Medical fee schedule
Effective date: 1 July 2015
Contents
Returning to work and the role of the health provider
4
ReturnToWorkSA’s expectations
4
How to use this fee booklet
5
Schedule 1A – Clinical medical services
Variations to the Medicare Benefits Schedule
6
6
Derived fees
10
Schedule 1B – Other medical services
49
Short medical report – treating doctor .................................................................................................................. 49
Short medical report – treating doctor .................................................................................................................. 50
Standard medical report – treating doctor (excluding psychiatrists) ...................................................................... 51
Complex medical report – treating doctor (excluding psychiatrists) ....................................................................... 52
Standard medical report – treating psychiatrist ..................................................................................................... 53
Complex medical report – treating psychiatrist ..................................................................................................... 54
Consultation, medical review for preparation of a report – treating doctor ............................................................ 54
Reading time to prepare a report – treating doctor................................................................................................ 55
Medical report clarification – treating doctor ......................................................................................................... 56
Telephone calls ..................................................................................................................................................... 57
Case conference .................................................................................................................................................... 57
Worksite assessment............................................................................................................................................. 58
Third-party consultation ........................................................................................................................................ 59
Attendance at a dispute resolution ........................................................................................................................ 60
Travel time: worksite assessment, case conference, dispute resolution or third-party consultation ....................... 61
Cancellation: case conference, worksite assessment, dispute resolution or third-party consultation ..................... 61
Job analysis and/or recommended job description statement ............................................................................... 62
Specified duties form ............................................................................................................................................ 63
Photocopying ........................................................................................................................................................ 63
Travel time – emergency attendance .................................................................................................................... 63
Travel time– emergency retrieval team ................................................................................................................. 64
Extra-corporeal shockwave therapy ...................................................................................................................... 64
Services delivered by ear, nose and throat surgeons .............................................................................................. 66
Services delivered by medical practitioners ........................................................................................................... 66
Services delivered by medical practitioners in the practice of hypnotherapy ......................................................... 66
Independent medical examiner services
67
Independent medical examiner – short medical report .......................................................................................... 68
Independent medical examiner – medical report (excluding psychiatrists)............................................................. 69
Independent medical examiner – psychiatrists medical report ............................................................................... 69
Independent medical examiner – consultation, medical review for preparation of a report .................................... 70
Independent medical examiner – reading time .......................................................................................................71
Independent medical examiner – medical report clarification .................................................................................71
Independent medical examiner – travel time: worksite assessment, case conference, dispute resolution or third
party consultation ................................................................................................................................................. 72
Independent medical examiner – non-attendance or cancellation of an appointment ............................................73
Independent medical examiner – travel for examinations ...................................................................................... 74
Permanent impairment services
75
Permanent impairment assessor – standard report ............................................................................................... 75
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Permanent impairment assessor – moderately complex report ............................................................................. 76
Permanent impairment assessor – complex report ................................................................................................ 76
Permanent impairment assessor – ENT report ....................................................................................................... 78
Permanent impairment assessor – standard report where an examination is conducted with the assistance of an
interpreter ............................................................................................................................................................. 79
Permanent impairment assessor – moderately complex report where an examination is conducted with the
assistance of an interpreter.................................................................................................................................... 79
Permanent impairment assessor – complex report where an examination is conducted with the assistance of an
interpreter ............................................................................................................................................................. 81
Permanent impairment assessor – ENT report where an examination is conducted with the assistance of an
interpreter ............................................................................................................................................................. 82
Permanent impairment assessor – non-attendance or cancellation of an appointment ......................................... 82
Permanent impairment assessor – supplementary report ...................................................................................... 82
Permanent impairment assessor – additional reading time .................................................................................... 83
Permanent impairment assessor – travel for examinations .................................................................................... 84
General information
Appropriately qualified providers
85
85
Emergency admission of injured workers to a psychiatric institution
85
Frequently asked questions
86
Key sections of the Return to Work Act 2014
88
Account process for patients with a work injury
91
Accounts and invoicing standards
92
Useful contacts
Claims agents
93
93
Self-insured employers
93
ReturnToWorkSA Serious Injury Unit
93
Allianz Australia SA CTP
93
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Returning to work and the role of the health provider
Why return to work is important
The beneficial effect that work can have on a person’s health and wellbeing has been well evidenced in the Australian
and New Zealand consensus statement on the health benefits of work - Position statement 2011: Realising the Health
Benefits of Work.
Source: The Australasian Faculty of Occupational and Environmental Medicine (AFOEM), and The Royal Australasian College of Physicians
(RACP).
The health provider’s role in the recovery process
Health providers have a vital role to play in helping injured workers stay at or return to work. The health provider is
best placed to advise and educate patients that, in most cases, a focus on return to work is in their best interest – for
both their future, quality of life and that of their family. Staying at home until completely recovered is often not the
best thing for an injured worker. Health providers can help by focusing on what a worker can do rather than what
they can’t.
To help make a difference, ensure that you:
 screen for risk early
 adopt a whole person approach
 set clear expectations
 provide clear certification of the worker’s capacity and detail about what the worker can do on the Work Capacity
certificate
 make enough time for clinical management
 contact the workplace where applicable.
For more information, visit the health provider tab at www.rtwsa.com.
ReturnToWorkSA’s expectations
Medical reports
The following guidelines apply to all reports in this schedule:

printed on A4 size paper and margins no more than 2.5cms

line spacing of no more than 1.5 lines and font size no more than 12pt

addressed specifically to the report requestor.
Payments
Payment for services contained in this schedule will not be made in advance.
All costs incurred by an injured worker under this fee schedule are subject to approval for payment. To ensure
payment, it is recommended to seek case manager authorisation prior to the provision of the service.
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How to use this fee booklet
This fee schedule must be read in conjunction with ReturnToWorkSA’s Medical Guidelines, available on our website at
www.rtwsa.com. This booklet contains information on services and fees that apply to medical practitioners who
provide services to workers who are managed under the Return to Work scheme.
This publication is based on Schedule 1A and 1B published by the Minister for Industrial Relations in the South
Australian Government Gazette. Gazetted fees are the maximum fees chargeable, excluding GST. Where applicable,
GST can be applied over and above the gazetted fee.
All services and fees in this schedule are effective 1 July 2015.
Invoicing and service provision is actively monitored to ensure services are billed in accordance with this fee schedule
and that services are reasonable for the work injury and payable under the Return to Work Act 2014, (the Act).
This schedule is divided into three sections:
1.
Schedule 1A – Clinical medical services
Schedule 1A utilises the Medicare Benefits Schedule (MBS) item numbers, descriptions and payment rules with
the permission from the Commonwealth of Australia.
ReturnToWorkSA has made some variations to the Medicare Benefits Schedule services to reflect the Return to
Work scheme. Please refer to page 6-10 for an explanation of these items.
In order to reduce the size of this publication, we have not included service descriptors and guidelines. However,
For the full service descriptions, please refer to the Medicare Benefits Schedule or the Government Gazette.
2.
Schedule 1B – Other medical services
Schedule 1B includes services specifically related to the Return to Work scheme. This schedule includes:
3.

treating doctor services

independent medical examinations

permanent impairment assessments.
General information
This section provides general information relating to account and invoicing standards, useful contact numbers
and information, medical expert referrals, completing a Work Capacity Certificate and relevant sections of the
Return to Work Act 2014 (the Act).
For copies of this document visit our website at www.rtwsa.com.
The gazetted sections (1A and 1B) of this schedule, complete with descriptions can be downloaded from the
South Australian Government Gazette website at www.governmentgazette.sa.gov.au.
If you have any questions please call ReturnToWorkSA on 13 18 55.
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Schedule 1A – Clinical medical services
This schedule must be read in conjunction with ReturnToWorkSA’s Medical Schedule Guidelines. These guidelines are
available from our website www.rtwsa.com.
The following abbreviations apply:
DF = Derived fees: Refer to the derived fee descriptions on pages 10 to 16.
NA = Not applicable: These services are not applicable to the Return to Work scheme.
Variations to the Medicare Benefits Schedule
Category One, Group A3 – Specialist referred consultation
Item 104 (initial specialist consultation) has been split into two – item 104 is now for consultations of 25 minutes or
less, and item 104A is for consultations of more than 25 minutes.
This two-tiered structure was created in recognition that some highly specialised provider groups occasionally need
to undertake longer initial consultations due to the medical complexity of the case. Under this structure the specialist
has the flexibility to allocate the appropriate consultation time required.
Item no.
Service description
00104
Specialist, referred consultation of 25 minutes or less – surgery or hospital.
Max fee (ex GST)
$146.90
Professional attendance at consulting rooms or hospital by a specialist in the
practice of his or her specialty where the patient is referred to him or her. Initial
attendance in a single course of treatment, not being a service to which item
00106 or 00109 apply.
0104A
Specialist, referred consultation of more than 25 minutes – surgery or hospital.
Professional attendance at consulting rooms or hospital by a specialist in the
practice of his or her specialty where the patient is referred to him or her. Initial
attendance in a single course of treatment, not being a service to which item
00106 or 00109 apply.
$178.40
Note 1:
Item number 0104A is not to be charged for independent medical examinations (IME) – refer
to Schedule B for IME consultation.
Note 2:
These item numbers are for initial consultations only. Doctors should bill subsequent
consultations in the usual manner.
Note 3:
The majority of consultations should fall into the 00104 category. The fact that a patient has
a work injury claim should not automatically necessitate a longer consultation. Factors that
would extend the length of the consultation include:
 the need to obtain a more detailed history or perform a more extensive examination than
usual
 additional time is required to review previous investigations, results or reports
 previous intervention or other related medical complaints necessitate increased time and
effort in order to determine appropriate treatment
 extensive advice/counselling regarding ongoing treatment is required
Category 1, Group A4 – Consultant physician attendances to which no other item applies
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Item no.
Service description
00132
Professional attendance of at least 45 minutes duration for an initial assessment
of a patient with at least two morbidities where the patient is referred by a
medical practitioner, and where:
Max fee (ex GST)
$347.80
(a) assessment is undertaken that covers:
 a comprehensive patient history including psychosocial history and
medication review
 comprehensive multi or detailed single organ system assessment
 the formulation of differential diagnoses, and
(b) a treatment and management plan is developed and provided to the referring
practitioner that involves:
 an opinion on diagnosis and risk assessment
 treatment options and decisions including suggestions to facilitate a
return to work
 medication recommendations,
not being an attendance on a patient in respect of whom, an attendance under
item 00110, 00116 and 00119 has been received on the same day by the same
consultant physician.
00133
Note 1:
Item 00132 is only available once in the preceding 12 months.
Note 2:
Should further reviews of the treatment and management plan be required, the appropriate
item for such service(s) is 00116.
Note 3:
A written copy of the treatment and management plan must be provided to the patient and
referring medical practitioner.
Professional attendance of at least 20 minutes duration subsequent to the first
attendance in a single course of treatment for a review of a patient with at least
two morbidities where:
a)
$181.90
a review is undertaken that covers:
 review of initial presenting problem(s) and results of diagnostic
investigations
 review of responses to treatment and medication plans initiated at time of
initial consultation comprehensive multi or detailed single organ system
assessment,
 review of original and differential diagnoses; and
b) a modified treatment and management plan is provided to the referring
practitioner (see Note 3) that involves, where appropriate:
 a revised opinion on the diagnosis and risk assessment
 treatment options and decisions including suggestions to facilitate a
return to work
 revised medication recommendations,
not being an attendance on a patient in respect of whom, an attendance under
item 00110, 00116 and 00119 has been received on the same day by the same
consultant physician.
Note 1:
Item 00133 is only available twice in the preceding 12 months.
Note 2:
Should further reviews of the treatment and management plan be required, the appropriate
item for such service(s) is 00116.
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Note 3:
A written copy of the treatment and management plan must be provided to the patient,
referring practitioner and relevant allied health provider involved in treatment.
Category 1, Group A15 – GP management plans and team care arrangements
Item no.
Service description
00721
Attendance by a medical practitioner (including a general practitioner, but not
including a specialist or consultant physician) for the PREPARATION of a GP
MANAGEMENT PLAN (GPMP) for a patient.
Max fee (ex GST)
$171.30
This Chronic Disease Management (CDM) service is for a patient who has at least
one medical condition that has been (or is likely to be) present for at least six
months.
The GPMP must be in writing and contain suggestions to facilitate a return to
work. A copy of the GPMP must be given to the patient.
A fee will not be paid within twelve months of a previous claim for item 00721, or
within three months of a claim for item 00732 (for a review of a GPMP), except
where there are exceptional circumstances that require the preparation of a new
GPMP.
00723
Attendance by a medical practitioner (including a general practitioner, but not
including a specialist or consultant physician) to COORDINATE the development
of TEAM CARE ARRANGEMENTS (TCAs) for a patient. This Chronic Disease
Management (CDM) service is for a patient who:
$135.40
(a) has at least one medical condition that has been (or is likely to be) present for
at least six months; and
(b) requires ongoing care from at least three collaborating health or care
providers, each of whom provides a different kind of treatment or service to
the patient, and at least one of whom is a medical practitioner.
The medical practitioner shall document the TCA and provide a copy to the
collaborating health or care providers and to the patient. A fee will not be paid
within twelve months of a previous claim for item 00723, or within three months
of a claim for item 00732 (for a review of TCAs), except where there are
exceptional circumstances that require the coordination of new TCAs.
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Category 1, Group A15 – GP management plans and team care arrangements
Item no.
Service description
00732
Attendance by a medical practitioner (including a general practitioner, but not
including a specialist or consultant physician) to:
Max fee (ex GST)
$85.70
(a) REVIEW A GP MANAGEMENT PLAN (GPMP) to which item 00721 applies.
Where these services were provided by that medical practitioner (or an
associated medical practitioner).
This Chronic Disease Management (CDM) service is for a patient who has at
least one medical condition that has been (or is likely to be) present for at
least six months.
If following a review of the GPMP variations or changes are agreed then
those amendments must be in writing with a copy given to the patient.
(b) COORDINATE A REVIEW OF TEAM CARE ARRANGEMENTS to which item
00723 applies.
This Chronic Disease Management (CDM) service is for a patient who has at
least one medical condition that has been (or is likely to be) present for at
least six months and also requires ongoing care from at least three
collaborating health or care providers, each of whom provides a different
kind of treatment or service to the patient, and at least one of whom is a
medical practitioner.
If following a review of the TCA variations or changes are agreed then the
medical practitioner shall provide a written copy of the variations or changes
to the collaborating health or care providers and to the patient.
Each service to which item 00732 applies may only be claimed once in a three
month period, except where there are exceptional circumstances that
necessitate earlier performance of the service to the patient.
Category 3, Group T9 – Assistance at operations
Note: Benefit in respect of assistance at an operation is not payable unless the assistance is rendered by a medical
practitioner other than the anaesthetist or assistant anaesthetist. The amount specified is the amount payable
whether the assistance is rendered by one or more than one medical practitioner.
Item no.
Service description
51300
Assistance at any operation identified by the word ‘Assist’ for which the fee does
not exceed $962.10 or at a series or combination of operations identified by
the word ‘Assist’ where the fee for the series or combination of operations
identified by the word ‘Assist’ does not exceed $962.10.
51303
Assistance at any operation identified by the word ‘Assist’ for which the fee
exceeds $962.10 or at a series of operations identified by the word ‘Assist’ for
which the aggregate fee exceeds $962.10.
Max fee (ex GST)
$150.50
DF
Derived fee:
One fifth of the established fee for the operation or combination of operations.
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Category 4, Group O2 – Assistance at operations
Item no.
Service description
Max fee (ex GST)
51800
Assistance by an approved dental practitioner in the practice of oral and
maxillofacial surgery at any operation identified by the word ‘Assist’ for which the
fee does not exceed $962.10 or at a series or combination of operations identified
by the word ‘Assist’ where the fee for the series or combination of operations
identified by the word ‘Assist’ does not exceed $962.10.
$150.50
51803
Assistance by an approved dental practitioner in the practice of oral and
maxillofacial surgery at any operation identified by the word Assist’ for which the
fee does not exceed $962.10 or at a series or combination of operations identified
by the word ‘Assist’ where the aggregate fee exceeds $962.10.
DF
Derived fee:
One fifth of the established fee for the operation or combination of operations.
Derived fees
All other derived fees
Item no.
Service description
00099
Professional attendance on a patient by a specialist practising in his or her specialty if:
(a) the attendance is by video conference; and
(b) the attendance is for a service: (i) provided with item 104 lasting more than 10 minutes; or
(ii) provided with item 105; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of the
attendance-at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care
service; or (iii) is a patient of: (a) an Aboriginal Medical Service; or (b) an Aboriginal Community
Controlled Health Service for which a direction made under subsection 19 (2) of the Health Insurance Act
1973applies.
Derived fee: 50% of the fee for the associated item.
00112
Professional attendance on a patient by a consultant physician practising in his or her specialty if:
(a) the attendance is by video conference; and
(b) the attendance is for a service: (i) provided with item 110 lasting more than 10 minutes; or
(ii) provided with item 116, 119, 132 or 133; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the
attendance-at least 15 kms by road from the physician; or (ii) is a care recipient in a residential care
service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community
Controlled Health Service for which a direction made under subsection 19 (2) of the Health Insurance Act
1973 applies.
Derived fee: 50% of the fee for the associated item.
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Item no.
Service description
00149
Professional attendance on a patient by a consultant physician or specialist practising in his or her
specialty of geriatric medicine if:
(a) the attendance is by video conference; and
(b) item 141 or 143 applies to the attendance; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the
attendance-at least 15 kms by road from the physician or specialist; or (ii) is a care recipient in a
residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal
Community Controlled Health Service for which a direction made under subsection 19 (2) of the Health
Insurance Act 1973 applies.
Derived fee: 50% of the fee for the associated item.
00288
Professional attendance on a patient by a consultant physician practising in his or her specialty of
psychiatry if:
(a) the attendance is by video conference; and
(b) item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352 applies to the
attendance; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the
attendance - at least 15 kms by road from the physician; or (ii) is a care recipient in a residential care
service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community
Controlled Health Service for which a direction made under subsection 19 (2) of the Health Insurance Act
1973 applies.
Derived fee: 50% of the fee for item 291, 293,296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319,
348, 350 or 352.
02820
Professional attendance on a patient by a specialist or consultant physician practising in his or her
specialty of pain medicine if:
(a) the attendance is by video conference;
(b) and the attendance is for a service: (i) provided with item 2801 lasting more than 10 minutes; or
(ii) provided with item 2806 or 2814; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the
attendance-at least 15 kms by road from the specialist or physician; or (ii) is a care recipient in a
residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal
Community Controlled Health Service for which a direction made under subsection 19 (2) of the Health
Insurance Act 1973 applies.
Derived fee: 50% of the fee for the associated item.
03015
Professional attendance on a patient by a specialist or consultant physician practising in his or her
specialty of palliative medicine if:
(a) the attendance is by video conference; and
(b) the attendance is for a service: (i) provided with item 3005 lasting more than 10 minutes; or (ii)
provided with item 3010 or 3014; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the
attendance-at least 15 kms by road from the specialist or physician; or (ii) is a care recipient in a
residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal
Community Controlled Health Service for which a direction made under subsection 19 (2) of the Health
Insurance Act 1973 applies.
Derived fee: 50% of the fee for the associated item.
Item no.
Service description
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06016
Professional attendance on a patient by a specialist practising in his or her specialty of neurosurgery if:
(a) the attendance is by video conference; and
(b) item 6007, 6009, 6011, 6013 or 6015 applies to the attendance; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) outside an inner metropolitan area; and (B) at the time of the
attendance-at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care
service; or (iii) is a patient of: (A) an Aboriginal Medical Service; (B) or an Aboriginal Community
Controlled Health Service for which a direction made under subsection 19 (2) of the Health Insurance Act
1973 applies.
Derived fee: 50% of the fee for the associated item.
13210
Professional attendance on a patient by a specialist practising in his or her specialty if:
(a) the attendance is by video conference; and
(b) item 13209 applies to the attendance; and
(c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (A) within a telehealth
eligible area; and (B) at the time of the attendance-at least 15 kms by road from the specialist; or (ii) is a
care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service;
(B) or an Aboriginal Community Controlled Health Service for which a direction made under subsection
19 (2) of the Health Insurance Act 1973 applies.
Derive fee: 50% of the fee for the associated item.
15003
Radiotherapy, superficial (including treatment with x-rays, radium rays or other radioactive substances),
not being a service to which another item in this group applies each attendance at which fractionated
treatment is given.
– Two or more fields up to a maximum of five additional fields.
Derived fee: The fee for item 15000 ($71.10) plus for each field in excess of one, an amount of $40.70.
15009
Radiotherapy, superficial, attendance at which single dose technique is applied.
– Two or more fields up to a maximum of five additional fields.
Derived fee: The fee for item 15006 ($189.80) plus each field in excess of one, an amount of $43.10.
15103
Radiotherapy, deep or orthovoltage each attendance at which fractionated treatment is given at three
or more treatments per week.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields).
Derived fee: The fee for item 15100 ($79.60) plus for each field in excess of one, an amount of $44.80.
15109
Radiotherapy, deep or orthovoltage each attendance at which fractionated treatment is given at two
treatments per week or less frequently.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields).
Derived fee: The fee for item 15106 ($94.10) plus for each field in excess of one, an amount of $54.10.
15115
Radiotherapy, deep or orthovoltage attendance at which single dose technique is applied.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields).
Derived fee: The fee for item 15112 ($200.70) plus for each field in excess of one, an amount of $112.50.
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Item no.
Service description
15214
Radiation oncology treatment, using cobalt unit or caesium teletherapy unit each attendance at which
treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields).
Derived fee: The fee for item 15211 ($88.60) plus for each field in excess of one, an amount of $55.00.
15230
Radiation oncology treatment, using a single photon energy linear accelerator with or without electron
facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site (lung).
Derived fee: The fee for item 15215 ($99.50) plus for each field in excess of one, an amount of $66.00.
15233
Radiation oncology treatment, using a single photon energy linear accelerator with or without electron
facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site (prostate).
Derived fee: The fee for item 15218 ($99.50) plus for each field in excess of one, an amount of $66.00.
15236
Radiation oncology treatment, using a single photon energy linear accelerator with or without electron
facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site (breast).
Derived fee: The fee for item 15221 ($99.50) plus for each field in excess of one, an amount of $66.00.
15239
Radiation oncology treatment, using a single photon energy linear accelerator with or without electron
facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site for diseases and conditions not covered by items 15230, 15233 or
15236.
