Veteran's affairs (DVA) Patientss

PHYSIOTHERAPY Consultations

You can only claim one consultation (including all treatment) for the same patient on the same day.

Initial Consultation

Each treatment cycle must start with an initial consultation. You can only claim one initial consultation item with each treatment cycle.

The initial consultation includes creating or updating the patient care plan.

You need to establish whether the client is eligible before you start treatment. Treatment for White Card holders must be related to an accepted disability.

Standard Consultation

After the initial consultation, use standard consultations to treat a DVA client. You can provide a standard consultation:

• in rooms

• in the home

• at a public or private hospital

• at a residential aged care facility.

Group and aquatic physiotherapy treatments are also considered standard consultations for treatment cycle purposes.

Standard consultations should be claimed for the ongoing treatment of a musculoskeletal condition.

Extended Consultation

 An extended consultation covers treatment of either:

• 2 acute and unrelated areas

• an acute condition when a chronic condition needs ongoing treatment.

You should not claim an extended consultation for treatment of:

• related areas

• multiple, chronic musculoskeletal conditions.

CONSUMABLES 

All items noted below are in the Schedule of Fees for Physiotherapists. (These are not RAP items).

Consumables

Item number PH92 covers consumables used for treatment during the consultation, such as tape and acupuncture needles.

Item number PH93 covers items provided to the client for use after the consultation, such as Therabands, small weights, Pilates mats and gym balls.

You cannot claim items the client should purchase at a pharmacy or supermarket for self-management of conditions, such as fisiocrem or hot/cold packs.

Small medical aids and appliances

Use item number PH94 for small, low cost items only. These may include:

• walking aids

• compression garments

• TENS units

• orthoses such as a soft collar or knee brace.

You cannot claim items that exceed the maximum fee allowable under item number PH94.  

Postage/freight

Item number PH98 covers postage or freight only for an item you buy for a DVA client and claim for under PH94.

The postage PH98 claim must always be submitted along with the related PH94 claim for that posted item.

Splints and Casts

Item numbers PH95 and PH96 are for the supply of splints and casts only.

You can also order splints through RAP.

Exercise physiology consultations

Before you treat a DVA client, please check the Schedule of Fees and Notes for full details about limits and restrictions on exercise physiology services.

Some common compliance issues include the following. Please note these are not exhaustive and you must check the Schedule of Fees for complete details about your profession’s Schedule of Fees item numbers.

Treatment aims and requirements

We will pay for an exercise physiologist to provide treatment to an eligible DVA client that is:

• compliant with referral and treatment cycle arrangements

• specific to the client’s referred condition

• clinically necessary for that condition

• evidence and outcome based.

The aim of treatment is to give the client the skills and knowledge to manage their own condition and promote independent recovery.

Subsequent consultations

A subsequent consultation must be:

• the only consultation or session for the same client on the same day

• one-on-one rather than in a group setting

• at least 20 minutes long.

Patient care plan

You must prepare a patient care plan following an initial consultation. The plan should be revised with any changes in the client’s clinical circumstances, such as following a reassessment or as part of a discharge plan.

You must create and maintain detailed clinical records. The records should include all administrative and clinical aspects of the client’s treatment.

Qualified provider

The treatment must be provided by a qualified exercise physiologist, who is accredited through ESSA and registered with Services Australia.

An aide or trainee student cannot provide treatment on behalf of the claiming exercise physiologist.

Group consultation/exercise sessions

Treatment of a DVA client in a group format must be clinically necessary and tailored specifically to that client.

You must be present for the entire session, and provide constant group supervision with intermittent individual care.

Item numbers EP30 and EP32 can only be used to claim sessions that are:

• part of an individual treatment plan for the client’s specific, referred condition

• undertaken intermittently as clinically required

• part of group sessions of no more than 12 participants.

You cannot use item numbers EP30 and EP32 to claim payment from DVA for:

• ongoing general fitness

• general gym programs

• gym memberships

• pool or gym entry fees.

Your consultation fee must cover any gym or pool entry fees for a client to access clinically required treatment.