for on the progress rehabilitation report. |
| 005. | Out-patients: All treatment sessions will need pre-authorisation. All request for pre-authorisation must be based on clinical need, best practice and be in the best interest of the patient. The physiotherapist must submit a referral with motivation from the treating doctor and a treatment plan. The first consultation can be done before pre-authorisation to allow the physiotherapist to provide a treatment plan to the fund for pre-authorisation. Practitioners will be allowed up to ten (10) treatment sessions to continue with treatment after submitting their request while awaiting response from the Fund. The rehabilitation professional must submit monthly progress report. |
| 006. | "After hour treatment" shall mean all physiotherapy performed where emergency treatment and/or essential continuation of care is required after working hours, before 07:00 and after 17:00 on weekdays, and any treatment over a weekend or public holiday . In cases where the physiotherapist's scheduled working hours extend after 17:00 and before 07:00 during the week or weekend, the above rule shall not apply and the treatment fee shall be that of the normal listed tariff. The fee for all treatment under this rule shall be the total fee for the treatment plus 50 per cent. Modifier 006 must then be quoted after the appropriate tariff code to indicate that this rule is applicable. |
For the purpose of this rule:
Emergency treatment and/or essential continuation of care refers to a physiotherapy procedure, where failure to provide the procedure would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the patient's life in serious jeopardy.
| 007. | The physiotherapist shall submit his/her account for treatment to the employer of the employee concerned. |
| 008. | When an employee is referred for physiotherapy treatment after a surgical procedure, a new treatment plan needs to be provided to the Fund. |
| 011. | Cost of material does not include consumables (e.g. ultrasound gel, massage oil, gloves, alcohol swabs, facial tissues, paper towels and etc.) |
| 012. | An account for services rendered will be assessed and added without VAT. VAT is then calculated and added to the final payment amount. |
| 013. | Where a physiotherapist is called out from residence or rooms to an employee's home or hospital, travelling fees to be charged for travelling will be R 4.12 per kilometer from the 1st kilometer. If more than one employee is attended to during the course of a trip, the full travelling expenses must be divided pro rata between the relevant employees (the physiotherapist will claim for one trip). A physiotherapist is not entitled to charge any travelling expenses or travelling time to his/her rooms. |
| 014. | Physiotherapy services rendered in a hospital or nursing facility. |
| 018 | Information Modifier to indicate services rendered to outpatients |
| 015. | The services of a physiotherapist shall be available only on referral from the treating medical practitioner. Where a physiotherapist's letterhead is used as a referral letter, it must bear the medical practitioner's signature, date and stamp. The referral letter for any physiotherapy treatment provided should be submitted to the Compensation Commissioner with the account for such services. |
| 016 | Physiotherapists, Occupational Therapist and Chiropractors may not provide simultaneous treatment at the same time on a day, but may treat the same patient. Multidisciplinary treatment goals must be considered and the best placed service provider to achieve the rehabilitation goal must address that specific goal. |
| NB | Only one of the following codes can be claimed per session/consultation: |
72925, 72926, 72921, 72923, 72928, 72927, 72501 and 72503
MODIFIERS GOVERNING THE TARIFF
| 0001 | To be quoted after appropriate treatment codes when rule 001 is applicable. |
| 0006 | Add 50% of the total fee for the treatment. |
| 0013 | R4.12 per km for each kilometre |
| 0014. | Treatment in a nursing facility. |