Derived fee: The fee for item 15224 ($101.50) plus for each field in excess of one, an amount of $66.00.
15242
Radiation oncology treatment, using a single photon energy linear accelerator with or without electron
facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to secondary site.
Derived fee: The fee for item 15227 ($101.50) plus for each field in excess of one, an amount of $66.00.
15260
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher
energy of at least 10MV photons, with electron facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site (lung).
Derived fee: The fee for item 15245 ($101.50) plus for each field in excess of one, an amount of $66.00.
15263
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher
energy of at least 10MV photons, with electron facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site (prostate).
Derived fee: The fee for item 15248 ($99.50) plus for each field in excess of one, an amount of $66.00.
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Item no.
Service description
15266
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher
energy of at least 10MV photons, with electron facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site (breast).
Derived fee: The fee for item 15251 ($101.50) plus for each field in excess of one, an amount of $66.00.
15269
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher
energy of at least 10MV photons, with electron facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to primary site for diseases and conditions not covered by items 15260, 15263 or
15266.
Derived fee: The fee for item 15254 ($101.50) plus for each field in excess of one, an amount of $66.00.
15272
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher
energy of at least 10MV photons, with electron facilities – each attendance at which treatment is given.
– Two or more fields up to a maximum of five additional fields (rotational therapy being three fields) –
treatment delivered to secondary site.
Derived fee: The fee for item 15257 ($101.50) plus for each field in excess of one, an amount of $66.00.
16399
Professional attendance on a patient by a specialist practising in his or her specialty of obstetrics if:
(a) the attendance is by video conference; and
(b) item 16401, 16404, 16406, 16500, 16590 or 16591 applies to the attendance; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the
attendance-at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care
service; or (iii) is a patient of: (A) an Aboriginal Medical Service; (B) or an Aboriginal Community
Controlled Health Service for which a direction made under subsection 19 (2) of the Health Insurance Act
1973 applies.
Derived fee: 50% of the fee for the associated item.
16633
Procedure on multiple pregnancies relating to items 16606, 16609, 16612, 16615 and 16627.
Derived fee: 50% of the fee for the first foetus for any additional foetus tested.
16636
Procedure on multiple pregnancies relating to items 16600, 16603, 16618, 16621 and 16624.
Derived fee: 50% of the fee for the first foetus for any additional foetus tested.
17609
Professional attendance on a patient by a specialist practising in his or her specialty of anaesthesia if: (a)
the attendance is by video conference; and
(b) item 17610, 17615, 17620, 17625, 17640, 17645, 17650, or 17655 applies to the attendance; and
(c) the patient is not an admitted patient; and
(d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the
attendance-at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care
service; or (iii) is a patient of: (A) an aboriginal medical service; or (B) an aboriginal community
controlled health service for which a direction made under subsection 19 (2) of the Health Insurance Act
1973 applies.
Derived fee: 50% of the fee for the associated item.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 14
Item no.
Service description
18219
Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, where
continuous attendance by the medical practitioner extends beyond the first hour.
Derived fee: The fee for item 18216 ($373.90) plus $36.50 for each additional 15 minutes or part thereof
beyond the first hour of attendance by the medical practitioner.
18227
Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, where
continuous attendance by the medical practitioner extends beyond the first hour, for a patient in labour,
where the service is provided in the after-hours period, being the period from 8pm to 8am on any
weekday, or any time on a Saturday, Sunday or a public holiday.
Derived fee: The fee for item 18226 ($574.50) plus $45.60 for each additional 15 minutes or part thereof
beyond the first hour of attendance by the medical practitioner.
25025
Emergency anaesthesia performed in the after-hours period where the patient requires significant
threat to life or body part and where more than 50% of the time for the emergency anaesthesia service
is provided in the after-hours period, being the period from 8pm to 8am on any weekday, or at any time
on a Saturday, Sunday or a public holiday – not being a service associated with a service to which item
25020, 25030 or 25050 applies.
Derived fee: An additional amount of 50% of the fee for the anaesthetic service. That is:
(a) an anaesthesia item(s) in the range 20100 – 21997 or 22900 plus,
(b) an item in the range 23010 – 24136, plus
(c) where applicable, an item in the range 25000 – 25015,
(d) where performed, any associated therapeutic or diagnostic service(s) in the range 22001 – 22050.
25030
Assistance at after-hours emergency anaesthesia where the patient requires immediate treatment
without which there would be significant threat to life or body part and where more than 50% of the
time for which the assistant is in professional attendance on the patient is provided in the after-hours
period, being the period from 8pm to 8am on any weekday, or at any time on a Saturday, Sunday or a
public holiday – not being a service associated with a service to which item 25020, 25025 or 25050
applies.
Derived fee: An additional amount of 50% of the fee for the anaesthetic service. That is:
(a) an assistant anaesthesia item in the range 25200 - 25205 plus,
(b) an item in the range 23010 – 24136, plus
(c) where applicable, an item in the range 25000 – 25015 plus,
(d) where performed, any associated therapeutic or diagnostic service(s) in the range 22001 – 22050.
25050
After-hours emergency perfusion where the patient requires immediate treatment without which there
would be significant threat to life or body part and where more than 50% of the perfusion service is
provided in the after-hours period, being the period from 8pm to 8am on any weekday, or at any time
on a Saturday, Sunday or a public holiday – not being a service associated with a service to which item
25020, 25025 or 25030 applies.
Derived fee: An additional amount of 50% of the fee for the perfusion service. That is:
(a) item 22060, plus
(b) an item in the range 23010 – 24136, plus
(c) where applicable, an item in the range 25000 – 25015 plus,
(d) where performed, any associated therapeutic or diagnostic service(s) in the range 22001 – 22050
and 22065 – 22075.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 15
Item no.
Service description
25200
Assistance in the administration of anaesthesia on a patient in imminent danger of death requiring
continuous life-saving emergency treatment, to the exclusion of all other patients (five basic units).
Derived fee: An amount of $264.50 (5 basic units) plus an item in the range 23010 – 24136 plus, where
applicable, an item in the range 25000 – 25020.
25205
Assistance in the administration of elective anaesthesia where: (i) the patient has complex airway
problems; or (ii) the patient is a neonate or a complex paediatric case; or (iii) there is anticipated to be
massive blood loss (greater than 50% of blood volume) during the procedure; or (iv) the patient is
critically ill, with multiple organ failure; or (v) where the anaesthesia time exceeds six hours and the
assistance is provided to the exclusion of all other patients (five basic units).
Derived fee: An amount of $264.50 (5 basic units), plus an item in the range 23010 – 24136, plus, where
applicable, an item in the range 25000 – 25020.
30001
Operative procedure, not being a service to which any other item in this group applies, being a service to
which an item in this group would have applied had the procedure not been discontinued on medical
grounds.
Derived fee: 50% of the fee which would have applied had the procedure not been discontinued.
31340
Note: Multiple operation and multiple anaesthetic rules apply to this item.
Muscle, bone or cartilage, excision of one or more of, where clinically indicated, where the specimen
excised is sent for histological confirmation, performed in association with excision of malignant tumour
of skin covered by item 31255, 31256, 31257, 31258, 31260, 31261, 31262, 31263, 31265, 31266, 31267,
31268, 31270, 31271, 31272, 31273, 31275, 31276, 31277, 31278, 31280, 31281, 31282, 31283, 31285, 31286,
31287, 31288, 31290, 31291, 31292, 31293, 31295, 31300, 31305, 31310, 31315, 31320, 31325, 31330 or
31335 (Anaes.)
Derived fee: 75% of the fee for excision of malignant tumour.
44376
Amputation stump, reamputation of, to provide adequate skin and muscle cover (Assist).
Derived fee: 75% of the original amputation fee.
51309
Assistance at a series or combination of operations which have been identified by the word ‘Assist’ and
assistance at a delivery involving Caesarean section.
Derived fee: One-fifth of the established fee for the operation or combination of operations (the fee for
item 16520 being the schedule fee for the Caesarean section component in the calculation of the
established fee).
51312
Assistance at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615,
16627 and 16633.
Derived fee: One-fifth of the established fee for the procedure or combination of procedures.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 16
Item No
Max. Fee
(ex GST)
Category 1:
Professional attendances
Fees incorporate the completion
and lodgement of a medical
certificate where appropriate.
GP attendances
00003
$27.80
00004 (per patient)
$74.90
00020 (per patient)
$97.20
00023
$69.60
00024 (per patient)
$110.70
00035 (per patient)
$133.10
00036
$112.10
00037 (per patient)
$155.50
00043 (per patient)
$177.90
00044
$170.50
$216.9
0
$239.2
0
00047 (per patient)
00051 (per patient)
00052
NA
00053
NA
00054
NA
00057
00058
00059
00060
00065
NA
Please
use item
numbers
between
1 – 51
NA
NA
NA
NA
00092
NA
00093
NA
00095
NA
00096
NA
Specialist attendances
00099
DF
00104
$146.90
0104A
$178.40
00105
$81.00
00106
00107
$131.30
$173.00
00108
$111.80
00109
$210.90
Consultant physician
attendances
00110
$244.80
00112
DF
Specialist attendance
00113
$101.60
Consultant physician
attendances
00114
$179.10
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
00116
$125.90
00306
$349.70
00412
$134.00
00119
$64.90
00308
$393.50
00413
$198.30
00122
$273.40
00310
$89.30
00128
$157.00
00312
00131
$122.60
00314
00132
$347.80
00316
00133
$181.90
Other attendances
00414 (1 patient)
$76.40
$138.50
00414 (2)
$54.50
$188.80
00414 (3)
$47.10
$241.80
00414 (4)
$43.50
00318
$247.00
00414 (5)
$41.30
00319
$295.50
00414 (6)
$39.80
00135
$347.80
00320
$81.10
00137
$347.80
00322
$163.70
00415 (1 patient)
00139
$213.20
00324
$242.00
00415 (2)
$93.00
00141
$547.20
00326
$349.70
00415 (3)
$85.60
00143
$342.00
00328
$405.60
00415 (4)
$82.00
00145
$663.30
00330
$110.10
00415 (5)
$79.80
00147
$414.60
00332
$179.00
00415 (6)
$78.30
00149
DF
00334
$244.80
00415 (>7)
$73.60
00160
$317.10
00336
$349.70
00416 (1 patient)
$177.90
00161
$512.50
00338
$474.80
00416 (2)
$156.00
00162
$692.50
00342
$83.00
00416 (3)
$148.60
00163
$861.60
00344
$114.20
00416 (4)
$145.00
00164
$1,019.60
00346
$163.00
00416 (5)
$142.80
00170
$216.70
00348
$219.10
00416 (6)
$141.30
00171
$222.60
00350
$317.80
00416 (>7)
$136.60
00172
$256.00
00352
$153.20
00417 (1 patient)
$242.20
00173
$43.20
00353
$84.70
00417 (2)
$220.30
00193
$64.40
00355
$169.10
00417 (3)
$212.90
$108.30
00356
$248.20
00417 (4)
$209.30
00195 (2)
$86.40
00357
$342.50
00417 (5)
$207.10
00195 (3)
$79.00
00358
$417.20
00417 (6)
$205.60
00195 (4)
$75.40
00359
$472.60
00417 (>7)
$200.90
Emergency physician
attendances
00195 (1 patient)
00195 (5)
$73.20
00361
$361.60
00195 (6)
$71.70
00364
$72.30
00195 (>7)
$67.00
00366
$147.10
00197
$102.60
00367
$215.50
00199
$171.80
00369
$327.10
00370
$355.90
NA
Psychiatrist attendances
00288
DF
00384
00289
$433.10
00385
00291
$547.20
00386
00293
$342.00
00387
00296
$375.00
00388
00297
$375.00
00389
00299
$445.00
00300
$81.10
Public health physician
attendances
00302
$163.70
00304
$242.00
Please
use item
numbers
between
110 – 128
NA
NA
NA
NA
NA
00410
$32.50
00411
$71.00
00414 (>7)
$35.10
$114.90
00501
$63.90
00503
$108.80
00507
$181.50
00511
$257.80
00515
$332.00
00519
$250.30
00520
$388.30
00530
$615.40
00532
$861.70
00534
$1,108.20
00536
$1,046.60
Urgent attendances after
hours
00597
$193.00
00598
$193.00
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 17
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
00599
$279.80
02122 (5)
$42.00
02199 (6)
$219.10
02522 (4)
$125.60
00600
$214.90
02122 (6)
$40.70
02199 (>7)
$215.60
02522 (5)
$123.40
00701
$70.90
02122 (>7)
$37.20
02220 (1 patient)
$282.90
02522 (6)
$121.90
00703
$163.50
02125 (1 patient)
$104.50
02220 (2)
$247.80
02522 (>7)
$117.20
00705
$225.50
02125 (2)
$69.40
02220 (3)
$236.00
02525
$168.70
00707
$318.60
02125 (3)
$57.60
02220 (4)
$230.20
02526 (1 patient)
$212.60
00715
$251.50
02125 (4)
$51.80
02220 (5)
$226.70
02526 (2)
$190.70
00721
$171.30
02125 (5)
$48.30
02220 (6)
$224.30
02526 (3)
$183.30
00723
$135.40
02125 (6)
$45.90
02220 (>7)
$217.60
02526 (4)
$179.70
00729
NA
02125 (>7)
$39.20
02497
$27.50
02526 (5)
$177.50
00731
NA
02126
$74.60
02501
$61.00
02526 (6)
$176.00
00732
$85.70
$104.90
02526 (>7)
$171.30
00735
$60.40
02137 (1 patient)
$113.70
02503 (1 patient)
NA
02137 (2)
$94.20
02503 (2)
$83.00
02546
00739
NA
02137 (3)
$87.60
02503 (3)
$75.60
02547 (1 patient)
00743
NA
02137 (4)
$84.40
02503 (4)
$72.00
02547 (2)
$82.40
00747
NA
02137 (5)
$82.40
02503 (5)
$69.80
02547 (3)
$75.00
00750
NA
02137 (6)
$81.10
02503 (6)
$68.30
02547 (4)
$71.40
00758
NA
02137 (>7)
$77.60
02503 (>7)
$63.60
02547 (5)
$69.20
00820
NA
02138 (1 patient)
$144.90
02504
$114.60
02547 (6)
$67.70
00822
NA
02138 (2)
$109.80
02506 (1 patient)
$158.50
02547 (>7)
00823
NA
02138 (3)
$98.00
02506 (2)
$136.60
02552
$114.60
00825
NA
02138 (4)
$92.20
02506 (3)
$129.20
02553 (1 patient)
$158.50
00826
NA
02138 (5)
$88.70
02506 (4)
$125.60
02553 (2)
$136.60
00828
NA
02138 (6)
$86.30
02506 (5)
$123.40
02553 (3)
$129.20
00830
NA
02138 (>7)
$79.60
02506 (6)
$121.90
02553 (4)
$125.60
00832
NA
02143
$144.40
02506 (>7)
$117.20
02553 (5)
$123.40
00834
NA
02147 (1 patient)
$183.50
02507
$168.70
02553 (6)
$121.90
00835
NA
02147 (2)
$164.00
02509 (1 patient)
$212.60
02553 (>7)
$117.20
00837
NA
02147 (3)
$157.40
02509 (2)
$190.70
02558
$168.70
00838
NA
02147 (4)
$154.20
02509 (3)
$183.30
02559 (1 patient)
$212.60
00855
NA
02147 (5)
$152.20
02509 (4)
$179.70
02559 (2)
$190.70
00857
NA
02147 (6)
$150.90
02509 (5)
$177.50
02559 (3)
$183.30
00858
NA
02147 (>7)
$147.40
02509 (6)
$176.00
02559 (4)
$179.70
00861
NA
02179 (1 patient)
$214.70
02509 (>7)
$171.30
02559 (5)
$177.50
00864
NA
02179 (2)
$179.60
02517
$60.40
02559 (6)
$176.00
00866
NA
02179 (3)
$167.80
02518 (1 patient)
$104.30
02559(>7)
$171.30
00871
NA
02179 (4)
$162.00
02518 (2)
$82.40
02598
NA
00872
NA
02179 (5)
$158.50
02518 (3)
$75.00
02600
NA
00880
NA
02179 (6)
$156.10
02518 (4)
$71.40
02603
00900
$252.10
02179 (>7)
$149.40
02518 (5)
$69.20
00903
$172.60
02100
$34.20
$104.30
$63.00
Please use
NA
02606
item
NA
NA
02195
$212.60
02518 (6)
$67.70
02610
numbers
02199 (1 patient)
$251.70
02518 (>7)
$63.00
02613
between
NA
2497-2559
NA
02122 (1 patient)
$73.30
02199 (2)
$232.20
02521
$114.60
02616
02122 (2)
$53.80
02199 (3)
$225.60
02522 (1 patient)
$158.50
02620
NA
02122 (3)
$47.20
02199 (4)
$222.40
02522 (2)
$136.60
02622
NA
02122 (4)
$44.00
02199 (5)
$220.40
02522 (3)
$129.20
02624
NA
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 18
Item No
Max. Fee
(ex GST)
02631
02633
02635
02664
02666
02668
02673
Please use
item
numbers
between
2497-2559
02675
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
NA
02984
$348.30
05227
NA
10984
NA
NA
02988
$464.10
05228
NA
10986
NA
$157.50
05260
NA
10987
NA
NA
10988
NA
NA
10989
NA
NA
10990
NA
NA
02992
NA
02996
$253.10
05263
NA
03000
$345.30
05265
NA
03003
$179.10
05267
NA
03005
$244.80
Neurosurgery attendances
10991
NA
NA
03010
$125.90
06004
$153.80
10992
NA
06007
$240.0
0
10997
NA
02677
NA
03014
$64.90
02700
$117.70
03015
DF
02701
$173.20
03018
$273.40
02712
$179.10
03023
$157.00
02713
$130.60
03028
$118.60
02715
$149.50
03032
$232.10
02717
$220.00
03040
$348.30
02721
$132.70
03044
$464.10
02723 (1 patient)
$176.60
03051
$120.90
02723 (2)
$154.70
03055
$218.80
02723 (3)
$147.30
03062
$345.30
02723 (4)
$143.70
03069
$252.50
02723 (5)
$141.50
03074
$378.90
02723 (6)
$140.00
03078
$505.00
02723 (>7)
$135.30
03083
$157.50
02725
$178.10
03088
$253.10
