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R 385
Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers - 2024Occupational Therapy Gazette 2024Occupational Therapy Tariff of Fees as from 1 April 2024 (Practice Type 066) |
General Rules |
|
Rule |
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. |
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 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 |
Newly hospitalised patients will be allowed up to 20 sessions without pre-authorization. If further treatment is necessary after a series of 20 treatment sessions for the same condition,the treating doctor must submit a motivation with treatment plan to the Compensation Fund for authorization. |
005 |
Out-patient:Patients will be allowed up to 10 sessions without pre-authorization. If further treatment is necessary after a series of 10 treatment sessions for the same condition, the treating doctor must submit a motivation with treatment plan to the Compensation Fund for authorization. |
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 treated as Sundays. The fee for all treatment under this rule shall be the total fee for the treatment plus 50 percent. 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 be quoted after the appropriate tariff code 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 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 performs treatment away from his/her premises conducting work visit at the employer's premises. The travelling costs more than 16 kilometres will be calculated at R4,84 per km for each kilometre travelled in own car e.g. 19 km total = 19X R4,84 = R91.96. If more than one employee is attended to during the course of a trip, the full travelling expenses must be pro-rata between the relevant employees (the practitioner will charge for one trip). Note: POEs to be attached :work visit attendance register, work visit report and google map intake from the practice to the destination. |
014 |
Only one Evaluation Procedure code may be billed per treatment session and utilised as per the rule of the individual code |
016 |
Occupational Therapists.Physiotherapists and Chiropractors may not provide simultaneous treatment at the same time on a day,but may treat the same patient. (Multidisciplinary 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 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. If more than 10 sessions are necessary the authorization must be requested from the Fund. Note: The Occupational therapist to add the confirmation of employment which must accompany the pre-authorization request for work hardening. |
Modifiers |
|
Modifier |
Modifier Description |
0017 |
Services rendered to hospital in-patients: Quote modifier 0017 on all invoices for services performed on hospital in-patients. |
0018 |
Services rendered to out-patients: Quote modifier 0018 on all invoices for services performed on hospital outpatients. |
0006 |
Emergency modifier: add 50% of the total fee for treatment. Refer to Rule 006 |
0008 |
Aids or assistive devices should be charged at cost. Refer to Rule 008 |
0009 |
Materials used for construction of orthoses or pressure garments should be charged as per Annexures "A and B" for the applicable device and pressure garments. See Annexures "A and B" for non-standard products. Refer to Rule 009 |
0010 |
Materials used in treatment should be charged at cost. Refer to Rule 010 |
0011 |
Travelling cost according to CF agreed rates. Refer to Rule 011. |
0012 |
A detailed report of the work assessment with signatures of the employer and the injured worker shall be submitted to the Compensation Commissioner with the invoice. |
1. |
CONSULTATION TARIFF CODES |
|
|
Code |
Code Description |
UNITS |
RAND |
66101 |
First consultation (5-15 min). Charged once. |
60 |
795.15 |
66108 |
Follow-up consultation (15-30 min). May be charged twice only per week. |
15 |
198.79 |
66109 |
Follow-up consultation (30-60 min). May be charged up to four times per week. |
30 |
397.58 |
2. |
EVALUATION PROCEDURES |
|
|
Code |
Code Description |
UNITS |
RAND |
66201 |
Observation and screening. May be charged at every treatment session as clinically appropriate. |
10 |
132.53 |
66203 |
Specific evaluation for a single aspect of dysfunction (Specify which aspect). May be charged once per week as clinically appropriate. |
7.5 |
99.39 |
66205 |
Specific evaluation of dysfunction involving one part of the body for a specific functional problem (Specify part and aspects evaluated). May be charged once per week as clinically appropriate. |
22.5 |
298.18 |
66207 |
Specific evaluation for dysfunction involving the whole body (Specify condition and which aspects evaluated). May be charged once per three months as clinically appropriate. |
45 |
596.37 |
66209 |
Specific in depth evaluation of certain functions affecting the total person (Specify the aspect assessed). May be charged once per three months as clinically appropriate. |
75 |
993.94 |
66211 |
Comprehensive in depth evaluation of the total person (Specify aspects assessed). Tariff code 66211 cannot be charged together with tariff code 66136. |
105 |
1391.52 |
66136 |
