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Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

Scale of Fees

Annual Increase in Medical Tariffs for Medical Service Providers - 2023

Occupational Therapy Gazette 2023

Occupational Therapy Tariff of Fees as from 1 April 2023

General Rules

 

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 treating doctor. The medical treating doctor must clearly indicate the reason for the refferal, 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 Newly hospitalised patients will be allowed up 20 sessions without pre-authorisation. If further treatment is necessary after a series of 20 treatment sessions for the same condition, the treating medical practitioner must submit a motivation with treatment plan to the Compensation Fund for considering further authorisation.

 

005 Out Patient : In cases of 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 medical practitioner and the 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  Occupational Therapist must submit monthly progress report.

 

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 hospital 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 then be quoted after the appropriate tariff code to indicate that 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 tariff code 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 code 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.

 

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).

 

020 The use of the work hardening codes must each 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.