02727 (1 patient)
$222.00
03093
$345.30
02727 (2)
$200.10
04001
$124.70
02727 (3)
$192.70
05000
$45.10
02727 (4)
$189.10
05003 (per patient)
$91.80
02727 (5)
$186.90
05010 (per patient)
02727 (6)
$185.40
05020
02727 (>7)
$180.70
05023 (per patient)
$136.50
02799
$179.10
05028 (per patient)
02801
$266.80
$158.9
0
02806
$125.90
02814
$64.90
02820
DF
02824
$273.40
02832
$157.00
02840
$118.60
02946
$232.10
02949
$348.30
02954
$464.10
02958
$120.90
02972
$253.10
02974
$264.40
02978
$252.50
$114.10
$90.50
05040
$143.50
05043 (per patient)
$188.30
05049 (per patient)
$210.50
05060
05063 (per patient)
05067 (per patient)
05200
$221.8
0
$268.2
0
$290.5
0
Please use
item
numbers
between
5000-5067
06009
06011
06013
06015
$80.40
$162.8
0
$224.4
0
$265.0
0
06016
DF
Contact lenses attendances
10801
10802
10803
10804
10805
10806
10807
10808
10809
10816
$201.9
0
$201.9
0
$201.9
0
$229.1
0
$201.9
0
$201.9
0
$201.9
0
$201.9
0
$201.9
0
$201.9
0
Category 8:
Miscellaneous services
Category 2:
Diagnostic procedures &
investigations
11000
11003
11004
$231.20
$509.2
0
$568.0
0
11005
$543.70
11006
$263.5
0
11009
$352.20
11012
$187.00
11015
$266.5
0
11018
$389.70
11021
$263.70
11024
$176.70
11027
$260.9
0
11200
$62.60
11204
$179.60
11205
$179.60
11210
$179.60
11211
$179.60
11215
$230.9
0
$285.5
0
10950
NA
11218
10951
NA
11221
$155.70
10952
NA
11222
10953
NA
$149.5
0
11224
$86.80
10954
NA
11225
$82.40
10956
NA
11235
$232.10
10958
NA
10960
NA
11237
$154.4
0
$154.4
0
NA
10962
NA
11240
05203
Please use
NA
10964
NA
item
11241
$182.30
05207
NA
10966
NA
05208
numbers
NA
11242
10968
NA
$145.4
0
NA
10970
NA
11243
$133.00
NA
10983
NA
11244
$124.70
11300
$306.8
05220
05223
between
5000-5067
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 19
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
0
11724
$316.10
12521
$211.40
13709
$76.30
$306.8
0
$499.9
0
11727
$160.00
12524
$264.20
13750
$211.00
11800
$325.90
12527
$141.70
13755
$211.00
11810
$287.30
12530
$211.40
13757
$102.00
11306
$34.50
11820
$2,469.10
12533
$141.10
13760
$1,188.30
11309
$40.40
11823
$3,403.60
$134.80
$58.30
11830
$236.80
Category 3:
Therapeutic procedures
13815
11312
13818
$208.10
11315
$76.30
11833
$404.70
13830
$117.50
11318
$106.70
11900
$47.90
11321
$180.2
0
11903
$210.20
11324
$58.30
11906
$188.60
11327
$36.70
11909
$275.60
11330
$14.00
11912
$281.70
11332
$97.30
11915
$281.70
11333
$75.90
11917
$728.60
11336
$83.30
11919
$728.60
11339
$76.30
11921
$142.20
11500
$278.8
0
12000
$71.90
11503
$232.30
12003
$108.10
11506
$32.50
11509
$64.10
11512
$95.50
11600
$101.80
11602
$89.90
11604
$93.90
11605
$91.40
11610
$89.90
11611
$89.90
11612
$141.10
11614
$93.90
11615
$132.10
11303
11304
11627
$379.80
11700
$53.20
11701
$26.40
11702
$26.40
11708
$213.30
11709
$286.50
11710
$94.80
11711
$53.20
11712
$266.50
11713
$131.30
11715
$202.00
11718
$60.80
11721
$120.20
11722
$60.90
12012
$38.80
12015
$116.70
12018
$153.50
12021
$222.20
12200
$69.60
12201
$2,892.20
12203
$891.70
12207
$891.70
12210
$1,165.50
12213
$1,050.00
12215
$1,165.50
12217
$1,050.00
12250
$559.60
12306
$180.20
12309
$180.20
12312
$180.20
12315
$180.20
12318
$170.90
12321
$180.20
12323
$170.10
12500
$337.00
12503
$621.70
12506
$449.50
12509
$337.00
12512
$187.50
12515
$352.20
12518
$175.40
13015
$423.00
13020
$432.40
13025
$217.40
13030
$272.60
13100
$242.10
13103
$135.10
13104
$247.10
13106
$182.90
13109
$429.50
13110
$379.40
13112
$260.90
13200
$4,963.30
13201
$4,639.60
13202
$744.50
13203
$891.30
13206
$1,251.10
13209
$192.00
13210
DF
13212
$604.90
13215
$209.10
13218
$1,729.70
13221
$107.20
13251
$717.30
13290
$339.20
13292
$678.90
13300
$94.60
13303
$140.30
13306
$554.70
13309
$473.10
13312
$47.20
13318
$377.70
13319
$377.70
13400
$158.60
13500
$284.50
13503
$561.80
13506
$306.80
13700
$517.20
13703
$188.60
13706
$128.90
13839
$38.40
13842
$106.60
13847
$283.40
13848
$216.20
13851
$839.40
13854
$194.50
13857
$240.50
13870
$524.60
13873
$384.40
13876
$107.80
13881
$265.80
13882
$209.30
13885
$278.70
13888
$143.70
13915
$111.10
13918
$152.80
13921
$173.60
13924
$101.50
13927
$133.20
13930
$185.90
13933
$203.90
13936
$133.20
13939
$152.80
13942
$101.50
13945
$82.10
13948
$101.50
14050
$88.10
14053
$88.10
14100
$405.40
14106
$405.40
14109
$488.90
14112
$586.50
14115
$596.00
14118
$835.20
14124
$322.00
14200
$107.10
14201
$388.80
14202
$196.70
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 20
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
14203
$82.10
15272
DF
15562
$1,526.80
16609
$823.70
14206
$52.60
15303
$595.90
15600
$3,655.00
16612
$648.00
14209
$144.00
15304
$595.90
15700
$80.70
16615
$345.30
14212
$309.40
15307
$1,129.70
15705
$134.70
16618
$350.00
14218
$158.60
15308
$1,129.70
15710
$135.20
16621
$345.30
14221
$89.30
15311
$556.20
15800
$177.50
16624
$496.80
14224
$113.90
15312
$552.10
15850
$440.00
16627
$1,011.20
14227
$162.60
15315
$1,092.10
16003
$1,123.70
16633
DF
14230
$494.90
15316
$1,102.90
16006
$861.50
16636
DF
14233
$601.00
15319
$677.70
16009
$569.30
17609
DF
14236
$1,095.90
15320
$677.70
16012
$492.80
17610
$80.70
14239
$264.90
15323
$1,205.10
16015
$6,007.70
17615
$160.60
14242
$786.50
15324
$1,228.70
16018
$3,202.40
17620
$226.20
14245
$162.60
15327
$1,311.10
16399
NA
17625
$282.60
15000
$71.10
15328
$1,625.00
16400
$41.20
17640
$82.00
15003
DF
15331
$1,244.80
16401
$187.10
17645
$149.80
15006
$189.80
15332
$1,459.60
16404
$80.70
17650
$209.40
15009
DF
15335
$1,129.70
16406
$219.80
17655
$286.10
15012
$101.00
15336
$1,129.70
16500
$86.30
17680
$169.20
15100
$79.60
15338
$1,768.70
16501
$233.40
17690
$66.00
15103
DF
15339
$150.00
16502
$77.30
18213
$149.20
15106
$94.10
15342
$317.60
16504
$71.10
18216
$373.90
15109
DF
15345
$861.50
16505
$82.90
18219
DF
15112
$200.70
15348
$98.70
16508
$77.20
18222
$91.10
15115
DF
15351
$231.80
16509
$89.00
18225
$127.50
15211
$88.60
15354
$236.00
16511
$416.00
18226
$574.50
15214
DF
15357
$79.50
16512
$119.30
18227
DF
15215
$99.50
15500
$367.30
16514
$61.00
18228
$155.20
15218
$99.50
15503
$502.10
16515
$1,164.90
18230
$450.90
15221
$99.50
15506
$786.70
16518
$1,040.80
18232
$333.10
15224
$101.50
15509
$349.70
16519
$1,788.60
18233
$346.10
15227
$101.50
15512
$327.70
16520
$1,933.50
18234
$216.30
15230
DF
15513
$575.00
16522
$2,603.40
18236
$117.90
15233
DF
15515
$604.30
16525
$917.20
18238
$63.10
15236
DF
15518
$146.60
16527
$739.60
18240
$183.30
15239
DF
15521
$637.40
16528
$1,331.10
18242
$71.80
15242
DF
15524
$1,204.90
16564
$410.90
18244
$241.40
15245
$101.50
15527
$132.00
16567
$578.70
18246
$191.60
15248
$99.50
15530
$517.20
16570
$715.30
18248
$166.00
15251
$101.50
15533
$1,018.50
16571
$599.30
18250
$162.40
15254
$101.50
15536
$560.40
16573
$466.70
18252
$190.60
15257
$101.50
15539
$1,490.00
16590
$356.10
18254
$248.50
15260
DF
15550
$839.80
16591
$238.10
18256
$130.10
15263
DF
15553
$858.80
16600
$153.00
18258
$120.50
15266
DF
15556
$825.40
16603
$228.50
18260
$185.70
15269
DF
15559
$1,102.60
16606
$404.00
18262
$163.10
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 21
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
18264
$203.00
20147
$317.40
20524
$211.60
20815
$317.40
18266
$144.70
20148
$211.60
20526
$529.00
20820
$264.50
18268
$176.90
20160
$317.40
20528
$423.20
20830
$211.60
18270
$319.80
20162
$370.30
20540
$687.70
20832
$317.40
18272
$183.30
20164
$211.60
20542
$793.50
20840
$317.40
18274
$180.10
20170
$317.40
20546
$793.50
20841
$423.20
18276
$249.40
20172
$370.30
20548
$793.50
20842
$211.60
18278
$192.30
20174
$476.10
20560
$1,058.00
20844
$529.00
18280
$258.10
20176
$529.00
20600
$529.00
20845
$529.00
18282
$292.90
20190
$264.50
20604
$687.70
20846
$529.00
18284
$292.90
20192
$529.00
20620
$529.00
20847
$529.00
18286
$292.90
20210
$793.50
20622
$687.70
20848
$529.00
18288
$288.00
20212
$264.50
20630
$423.20
20850
$634.80
18290
$417.00
20214
$476.10
20632
$370.30
20855
$793.50
18292
$269.40
20216
$1,058.00
20634
$529.00
20860
$317.40
18294
$333.00
20220
$529.00
20670
$687.70
20862
$370.30
18296
$318.00
20222
$317.40
20680
$158.70
20863
$529.00
18298
$293.60
20225
$634.80
20690
$264.50
20864
$529.00
18350
$209.80
20230
$634.80
20700
$158.70
20866
$529.00
18351
$226.80
20300
$264.50
20702
$211.60
20867
$529.00
18353
$417.00
20305
$793.50
20703
$211.60
20868
$529.00
18354
$226.20
20320
$317.40
20704
$529.00
20880
$793.50
18360
$208.40
20321
$529.00
20705
$317.40
20882
$529.00
18361
$204.90
20330
$423.20
20706
$370.30
20884
$264.50
18362
$496.00
20350
$529.00
20730
$264.50
20886
$317.40
18365
$209.30
20352
$264.50
20740
$264.50
20900
$158.70
18366
$303.50
20355
$634.80
20745
$317.40
20902
$211.60
18368
$445.70
20400
$158.70
20750
$211.60
20904
$370.30
18369
$92.00
20401
$211.60
20752
$317.40
20905
$529.00
18370
$79.10
20402
$264.50
20754
$370.30
20906
$211.60
18372
$207.30
20403
$264.50
20756
$476.10
20910
$211.60
18374
$207.30
20404
$317.40
20770
$793.50
20911
$264.50
18375
$363.70
20405
$423.20
20790
$423.20
20912
$264.50
18377
$197.50
20406
$687.70
20791
$529.00
20914
$370.30
18379
$352.70
20410
$264.50
20792
$687.70
20916
$370.30
20100
$264.50
20420
$264.50
20793
$793.50
20920
$211.60
20102
$317.40
20440
$211.60
20794
$634.80
20924
$211.60
20104
$211.60
20450
$264.50
20798
$529.00
20926
$211.60
20120
$264.50
20452
$317.40
20799
$317.40
20928
$317.40
20124
$211.60
20470
$317.40
20800
$158.70
20930
$211.60
20140
$264.50
20472
$529.00
20802
$264.50
20932
$211.60
20142
$317.40
20474
$687.70
20803
$211.60
20934
$317.40
20143
$317.40
20475
$529.00
20804
$529.00
20936
$423.20
20144
$423.20
20500
$793.50
20805
$317.40
20938
$211.60
20145
$423.20
20520
$317.40
20806
$370.30
20940
$211.60
20146
$264.50
20522
$211.60
20810
$211.60
20942
$264.50
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 22
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
20943
$211.60
21382
$211.60
21685
$529.00
21916
$264.50
20944
$317.40
21390
$158.70
21700
$158.70
21918
$264.50
20946
$423.20
21392
$211.60
21710
$211.60
21922
$370.30
20948
$211.60
21400
$211.60
21712
$264.50
21925
$211.60
20950
$264.50
21402
$370.30
21714
$264.50
21926
$264.50
20952
$211.60
21403
$529.00
21716
$264.50
21927
$264.50
20953
$264.50
21404
$264.50
21730
$158.70
21930
$317.40
20954
$529.00
21420
$158.70
21732
$211.60
21935
$264.50
20956
$211.60
21430
$211.60
21740
$264.50
21936
$317.40
20958
$264.50
21432
$264.50
21756
$317.40
21939
$158.70
20960
$370.30
21440
$423.20
21760
$370.30
21941
$370.30
21100
$158.70
21445
$529.00
21770
$423.20
21942
$529.00
21110
$264.50
21460
$158.70
21772
$317.40
21943
$264.50
21112
$211.60
21461
$211.60
21780
$211.60
21945
$264.50
21114
$264.50
21462
$158.70
21785
$529.00
21949
$264.50
21116
$317.40
21464
$211.60
21790
$793.50
21952
$529.00
21120
$317.40
21472
$264.50
21800
$158.70
21955
$264.50
21130
$158.70
21474
$264.50
21810
$211.60
21959
$264.50
21140
$793.50
21480
$211.60
21820
$158.70
21962
$264.50
21150
$529.00
21482
$264.50
21830
$211.60
21965
$264.50
21155
$529.00
21484
$264.50
21832
$370.30
21969
$423.20
21160
$211.60
21486
$370.30
21834
$211.60
21970
$793.50
21170
$423.20
21490
$158.70
21840
$423.20
21973
$264.50
21195
$158.70
21500
$423.20
21842
$317.40
21976
$264.50
21199
$211.60
21502
$317.40
21850
$211.60
21980
$264.50
21200
$211.60
21520
$211.60
21860
$158.70
21981
$211.60
21202
$211.60
21522
$264.50
21865
$529.00
21990
$158.70
21210
$317.40
21530
$793.50
21870
$793.50
21992
$211.60
21212
$529.00
21532
$423.20
21872
$423.20
21997
$211.60
21214
$529.00
21535
$529.00
21878
$158.70
22001
$158.70
21216
$740.60
21600
$158.70
21879
$264.50
22002
$211.60
21220
$211.60
21610
$264.50
21880
$370.30
22007
$211.60
21230
$317.40
21620
$211.60
21881
$476.10
22008
$211.60
21232
$264.50
21622
$264.50
21882
$581.90
22012
$158.70
21234
$423.20
21630
$264.50
21883
$687.70
22014
$158.70
21260
$211.60
21632
$317.40
21884
$793.50
22015
$317.40
21270
$423.20
21634
$476.10
21885
$899.30
22018
$370.30
21272
$211.60
21636
$793.50
21886
$1,005.10
22020
$211.60
21274
$317.40
21638
$529.00
21887
$1,110.90
22025
$211.60
21275
$529.00
21650
$423.20
21900
$158.70
22031
$264.50
21280
$793.50
21652
$529.00
21906
$264.50
22036
$158.70
21300
$158.70
21654
$423.20
21908
$317.40
22040
$105.80
21321
$211.60
21656
$529.00
21910
$476.10
22045
$158.70
21340
$211.60
21670
$211.60
21912
$264.50
22050
$105.80
21360
$264.50
21680
$158.70
21914
$317.40
22051
$476.10
21380
$158.70
21682
$211.60
21915
$264.50
22055
$634.80
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 23
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
22060
$1,058.00
23230
$1,428.30
23690
$3,861.70
24115
$6,295.10
22065
$264.50
23240
$1,481.20
23700
$3,914.60
24116
$6,348.00
22070
$529.00
23250
$1,534.10
23710
$3,967.50
24117
$6,400.90
22075
$793.50
23260
$1,587.00
23720
$4,020.40
24118
$6,453.80
22900
$317.40
23270
$1,639.90
23730
$4,073.30
24119
$6,506.70
22905
$317.40
23280
$1,692.80
23740
$4,126.20
24120
$6,559.60
23010
$52.90
23290
$1,745.70
23750
$4,179.10
24121
$6,612.50
23021
$105.80
23300
$1,798.60
23760
$4,232.00
24122
$6,665.40
23022
$105.80
23310
$1,851.50
23770
$4,284.90
24123
$6,718.30
23023
$105.80
23320
$1,904.40
23780
$4,337.80
24124
$6,771.20
23031
$158.70
23330
$1,957.30
23790
$4,390.70
24125
$6,824.10
23032
$158.70
23340
$2,010.20
23800
$4,443.60
24126
$6,877.00
23033
$158.70
23350
$2,063.10
23810
$4,496.50
24127
$6,929.90
23041
$211.60
23360
$2,116.00
23820
$4,549.40
24128
$6,982.80
23042
$211.60
23370
$2,168.90
23830
$4,602.30
24129
$7,035.70
23043
$211.60
23380
$2,221.80
23840
$4,655.20
24130
$7,088.60
23051
$264.50
23390
$2,274.70
23850
$4,708.10
24131
$7,141.50
23052
$264.50
23400
$2,327.60
23860
$4,761.00
24132
$7,194.40
23053
$264.50
23410
$2,380.50
23870
$4,813.90
24133
$7,247.30
23061
$317.40
23420
$2,433.40
23880
$4,866.80
24134
$7,300.20
23062
$317.40
23430
$2,486.30
23890
$4,919.70
24135
$7,353.10
23063
$317.40
23440
$2,539.20
23900
$4,972.60
24136
$7,406.00
23071
$370.30
23450
$2,592.10
23910
$5,025.50
25000
$52.90
23072
$370.30
23460
$2,645.00
23920
$5,078.40
25005
$105.80
23073
$370.30
23470
$2,697.90
23930
$5,131.30
25010
$158.70
23081
$423.20
23480
$2,750.80
23940
$5,184.20
25015
$52.90
23082
$423.20
23490
$2,803.70
23950
$5,237.10
25020
$105.80
23083
$423.20
23500
$2,856.60
23960
$5,290.00
25025
DF
23091
$476.10
23510
$2,909.50
23970
$5,342.90
25030
DF
23101
$529.00
23520
$2,962.40
23980
$5,395.80
25050
DF
23111
$581.90
23530
$3,015.30
23990
$5,448.70
25200
DF
23112
$634.80
23540
$3,068.20
24100
$5,501.60
25205
DF
23113
$687.70
23550
$3,121.10
24101
$5,554.50
30001
DF
23114
$740.60
23560
$3,174.00
24102
$5,607.40
30003
$52.30
23115
$793.50
23570
$3,226.90
24103
$5,660.30
30006
$77.70
23116
$846.40
23580
$3,279.80
24104
$5,713.20
30009
$101.50
23117
$899.30
23590
$3,332.70
24105
$5,766.10
30010
$139.20
23118
$952.20
23600
$3,385.60
24106
$5,819.00
30013
$270.90
23119
$1,005.10
23610
$3,438.50
24107
$5,871.90
30014
$292.10
23121
$1,058.00
23620
$3,491.40
24108
$5,924.80
30017
$544.10
23170
$1,110.90
23630
$3,544.30
24109
$5,977.70
30020
$1,195.70
23180
$1,163.80
23640
$3,597.20
24110
$6,030.60
30023
$620.90
23190
$1,216.70
23650
$3,650.10
24111
$6,083.50
30024
$591.90
23200
$1,269.60
23660
$3,703.00
24112
$6,136.40
30026
$87.30
23210
$1,322.50
23670
$3,755.90
24113
$6,189.30
30029
$150.10
23220
$1,375.40
23680
$3,808.80
24114
$6,242.20
30032
$137.60
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 24
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
30035
$196.30
30189
$290.00
30294
$2,927.20
30405
$1,720.30
30038
$150.10
30190
$747.30
30296
$2,101.60
30406
$98.00
30041
$240.40
30192
$66.50
30297
$1,912.70
30408
$736.90
30042
$353.40
30195
$106.50
30299
$1,200.30
30409
$331.90
30045
$196.30
30196
$209.90
30300
$1,444.70
30411
$200.00
30048
$249.80
30197
$738.70
30302
$959.10
30412
$98.20
30049
$350.10
30202
$80.10
30303
$1,081.60
30414
$1,297.80
30052
$444.90
30203
$285.60
30306
$1,575.70
30415
$2,587.20
30055
$139.20
30205
$209.90
30308
$1,800.00
30416
$1,406.00
30058
$270.10
30207
$84.30
30309
$2,175.80
30417
$2,108.60
30061
$40.40
30210
$301.40
30310
$865.10
30418
$3,002.10
30062
$101.00
30213
$223.50
30313
$669.40
30419
$1,530.70
30064
$183.50
30214
$183.30
30314
$1,054.50
30421
$3,747.60
30067
$373.40
30216
$44.50
30315
$2,210.80
30422
$1,266.90
30068
$522.70
30219
$44.50
30317
$2,564.90
30425
$2,457.20
30071
$98.30
30223
$301.80
30318
$1,711.20
30427
$2,605.40
30074
$210.70
30224
$432.80
30320
$2,564.90
30428
$2,787.50
30075
$285.70
30225
$502.40
30321
$1,704.00
30430
$4,362.00
30078
$86.10
30226
$282.90
30323
$2,564.90
30431
$982.90
30081
$184.30
30229
$513.90
30324
$2,583.50
30433
$1,359.50
30084
$106.50
30232
$422.30
30329
$462.60
30434
$1,106.00
30087
$53.50
30235
$556.90
30330
$1,358.90
30436
$1,090.60
30090
$232.60
30238
$282.80
30332
$649.40
30437
$1,440.80
30093
$284.40
30241
$679.70
30335
$1,514.20
30438
$2,163.30
30094
$350.10
30244
$730.00
30336
$1,947.00
30439
$349.40
30096
$306.80
30246
$1,299.10
30373
$906.90
30440
$975.10
30097
$182.70
30247
$1,310.10
30375
$983.50
30441
$257.30
30099
$160.30
30250
$2,562.20
30376
$983.50
30442
$353.40
30102
$265.30
30251
$3,690.30
30378
$983.50
30443
$1,389.60
30103
$344.90
30253
$1,784.60
30379
$1,742.40
30445
$1,381.40
30104
$245.20
30255
$2,495.00
30382
$2,457.20
30446
$1,406.40
30106
$271.50
30256
$833.30
30384
$2,071.70
30448
$1,828.10
30107
$419.30
30259
$412.50