In depth evaluation of the total person to enable the vocational rehabilitation specialist to complete a comprehensive assessment of certain functions affecting the total person. (This code can only be requested by the Compensation Fund for Section 42 Case reviews). Tariff code 66136 cannot be charged together with tariff code 66211. |
218.15 |
2891.05 |
3. |
MEASUREMENT FOR DESIGNING |
|
|
Code |
Code Description |
UNITS |
RAND |
66213 |
Measurement for designing a static orthosis. |
10 |
132.53 |
66215 |
Measurement for designing a dynamic orthosis |
10 |
132.53 |
66217 |
Measurement for designing a pressure garment for one limb orthosis |
10 |
132.53 |
66219 |
Measurement for designing a pressure garment for one hand orthosis |
10 |
132.53 |
66221 |
Measurement for designing a pressure garment for the trunk orthosis |
10 |
132.53 |
66223 |
Measurement for designing a pressure garment for the face (chin strap only) |
10 |
132.53 |
66225 |
Measurement for designing a pressure garment for the face (full face mask) orthosis |
10 |
132.53 |
The whole body or part thereof will be the sum total of the parts. |
|
|
4. |
PROCEDURES FOR THERAPY |
|
|
Code |
Code Description |
UNITS |
RAND |
66301 |
Group treatment in a task-cantered activity, per patient (treatment time 60 minutes or more). |
10 |
132.53 |
66303 |
Placement of a patient in an appropriate treatment situation requiring structuring the environment, adapting equipment and positioning the patient. This does not require individual attention for the whole treatment session |
20 |
265.05 |
66305 |
Groups directed to achieve common goals per person. |
20 |
265.05 |
66307 |
Simultaneous treatment of two to four neuro - behavioural and stress related conditions or severe head injury patients,each with specific problems utilising individual activities, per patient (treatment time 90 minutes or more) |
48 |
636.12 |
66308 |
Simultaneous treatment of two to four patients,each with specific problems utilising individual activities, per patient (treatment time 60 minutes or more) |
30 |
397.58 |
5. |
INDIVIDUAL AND UNDIVIDED ATTENTION DURING TREATMENT SESSIONS UTILISING SPECIFIC ACTIVITY OR TECHNIQUES IN AN INTEGRATED TREATMENT SESSION (TIME OF TREATMENT MUST BE SPECIFIED) |
|
|
Code |
Code Description |
UNITS |
RAND |
66309 |
On level one (15 min) |
12 |
159.03 |
66311 |
On level two (30 min) |
24 |
318.06 |
66313 |
On level three (45 min) |
36 |
477.09 |
66315 |
One level four (60 min) |
48 |
636.12 |
66317 |
On level five (90 min) |
72 |
954.19 |
66319 |
On level six (120 min) |
96 |
1272.25 |
6. |
PROCEDURES FOR WORK REHABILITATION |
|
|
Code |
Code Description |
UNITS |
RAND |
66321 |
Work evaluation - This includes an assessment of the inherent demands of the job and the patient's ability to perform these. A detailed report is not included in this code (charged for under 66325), but must be submitted with the referral from the medical practitioner.) Tariff code 66321 cannot be charged together with tariff code 66211 or 66136. |
80 |
1060.21 |
66323 |
Work Visit Evaluation of the job tasks by observing while the patient or a colleague in the same role performs the job tasks. May include discussing possible adaptations to the process or the work station and making the necessary recommendations to enable a patient to return to work: Rule: A maximum of two work visits are allowed per patient. However, in extenuating circumstances,further motivation may be made to the Compensation Fund. Tariff code 66323 cannot be charged with tariff code 66211or 66136. |
40 |
530.10 |
66325 |
Reports - To be used only when reporting on work assessments. Use once per day and per claim only |
22.14 |
293.41 |
66327 |
Work hardening. Must include a graded return to work plan. Refer to Rule 020. |
80 |
1060.21 |
7. |
PROCEDURES REQUIRED TO PROMOTE TREATMENT |
|
|
Code |
Code Description |
UNITS |
RAND |
66401 |
Workplace assessment (Recommendation as regards to assistive device and environmental adaptations.) Tariff coce 66401 can only be charged together with tariff codes 66211, 66321, 66323 and 66327. |
15 |
198.79 |
8. |
DESIGNING AND CONSTRUCTING A CUSTOM MADE ADAPTATION OR ASSISTIVE DEVICE, SPLINT OR SIMPLE PRESSURE GARMENT FOR TREATMENT IN TASK-CENTERED ACTIVITY (SPECIFY THE ADAPTATION, DEVICE, SPLINT OR PRESSURE GARMENT) |
|
|
Code |
Code Description |
UNITS |
RAND |
66403 |
On level one |
12 |
159.03 |
66405 |
On level two |
24 |
318.06 |
66407 |
On level three |
36 |
477.09 |
66409 |
On level four |
48 |
636.12 |
66411 |
On level five |
60 |
795.15 |
66413 |
On level six |
72 |
954.19 |
66415 |
Designing and constructing a static orthosis |
60 |
795.15 |
66417 |
Designing and constructing a dynamic orthosis |
120 |
1590.31 |
9. |
DESIGNING AND MAKING PRESSURE GARMENT |
|
|
Code |
Code Description |
UNITS |
RAND |
66419 |
Per limb |
60 |
795.15 |
66421 |
Face (chin strap only) |
45 |
596.37 |
66423 |
Face (full face mask) |
60 |
795.15 |
66425 |
Trunk |
90 |
1192.73 |
66427 |
Per hand |
90 |
1192.73 |
The whole body or part thereof will be the subtotal of the parts for the first garment and 75% of the fee for any additional garments on the same pattern |
|
||
66431 |
Planning and preparing in depth home programme on a monthly basis. |
90 |
1192.73 |