RULE

DESCRIPTION

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

Pre-authorisation for Chiropractor services may only be granted if the primary medical practitioners written referral letter clearly indicates the reason for the referral, relationship to the original injury. The referral may be on the Chiropractors or medical practitioners letterhead, provided it is signed by the referring doctor.

Submission of a report is required after every consultation, treatment and/or therapy services rendered with the applicable codes

Chiropractor services only applicable for outpatient

Only one visit per day and a maximum of 5 visits per claim is allowed.

003

The consultation code may be charged only once per day and once per claim. Consultation includes history taking, guidance, education, health promotion and/or consultation.

Subsequent visits are considered as follow-up to the initial visits

004

A maximum of three diagnostic procedures may be charged at the same consultation or visit. Diagnostic procedures include physical examination, neurological examination, orthopaedic examination, ergonomical analysis and postural analysis.

005

A maximum of three types of treatment procedures (modalities and or methods) may be charged at the same consultation or visit for any single diagnosis.

Treatment procedures include, inter alia: spinal or extra-spinal manipulation, acupuncture, cold applications, non-heating modalities, deep heating radiation, soft tissue manipulation, superficial heating therapy and therapeutic exercises (other than in relation to preparation or fitting of appliances).

006

After a series of 5 treatments in respect to one patient for the same condition, the Chiropractor should refer the patient/employee back to the treating medical practitioner concerned to report to the Compensation Fund if further treatment is necessary. Payment for treatment in excess of the stipulated number may be granted by the Compensation Fund after receipt of motivation letter from the treating medical practitioner concerned.

007

X-ray films: Chiropractor practitioners to use x-ray results from referring medical practitioner