30385
$1,059.40
30449
$2,034.80
30110
$546.00
30262
$113.20
30387
$1,275.10
30450
$984.90
30111
$700.40
30265
$195.20
30388
$3,002.10
30451
$471.70
30114
$700.70
30266
$285.60
30390
$414.00
30452
$705.80
30165
$930.00
30269
$345.00
30391
$557.60
30454
$1,646.20
30168
$907.30
30272
$564.50
30392
$1,144.00
30455
$1,912.00
30171
$1,395.00
30275
$3,363.40
30393
$990.70
30457
$2,596.00
30174
$1,395.00
30278
$81.70
30394
$929.00
30458
$1,909.60
30177
$2,090.00
30281
$265.00
30396
$1,912.30
30460
$1,620.00
30180
$280.00
30282
$258.10
30397
$437.00
30461
$2,762.90
30183
$558.20
30283
$350.80
30399
$599.50
30463
$3,641.60
30185
$304.60
30286
$851.80
30400
$1,190.20
30464
$4,093.40
30186
$79.20
30289
$1,011.00
30402
$875.50
30466
$2,356.80
30187
$360.50
30293
$841.50
30403
$982.90
30467
$2,908.70
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 25
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
30469
$3,232.30
30539
$1,643.30
30606
$2,087.90
31230
$313.80
30472
$1,727.00
30541
$2,848.30
30609
$875.50
31235
$273.80
30473
$334.10
30542
$1,934.50
30612
$718.60
31240
$313.80
30475
$603.90
30544
$1,617.60
30614
$867.20
31245
$702.30
30476
$462.90
30545
$3,448.00
30615
$982.90
31250
$658.50
30478
$472.70
30547
$2,108.80
30616
$440.50
31255
$421.40
30479
$899.60
30548
$1,773.40
30617
$591.80
31256
$407.50
30481
$667.50
30550
$3,870.30
30620
$719.70
31257
$421.40
30482
$475.60
30551
$2,672.80
30621
$769.90
31258
$421.40
30483
$330.80
30553
$1,757.00
30628
$61.80
31260
$594.40
30484
$683.70
30554
$3,829.60
30631
$464.10
31261
$594.40
30485
$1,059.40
30556
$2,699.50
30634
$445.70
31262
$594.40
30487
$338.20
30557
$1,951.00
30635
$605.10
31263
$594.40
30488
$168.30
30559
$1,597.60
30638
$578.70
31265
$347.90
30490
$983.50
30560
$1,773.40
30641
$760.70
31266
$320.50
30491
$1,036.70
30562
$1,120.70
30644
$997.30
31267
$347.90
30492
$1,401.50
30563
$1,120.70
30653
$77.20
31268
$347.90
30493
$629.10
30564
$1,457.90
30656
$179.50
31270
$483.50
30494
$791.50
30565
$1,636.20
30659
$425.00
31271
$458.00
30495
$1,401.50
30566
$1,811.80
30660
$425.00
31272
$488.40
30496
$981.80
30568
$1,367.40
30663
$239.60
31273
$488.40
30497
$1,170.50
30569
$698.30
30666
$89.80
31275
$569.00
30499
$1,569.10
30571
$849.00
30672
$847.10
31276
$565.20
30500
$1,674.40
30572
$850.50
30675
$499.80
31277
$569.00
30502
$1,645.30
30574
$264.20
30676
$716.50
31278
$571.00
30503
$1,842.20
30575
$968.50
30679
$172.30
31280
$296.50
30505
$1,095.50
30577
$2,042.00
30680
$1,967.50
31281
$261.10
30506
$1,611.90
30578
$2,157.30
30682
$1,967.50
31282
$293.60
30508
$1,912.30
30580
$1,965.60
30684
$2,421.40
31283
$295.30
30509
$1,912.30
30581
$1,272.50
30686
$2,421.40
31285
$396.10
30515
$1,326.60
30583
$2,234.20
30687
$770.50
31286
$355.60
30517
$1,716.30
30584
$3,316.60
30688
$613.60
31287
$401.00
30518
$2,240.00
30586
$1,320.20
30690
$947.30
31288
$400.90
30520
$1,266.90
30587
$1,367.40
30692
$613.60
31290
$468.70
30521
$2,403.30
30589
$2,349.30
30694
$947.30
31291
$418.80
30523
$2,621.90
30590
$2,587.20
30696
$918.80
31292
$468.70
30524
$3,168.20
30593
$3,546.80
30710
$918.80
31293
$468.70
30526
$4,046.00
30594
$4,093.40
31000
$1,073.70
31295
$558.90
30527
$1,679.80
30596
$1,689.30
31001
$1,308.10
31300
$609.10
30529
$2,457.20
30597
$1,351.10
31002
$1,554.30
31305
$749.40
30530
$1,471.30
30599
$2,457.20
31200
$60.50
31310
$528.90
30532
$1,699.60
30600
$1,462.10
31205
$163.00
31315
$669.50
30533
$2,011.60
30601
$1,803.10
31210
$231.70
31320
$749.40
30535
$3,193.80
30602
$2,867.90
31215
$273.80
31325
$514.60
30536
$3,232.30
30603
$2,739.10
31220
$367.00
31330
$609.10
30538
$2,241.50
30605
$3,501.30
31225
$655.50
31335
$702.30
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 26
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
31340
DF
31554
$807.00
32078
$318.40
32183
$1,019.80
31345
$400.50
31557
$654.00
32081
$434.20
32186
$1,019.80
31346
$352.00
31560
$654.70
32084
$209.30
32200
$493.50
31350
$826.20
31563
$415.40
32087
$384.90
32203
$1,178.20
31355
$1,394.80
31566
$264.70
32090
$627.20
32206
$1,065.10
31400
$564.50
31569
$1,344.00
32093
$883.40
32209
$1,538.80
31403
$650.90
31572
$1,653.90
32094
$1,036.70
32210
$565.00
31406
$1,020.00
31575
$1,344.00
32095
$239.30
32212
$276.20
31409
$3,255.40
31578
$1,344.00
32096
$512.20
32213
$1,200.30
31412
$3,628.20
31581
$1,653.90
32099
$629.10
32214
$625.70
31420
$305.40
31584
$2,435.00
32102
$1,190.20
32215
$209.80
31423
$757.10
31587
$155.00
32103
$1,409.50
32216
$1,077.80
31426
$1,875.00
31590
$398.30
32104
$1,827.30
32217
$283.90
31429
$2,354.70
32000
$1,924.60
32105
$903.50
32218
$295.40
31432
$3,120.00
32003
$2,010.80
32106
$2,535.40
32220
$1,508.60
31435
$1,855.80
32004
$2,157.30
32108
$1,870.10
32221
$1,535.50
31438
$3,305.00
32005
$2,442.40
32111
$1,178.20
32500
$250.00
31450
$713.00
32006
$2,157.30
32112
$1,439.60
32501
$183.30
31452
$1,337.30
32009
$2,537.90
32114
$321.80
32504
$625.00
31454
$1,003.20
32012
$2,803.70
32115
$234.20
32507
$1,005.70
31456
$407.80
32015
$3,326.70
32117
$1,870.10
32508
$996.90
31458
$489.40
32018
$2,930.60
32120
$478.90
32511
$1,624.10
31460
$623.70
32021
$939.90
32123
$620.90
32514
$1,758.60
31462
$973.60
32023
$898.80
32126
$911.80
32517
$2,376.90
31464
$1,887.10
32024
$2,552.90
32129
$1,178.20
32520
$893.30
31466
$2,446.70
32025
$3,399.00
32131
$992.60
32522
$1,328.10
31468
$2,686.90
32026
$3,663.30
32132
$84.80
32523
$863.60
31470
$1,356.80
32028
$3,976.70
32135
$125.80
32526
$1,284.00
31472
$1,942.70
32029
$782.50
32138
$693.60
32700
$2,734.60
31500
$490.40
32030
$1,934.50
32139
$693.60
32703
$2,236.20
31503
$647.70
32033
$2,833.60
32142
$127.20
32708
$2,678.80
31506
$732.40
32036
$3,566.60
32145
$255.40
32710
$3,170.60
31509
$606.40
32039
$2,904.60
32147
$79.80
32711
$3,314.70
31512
$1,223.50
32042
$2,411.00
32150
$484.80
32712
$2,345.20
31515
$784.70
32045
$903.50
32153
$131.50
32715
$2,096.10
31519
$1,129.50
32046
$1,406.00
32156
$276.20
32718
$2,265.90
31524
$1,872.00
32047
$1,636.20
32159
$677.50
32721
$3,591.90
31525
$797.90
32051
$4,312.80
32162
$903.50
32724
$4,084.70
31530
$1,013.20
32054
$4,461.10
32165
$1,178.20
32730
$3,100.00
31533
$234.50
32057
$1,071.30
32166
$392.80
32733
$3,591.90
31536
$322.10
32060
$4,312.80
32168
$248.00
32736
$780.20
31539
$665.80
32063
$3,549.00
32171
$166.10
32739
$2,466.60
31542
$328.80
32066
$939.90
32174
$155.70
32742
$2,768.50
31545
$994.20
32069
$3,188.90
32175
$304.20
32745
$3,227.80
31548
$253.60
32072
$93.60
32177
$326.30
32748
$3,488.40
31551
$368.70
32075
$168.70
32180
$471.40
32751
$2,265.90
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 27
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
32754
$2,768.50
33521
$2,608.50
34148
$3,380.00
35300
$968.30
32757
$838.80
33524
$3,100.00
34151
$3,726.40
35303
$1,243.30
32760
$766.00
33527
$3,591.90
34154
$4,371.20
35306
$1,161.00
32763
$2,265.90
33530
$3,100.00
34157
$1,983.30
35307
$2,035.80
32766
$2,383.00
33533
$3,150.30
34160
$3,715.30
35309
$1,437.80
32769
$513.10
33536
$2,246.70
34163
$4,769.60
35312
$1,631.70
33050
$2,719.50
33539
$1,831.70
34166
$5,351.70
35315
$1,701.70
33055
$2,228.50
33542
$2,631.40
34169
$2,964.40
35317
$671.50
33070
$1,605.30
33545
$517.00
34172
$2,466.60
35319
$1,211.10
33075
$2,002.10
33548
$1,060.90
34175
$2,265.90
35320
$1,486.00
33080
$2,441.80
33551
$517.00
34500
$514.60
35321
$1,526.80
33100
$2,734.60
33554
$513.40
34503
$782.10
35324
$573.00
33103
$3,838.00
33800
$2,242.90
34506
$395.40
35327
$682.20
33109
$4,650.80
33803
$2,129.80
34509
$1,856.10
35330
$979.30
33112
$4,017.20
33806
$1,550.80
34512
$2,049.40
35331
$1,054.70
33115
$2,685.30
33810
$1,028.90
34515
$1,460.40
35360
$1,382.30
33116
$2,437.90
33811
$3,318.70
34518
$2,452.30
35361
$1,264.50
33118
$2,991.50
33812
$1,774.20
34521
$1,045.40
35362
$1,054.70
33119
$2,935.90
33815
$1,610.30
34524
$772.00
35363
$904.00
33121
$3,520.90
33818
$1,877.60
34527
$911.40
35404
$575.60
33124
$2,303.30
33821
$2,140.50
34528
$509.40
35406
$1,350.60
33127
$2,648.40
33824
$2,050.00
34530
$348.90
35408
$1,013.10
33130
$2,629.50
33827
$2,246.30
34533
$2,352.30
35410
$1,350.60
33133
$1,974.90
33830
$3,079.30
34538
$474.80
35412
$4,745.30
33136
$4,986.20
33833
$2,533.90
34539
$356.30
35500
$153.40
33139
$2,964.40
33836
$2,964.40
34800
$1,827.60
35502
$148.70
33142
$2,768.50
33839
$3,525.80
34803
$3,563.50
35503
$102.20
33145
$4,837.20
33842
$1,719.90
34806
$1,619.20
35506
$92.30
33148
$5,284.00
33845
$1,194.90
34809
$1,619.20
35507
$336.40
33151
$5,731.50
33848
$1,194.90
34812
$2,198.10
35508
$484.30
33154
$4,248.10
34100
$1,348.70
34815
$1,831.70
35509
$183.50
33157
$4,642.40
34103
$780.30
34818
$2,035.20
35512
$335.00
33160
$6,165.00
34106
$685.00
34821
$2,422.50
35513
$414.00
33163
$3,889.40
34109
$635.40
34824
$1,175.00
35516
$249.90
33166
$3,514.80
34112
$1,632.40
34827
$1,288.40
35517
$287.90
33169
$2,736.20
34115
$1,831.70
34830
$1,180.00
35518
$355.40
33172
$2,429.30
34118
$2,309.40
34833
$1,531.20
35520
$104.90
33175
$2,199.60
34121
$2,109.70
35000
$1,348.70
35523
$126.00
33178
$2,800.60
34124
$2,020.90
35003
$1,943.90
35526
$239.00
33181
$3,424.10
34127
$2,648.40
35006
$2,160.10
35527
$308.20
33500
$2,140.10
34130
$933.10
35009
$1,678.90
35530
$580.00
33506
$2,121.20
34133
$1,062.50
35012
$1,359.50
35533
$760.00
33509
$2,669.30
34136
$1,676.30
35100
$682.90
35534
$536.90
33512
$2,843.00
34139
$1,699.90
35103
$439.70
35536
$654.30
33515
$3,293.00
34142
$2,331.00
35200
$324.10
35539
$515.30
33518
$2,407.80
34145
$1,581.60
35202
$1,526.20
35542
$658.00
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 28
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
35545
$305.10
35639
$224.10
35756
$1,506.30
36615
$1,439.90
35548
$1,586.40
35640
$344.10
35759
$1,024.40
36618
$1,084.70
35551
$1,427.00
35641
$2,687.90
36500
$1,743.10
36621
$790.70
35554
$72.10
35643
$362.00
36502
$1,475.00
36624
$997.00
35557
$405.10
35644
$338.20
36503
$2,489.50
36627
$1,282.20
35560
$1,287.00
35645
$575.30
36506
$1,657.30
36630
$613.30
35561
$2,604.70
35646
$385.20
36509
$1,413.90
36633
$1,327.60
35562
$1,880.90
35647
$408.80
36516
$1,773.70
36636
$820.00
35564
$1,225.00
35648
$596.50
36519
$2,426.70
36639
$1,555.50
35565
$1,531.00
35649
$1,055.00
36522
$2,285.00
36642
$753.00
35566
$741.70
35653
$1,264.90
36525
$3,235.00
36645
$2,021.40
35568
$1,200.20
35657
$1,260.10
36526
$2,665.00
36648
$1,800.20
35569
$306.60
35658
$816.60
36527
$3,206.30
36649
$486.50
35570
$1,041.90
35661
$1,712.40
36528
$2,665.00
36650
$266.50
35571
$1,043.90
35664
$2,767.70
36529
$3,224.10
36652
$1,223.70
35572
$233.40
35667
$2,374.10
36531
$2,370.60
36654
$1,559.70
35573
$1,580.70
35670
$1,939.20
36532
$3,348.30
36656
$2,004.00
35577
$1,280.10
35673
$1,425.00
36533
$3,699.50
36658
$878.60
35578
$1,261.80
35674
$345.30
36537
$1,284.10
36660
$426.50
35595
$2,188.90
35676
$784.00
36540
$2,091.50
36662
$1,018.60
35596
$1,287.70
35677
$1,015.90
36543
$2,467.10
36663
$1,238.80
35597
$2,938.60
35678
$1,214.90
36546
$1,297.60
36664
$990.50
35599
$1,278.30
35680
$1,219.10
36549
$1,517.20
36665
$209.30
35602
$1,465.00
35683
$790.00
36552
$1,327.60
36666
$759.00
35605
$690.90
35684
$879.30
36558
$1,335.00
36667
$261.00
35608
$121.50
35687
$613.20
36561
$302.00
36668
$261.00
35611
$115.40
35688
$745.90
36564
$1,905.00
36800
$49.90
35612
$924.50
35691
$281.70
36567
$1,821.80
36803
$875.40
35613
$695.10
35694
$1,204.70
36570
$2,665.00
36806
$1,226.60
35614
$120.70
35697
$1,761.50
36573
$1,681.20
36809
$1,570.50
35615
$101.60
35700
$1,575.00
36576
$2,380.00
36811
$611.20
35616
$857.30
35703
$148.00
36579
$1,525.00
36812
$312.90
35617
$355.70
35706
$141.40
36585
$1,237.80
36815
$449.60
35618
$450.60
35709
$82.70
36588
$1,657.30
36818
$521.40
35620
$99.80
35710
$926.60
36591
$2,076.20
36821
$608.40
35622
$1,129.90
35712
$682.10
36594
$1,796.40
36824
$440.00
35623
$1,551.70
35713
$851.50
36597
$1,755.20
36825
$1,184.80
35626
$158.00
35716
$815.20
36600
$2,071.90
36827
$437.90
35627
$212.80
35717
$1,023.00
36603
$2,422.60
36830
$383.80
35630
$362.10
35720
$1,315.00
36604
$486.50
36833
$527.60
35633
$451.10
35723
$943.50
36605
$1,152.80
36836
$433.10
35634
$1,147.70
35726
$958.30
36606
$4,334.40
36840
$607.90
35635
$754.60
35729
$478.40
36607
$1,241.80
36842
$592.10
35636
$913.20
35750
$1,553.40
36608
$508.00
36845
$1,292.40
35637
$760.30
35753
$1,819.90
36609
$1,411.70
36848
$440.70
35638
$1,412.30
35754
$2,416.50
36612
$1,239.70
36851
$437.90
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 29
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
36854
$875.60
37303
$133.80
37605
$704.20
38246
$1,677.60
36857
$691.60
37306
$1,179.40
37606
$1,040.80
38256
$435.50
36860
$305.30
37309
$1,755.50
37607
$1,778.80
38270
$1,642.10
36863
$888.80
37315
$247.90
37610
$2,481.80
38272
$1,623.90
37000
$1,509.80
37318
$521.90
37613
$570.00
38273
$1,400.00
37004
$1,163.50
37321
$177.30
37616
$2,050.50
38274
$1,400.00
37008
$782.60
37324
$440.00
37619
$1,176.10
38275
$528.70
37011
$190.00
37327
$606.60
37622
$424.80
38285
$307.50
37014
$2,156.10
37330
$1,218.10
37623
$444.70
38286
$279.50
37020
$1,422.10
37333
$931.50
37800
$974.70
38287
$3,728.10
37023
$855.00
37336
$1,327.60
37803
$982.00
38290
$4,744.90
37026
$695.00
37339
$454.00
37806
$1,082.50
38293
$5,095.30
37029
$1,689.00
37340
$790.60
37809
$1,055.70
38300
$975.30
37038
$1,306.70
37341
$1,717.50
37812
$1,027.80
38303
$1,252.70
37041
$87.80
37342
$1,715.00
37815
$176.50
38306
$1,446.00
37042
$1,752.20
37343
$2,611.20
37818
$833.10
38309
$1,542.20
37043
$1,259.20
37345
$1,430.00
37821
$1,567.20
38312
$1,926.40
37044
$1,346.50
37348
$1,430.00
37824
$2,380.00
38315
$2,177.40
37045
$2,756.10
37351
$517.50
37827
$886.00
38318
$2,730.80
37047
$2,985.00
37354
$670.00
37830
$1,148.10
38350
$1,056.90
37050
$1,327.60
37369
$349.40
37833
$668.60
38353
$442.50
37053
$1,429.90
37372
$872.30
37836
$1,154.30
38356
$1,380.90
37200
$2,095.00
37375
$2,380.00
37839
$1,307.90
38358
$5,207.80
37201
$1,607.30
37381
$1,525.00
37842
$2,894.60
38359
$253.80
37202
$694.40
37384
$2,380.00
37845
$1,154.30
38362
$715.50
37203
$2,028.30
37387
$665.00
37848
$2,077.40
38365
$584.90
37206
$1,140.00
37390
$1,743.50
37851
$1,539.00
38368
$2,215.90
37207
$1,775.00
37393
$417.10
37854
$666.40
38371
$541.10
37208
$743.30
37396
$1,237.80
38200
$715.10
38384
$1,909.90
37209
$2,665.00
37402
$950.00
38203
$917.70
38387
$543.70
37210
$3,275.00
37405
$1,905.00
38206
$1,185.10
38390
$1,919.70
37211
$3,980.00
37408
$950.00
38209
$1,246.30
38393
$538.80
37212
$461.70
37411
$1,543.40
38212
$2,132.60
38415
$753.10
37215
$783.60
37415
$83.00
38213
$779.00
38418
$1,790.00
37217
$227.00
37417
$1,140.00
38215
$667.20
38421
$2,757.00
37218
$255.40
37418
$1,525.00
38218
$1,072.60
38424
$1,774.70
37219
$529.30
37420
$611.50
38220
$335.40
38427
$2,219.30
37220
$2,185.00
37423
$1,905.00
38222
$592.20
38430
$1,247.60
37221
$950.00
37426
$2,000.00
38225
$1,006.70
38436
$463.70
37223
$370.50
37429
$665.00
38228
$1,335.60
38438
$2,829.90
37224
$617.10
37432
$1,769.80
38231
$1,664.90
38440
$2,066.40
37227
$2,185.00
37435
$190.00
38234
$1,342.10
38441
$3,409.20
37230
$2,380.00
37438
$525.00
38237
$1,677.60
38446
$2,183.20
37233
$926.80
37444
$1,668.40
38240
$2,013.30
38447
$2,894.80
37245
$2,042.60
37601
$527.50
38241
$850.80
38448
$773.40
37300
$82.50
37604
$565.00
38243
$789.40
38449
$4,016.60
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 30
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
38450
$1,605.20
38562
$5,901.00
38751
$3,880.80
39315
$1,946.70
38452
$1,047.60
38565
$6,629.10
38754
$4,460.00
39318
$1,308.70
38453
$3,184.20
38568
$3,402.60
38757
$4,405.00
39321
$950.10
38455
$3,885.10
38571
$3,485.00
38760
$3,562.80
39323
$519.80
38456
$2,851.90
38572
$3,792.30
38763
$4,016.70
39324
$523.20
38457
$2,670.60
38577
$1,054.60
38766
$4,033.90
39327
$946.10
38458
$1,620.00
38588
$867.30
38800
$74.20
39330
$583.00
38460
$510.50
38600
$2,756.80
38803
$138.30
39331
$602.60
38462
$604.40
38603
$1,826.40
38806
$253.80
39333
$752.00
38464
$660.00
38609
$902.60
38809
$308.10
39500
$3,270.00
38466
$1,782.50
38612
$896.40
38812
$398.70
39503
$1,787.10
38468
$2,749.40
38613
$1,125.10
39000
$172.80
39600
$917.00
38469
$2,872.40
38615
$2,756.80
39003
$174.10
39603
$2,280.80
38470
$1,801.90
38618
$3,432.40
39006
$405.00
39606
$1,488.70
38473
$1,028.60
38621
$1,363.10
39009
$114.90
39609
$1,816.20
38475
$1,574.00
38624
$1,539.30
39012
$449.10
39612
$2,270.10
38477
$3,791.30
38627
$1,353.60
39013
$204.00
39615
$2,280.80
38478
$1,836.30
38637
$998.90
39015
$709.60
39640
$5,947.20
38480
$3,784.10
38640
$1,769.40
39018
$696.90
39642
$6,532.20
38481
$4,275.70
38643
$1,978.20
39100
$396.60
39646
$6,920.10
38483
$2,872.40
38647
$3,934.30
39106
$1,983.30
39650
$6,810.00
38485
$1,536.10
38650
$3,578.10
39109
$1,022.10
39653
$9,593.90
38487
$2,872.40
38653
$3,624.20
39112
$3,093.40
39654
$6,525.80
38488
$3,605.90
38654
$2,229.40
39115
$180.20
39656
$6,600.00
38489
$4,320.00
38656
$1,736.00
39118
$561.30
39658
$5,780.50
38490
$1,046.90
38670
$3,391.30
39121
$1,054.40
39660
$5,906.30
38493
$3,625.90
38673
$4,158.20
39124
$3,775.00
39662
$5,780.50
38496
$1,179.90
38677
$3,706.40
39125
$659.40
39700
$1,232.00
38497
$3,863.10
38680
$4,396.50
39126
$676.50
39703
$1,100.90
38498
$3,784.90
38700
$1,924.60
39127
$1,084.00
39706
$2,320.90
38500
$4,194.90
