001 Unless timely steps are taken to cancel an appointment the relevant fee may be charged from the employee. Each case shall however, be considered on merit and if the circumstances warrant, no fee shall be charged. Modifier 0001 to be quoted.
002 In exceptional cases where the tariff fee is disproportionately low in relation to the actual services rendered by a physiotherapist, 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 services of a physiotherapist shall be available only on referral by a medical or dental practitioner.
004 In the case of prolonged or costly treatments these should only be embarked upon after negotiations between the referring medical practitioner and the Compensation Commissioner.
005 After a series of 20 treatments for the same condition, the physiotherapist must refer the employee back to the medical practitioner and report to him the progress already made. If further physiotherapy treatment is required the medical practitioner must submit a progress report to the Compensation Commissioner indicating the necessity for further treatment and the number of further treatments required. Without such a report payment for treatments in excess of 20 shall not be considered.
006 "After hour treatments" shall mean those performed by arrangement at night between 18:00 and 07:00 on the following day or during weekends between 13:00 Saturdays and 07:00 on Monday. Public holidays are regarded as Sundays.
This rule shall apply for all treatments whether given in the practitioner's rooms, or at a nursing home or private residence only by arrangement when the patient's condition necessitates it.
The fee for all treatments under this rule shall be the total fee for the treatment plus 50 per cent. Modifier 0006 must then be quoted after the appropriate Tariff number to indicate that this rule is applicable.
In cases where the physiotherapist's scheduled working hours extend after 18:00 during the week or 13:00 on a Saturday the above rule shall not apply and the treatment fee shall be that of the normal listed tariff.
007 The physiotherapist shall submit his/her account for treatment under the Act to the employer of the employee concerned.
008 The fee in respect of more than one procedure (save for evaluation and visiting codes: 72701 up to 72903 + 72407) performed at the same consultation or visit, shall be the tariff fee for the major procedure plus half the tariff fee in respect of each additional procedure, but under no circumstances may fees be charged for more than four procedures carried out in the treatment of one condition. Modifier 0008 must then be quoted after the appropriate tariff numbers for the additional procedures to indicate that this rule is applicable.
009 When more than one condition requires treatment and each of these conditions necessitates an individual treatment time, they shall be charged as individual treatments. Full details of the nature of the treatments must be stated. Modifier 0009 must then be quoted after the appropriate tariff numbers to indicate that this rule is applicable.
010 When the treatment times of two completely separate and different conditions overlap, the fee shall be the full tariff fee for the one condition and 50 per cent of the fee for the other condition. Modifier 0010 must then be quoted after the appropriate tariff numbers to indicate that this rule is applicable.
011 Items 72305, 72501 and 72503 cannot be claimed simultaneously.
012 Where a physiotherapist uses equipment which is not owned by that physiotherapist, a reduction of 15% of the relevant tariff will be applicable. Modifier 0012 must be quoted where this rule is applied.
013 Applies to VAT vendors only i.e. only when VAT is added. Monetary values to be rounded off to the nearest 10 cents, on the basis that monetary values ending with 1 to 4 cents be rounded off downwards and 5 to 9 cents be rounded off upwards.
014 Where a physiotherapist was called out from residence or rooms to an employees home or the hospital, travelling fees can be charged for travelling more than 16 kilometres in total.
If more than one employee would be attended to during the course of a trip, the full travelling expenses must be divided pro rata between the relevant employees.
A physiotherapist is not entitled to charge for any travelling expenses or travelling time to his/her rooms.
0001 To be quoted after appropriate treatment codes when rule 001 is implemented.
0006 Add 50 per cent of the total fee for the treatment.
0008 Only 50 per cent of the fee for these additional procedures may be charged.
0009 The full Tariff for the additional treatments may be charged.
0010 Only 50 per cent of the fee for the second condition may be charged.
0012 15% of the relevant tariff to be deducted where equipment used is not owned by the physiotherapist.
0014 R1,00 per km for each kilometre in excess of 16 kilometres total travelled in own car: 19 km total = 3 x R1,00 = R3,00 (no travelling time).
Note: Monetary value of ten units = R21,80.
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