Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers - 2021Occupational Therapy Gazette 2021General Rules governing the tariff |
| 001 | Unless timely steps are taken (at least two hours) to cancel an appointment for a consultation the relevant consultation fee shall be payable by the employee. |
| 002 | In exceptional cases where the tariff fees is disproportionately low in relation to the actual services rendered by the practitioner, 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 | The service of an occupational therapist shall be available only on written referral by a medical practitioner. The medical practitioners must clearly indicate the reason for the referral, relationship to the original injury. The referral may be on the service providers (Occupational therapy practice) letterhead, provided it is signed by the referring doctor. |
| 004 | In-Patient: The Occupational Therapist must submit the supporting referral with motivation from the medical practitioner together with the detailed rehabilitation report and treatment plan following the first consultation to enable the fund to authorise the treatment. The therapist is able to provide up to a maximum of twenty (20) treatment sessions, as clinically appropriate and supported by the rehabilitation plan, while authorisation by the Compensation Fund is been provided. The Occupational therapist must submit monthly progress reports which reflect the nature of the rehabilitation progression against the rehabilitation plan. Occupational therapists must reflect the final change in the outcome measurements the final rehabilitation report. |
| 005 | Should additional treatment sessions over and above the initial 20 treatment sessions be required, the Occupational therapist must provide an updated rehabilitation report, including outcome based measures and rehabilitation plan, with referral from the medical practitioner clearly stating the requirement for further treatment sessions. Such treatment must be authorised by the Compensation Fund prior to the treatment being provided. |
| 006 | "After hours treatment" shall mean those emergency treatment sessions performed at night between 18:00 and 07:00 on the following day or during weekends between 13:00 Saturday and 07:00 Monday. Public holidays are regarded as Sundays. The fee for all treatment under this rule shall be the total fee for the treatment plus 50 per cent. This rule shall apply for all treatment administered in the practitioner's rooms, or at a nursing home or private residence (only by arrangement when the patient's condition necessitates it). Modifier 0006 must then be quoted after the appropriate tariff code to indicate that this rule is applicable. |
| 008 | The provision of aids or assistive devices shall be charged at cost. Modifier 0008 must be quoted after the appropriate codes to show this rule is applicable. |
| 009 | Materials used in the construction of orthoses will be charged as per Annexure "A" for the applicable device and pressure garments will be charged as per Annexure "B" for the applicable garment. Modifier 0009 must be quoted after the appropriate codes to show that this rule is applicable. |
| 010 | Materials used in treatment shall be charged at cost. Modifier 0010 must be quoted after the appropriate tariff codes to show that this rule is applicable. |
| 011 | When the occupational therapist administers treatment away from his / her premises, travelling costs shall be charged as follows: R4.12 per km for each kilometre travelled in own car e.g. 19 km total = 19 X R4.12 = R78.28 |
| 012 | The occupational therapist shall submit the account for treatment to the employer of the employee concerned. [Discontinued 2020] |
| 013 | 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. |
| 016 | 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 Occupational Therapist 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 Occupational Therapist 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. |
| 017 | Information Modifier to indicate services rendered to hospital inpatients |
| 018 | Information Modifier to indicate services rendered to outpatients |
| 020 | The use of the work hardening code must match the rehabilitation plan provided by the Occupational Therapist and should clearly indicate how the work hardening program will be included in their rehabilitation program and graded return to work plan. The therapist may provide a maximum of 10 sessions of group work hardening intervention per patient, where a maximum of 5 patients are treated simultaneously in the same treatment area and each patient is set up with customised work simulation tasks. Each session to take place on a separate day and to be of duration of at least 120 minutes. |