38703
$3,463.90
39128
$1,239.50
39709
$3,088.70
38501
$4,021.00
38706
$3,275.00
39130
$1,264.40
39712
$5,379.00
38503
$4,525.40
38709
$3,841.40
39131
$220.40
39715
$3,958.70
38504
$4,512.40
38712
$4,781.50
39133
$298.40
39718
$1,918.60
38505
$554.00
38715
$2,847.90
39134
$648.80
39721
$1,488.70
38506
$2,714.40
38718
$3,964.10
39135
$302.30
39800
$5,395.40
38507
$3,487.50
38721
$2,757.40
39136
$298.40
39803
$5,366.10
38508
$4,247.70
38724
$3,841.40
39137
$1,077.80
39806
$2,596.90
38509
$4,296.30
38727
$2,694.80
39138
$1,275.40
39812
$1,260.10
38512
$3,796.70
38730
$3,841.40
39139
$1,961.90
39815
$3,049.90
38515
$4,856.90
38733
$2,496.50
39140
$547.90
39818
$3,946.50
38518
$5,160.20
38736
$3,562.80
39300
$665.80
39821
$4,099.30
38550
$3,671.10
38739
$3,211.60
39303
$929.90
39900
$975.80
38553
$4,949.10
38742
$3,562.80
39306
$1,268.20
39903
$2,977.30
38556
$5,562.70
38745
$4,027.10
39309
$1,568.70
39906
$1,488.70
38559
$4,769.80
38748
$4,405.00
39312
$815.30
40000
$1,531.20
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 31
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
40003
$1,744.10
40850
$4,083.90
41599
$3,465.00
41729
$1,069.80
40006
$1,311.30
40851
$10,125.00
41603
$1,260.00
41731
$1,609.80
40009
$992.20
40852
$870.00
41604
$470.00
41734
$1,893.00
40012
$1,936.40
40854
$874.10
41608
$2,140.00
41737
$920.00
40015
$1,219.50
40856
$655.00
41611
$1,331.90
41740
$122.00
40018
$298.40
40858
$1,328.80
41614
$2,050.00
41743
$638.90
40100
$1,324.50
40860
$4,174.10
41615
$2,052.20
41746
$1,393.60
40103
$1,694.50
40862
$315.10
41617
$3,606.20
41749
$1,143.90
40106
$2,655.00
40903
$1,425.00
41620
$1,551.60
41752
$562.20
40109
$2,855.00
40905
$1,004.30
41623
$2,042.20
41755
$78.60
40112
$2,794.20
41500
$137.60
41626
$270.10
41758
$196.30
40115
$1,204.90
41503
$448.50
41629
$995.00
41761
$231.50
40118
$1,594.00
41506
$271.20
41632
$455.50
41764
$214.70
40300
$2,040.00
41509
$271.90
41635
$2,181.50
41767
$1,230.20
40301
$2,050.00
41512
$1,113.20
41638
$2,700.40
41770
$1,430.00
40303
$2,125.00
41515
$779.60
41641
$94.70
41773
$1,149.90
40306
$3,006.20
41518
$1,920.00
41644
$267.90
41776
$1,184.80
40309
$2,241.80
41521
$2,020.00
41647
$183.50
41779
$1,170.50
40312
$2,799.20
41524
$585.00
41650
$220.00
41782
$1,912.40
40315
$2,648.40
41527
$1,120.00
41653
$164.00
41785
$2,410.00
40316
$4,754.80
41530
$1,821.30
41656
$230.40
41786
$1,488.30
40318
$4,467.20
41533
$2,156.00
41659
$138.30
41787
$1,141.00
40321
$2,177.40
41536
$2,432.70
41662
$163.40
41788
$365.40
40324
$1,630.00
41539
$2,041.20
41665
$485.00
41789
$490.90
40327
$1,067.00
41542
$2,265.40
41668
$478.20
41792
$755.00
40330
$2,313.90
41545
$993.80
41671
$970.00
41793
$755.00
40331
$1,879.80
41548
$1,325.00
41672
$1,245.00
41796
$310.50
40332
$2,965.20
41551
$3,062.50
41674
$207.30
41797
$271.20
40333
$2,040.00
41554
$3,807.60
41677
$167.60
41800
$320.00
40334
$2,715.00
41557
$2,140.00
41680
$271.90
41801
$320.00
40335
$3,687.00
41560
$2,317.70
41683
$209.90
41804
$178.00
40336
$527.20
41563
$2,960.00
41686
$164.00
41807
$133.70
40339
$3,064.70
41564
$3,702.00
41689
$265.00
41810
$71.00
40342
$3,775.00
41566
$2,058.40
41692
$360.00
41813
$669.30
40345
$3,305.30
41569
$2,250.10
41695
$179.60
41816
$348.20
40348
$3,276.60
41572
$1,870.10
41698
$61.80
41819
$652.70
40351
$3,262.10
41575
$4,706.70
41701
$189.70
41820
$790.60
40600
$2,063.70
41576
$6,826.00
41704
$65.80
41822
$450.10
40700
$4,459.10
41578
$4,845.00
41707
$846.10
41825
$672.40
40703
$2,909.70
41579
$3,635.00
41710
$1,062.60
41828
$97.50
40706
$3,577.20
41581
$5,272.80
41713
$1,139.20
41831
$673.40
40709
$1,320.00
41584
$3,817.30
41716
$560.00
41832
$379.40
40712
$2,680.00
41587
$4,925.90
41719
$240.00
41834
$2,458.00
40800
$1,458.10
41590
$2,345.00
41722
$1,052.80
41837
$2,278.40
40801
$4,480.00
41593
$2,598.10
41725
$843.20
41840
$2,887.60
40803
$2,334.40
41596
$3,465.00
41728
$1,730.60
41843
$2,532.60
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 32
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
41846
$313.20
42554
$1,392.20
42680
$610.00
42801
$2,012.00
41849
$518.80
42557
$1,936.30
42683
$234.40
42802
$1,064.00
41852
$645.00
42563
$1,040.80
42686
$530.60
42805
$978.90
41855
$636.20
42569
$1,936.30
42689
$219.80
42806
$669.80
41858
$925.70
42572
$194.90
42692
$519.80
42807
$552.40
41861
$1,235.00
42573
$427.20
42695
$854.80
42808
$552.40
41864
$812.00
42574
$886.00
42698
$1,569.50
42809
$800.60
41867
$1,167.40
42575
$155.40
42701
$1,098.50
42810
$1,205.00
41868
$732.20
42581
$204.00
42702
$2,206.80
42811
$819.30
41870
$910.00
42584
$521.40
42703
$1,070.00
42812
$315.80
41873
$1,107.30
42587
$91.00
42704
$771.40
42815
$1,114.40
41876
$1,177.40
42590
$755.00
42707
$1,379.80
42818
$1,108.10
41879
$1,937.10
42593
$341.50
42710
$1,413.90
42821
$163.00
41880
$481.00
42596
$952.20
42713
$694.90
42824
$123.90
41881
$768.00
42599
$1,155.40
42716
$2,600.00
42833
$1,325.00
41884
$170.10
42602
$1,193.40
42719
$975.80
42836
$1,548.10
41885
$513.80
42605
$929.70
42725
$2,520.40
42839
$1,530.00
41886
$314.10
42608
$534.70
42731
$2,775.90
42842
$1,870.00
41889
$314.10
42610
$176.90
42734
$564.40
42845
$388.90
41892
$424.60
42611
$272.90
42738
$477.60
42848
$1,530.00
41895
$661.60
42614
$90.80
42739
$477.60
42851
$1,629.00
41898
$463.70
42615
$132.90
42740
$564.40
42854
$667.70
41901
$1,122.20
42617
$220.30
42741
$595.70
42857
$738.70
41904
$466.90
42620
$121.70
42743
$1,193.70
42860
$1,578.50
41905
$770.90
42622
$152.60
42744
$544.60
42863
$1,458.90
41907
$232.70
42623
$1,498.40
42746
$1,791.70
42866
$1,435.10
41910
$734.50
42626
$2,041.90
42749
$2,262.80
42869
$1,026.80
42503
$235.00
42629
$1,651.80
42752
$2,506.90
42872
$515.00
42506
$906.90
42632
$220.60
42755
$314.10
43021
$832.90
42509
$1,325.00
42635
$568.00
42758
$1,335.30
43022
$907.00
42510
$1,480.00
42638
$713.20
42761
$975.80
43023
$147.00
42512
$803.20
42641
$925.80
42764
$937.90
43500
$227.00
42515
$1,154.30
42644
$123.80
42767
$2,216.90
43503
$386.70
42518
$660.00
42647
$435.20
42770
$595.00
43506
$668.20
42521
$2,113.10
42650
$136.40
42773
$1,692.90
43509
$651.80
42524
$386.70
42651
$305.30
42776
$2,554.80
43512
$672.70
42527
$775.30
42653
$2,715.70
42779
$2,843.10
43515
$672.70
42530
$1,325.00
42656
$3,186.50
42782
$589.70
43518
$1,105.70
42533
$778.40
42662
$1,686.30
42783
$734.30
43521
$809.70
42536
$1,569.10
42665
$1,123.80
42785
$581.60
43524
$1,052.80
42539
$2,672.90
42667
$238.60
42786
$581.60
43801
$1,589.70
42542
$951.70
42668
$141.30
42788
$581.60
43804
$1,692.80
42543
$1,662.90
42672
$1,606.20
42789
$581.60
43807
$1,846.60
42545
$2,515.00
42673
$915.00
42791
$581.60
43810
$2,154.40
42548
$1,671.40
42676
$217.40
42792
$581.60
43813
$2,154.40
42551
$1,193.70
42677
$118.00
42794
$114.10
43816
$2,000.40
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 33
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
43819
$1,615.70
43984
$2,154.40
45033
$452.50
45472
$2,900.20
43822
$1,615.70
43987
$2,385.10
45035
$1,315.60
45474
$4,629.00
43825
$1,846.60
43990
$2,923.80
45036
$2,124.80
45475
$3,492.50
43828
$2,040.40
43993
$3,154.60
45039
$450.70
45477
$5,413.00
43831
$1,589.70
43996
$3,539.30
45042
$577.50
45478
$4,082.80
43834
$1,846.60
43999
$442.70
45045
$583.10
45480
$6,196.70
43837
$2,308.00
44102
$488.60
45048
$1,722.10
45481
$4,675.40
43840
$2,000.40
44105
$74.90
45051
$1,125.00
45483
$7,060.20
43843
$3,077.70
44108
$816.30
45054
$409.30
45484
$5,327.10
43846
$3,308.30
44111
$955.90
45200
$534.70
45485
$1,571.40
43849
$846.40
44114
$955.90
45203
$767.10
45486
$1,031.40
43852
$2,692.70
44130
$803.30
45206
$720.30
45487
$677.70
43855
$2,847.00
44133
$710.90
45207
$671.00
45488
$753.00
43858
$1,000.10
44136
$305.00
45209
$891.30
45489
$1,129.70
43861
$2,769.90
44325
$559.80
45212
$442.30
45490
$1,852.50
43864
$2,077.40
44328
$594.80
45215
$1,934.10
45491
$1,882.70
43867
$1,154.30
44331
$980.90
45218
$870.00
45492
$3,082.80
43870
$1,615.70
44334
$2,089.00
45221
$536.60
45493
$965.00
43873
$2,154.40
44338
$270.80
45224
$231.60
45494
$3,106.10
43876
$1,846.60
44342
$484.50
45227
$850.00
45496
$810.30
43879
$2,154.40
44346
$496.70
45230
$470.20
45497
$633.60
43882
$2,769.90
44350
$481.00
45233
$964.80
45498
$510.90
43900
$1,846.60
44354
$617.70
45236
$767.40
45499
$379.90
43903
$3,077.70
44358
$345.50
45239
$495.40
45500
$2,047.50
43906
$2,692.70
44359
$494.80
45240
$489.20
45501
$3,320.40
43909
$2,692.70
44361
$594.80
45400
$382.40
45502
$4,005.00
43912
$2,544.00
44364
$534.70
45403
$762.10
45503
$3,691.10
43915
$2,006.70
44367
$970.50
45406
$917.10
45504
$3,367.20
43930
$739.60
44370
$1,202.10
45409
$1,133.10
45505
$3,354.20
43933
$865.80
44373
$2,467.70
45412
$1,706.90
45506
$413.80
43936
$1,615.70
44376
DF
45415
$1,696.10
45512
$580.90
43939
$1,231.20
45000
$1,035.70
45418
$1,631.60
45515
$353.30
43942
$437.90
45003
$1,133.70
45439
$532.10
45518
$459.40
43945
$1,615.70
45006
$2,004.70
45442
$1,100.90
45519
$1,050.00
43948
$231.00
45009
$749.30
45445
$1,049.80
45520
$2,200.00
43951
$1,446.90
45012
$1,189.70
45448
$705.90
45522
$1,545.00
43954
$1,769.70
45015
$735.00
45451
$895.60
45524
$1,605.00
43957
$1,923.40
45018
$1,168.00
45460
$2,092.00
45527
$1,610.00
43960
$676.60
45019
$796.80
45461
$2,261.20
45528
$2,415.00
43963
$2,692.70
45020
$940.00
45462
$1,125.10
45530
$2,375.00
43966
$3,077.70
45021
$380.00
45464
$5,130.00
45533
$2,690.00
43969
$4,231.70
45024
$945.00
45465
$2,274.90
45536
$861.30
43972
$3,127.10
45025
$380.00
45466
$1,715.80
45539
$2,300.20
43975
$3,616.30
45026
$850.00
45468
$3,058.90
45542
$1,320.00
43978
$3,077.70
45027
$225.30
45469
$2,597.20
45545
$1,220.60
43981
$846.40
45030
$226.60
45471
$3,845.00
45546
$333.20
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 34
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
45548
$680.00
45632
$1,215.00
45738
$3,815.60
45849
$1,124.10
45551
$1,085.00
45635
$1,440.00
45741
$2,958.20
45851
$254.40
45552
$1,440.00
45638
$2,490.00
45744
$4,565.00
45853
$1,486.90
45553
$1,440.00
45639
$2,485.00
45747
$3,227.30
45855
$682.20
45554
$1,715.00
45641
$2,550.00
45752
$4,353.90
45857
$1,091.30
45555
$1,440.00
45644
$2,985.00
45753
$3,636.40
45859
$550.10
45556
$1,870.00
45645
$373.40
45754
$4,913.80
45861
$1,631.60
45557
$1,870.00
45646
$1,952.30
45755
$613.70
45863
$2,249.10
45558
$2,805.00
45647
$2,955.90
45758
$1,235.80
45865
$552.40
45559
$2,770.00
45650
$330.00
45761
$1,580.00
45867
$521.40
45560
$1,110.00
45652
$745.00
45767
$4,192.20
45869
$1,983.30
45561
$3,487.50
45653
$704.20
45770
$3,211.30
45871
$3,260.00
45562
$2,069.30
45656
$1,132.90
45773
$2,926.70
45873
$2,839.70
45563
$2,077.40
45659
$1,145.00
45776
$2,992.60
45875
$1,075.90
45564
$5,017.20
45660
$5,439.60
45779
$2,151.80
45877
$785.60
45565
$3,589.10
45661
$2,412.00
45782
$1,859.90
45879
$780.00
45566
$2,096.40
45662
$1,205.50
45785
$2,784.10
45882
$71.70
45568
$773.50
45665
$614.30
45788
$2,812.80
45885
$762.60
45569
$1,430.00
45668
$616.10
45791
$1,486.90
45888
$685.10
45570
$1,895.00
45669
$646.40
45794
$1,235.00
45891
$1,035.60
45572
$556.80
45671
$1,610.00
45797
$371.60
45894
$446.90
45575
$1,440.40
45674
$483.40
45799
$72.00
45897
$1,775.40
45578
$1,604.90
45675
$911.80
45801
$264.80
45900
$454.60
45581
$680.00
45676
$1,081.50
45803
$616.30
45939
$835.00
45584
$1,550.00
45677
$1,033.50
45805
$420.00
45945
$198.20
45585
$1,550.00
45680
$1,129.70
45807
$438.80
45975
$215.60
45586
$1,550.00
45683
$1,255.10
45809
$697.60
45978
$263.30
45587
$1,865.00
45686
$1,634.30
45811
$945.30
45981
$161.60
45588
$2,790.00
45689
$600.00
45813
$1,110.10
45984
$1,029.30
45590
$1,015.00
45692
$565.00
45815
$677.10
45987
$1,230.90
45593
$1,190.00
45695
$1,075.00
45817
$775.30
45990
$1,507.10
45596
$1,960.00
45698
$765.60
45819
$1,964.90
45993
$1,800.50
45597
$2,011.80
45701
$2,320.80
45821
$677.90
45996
$398.70
45599
$1,241.80
45704
$555.60
45823
$265.00
46300
$701.70
45602
$1,331.80
45707
$1,327.60
45825
$628.20
46303
$738.20
45605
$1,110.20
45710
$888.00
45827
$575.60
46306
$1,118.50
45608
$1,686.50
45713
$1,051.60
45829
$439.30
46307
$1,000.10
45611
$1,265.00
45714
$1,432.10
45831
$575.60
46309
$1,027.20
45614
$1,108.20
45716
$1,768.80
45833
$677.70
46312
$1,299.00
45617
$495.00
45720
$1,823.80
45835
$840.90
46315
$1,745.10
45620
$685.00
45723
$2,495.00
45837
$1,044.00
46318
$2,354.00
45623
$1,419.20
45726
$2,312.90
45839
$1,044.00
46321
$2,603.40
45624
$1,693.10
45729
$3,170.00
45841
$878.30
46324
$1,694.10
45625
$345.70
45731
$2,629.70
45843
$705.00
46325
$1,700.40
45626
$655.00
45732
$3,615.00
45845
$947.40
46327
$443.30
45629
$1,110.00
45735
$3,043.30
45847
$332.20
46330
$766.40
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 35
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
46333
$1,126.70
46465
$472.60
47054
$504.60
47411
$188.30
46336
$669.40
46468
$1,010.00
47057
$169.10
47414
$530.80
46339
$919.30
46471
$1,126.40
47060
$226.60
47417
$495.90
46342
$919.30
46474
$1,224.00
47063
$338.40
47420
$1,288.40
46345
$1,126.40
46477
$1,506.50
47066
$625.80
47423
$390.90
46348
$485.00
46480
$746.50
47069
$94.40
47426
$820.00
46351
$753.20
46483
$593.80
47072
$174.70
47429
$856.30
46354
$1,001.60
46486
$476.70
47300
$141.50
47432
$1,041.10
46357
$1,250.00
46489
$544.60
47303
$164.90
47435
$789.80
46360
$1,498.40
46492
$689.50
47306
$244.40
47438
$1,254.70
46363
$461.40
46494
$415.00
47309
$296.20
47441
$1,642.90
46366
$329.10
46495
$401.10
47312
$212.10
47444
$393.70
46369
$464.40
46498
$451.60
47315
$276.60
47447
$645.30
46372
$850.00
46500
$538.10
47318
$340.50
47450
$968.70
46375
$1,008.20
46501
$658.60
47321
$480.40
47451
$1,159.90
46378
$1,340.20
46502
$576.40
47324
$297.80
47453
$440.00
46381
$593.80
46503
$717.30
47327
$371.20
47456
$752.30
46384
$593.80
46504
$2,182.40
47330
$516.70
47459
$1,001.30
46387
$1,221.90
46507
$2,426.00
47333
$592.70
47462
$188.30
46390
$1,644.40
46510
$902.90
47336
$282.90
47465
$565.00
46393
$1,899.40
46513
$94.30
47339
$371.20
47466
$188.30
46396
$677.50
46516
$221.00
47342
$521.60
47467
$430.60
46399
$975.80
46519
$269.60
47345
$594.00
47468
$918.40
46402
$1,046.40
46522
$848.60
47348
$156.90
47471
$71.70
46405
$1,203.90
46525
$95.40
47351
$457.10
47474
$358.30
46408
$1,299.30
46528
$282.90
47354
$282.90
47477
$448.00
46411
$835.60
46531
$142.20
47357
$847.50
47480
$1,094.10
46414
$991.50
46534
$448.90
47360
$219.90
47483
$1,056.40
46417
$1,001.60
47000
$99.50
47363
$353.90
47486
$1,766.30
46420
$414.50
47003
$113.20
47366
$513.60
47489
$2,636.70
46423
$669.40
47006
$312.90
47369
$282.90
47492
$393.20
46426
$681.20
47009
$273.20
47372
$535.90
47495
$881.30
46429
$835.60
47012
$610.00
47375
$760.00
47498
$1,318.40
46432
$912.90
47015
$113.20
47378
$282.90
47501
$1,919.90
46435
$1,026.70
47018
$282.30
47381
$480.40
47504
$2,636.70
46438
$350.00
47021
$490.40
47384
$639.70
47507
$2,934.00
46441
$680.80
47024
$348.20
47385
$551.40
47510
$2,636.70
46442
$581.50
47027
$472.10
47386
$921.00
47513
$628.50
46444
$994.40
47030
$338.90
47387
$455.50
47516
$793.00
46447
$1,208.70
47033
$490.40
47390
$774.80
47519
$1,635.30
46450
$468.90
47036
$113.20
47393
$1,033.90
47522
$1,413.20
46453
$758.90
47039
$209.40
47396
$314.10
47525
$1,636.60
46456
$184.00
47042
$152.60
47399
$762.00
47528
$1,406.50
46459
$485.00
47045
$275.40
47402
$705.00
47531
$1,831.30
46462
$604.70
47048
$535.30
47405
$314.10
47534
$2,125.50
46464
$427.80
47051
$779.40
47408
$797.30
47537
$819.30
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 36
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
47540
$407.80
47681
$81.70
47930
$554.10
48600
$176.70
47543
$377.30
47684
$1,463.20
47933
$444.40
48603
$346.70
47546
$633.20
47687
$2,470.00
47936
$545.00
48606
$3,305.00
47549
$884.70
47690
$1,968.60
47948
$299.10
48612
$5,391.60
47552
$671.30
47693
$2,470.00
47951
$350.70
48613
$6,578.00
47555
$1,056.40
47696
$706.00
47954
$792.40
48615
$897.80
47558
$1,498.60
47699
$2,859.30
47957
$637.80
48618
$4,665.30
47561
$455.50
47702
$3,561.90
47960
$280.00
48621
$4,015.00
47564
$774.80
47703
$82.80
47963
$509.70
48624
$4,122.50
47565
$1,356.50
47705
$710.00
47966
$957.90
48627
$5,098.70
47566
$1,749.20
47708
$361.30
47969
$577.40
48630
$5,121.60
47567
$901.60
47711
$726.90
47972
$478.90
48632
$2,606.10
47570
$1,019.80
47714
$451.20
47975
$798.00
48636
$1,515.90
47573
$1,305.40
47717
$989.20
47978
$558.10
48639
$3,177.30
47576
$188.30
47720
$1,052.60
47981
$371.30
48640
$6,574.40
47579
$267.20
47723
$970.50
47982
$709.60
48642
$1,832.40
47582
$654.00
47726
$355.00
48200
$1,408.10
48645
$2,346.60
47585
$827.80
47729
$590.00
48203
$1,705.10
48648
$2,447.10
47588
$2,463.00
47732
$857.20
48206
$1,102.20
48651
$3,022.10
47591
$2,994.00
47735
$92.10
48209
$1,361.60
48654
$2,659.30
47594
$361.30
47738
$600.40
48212
$1,068.60
48657
$3,660.00
47597
$612.10
47741
$1,066.10
48215
$1,365.10
48660
$2,558.40
47600
$850.50
47753
$1,020.00
48218
$1,064.20
48663
$1,528.70
47603
$1,084.70
47756
$952.50
48221
$1,422.90
48666
$1,087.60
47606
$393.20
47762
$562.40
48224
$722.00
48669
$3,384.50
47609
$663.90
47765
$938.90
48227
$1,026.40
48672
$2,517.20
47612
$814.30
47768
$1,200.00
48230
$976.00
48675
$1,231.40
47615
$881.30
47771
$1,380.00
48233
$1,272.80
48678
$1,415.00
47618
$1,226.50
47774
$815.40
48236
$1,527.90
48681
$1,762.30
47621
$772.10
47777
$727.30
48239
$882.00
48684
$2,281.70
47624
$1,110.10
47780
$945.50
48242
$1,378.30
48687
$3,175.90
47627
$267.20
47783
$945.50
48400
$661.50
48690
$3,281.40
47630
$640.40
47786
$1,800.00
48403
$1,075.00
48691
$4,625.00
47633
$188.30
47789
$1,416.00
48406
$680.80
48692
$3,115.00
47636
$282.90
47900
$321.00
48409
$1,113.70
48693
$1,101.90
47639
$494.00
47903
$573.90
48412
$1,201.50
48694
$1,752.40
47642
$251.80
47904
$94.30
48415
$1,506.90
48900
$519.70
47645
$431.00
47906
$214.90
48418
$1,189.50
48903
$1,130.60
47648
$609.10
47912
$94.30
48421
$1,807.10
48906
$1,066.10
47651
$393.20
47915
$297.80
48424
$1,718.10
48909
$1,686.20
47654
$694.80
47916
$142.20
48427
$1,788.90
48912
$619.30
47657
$897.00
47918
$447.20
48500
$620.90
48915
$1,508.50
47663
$235.80
47920
$722.90
48503
$621.90
48918
$3,127.70
47666
$581.10
47921
$250.30
48506
$917.60
48921
$2,907.00
47672
$196.80
47924
$71.20
48509
$393.20
48924
$3,601.90
47678
$319.10
47927
$288.20
48512
$1,675.60
48927
$612.70
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 37
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
48930
$1,700.80
49336
$652.80
49716
$2,607.90
50201
$659.30
48933
$2,009.00
49339
$5,194.90
49717
$3,811.90
50203
$854.90
48936
$1,438.60
49342
$5,721.10
49718
$828.90
50206
$1,220.30
48939
$2,225.00
49345
$6,163.00
49721
$446.80
50209
$1,426.60
48942
$2,636.70
49346
$1,610.70
49724
$1,655.00
50212
$3,109.20
48945
$531.20
49360
$669.40
49727
$630.80
50215
$3,885.70
48948
$1,325.60
49363
$789.30
49728
$1,039.60
50218
$5,188.70
48951
$1,705.20
49366
$1,515.30
49800
$268.80
50221
$4,783.00
48954
$1,780.60
49500
$723.10
49803
$356.00
50224
$5,346.30
48957
$2,237.80
49503
$953.00
49806
$269.60
50227
$5,601.30
48960
$1,977.70
49506
$1,383.40
49809
$477.10
50230
$2,968.40
49100
$666.10
49509
$1,437.30
49812
$897.00
50233
$4,065.50
49103
$1,443.10
49512
$2,054.30
49815
$1,664.00
50236
$2,843.00
49106
$1,762.30
49515
$1,833.50
49818
$654.70
50239
$2,135.60
49109
$1,488.20
49517
$2,625.20
49821
$856.90
50300
$2,188.80
49112
$1,415.70
49518
$2,727.00
49824
$1,446.00
50303
$2,992.60
49115
$2,687.70
49519
$5,145.30
49827
$948.50
50306
$4,669.30
49116
$2,754.50
49521
$3,018.40
49830
$1,809.00
50309
$572.20
49117
$3,646.70
49524
$3,554.10
49833
$1,083.60
50312
$1,326.30
49118
$556.10
49527
$3,052.40
49836
$1,992.30
50315
$1,304.80
49121
$1,280.40
49530
$3,774.80
49837
$1,272.70
50318
$1,157.10
49200
$1,593.90
49533
$4,244.30
49838
$2,174.00
50321
$1,764.00
49203
$1,239.70
49534
$1,140.00
49839
$1,136.50
50324
$2,210.00
49206
$1,142.20
49536
$1,860.50
49842
$1,981.00
50327
$2,695.80
49209
$1,610.60
49539
$2,107.90
49845
$1,039.90
50330
$504.00
49210
$1,772.10
49542
$2,822.50
49848
$321.10
50333
$1,238.50
49211
$2,249.80
49545
$1,257.30
49851
$467.50
50336
$1,539.00
49212
$466.10
49548
$1,928.60
49854
$721.10
50339
$1,062.90
49215
$1,280.00
49551
$2,821.20
49857
$838.40
50342
$1,232.80
49218
$637.50
49554
$3,554.70
49860
$581.90
50345
$737.90
49221
$1,343.50
49557
$573.70
49863
$824.90
50348
$470.50
49224
$1,418.20
49558
$532.40
49866
$656.30
50349
$534.40
49227
$1,444.40
49559
$825.30
49878
$107.50
50351
$2,665.90
49300
$1,300.00
49560
$1,145.60
50100
$509.80
50352
$107.50
49303
$1,031.80
49561
$1,369.20
50102
$1,173.10
50353
$592.10
49306
$2,039.80
49562
$1,500.10
50103
$649.00
50354
$2,186.70
49309
$1,550.10
49563
$1,622.40
50104
$635.10
50357
$1,242.20
49312
$1,762.30
49564
$1,906.90
50106
$934.10
50360
$1,380.50
49315
$1,600.40
49566
$1,754.70
50109
$966.20
50363
$945.70
49318
$2,730.40
49569
$1,426.10
50112
$685.90
50366
$1,649.70
49319
$5,233.80
49700
$552.40
50115
$268.30
50369
$1,241.90
49321
$3,055.30
49703
$1,332.20
50118
$932.30
50372
$1,909.20
49324
$3,519.30
49706
$700.40
50121
$1,913.40
50375
$1,155.00
49327
$4,072.40
49709
$1,514.10
50127
$1,332.50
50378
$1,940.40
49330
$4,295.70
49712
$1,600.00
50130
$731.10
50381
$1,229.50
49333
$4,654.90
49715
$2,268.30
50200
$358.30
50384
$2,177.70
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 38
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
50387
$1,087.60
50576
$1,533.80
52018
$470.50
52108
$554.50
50390
$427.70
50580
$1,106.50
52021
$69.60
52111
$752.70
50393
$1,599.80
50584
$1,377.50
52024
$162.20
52114
$1,115.40
50394
$5,294.20
50588
$1,397.00
52025
$306.80
52117
$1,224.70
50396
$915.40
50600
$721.80
52027
$281.00
52120
$3,517.20
50399
$1,539.00
50604
$3,064.00
52030
$153.10
52122
$3,517.20
50402
$803.70
50608
$6,995.00
52033
$306.80
52123
$1,563.10
50405
$1,200.70
50612
$9,191.70
52034
$182.60
52126
$1,502.90
50408
$1,666.20
50616
$1,167.80
52035
$1,079.60
52129
$2,011.80
50411
$2,186.70
50620
$6,224.60
52036
$252.90
52130
$752.60
50414
$2,950.30
50624
$6,406.00
52039
$554.50
52131
$1,638.40
50417
$2,186.70
50628
$7,936.00
52042
$336.10
52132
$1,058.20
50420
$1,805.10
50632
$6,682.20
52045
$420.00
52133
$152.00
50423
$2,285.90
50636
$6,566.30
52048
$693.20
52135
$245.60
50426
$986.70
50640
$3,629.80
52051
$855.70
52138
$1,420.30
50450
$2,037.40
50644
$4,242.10
52054
$1,026.50
52141
$841.80
50451
$2,037.40
50650
$688.70
52055
$46.50
52144
$703.50
50455
$2,307.30
50654
$824.70
52056
$46.50
52147
$736.40
50456
$2,307.30
50658
$372.20
52057
$277.10
52148
$1,151.30
50460
$3,444.60
50950
$1,424.90
52058
$404.30
52158
$2,101.80
50461
$3,444.60
50952
$1,548.20
52059
$1,137.80
52180
$431.40
50465
$4,852.00
51300
$150.50
52060
$343.60
52182
$740.50
50466
$4,852.00
51303
DF
52061
$373.40
52184
$1,117.90
50470
$6,153.50
51306
$268.20
52062
$493.50
52186
$1,281.30
50471
$6,153.50
51309
DF
52063
$667.20
52300
$483.70
50475
$7,100.50
51312
DF
52064
$303.10
52303
$690.50
50476
$7,100.50
51315
$456.70
52066
$1,303.70
52306
$1,024.80
50500
$790.00
51318
$277.40
52069
$460.70
52309
$341.60
50504
$615.80
52072
$145.50
52312
$535.50
50508
$842.30
52073
$249.80
52315
$966.50
50512
$1,013.10
Category 4:
Oral & maxillofacial services
by approved dental
practitioners
52075
$326.80
52318
$402.30
50516
$646.50
51700
$145.50
52078
$564.70
52319
$731.90
$1,169.80
51703
$73.20
52081
$181.10
52321
$991.10
$681.80
51800
$150.50
52084
$240.70
52324
$1,839.60
$1,573.60
51803
DF
52087
$387.40
52327
$977.90
50532
$1,640.00
51900
$554.50
52090
$606.10
52330
$1,531.20
50536
$1,459.00
51902
$125.70
52092
$775.30
52333
$1,305.20
50540
$957.50
51904
$853.60
52094
$1,224.40
52336
$900.40
$440.00
51906
$1,154.60
52095
$868.10
52337
$2,114.10
$880.20
52000
$140.30
52096
$346.60
52339
$929.00
50552
$859.00
52003
$199.90
52097
$303.40
52342
$1,703.00
50556
$1,137.50
52006
$199.90
52098
$353.20
52345
$2,365.40
50560
$791.90
52009
$367.50
52099
$240.20
52348
$2,307.70
$1,055.90
52010
$569.60
52102
$264.50
52351
$4,502.00
$1,005.50
52012
$99.90
52105
$498.40
52354
$2,649.60
$1,395.10
52015
$409.50
52106
$336.20
52357
$4,145.70
50520
50524
50528
50544
50548
50564
50568
50572
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 39
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
52360
$2,868.30
52821
$1,719.70
53409
$766.80
55032
$205.80
52363
$5,593.20
52824
$754.60
53410
$142.90
55033
$72.00
52366
$3,014.90
52826
$396.60
53411
$598.30
55036
$207.90
52369
$6,464.40
52828
$589.90
53412
$736.90
55037
$72.30
52372
$3,289.00
52830
$778.00
53413
$928.30
55038
$207.90
52375
$5,932.30
52832
$1,067.00
53414
$1,539.10
55039
$72.00
52378
$2,549.00
53000
$71.00
53415
$825.30
55048
$212.40
52379
$2,994.50
53003
$173.40
53416
$741.20
55049
$75.10
52380
$3,813.80
53004
$116.00
53418
$945.50
55054
$205.20
52382
$6,628.90
53006
$886.70
53419
$1,064.00
55059
$83.90
52420
$624.20
53009
$549.80
53422
$1,797.50
55060
$29.20
52424
$1,461.70
53012
$213.60
53423
$1,263.40
55061
$93.00
52430
$1,819.80
53015
$999.70
53424
$2,024.70
55062
$32.20
52440
$903.70
53016
$1,225.60
53425
$1,293.60
55063
$83.90
52442
$1,129.70
53017
$2,336.00
53427
$1,732.90
55064
$29.20
52444
$1,255.10
53019
$1,351.10
53429
$1,646.00
55065
$150.80
52446
$1,481.20
53052
$204.90
53439
$448.40
55067
$77.10
52450
$502.00
53054
$483.20
53453
$1,162.20
55068
$53.70
52452
$831.30
53056
$122.20
53455
$1,767.20
55069
$27.40
52456
$1,380.80
53058
$204.90
53458
$73.00
55070
$201.50
52458
$502.00
53060
$167.80
53459
$532.60
55073
$63.90
52460
$1,305.20
53062
$150.10
53460
$1,682.50
55076
$236.60
52480
$838.30
53064
$271.90
53600
$65.00
55079
$89.00
52482
$806.60
53068
$580.20
53700
$208.40
55084
$184.50
52484
$960.20
53070
$516.70
53702
$104.40
55085
$63.90
52600
$644.90
53200
$132.80
53704
$62.70
55113
$437.70
52603
$550.10
53203
$198.20
53706
$530.80
55114
$440.30
52606
$419.50
53206
$272.90
55115
$434.70
52609
$550.10
53209
$2,752.50
Category 5:
Diagnostic imaging services
55116
$490.60
52612
$690.50
53212
$1,808.80
55117
$498.10
52615
$857.20
53215
$1,737.60
52618
$997.70
53218
$1,747.60
52621
$1,989.20
53220
$550.10
52624
$903.70
53221
$1,651.10
52626
$645.30
53224
$1,614.00
52627
$986.30
53225
$549.40
52630
$441.70
53226
$521.40
52633
$1,624.70
53227
$1,983.30
52636
$783.50
53230
$4,520.80
52800
$534.20
53233
$4,789.20
52803
$677.90
53236
$785.60
52806
$462.00
53239
$785.60
52809
$790.70
53242
$567.40
52812
$1,151.40
53400
$215.60
52815
$2,935.60
53403
$268.40
52818
$957.60
53406
$1,139.70
55005
$93.00
55007
$32.20
55008
$93.00
55010
$32.20
55011
$93.00
55013
$32.20
55014
$94.90
55016
$32.20
55017
$93.00
55019
$32.20
55023
$93.30
55025
$32.20
55026
$93.00
55028
$204.80
55029
$70.80
55030
$249.30
55031
$82.20
55118
$519.10
55119
$196.70
55120
$196.70
55121
$196.70
55122
$223.30
55123
$223.30
55125
$235.00
55130
$320.80
55131
$145.10
55135
$667.40
55136
$301.60
55220
$144.70
55221
$144.70
55222
$144.70
55223
$144.70
55224
$144.70
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 40
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
55226
$144.70
55719
$98.20
55815
$32.20
56022
$424.30
55227
$144.70
55720
$34.10
55816
$210.50
56028
$610.00
55228
$144.70
55721
$217.10
55817
$93.00
56030
$428.30
55229
$144.70
55722
$85.30
55818
$72.00
56036
$613.40
55230
$144.70
55723
$71.70
55819
$32.20
56041
$174.40
55232
$144.70
55724
$98.20
55820
$205.00
56047
$239.40
55233
$144.70
55725
$75.50
55821
$93.00
56050
$229.40
55235
$144.70
55726
$32.40
55822
$66.80
56053
$226.50
55236
$94.70
55727
$34.10
55823
$32.20
56056
$292.50
55238
$320.90
55729
$51.50
55824
$210.50
56062
$199.90
55244
$321.60
55730
$23.30
55825
$93.00
56068
$337.60
55246
$322.80
55735
$108.30
55826
$75.50
56070
$199.90
55248
$321.40
55736
$305.00
55827
$32.20
56076
$318.80
55252
$318.40
55737
$48.60
55828
$205.50
56101
$432.40
55274
$318.20
55739
$126.00
55829
$93.00
56107
$627.40
55276
$321.90
55759
$287.40
55830
$72.00
56141
$222.10
55278
$340.80
55760
$128.00
55831
$32.20
56147
$303.10
55280
$323.20
55762
$162.10
55832
$204.90
56219
$610.50
55282
$317.70
55763
$51.20
55833
$93.00
56220
$444.30
55284
$318.40
55764
$302.00
55834
$90.00
56221
$441.30
55292
$300.30
55765
$136.50
55835
$32.20
56223
$448.30
55294
$317.80
55766
$122.80
55836
$204.00
56224
$620.40
55296
$210.90
55767
$55.40
55837
$93.00
56225
$628.90
55600
$203.90
55768
$283.20
55838
$72.00
56226
$624.00
55601
$93.00
55769
$128.00
55839
$32.20
56227
$233.00
55603
$225.30
55770
$113.20
55840
$214.20
56228
$216.40
55604
$93.00
55771
$51.20
55841
$93.00
56229
$216.40
55700
$121.10
55772
$302.00
55842
$85.60
56230
$313.30
55701
$51.20
55773
$136.50
55843
$32.20
56231
$313.30
55702
$29.90
55774
$122.80
55844
$164.60
56232
$313.30
55703
$66.10
55775
$55.40
55845
$74.60
56233
$443.90
55704
$133.00
55800
$207.40
55846
$71.20
56234
$664.80
55705
$66.10
55801
$93.00
55847
$32.20
56235
$231.00
55706
$202.00
55802
$72.00
55848
$248.80
56236
$313.30
55707
$216.70
55803
$32.20
55849
$93.00
56237
$451.40
55708
$132.50
55804
$208.80
55850
$315.20
56238
$669.00
55709
$113.70
55805
$93.00
55851
$130.40
56239
$216.30
55710
$59.70
55806
$71.80
55852
$192.60
56240
$313.30
55711
$29.90
55807
$32.20
55853
$93.00
56259
$291.00
55712
$217.10
55808
$207.50
55854
$66.80
56301
$547.80
55713
$85.30
55809
$93.00
55855
$32.20
56307
$718.10
55714
$59.70
55810
$89.60
56001
$359.60
56341
$281.00
55715
$75.50
55811
$32.20
56007
$475.90
56347
$379.00
55716
$29.90
55812
$207.50
56010
$470.00
56401
$384.40
55717
$32.40
55813
$93.00
56013
$471.40
56407
$650.70
55718
$191.10
55814
$72.00
56016
$533.00
56409
$371.30
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 41
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
56412
$656.40
57533
$46.10
57945
$81.60
58526
$48.20
56441
$184.30
57535
$27.70
57947
$66.80
58527
$123.50
56447
$320.50
57536
$37.10
57950
$55.00
58529
$59.20
56449
$197.60
57538
$42.10
57953
$42.40
58700
$92.70
56452
$320.50
57539
$56.30
57956
$37.10
58702
$39.40
56501
$555.60
57700
$79.50
57959
$40.50
58706
$299.50
56507
$871.40
57702
$34.50
57960
$85.00
58708
$134.70
56541
$276.60
57703
$102.90
57962
$40.50
58715
$242.70
56547
$436.70
57705
$46.10
57963
$84.90
58717
$129.30
56552
$1,133.40
57706
$76.10
57965
$40.50
58718
$239.80
56554
$1,112.80
57708
$27.70
57966
$84.40
58720
$107.60
56619
$416.30
57709
$83.10
57968
$40.50
58721
$225.50
56625
$593.60
57711
$37.10
57969
$88.60
58723
$118.00
56659
$208.10
57712
$91.10
58100
$126.50
58900
$52.10
56665
$295.60
57714
$40.30
58102
$57.30
58902
$30.40
56801
$828.20
57715
$109.50
58103
$104.60
58903
$90.00
56807
$1,002.60
57717
$52.00
58105
$47.00
58905
$40.60
56841
$412.20
57721
$186.10
58106
$145.80
58909
$202.80
56847
$532.90
57723
$84.70
58108
$194.20
58911
$76.70
57001
$836.30
57901
$122.80
58109
$89.00
58912
$236.80
57007
$1,004.70
57902
$113.90
58111
$65.70
58914
$94.10
57041
$412.30
57903
$88.90
58112
$178.50
58915
$174.20
57047
$501.40
57906
$113.90
58114
$93.90
58916
$259.20
57201
$316.10
57909
$113.90
58115
$194.20
58917
$67.40
57247
$137.00
57911
$55.00
58117
$40.20
58920
$118.20
57341
$661.00
57912
$89.30
58120
$194.20
58921
$255.30
57345
$426.80
57914
$55.00
58121
$194.20
58923
$115.50
57350
$955.40
57915
$88.20
58123
$83.00
58924
$160.80
57351
$970.00
57917
$40.40
58124
$93.90
58926
$71.70
57355
$467.50
57918
$91.90
58126
$93.90
58927
$143.10
57356
$466.50
57920
$55.00
58127
$93.90
58929
$65.30
57360
$1,194.10
57921
$88.20
58300
$81.80
58933
$385.10
57361
$597.00
57923
$55.00
58302
$34.20
58935
$175.30
57362
$173.60
57924
$84.40
58306
$170.50
58936
$330.00
57363
$86.90
57926
$40.30
58308
$76.20
58938
$167.20
57506
$63.90
57927
$94.10
58500
$55.40
58939
$261.20
57509
$74.70
57929
$40.30
58502
$30.20
58941
$118.80
57512
$81.80
57930
$68.60
58503
$88.50
59103
$37.60
57515
$101.20
57932
$40.30
58505
$40.30
59104
$18.20
57518
$68.30
57933
$139.20
58506
$134.30
59300
$168.20
57521
$81.60
57935
$40.30
58508
$51.90
59301
$76.20
57524
$92.30
57938
$40.30
58509
$89.30
59303
$101.40
57527
$123.90
57939
$114.40
58511
$34.00
59304
$46.10
57529
$25.40
57941
$42.40
58521
$82.40
59306
$191.50
57530
$34.00
57942
$93.20
58523
$37.10
59307
$85.50
57532
$34.50
57944
$28.00
58524
$106.30
59309
$354.30
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 42
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
59310
$171.00
60004
$634.60
60073
$36.90
61386
$479.80
59312
$171.10
60006
$2,116.00
60075
$180.30
61387
$682.90
59313
$74.30
60007
$902.40
60076
$73.80
61389
$556.00
59314
$123.90
60009
$2,573.90
60078
$275.50
61390
$592.00
59315
$44.80
60010
$1,055.90
60079
$110.70
61393
$930.70
59318
$92.50
60012
$1,056.90
60100
$114.20
61397
$395.80
59319
$40.20
60013
$432.70
60101
$51.90
61401
$254.90
59503
$157.80
60015
$1,460.60
60500
$85.30
61402
$940.90
59504
$76.20
60016
$634.60
60501
$37.10
61405
$611.50
59700
$196.20
60018
$2,168.90
60503
$86.00
61409
$1,220.10
59701
$82.50
60019
$902.40
60504
$25.40
61413
$352.20
59703
$162.90
60021
$2,470.60
60506
$145.00
61417
$191.60
59704
$64.80
60022
$1,055.90
60507
$54.50
61421
$728.40
59712
$219.90
60024
$1,059.80
60509
$221.00
61425
$916.80
59713
$97.10
60025
$432.70
60510
$84.40
61426
$801.70
59715
$242.00
60027
$1,546.00
60918
$83.30
61429
$850.30
59716
$122.50
60028
$634.60
60927
$71.20
61430
$1,116.50
59718
$251.40
60030
$2,197.50
61109
$504.90
61433
$718.90
59719
$114.90
60031
$902.40
61110
$220.90
61434
$1,041.70
59724
$393.50
60033
$2,593.70
61302
$672.70
61437
$857.20
59725
$193.20
60034
$1,055.90
61303
$872.20
61438
$1,179.30
59733
$202.90
60036
$1,057.10
61306
$1,072.50
61441
$711.70
59734
$92.00
60037
$432.70
61307
$1,309.50
61442
$1,174.80
59736
$178.00
60039
$1,460.60
61310
$551.30
61445
$403.50
59737
$52.90
60040
$634.60
61313
$456.70
61446
$494.10
59739
$135.40
60042
$2,184.70
61314
$636.80
61449
$816.90
59740
$63.00
60043
$902.40
61316
$636.80
61450
$609.20
59751
$242.80
60045
$2,562.90
61317
$747.70
61453
$906.10
59752
$118.70
60046
$1,055.90
61320
$352.20
61454
$509.20
59754
$387.40
60048
$1,057.90
61328
$333.90
61457
$831.00
59755
$187.20
60049
$432.70
61340
$323.70
61458
$628.20
59760
$228.00
60051
$1,517.40
61348
$652.10
61461
$932.30
59761
$98.30
60052
$634.60
61352
$397.10
61462
$227.80
59763
$241.20
60054
$2,197.50
61353
$603.30
61465
$404.70
59764
$114.20
60055
$902.40
61356
$587.20
61469
$614.50
59903
$231.10
60057
$2,578.70
61360
$767.40
61473
$333.60
59912
$611.60
60058
$1,055.90
61361
$849.10
61480
$561.80
59925
$736.60
60060
$1,072.40
61364
$728.80
61484
$1,235.90
59970
$297.10
60061
$432.70
61368
$344.30
61485
$1,557.90
59971
$101.30
60063
$1,566.30
61369
$3,559.90
61495
$344.30
59972
$308.40
60064
$634.60
61372
$353.70
61499
$381.70
59973
$351.50
60066
$2,199.80
61373
$704.60
61505
$176.70
59974
$159.20
60067
$902.40
61376
$227.60
61523
$1,683.10
60000
$1,080.50
60069
$2,599.60
61381
$1,041.70
61529
$1,683.10
60001
$432.70
60070
$1,055.90
61383
$987.60
61538
$1,591.40
60003
$1,474.10
60072
$92.50
61384
$1,214.50
61541
$1,683.10
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 43
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
61553
$1,764.40
61680
$316.10
63014
$343.80
63170
$594.10
61559
$1,621.40
61681
$349.80
63016
$343.80
63173
$594.10
61565
$1,683.10
61682
$516.40
63017
$286.50
63176
$594.10
61571
$1,683.10
61683
$210.60
63040
$567.40
63179
$594.10
61575
$1,625.80
61684
$138.50
63043
$594.10
63182
$594.10
61577
$1,683.10
61685
$516.10
63046
$647.70
63185
$594.10
61598
$1,683.10
61686
$295.10
63049
$647.70
63186
$305.70
61604
$1,683.10
61687
$745.10
63052
$647.70
63187
$305.70
61610
$1,683.10
61688
$192.80
63055
$647.70
63188
$305.70
61616
$1,683.10
61689
$101.50
63058
$647.70
63189
$305.70
61620
$1,625.80
61690
$409.20
63061
$647.70
63190
$305.70
61622
$1,683.10
61691
$512.30
63064
$647.70
63191
$305.70
61628
$1,683.10
61692
$473.20
63067
$647.70
63192
$305.70
61632
$1,625.80
61693
$463.20
63070
$647.70
63193
$305.70
61640
$1,764.40
61694
$562.40
63073
$647.70
63194
$305.70
61646
$1,764.40
61695
$423.90
63074
$286.50
63201
$710.60
61650
$1,569.50
61696
$524.90
63075
$305.70
63204
$710.60
61651
$383.00
61697
$463.00
63076
$343.80
63207
$382.00
61652
$482.20
61698
$574.10
63077
$343.80
63208
$382.00
61653
$605.30
61699
$417.70
63078
$343.80
63219
$710.60
61654
$712.10
61700
$641.80
63079
$343.80
63222
$710.60
61655
$313.30
61701
$244.60
63080
$343.80
63225
$710.60
61656
$258.80
61702
$284.60
63081
$343.80
63228
$710.60
61657
$358.20
61703
$389.10
63082
$343.80
63231
$710.60
61658
$325.10
61704
$339.10
63083
$343.80
63234
$710.60
61659
$419.90
61705
$439.00
63084
$343.80
63237
$710.60
61660
$195.30
61706
$296.90
63085
$343.80
63240
$710.60
61661
$194.20
61707
$401.40
63101
$773.20
63243
$710.60
61662
$215.80
61708
$338.70
63104
$420.50
63257
$382.00
61663
$378.30
61709
$450.20
63111
$773.20
63258
$382.00
61664
$221.30
61710
$110.00
63114
$773.20
63259
$382.00
61665
$329.80
61711
$226.50
63117
$420.50
63260
$382.00
61666
$334.90
61712
$296.90
63119
$420.50
63261
$382.00
61667
$344.00
61713
$149.70
63125
$773.20
63262
$382.00
61668
$393.70
61714
$330.00
63128
$773.20
63263
$382.00
61669
$423.90
61715
$751.40
63131
$773.20
63264
$382.00
61670
$190.30
61716
$852.40
63134
$420.50
63265
$382.00
61671
$1,719.40
61717
$190.30
63135
$420.50
63271
$773.20
61672
$190.30
61718
$215.80
63136
$420.50
63274
$773.20
61673
$417.70
61719
$85.30
63151
$594.10
63277
$773.20
61674
$122.40
61729
$749.40
63154
$594.10
63280
$773.20
61675
$489.90
63001
$647.70
63157
$305.70
63282
$420.50
61676
$533.20
63004
$647.70
63158
$305.70
63283
$420.50
61677
$586.60
63007
$647.70
63161
$594.10
63284
$420.50
61678
$283.60
63010
$567.40
63164
$594.10
63285
$420.50
61679
$367.40
63013
$343.80
63167
$594.10
63301
$620.60
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 44
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
63304
$620.60
63461
$594.10
64990
NA
65176
$86.40
63307
$620.60
63464
$1,238.50
64991
NA
65177
$128.00
$1,233.60
Category 6:
Pathology services
65178
$169.30
65179
$210.70
65180
$45.00
65181
$41.40
66500
$12.50
66503
$14.90
63310
$324.70
63467
63311
$324.70
63470
$647.90
63313
$324.70
63473
$961.20
63322
$647.90
63476
$711.90
63325
$647.90
63479
$343.80
63328
$647.90
63481
$534.90
63331
$647.90
63482
$711.90
63334
$567.40
63484
$343.80
63337
$710.60
63486
$343.80
63340
$647.90
63491
$79.20
63341
$343.80
63494
$79.20
63342
$343.80
63497
$276.80
63343
$343.80
63498
$76.30
63345
$343.80
63499
$267.50
63346
$286.50
63501
$853.00
63347
$382.00
63502
$853.00
63348
$343.80
63504
$853.00
63361
$647.90
63505
$853.00
63364
$343.80
63507
$647.70
63385
$710.60
63508
$343.80
63388
$710.60
63510
$710.60
63391
$647.90
63511
$382.00
63392
$382.00
63513
$647.90
63393
$382.00
63514
$343.80
63394
$343.80
63516
$647.90
63401
$647.90
63517
$343.80
63404
$647.90
63519
$647.90
63407
$343.80
63520
$343.80
63408
$343.80
63522
$710.60
63416
$647.90
63523
$382.00
63419
$343.80
63551
$637.80
63425
$647.90
63552
$319.00
63428
$647.90
63554
$567.00
63432
$343.80
63555
$283.50
63433
$343.80
63557
$779.60
63440
$647.90
63558
$389.90
63443
$647.90
63560
$637.80
63446
$647.90
63561
$319.00
63447
$343.80
63740
$701.60
63448
$343.80
63741
$407.10
63449
$343.80
63743
$618.70
63455
$305.70
63744
$350.80
63457
$588.40
63746
$203.60
63458
$588.40
63747
$309.40
65060
$14.50
65066
$13.40
65070
$30.10
65072
$18.00
65075
$82.80
65078
$160.20
65079
$160.20
65081
$172.00
65082
$172.00
65084
$296.70
65087
$147.60
65090
$19.70
65093
$39.20
65096
$72.90
65099
$196.60
65102
$293.10
65105
$198.60
65108
$254.90
65109
$24.00
65110
$24.00
65111
$42.50
65114
$11.80
65117
$36.00
65120
$24.40
65123
$37.00
65126
$52.40
65129
$64.10
65137
$45.00
65142
$45.00
65144
$100.70
65147
$67.00
65150
$126.10
65153
$252.20
65156
$378.30
65157
$126.10
65158
$126.10
65159
$126.10
65162
$19.80
65165
$66.10
65166
$61.30
65171
$45.00
65175
$45.00
66506
$17.50
66509
$20.20
66512
$22.90
66517
$34.90
66518
$35.10
66519
$75.30
66536
$14.20
66539
$41.00
66542
$29.60
66545
$30.00
66548
$37.10
66551
$29.80
66554
$29.80
66557
$17.20
66560
$35.90
66563
$31.80
66566
$50.30
66569
$75.70
66572
$90.80
66575
$107.30
66578
$122.40
66581
$137.50
66584
$17.20
66587
$84.40
66590
$58.60
66593
$31.90
66596
$57.80
66605
$54.50
66606
$54.50
66607
$134.70
66610
$130.10
66623
$53.40
66626
$42.90
66629
$35.90
66632
$35.90
66635
$35.90
66638
$63.10
66639
$52.00
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 45
Item No
Max. Fee
(ex GST)
Item No
66641
$52.00
66751
66642
$52.00
66644
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
$104.30
66837
$59.90
69413
$99.00
66752
$43.90
66838
$36.20
69415
$113.90
$26.00
66755
$69.20
66839
$65.90
69418
$112.90
66647
$58.00
66756
$174.70
66840
$36.20
69419
$112.90
66650
$43.30
66757
$174.70
66841
$25.80
69445
$163.90
66651
$43.30
66758
$43.90
66900
$138.00
69451
$163.90
66652
$36.20
66761
$23.40
69300
$19.50
69471
$61.90
66653
$79.30
66764
$15.90
69303
$39.20
69472
$27.80
66655
$35.90
66767
$31.60
69306
$58.30
69474
$50.90
66656
$35.90
66770
$47.60
69309
$84.70
69475
$27.80
66659
$66.00
66773
$31.70
69312
$58.30
69478
$52.00
66660
$66.80
66776
$31.70
69316
$50.90
69481
$72.00
66662
$142.20
66779
$71.10
69317
$63.80
69482
$270.40
66663
$142.20
66780
$71.10
69318
$58.30
69483
$270.40
66665
$39.50
66782
$24.90
69319
$76.20
69484
$30.30
66666
$54.50
66783
$23.40
69321
$90.70
69488
$320.30
66667
$54.50
66785
$71.10
69324
$75.70
69489
$320.30
66671
$65.60
66788
$117.10
69325
$76.40
69491
$364.20
66674
$71.50
66789
$71.10
69327
$148.30
69492
$364.20
66677
$19.70
66790
$46.10
69328
$151.00
69494
$50.90
66680
$140.00
66791
$132.40
69330
$224.90
69495
$63.80
66683
$132.40
66792
$132.40
69331
$227.60
69496
$76.40
66686
$90.00
66800
$33.50
69333
$36.60
69497
$50.90
66695
$39.30
66803
$56.30
69336
$59.30
69498
$12.90
66696
$54.30
66804
$32.10
69339
$24.60
69499
$163.90
66697
$23.40
66805
$21.90
69345
$94.10
69500
$163.90
66698
$77.70
66806
$78.40
69354
$46.00
71057
$61.80
66701
$101.30
66812
$61.80
69357
$91.90
71058
$89.30
66704
$124.70
66815
$105.90
69360
$137.50
71059
$51.90
66707
$148.30
66816
$61.80
69363
$44.50
71060
$77.70
66711
$53.50
66817
$44.00
69378
$320.30
71062
$77.70
66712
$80.50
66819
$54.50
69379
$320.30
71064
$37.00
66714
$56.60
66820
$54.50
69380
$1,322.90
71066
$26.00
66715
$30.00
66821
$38.70
69381
$320.30
71068
$26.00
66716
$32.20
66822
$93.10
69382
$320.30
71069
$29.30
66719
$44.80
66825
$54.50
69383
$320.30
71071
$40.00
66722
$67.40
66826
$54.50
69384
$27.80
71072
$26.00
66723
$67.40
66827
$38.70
69387
$51.70
71073
$136.60
66724
$23.40
66828
$93.10
69390
$74.90
71074
$26.00
66725
$90.70
66830
$109.50
69393
$94.40
71075
$29.60
66728
$114.10
66831
$57.20
69396
$113.90
71076
$188.60
66731
$137.40
66832
$55.00
69400
$27.80
71077
$48.10
66734
$160.80
66833
$46.10
69401
$23.70
71079
$47.70
66743
$38.30
66834
$46.10
69405
$27.80
71081
$71.90
66749
$62.20
66835
$59.90
69408
$51.70
71083
$26.00
66750
$76.40
66836
$59.90
69411
$75.40
71085
$37.30
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 46
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
71087
$50.00
71170
$23.00
73063
$176.70
73804
$14.50
71089
$37.50
71180
$61.50
73064
$127.50
73805
$8.30
71090
$51.80
71183
$84.30
73065
$152.90
73806
$18.00
71091
$68.10
71186
$107.30
73066
$380.40
73807
$12.50
71092
$42.00
71189
$27.50
73067
$221.70
73808
$19.00
71093
$98.40
71192
$50.50
73287
$749.30
73809
$4.20
71095
$72.00
71195
$71.20
73289
$638.20
73810
$15.20
71096
$72.00
71198
$72.00
73290
$701.40
73811
$21.40
71097
$31.40
71200
$64.80
73291
$410.60
73828
NA
71099
$34.10
71203
$72.00
73292
$1,048.60
73829
NA
71101
$22.40
72813
$136.10
73293
$410.60
73830
NA
71103
$67.00
72816
$153.60
73294
$410.60
73831
NA
71106
$20.20
72817
$172.30
73300
$179.90
73832
NA
71119
$22.40
72818
$200.00
73305
$360.30
73833
NA
71121
$26.80
72823
$184.40
73308
$64.90
73834
NA
71123
$31.20
72824
$212.40
73309
$64.90
73835
NA
71125
$35.60
72825
$330.00
73311
$64.90
73836
NA
71127
$227.10
72826
$369.50
73312
$64.90
73837
NA
71129
$280.40
72827
$388.30
73314
$410.70
73920
$4.30
71131
$333.90
72828
$430.10
73315
$410.70
73922
$14.90
71133
$18.40
72830
$400.20
73317
$64.90
73923
$4.30
71134
$185.00
72836
$652.50
73318
$64.90
73924
$27.10
71135
$267.70
72838
$815.20
73320
$72.00
73925
$4.40
71137
$67.00
72844
$58.30
73321
$72.00
73926
$14.50
71139
$134.00
72846
$84.50
73323
$72.00
73927
$4.30
71141
$254.10
72847
$128.90
73324
$72.90
73928
$10.50
71143
$334.60
72848
$115.90
73325
$128.00
73929
$4.30
71145
$573.50
72849
$147.10
73326
$396.70
73930
$15.20
71146
$185.00
72850
$167.60
73327
$89.20
73931
$4.40
71147
$72.00
72851
$288.20
73332
$541.60
73932
$18.20
71148
$72.00
72852
$396.10
73333
$971.00
73933
$4.30
71149
$139.30
72855
$311.10
73334
$550.30
73934
$31.40
71151
$153.00
72856
$412.80
73335
$760.70
73935
$4.30
71153
$44.50
72857
$544.50
73336
$365.30
73936
$10.60
71154
$61.50
73043
$38.20
73337
$628.60
73937
$4.30
71155
$61.10
73045
$77.70
73338
$365.30
73938
$14.20
71156
$23.00
73047
$162.10
73339
$613.80
73939
$4.30
71157
$77.70
73049
$109.30
73340
$306.90
73940
$18.20
71159
$94.20
73051
$322.80
73521
$18.40
74990
NA
71163
$44.00
73053
$34.60
73523
$87.00
74991
NA
71164
$71.00
73055
$34.60
73525
$53.80
74992
NA
71165
$61.50
73057
$34.60
73527
$17.80
74993
NA
71166
$84.30
73059
$76.30
73529
$50.90
74994
NA
71167
$107.30
73060
$89.30
73801
$13.10
74995
NA
71168
$130.10
73061
$96.40
73802
$8.10
74996
NA
71169
$61.50
73062
$158.30
73803
$11.30
74997
NA
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 47
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
74998
NA
82000
NA
74999
NA
82005
NA
82010
NA
82015
NA
82020
NA
82025
NA
82035
NA
82150
NA
82151
NA
82152
NA
82220
NA
82221
NA
82222
NA
82223
NA
82224
NA
82225
NA
Category 8:
Miscellaneous services
80000
NA
80005
NA
80010
NA
80015
NA
80020
NA
80100
NA
80105
NA
80110
NA
80115
NA
80120
NA
80125
NA
80130
NA
80135
NA
80140
NA
80145
NA
80150
NA
80155
NA
80160
NA
80165
NA
80170
NA
81000
NA
81005
NA
81010
NA
81100
NA
81105
NA
81110
NA
81115
NA
81120
NA
81125
NA
81300
NA
81305
NA
81310
NA
81315
NA
81320
NA
81325
NA
81330
NA
81335
NA
81340
NA
81345
NA
81350
NA
81355
NA
81360
NA
Item No
Max. Fee
(ex GST)
Item No
Max. Fee
(ex GST)
DF = derived fee, refer to pages 10-16, NA = not applicable, refer to page 6.
Schedule 1A must be read in conjunction with the Medical fee schedule guidelines.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 48
Schedule 1B – Other medical services
Short medical report – treating doctor
Item no.
Service description
RRTWG
General practitioner: reviewing and signing of a Recovery/Return to Work
Plan, expected to be provided within 10 business days of receipt of the
initial request.
$64.30
RRTWR
Consultant physicians, specialists in a surgical discipline: reviewing and
signing of a Recovery/Return to Work Plan, expected to be provided within
10 business days of receipt of the initial request.
$126.40
Note 1:
Max fee (ex GST)
A Recovery/Return to Work Plan must be requested by a:
- case manager or self-insured employer
- return to work consultant.
Note 2:
The date of request is taken to be two business days after the letter of request is
posted, or one business day after the request is faxed. A business day is any day,
excluding Saturday, Sunday and public holidays in South Australia.
Note 3:
Payment will only be made following submission of the signed plan.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 49
Short medical report – treating doctor
Item no.
Service description
WMG37
General practitioners: Short medical report, expected to be provided within 72
hours of receipt of the initial request or examination (where applicable),
whichever is the later.
$99.00
WMP37
Consultant physicians: Short medical report, expected to be provided within 72
hours of receipt of the initial request or examination (where applicable),
whichever is the later.
$126.40
WMS37
Specialists in surgical discipline: Short medical report, expected to be provided
within 72 hours of receipt of the initial request or examination (where applicable),
whichever is the later.
$126.40
Note 1:
Max fee (ex GST)
A short medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
If a medical practitioner believes the incorrect report type has been requested, this should be
referred back to the case manager and clarified.
Note 4:
A short report should be based on the medical practitioner’s notes and would not usually
require a consultation with the patient. Where a consultation is appropriate (for example, if
the practitioner has not seen the patient for some time), a consultation fee is to be billed in
accordance with item numbers WMG70, WMP70, WMS70, WMY73. Consultation items in
Schedule 1A must not be used for this purpose.
Note 5:
A short report should be concise and focused. The expected length of a short report is
approximately half an A4 page.
Note 6:
A short report may be faxed to the requestor with the relevant account for services.
Note 7:
Payment will only be made following submission of the report.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 50
Standard medical report – treating doctor (excluding psychiatrists)
Item no.
Service description
WMG16
General practitioners: Treating doctor standard medical report, expected to be
provided within 10 business days of receipt of the initial request or examination
(where applicable), whichever is the later.
$257.70
WMP16
Consultant physicians: Treating doctor standard medical report, expected to be
provided within 10 business days of receipt of the initial request or examination
(where applicable), whichever is the later.
$482.90
WMS16
Specialists in a surgical discipline: Treating doctor standard medical report,
expected to be provided within 10 business days of receipt of the initial request or
examination (where applicable), whichever is the later.
$482.90
Note 1:
Max fee (ex GST)
A standard medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
If a medical practitioner believes the incorrect report type has been requested, this should be
referred back to the case manager and clarified.
Note 4:
A standard medical report should be based on the medical practitioner’s notes and would
not usually require a consultation with the patient. Where a consultation is appropriate (for
example, if the practitioner has not seen the patient for some time), a consultation fee is to
be billed in accordance with item numbers WMG70, WMP70, WMS70. Consultation items in
Schedule 1A must not be used for this purpose.
Note 5:
Payment will only be made following submission of the report.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 51
Complex medical report – treating doctor (excluding psychiatrists)
Item no.
Service description
WMG40
General practitioners: Treating doctor complex medical report, expected to be
provided within 10 business days of receipt of the initial request or examination
(where applicable), whichever is the later.
$322.10
WMP40
Consultant physicians: Treating doctor complex medical report, expected to be
provided within 10 business days of receipt of the initial request or examination
(where applicable), whichever is the later.
$605.50
WMS40
Specialists in a surgical discipline: Treating doctor complex medical report,
expected to be provided within 10 business days of receipt of the initial request or
examination (where applicable), whichever is the later.
$605.50
Note 1:
Max fee (ex GST)
A complex medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
If a medical practitioner believes the incorrect report type has been requested, this should be
referred back to the case manager and clarified.
Note 4:
A complex medical report should be based on the medical practitioner’s notes and would not
usually require a consultation with the patient. Where a consultation is appropriate (for
example, if the practitioner has not seen the patient for some time), a consultation fee is to
be billed in accordance with item numbers WMG70, WMP70, WMS70. Consultation items in
Schedule 1A must not be used for this purpose.
Note 5:
A complex medical report requires additional information above that required in a standard
report, and may be deemed complex compared to a standard report when the worker has:
- three or more ongoing compensable injuries arising from the same claim
- pre-existing conditions that have a significant impact on the compensable injury
- co-morbidities that have a significant impact on the compensable injury.
Note 6:
Payment will only be made following submission of the report.
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Page 52
Standard medical report – treating psychiatrist
Item no.
Service description
WMY43
Psychiatrists: Treating doctor standard medical report, expected to be provided
within 10 business days of receipt of the initial request or examination (where
applicable), whichever is the later.
Note 1:
Max fee (ex GST)
$605.50
A standard medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
If a medical practitioner believes the incorrect report type has been requested, this should be
referred back to the case manager and clarified.
Note 4:
A standard medical report should be based on the medical practitioner’s notes and would
not usually require a consultation with the patient. Where a consultation is appropriate (for
example, if the practitioner has not seen the patient for some time), a consultation fee is to
be billed in accordance with item number WMY73. Consultation items in Schedule 1A must
not be used for this purpose.
Note 5:
Payment will only be made following submission of the report.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 53
Complex medical report – treating psychiatrist
Item no.
Service description
WMY46
Psychiatrists: Treating doctor complex medical report, expected to be provided
within 10 business days of receipt of the initial request or examination (where
applicable), whichever is the later.
Note 1:
Max fee (ex GST)
$753.60
A complex medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
If a medical practitioner believes the incorrect report type has been requested, this should be
referred back to the case manager and clarified.
Note 4:
A complex medical report should be based on the medical practitioner’s notes and would not
usually require a consultation with the patient. Where a consultation is appropriate (for
example, if the practitioner has not seen the patient for some time), a consultation fee is to
be billed in accordance with item number WMY73. Consultation items in Schedule 1A must
not be used for this purpose.
Note 5:
Payment will only be made following submission of the report.
Consultation, medical review for preparation of a report – treating doctor
Item no.
Service description
WMG70
General practitioners: Consultation, medical review for the preparation of a
treating doctor report.
$59.00
WMP70
Consultant physicians: Consultation, medical review for the preparation of a
treating doctor report.
$118.10
WMS70
Specialists in a surgical discipline: Consultation, medical review for the
preparation of a treating doctor report.
$118.10
WMY73
Psychiatrists: Consultation, medical review for the preparation of a treating
doctor report.
$327.90
ReturnToWorkSA - Medical fee schedule 2015-16
Max fee (ex GST)
Page 54
Reading time to prepare a report – treating doctor
Item no.
Service description
WMG55
General practitioners: Reading time payable to a treating doctor for reading prior
reports or other information forwarded or approved by the requestor in order to
prepare a report.
Max fee (ex GST)
DF
Derived fee:
The fee for item WMG55 is $59.00 for reading time up to and including
12 pages, plus $5.10 per page thereafter.
WMP55
Consultant physicians: Reading time payable to a treating doctor for reading prior
reports or other information forwarded or approved by the requestor in order to
prepare a report.
DF
Derived fee:
The fee for item WMP55 is $118.10 for reading time up to and including
12 pages, plus $9.30 per page thereafter.
WMS55
Specialists in a surgical discipline: Reading time payable to a treating doctor for
reading prior reports or other information forwarded or approved by the
requestor in order to prepare a report.
DF
Derived fee:
The fee for item WMS55 is $118.10 for reading time up to and including
12 pages, plus $9.30 per page thereafter.
WMY55
Psychiatrists: Reading time payable to a treating doctor for reading prior reports
or other information forwarded or approved by the requestor in order to prepare a
report.
DF
Derived fee:
The fee for item WMY55 is $153.50 for reading time up to and including
12 pages, plus $9.30 per page thereafter.
Note 1:
Payment for the reading of written material will only be made where the reading is required
in order for the doctor to prepare a report, and where the reading is at the request or
approval of a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
A fee is not payable for the reading of case notes, clinical material or any other material that
is not directly supplied or approved by the parties listed in note 1.
Note 3:
A full page for reading time consists of a whole A4 size page of standard print (12 point font
or smaller) of information, full page letters and detailed reports. Examples include: hospital
treatment notes, medical reports, investigation reports.
A half page of reading time consists of half an A4 page or a full A5 size page of standard print
(12 point font or smaller) of information, brief file notes, scattered file notes on a page,
letters consisting of one or two paragraphs, results and certificates. Examples include:
pathology results, full page of handwritten notes.
Note 4:
The reading of material supplied by the requestor can only be charged once. No additional
charge can be submitted for re-reading of material.
ReturnToWorkSA - Medical fee schedule 2015-16
Page 55
Medical report clarification – treating doctor
Item no.
Service description
WMG25
General practitioners: Clarification of a medical report, re-examination not
required.
$58.00
WMP25
Consultant physicians: Clarification of a medical report, re-examination not
required.
$105.30
WMS25
Specialists in a surgical discipline: Clarification of a medical report,
re-examination not required.
$105.30
Note 1:
Max fee (ex GST)
Clarification of a medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The requestor must specify that he or she is seeking a clarification of a previous medical
report.
Note 3:
A medical report clarification fee is not payable if the clarification is sought as a result of
failure by the doctor to address the original questions in the letter of request.
Note 4:
Payment will only be made following submission of the report.
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Page 56
Telephone calls
Item no.
Service description
Max fee (ex GST)
WMG24
General practitioners: Telephone call up to and including 60 minutes duration.
$257.70 per hour
WMP24
Consultant physicians: Telephone call up to and including 60 minutes duration.
$505.00 per hour
WMS24
Specialists in a surgical discipline: Telephone call up to and including 60 minutes
duration.
$505.00 per hour
Note 1:
Telephone contact between treating/referring medical providers which forms part of the
clinical management of the case is not chargeable.
Note 2:
Telephone calls are chargeable if of a case specific nature, made to or received from a:
- case manager or self-insured employer
- worker’s employer (including the employer’s return to work co-ordinator)
- worker’s representative or advocate
- ReturnToWorkSA medical consultant
- return to work consultant.
Note 3:
There is no charge for a telephone call to or from a worker.
Note 4:
A fee is payable if the telephone contact occurs during a consultation with the worker
provided that the consultation duration excludes the duration of the telephone call. For
example, if the consultation and telephone call duration is 20 minutes and the call duration
alone is 10 minutes, the consultation should be charged as a 10 minute consultation.
Note 5:
Invoices for telephone calls in accordance with this item must record the name of the other
party and the duration of the phone call in minutes.
Note 6:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Case conference
Item no.
Service description
Max fee (ex GST)
WMG09
General practitioners: Case conference to determine details of limitations to
work, recommendations facilitating a return to work and options for management
$257.70 per hour
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Page 57
of the injured worker’s recovery, including medical treatment strategies.
WMP09
Consultant physicians: Case conference to determine details of limitations to
work, recommendations facilitating a return to work and options for management
of the injured worker’s recovery, including medical treatment strategies.
$505.00 per hour
WMS09
Specialists in a surgical discipline: Case conference to determine details of
limitations to work, recommendations facilitating a return to work and options for
management of the injured worker’s recovery, including medical treatment
strategies.
$505.00 per hour
Note 1:
A case conference may be requested by a:
- case manager or self-insured employer
- worker’s employer (including the employer’s return to work co-ordinator)
- worker or worker’s representative
- return to work consultant
- treating medical expert.
Note 2:
The case manager or self-insured employer should attend the case conference if possible. If
the case manager or self-insured employer is unable to attend, they should delegate a
representative.
No fee is payable for records made by any medical practitioner during the case conference
unless delegated as the representative by the case manager or self-insured employer.
It is the responsibility of the case manager, self-insured employer or delegated
representative to make a written and signed record of the case conference that is to be
distributed to all attendees. Differences of opinion should be noted in the record.
The worker or worker’s representative must always be invited to attend the case conference.
Note 3:
Case conferences conducted by telephone (teleconferencing) are chargeable under this
item.
Note 4:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Worksite assessment
Item no.
Service description
Max fee (ex GST)
WMG08
General practitioners: Worksite assessment, for the purpose of assessing and
reporting the duties that are or can be made available, and the capacity of the
worker to undertake these duties.
$257.70 per hour
WMP08
Consultant physicians: Worksite assessment, for the purpose of assessing and
reporting the duties that are or can be made available, and the capacity of the
worker to undertake these duties.
$505.00 per hour
WMS08
Specialists in a surgical discipline: Worksite assessment, for the purpose of
assessing and reporting the duties that are or can be made available, and the
capacity of the worker to undertake these duties.
$505.00 per hour
ReturnToWorkSA - Medical fee schedule 2015-16
Page 58
Note 1:
A worksite assessment may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
At worksite visits it is expected that the employer, worker or worker’s representative, case
manager or self-insured employer representative should be present.
Note 3:
The case manager or self-insured employer should contact the employer to ensure
appropriate access to the worksite and to arrange for an employer representative to be
available to help maximise the value of time spent in the workplace.
Note 4:
The worksite assessment must include an assessment of the physical environment, mental
work demands, human behaviour, working conditions, educational requirements and other
conditions.
Note 5:
The report of a worksite assessment is to be completed and distributed by the medical
practitioner undertaking the assessment to relevant parties in attendance during the
worksite assessment. A copy must also be provided to the case manager, treating doctor
and worker (if not present) within one week of the assessment. No additional fee is payable
for completion of the form.
Note 6:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Third-party consultation
Item no.
Service description
Max fee (ex GST)
WMG14
General practitioners: Third-party consultation at the doctor’s rooms where the
worker is usually not present.
$257.70 per hour
WMP14
Consultant physicians: Third-party consultation at the doctor’s rooms where the
worker is usually not present.
$505.00 per hour
WMS14
Specialists in a surgical discipline: Third-party consultation at the doctor’s rooms
where the worker is usually not present.
$505.00 per hour
Note 1:
A third-party consultation must involve at least one of the following:
- case manager or self-insured employer
- worker, worker’s representative or advocate
- worker’s employer (including the employer’s return to work co-ordinator)
ReturnToWorkSA - Medical fee schedule 2015-16
Page 59
- investigator
- return to work consultant.
Note 2:
A third-party consultation may include a video viewing of a worker’s normal duties,
alternative duties or other activities.
Note 3:
It is the responsibility of the case manager or self-insured employer to ensure a written and
signed record is made of the third-party consultation that is to be distributed to all
attendees. No fee is payable for records made by any medical practitioner during the third
party consultation.
Note 4:
If as a result of the third-party consultation the medical practitioner has amended details
regarding the worker’s limitations to work, capacity, recommendations for facilitating a
return to work and/or options for management of the worker, the medical practitioner must
consider the worker’s input into this decision.
Note 5:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Attendance at a dispute resolution
Item no.
Service description
Max fee (ex GST)
WMG15
General practitioners: Attendance at a dispute resolution.
$257.70 per hour
WMP15
Consultant physicians: Attendance at a dispute resolution.
$505.00 per hour
WMS15
Specialists in a surgical discipline: Attendance at a dispute resolution.
$505.00 per hour
Note 1:
Attendance at a dispute resolution must be at the request of a:
- case manager or self-insured employer
- worker, worker’s representative or advocate
- worker’s employer or employer’s representative.
Note 2:
Court attendances can be charged under this item.
Note 3:
A witness at a dispute resolution proceeding is entitled to reimbursement of any expense
that the dispute resolution authority certifies has been, or is likely to be, reasonably incurred
by the witness as a consequence of appearing before the authority.
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Note 4:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Travel time: worksite assessment, case conference, dispute resolution or third-party
consultation
Item no.
Service description
Max fee (ex GST)
WMG10
General practitioners: Travel time for the purpose of a worksite assessment, case
conference, dispute resolution or third-party consultation.
$257.70 per hour
WMP10
Consultant physicians: Travel time for the purpose of a worksite assessment, case
conference, dispute resolution or third-party consultation.
$505.00 per hour
WMS10
Specialists in a surgical discipline: Travel time for the purpose of a worksite
assessment, case conference, dispute resolution or third party consultation.
$505.00 per hour
Note 1:
All accounts must include the total time spent travelling plus the distance travelled.
Note 2:
Where more than one worksite assessment, case conference or dispute resolution is
conducted, the travel fee is to be apportioned accordingly.
Note 3:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Cancellation: case conference, worksite assessment, dispute resolution or third-party
consultation
Item no.
Service description
Max fee (ex GST)
WMG36
General practitioners: Cancellation of a case conference, worksite assessment,
dispute resolution or third-party consultation.
$257.70 per hour
WMP36
Consultant physicians: Cancellation of a case conference, worksite assessment,
dispute resolution or third-party consultation.
$505.00 per hour
WMS36
Specialists in a surgical discipline: Cancellation of a case conference, worksite
assessment, dispute resolution or third-party consultation.
$505.00 per hour
Note 1:
Payment for cancellation will only be made when the attendance was at the request of a:
- case manager or self-insured employer
- worker, worker’s representative or advocate
- employer or employer’s representative.
Note 2:
A cancellation fee is payable only if the cancellation occurs less than 24 hours (excluding
weekends and public holidays in South Australia) before the time of the proposed
attendance.
Note 3:
A cancellation fee is not payable if the doctor is responsible for the cancellation.
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Note 4:
If the cancelled appointment is subsequently filled with any other earning activity, no
cancellation fee will be payable.
Note 5:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Job analysis and/or recommended job description statement
Item no.
Service description
WMG56
General practitioners: Formal job analysis and/or recommended job descriptions.
Reading of and written recommendations on the suitability of proposals for return
to work, expected to be provided within 10 business days of receipt of the initial
request.
$99.00
WMP56
Consultant physicians: Formal job analysis and/or recommended job descriptions.
Reading of and written recommendations on the suitability of proposals for return
to work, expected to be provided within 10 business days of receipt of the initial
request.
$126.40
WMS56
Specialists in a surgical discipline: Formal job analysis and/or recommended job
descriptions. Reading of and written recommendations on the suitability of
proposals for return to work, expected to be provided within 10 business days of
receipt of the initial request.
$126.40
Note 1:
Max fee (ex GST)
A job analysis and/or job description statement must be requested in writing and may be
requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate
- return to work consultant.
Note 2:
The date of request is taken to be two business days after the letter of request is posted, or
one business day after the request is faxed. A business day is any day, excluding Saturday,
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Sunday and public holidays in South Australia.
Specified duties form
Item no.
Service description
WMG23
General practitioners: Completion of a specified duties form.
$22.80
WMP23
Consultant physicians: Completion of a specified duties form.
$22.80
WMS23
Specialists in a surgical discipline: Completion of a specified duties form.
$22.80
Note 1:
Max fee (ex GST)
This form is to be completed at the request of a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
A fee is not payable if the form is completed during a consultation with the worker.
Note 3:
Specified duties forms can be obtained by contacting ReturnToWorkSA on 13 18 55.
Photocopying
Item no.
Service description
WMGSP
General practitioners, consultant physicians, specialists in a surgical discipline:
Photocopying of documents.
Note 1:
Max fee (ex GST)
$0.20 per page
A fee is only payable if the photocopying is at the request of a:
- case manager or self-insured employer
- worker, worker’s representative or advocate
- investigator.
Note 2:
The number of pages should be stated on the account. Any accounts without the number of
pages stated will be returned for amendment.
Note 3:
Accounts must state the name of the doctor providing the photocopied information.
Accounts with the practice name only will be returned for amendment.
Note 4:
Accounts for administration time are not billable as this cost has been factored into the fee
per page.
Travel time – emergency attendance
Item no.
Service description
Max fee (ex GST)
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WMG58
General practitioners: Travel time, for the purpose of an initial emergency
attendance of a compensable injury, at a location other than consulting rooms,
hospital or other healthcare institution, when ambulance services are either not
readily available or unduly delayed.
$257.70 per hour
WMG59
General practitioners: Travel time, (out of normal business hours) for the purpose
of an initial emergency attendance of a compensable injury, at a location other
than consulting rooms, hospital or other healthcare institution, when ambulance
services are either not readily available or unduly delayed.
$374.80 per hour
Out of normal business hours means on a Sunday, public holiday in South
Australia, after 1pm on Saturday or between 8pm and 8am on weekdays.
Note 1:
Where more than one worker is treated at the site of the emergency, the travel fee is to be
apportioned accordingly.
Note 2:
All invoices must include the distance travelled, the travel commencement location, place of
emergency attendance and a brief reason for the attendance.
Note 3:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Travel time– emergency retrieval team
Item no.
Service description
Max fee (ex GST)
WMS51
Specialists: Travel time by a retrieval team doctor in association with a
professional attendance relating to item numbers 00160, 00161, 00162, 00163 and
00164, other than ‘out of hours’ travel (refer to item number WMS52).
$505.00 per hour
WMS52
Specialists: Travel time by a retrieval team doctor on a Sunday, public holiday in
South Australia, after 1pm on Saturday or between 8pm and 8am on weekdays, in
addition to a professional attendance relating to item numbers 00160, 00161,
00162, 00163 and 00164.
$731.80 per hour
Note 1:
Where more than one worker is treated at the site of the emergency, the travel fee is to be
apportioned accordingly.
Note 2:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
Extra-corporeal shockwave therapy
Item no.
Service description
WMI11
Specialists: Initial treatment of extra-corporeal shockwave therapy provided by a
specialist radiology practice.
$144.30
WMI12
Specialists: Subsequent treatments of extra-corporeal shockwave therapy
provided by a specialist radiology practice.
$118.10
WMI13
Specialists: Double treatments (bilateral or multiple) of extra-corporeal
shockwave therapy provided by a specialist radiology practice.
$196.80
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Max fee (ex GST)
Page 64
Note 1:
The I in prefix WMI item number represents the letter ‘I’ not a numeral one (1).
Note 2:
This treatment has been approved by ReturnToWorkSA for use in the following conditions:
- heel pain/plantar fasciitis
- calcific tendonitis of shoulder
- lateral epicondylitis (tennis elbow)
- medial epicondylitis
- non-united fractures
- patellar tendinopathy.
Note 3:
Where extra-corporeal shockwave therapy is delivered outside of the approved conditions it
is recommended to seek case manager authorisation prior to the provision of the service.
Note 4:
Epicondylitis treatment is NOT payable by ReturnToWorkSA for treatment provided within
three months or after five years from date of injury.
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Services delivered by ear, nose and throat surgeons
Item no.
Service description
Max fee (ex GST)
WME24
Otorhinolaryngologists: Cortical evoked response audiometry - verification.
$336.30
WME2A
Otorhinolaryngologists: Cortical evoked response audiometry - quantification.
$336.30
WME25
Otorhinolaryngologists: Sensonics smell identification test.
$146.10
Services delivered by medical practitioners
Item no.
Service description
WMG26
Medical practitioners: Fluids, intravenous drip infusion of – percutaneous.
$57.80
WMG27
Medical practitioners: Fluids, intravenous drip infusion of – open exposure.
$95.70
Note 1:
Max fee (ex GST)
Item WMG26 is only payable where the service is not in association with a surgical
procedure.
Services delivered by medical practitioners in the practice of hypnotherapy
Item no.
Service description
WMG31
Hypnotherapy at consulting rooms, not more than 15 minutes.
$49.70
WMG28
Hypnotherapy at consulting rooms, 16 to 30 minutes.
$86.00
WMG29
Hypnotherapy at consulting rooms, 31 to 45 minutes.
$129.30
WMG30
Hypnotherapy at consulting rooms, more than 46 minutes.
$176.10
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Max fee (ex GST)
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Independent medical examiner services
Service standards
ReturnToWorkSA expects doctors to conduct independent medical examination (IME) services in accordance with
recognised professional practices. Doctors should also follow the specific standards outlined below.
Appointments
Examine the worker as soon as possible after the request for an appointment is made, ideally within 10 business days.
Examinations
When conducting examinations, please follow the principles in the Australian Medical Association’s (AMA) position
statement ‘Independent Medical Assessments on behalf of parties other than the patient.’
The length of your examination should be sufficient to make a fair and comprehensive assessment of the worker.
Please verify previous history or collect new history if required.
Only refer workers for diagnostic examinations or tests when the findings of a medical examination would be
unreliable without further investigations. Please obtain prior approval from the case manager or self-insured
employer before referring the worker for any diagnostic examination or test.
Reports
You must:
(a) provide reports within 10 business days of examining the worker
(b) provide an accurate medical diagnosis (or state if there is insufficient clinical information to make a diagnosis)
(c) base your report on appropriate clinical examination
(d) be consistent with accepted clinical practice
(e) thoroughly address the questions asked - if a question cannot be answered, explain why
(f) limit your report to the relevant circumstances of the worker’s injury
(g) be accurate, unbiased, precise and consistent
(h) document any inconsistencies noted between symptoms and objective findings
(i) use simple language where possible, and explain any technical terms or jargon
(j) assess the worker’s general capacity to perform duties where possible.
Report context
Section 179(1) of the Act enables employers to receive copies of reports in ReturnToWorkSA’s possession prepared
by medical experts (where relevant to the worker’s medical condition, the worker’s recovery, or the extent of the
worker’s incapacity for work). You must therefore limit your reports to relevant information and not disclose any
information of a personal nature except where it relates to the work injury.
Providing testimony
Please follow the principles outlined in the AMA’s position statement ‘Guidelines for doctors acting as expert medical
witnesses’ when providing testimony at a court or tribunal.
Maintaining independence
You should ensure the worker understands that your role as an independent medical examiner does not include
recommending treatment (except where immediate medical attention is required in an emergency). You must
discuss this with the worker at the beginning of the consultation. You must explain that you are acting at
ReturnToWorkSA’s request in carrying out the examination and that the worker should see their own
doctor/specialist in relation to any concerns they have regarding their health or treatment. You can recommend
treatment in your report, if requested by the report requestor.
You should not refer the worker to any other medical practitioner or other health specialist for treatment. However,
you can alert the treating practitioner of the need for a referral if required.
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You must advise ReturnToWorkSA when you have been asked to conduct a service that may involve a conflict of
interest (eg, any ongoing relationship with the worker, the worker’s employer, medical practitioner or legal
representative, the report requestor or their parent companies).
Recognising diversity
When you are carrying out an examination on a worker, you are subject to the requirements of Section 15 of the
Return to Work Corporation of South Australia Act 1994. This states:
(1)
The Corporation must, in carrying out its functions, take into account racial, ethnic and linguistic diversity in the
population of the State, the interests of both sexes, and the interests of those who may be physically, mentally
or intellectually impaired, and seek to ensure that people who are entitled to benefits under Acts administered
by the Corporation are not disadvantaged because of their origins or background, their sex, or some physical,
mental or intellectual impairment.
(2)
The Corporation should, as far as reasonably practicable, ensure that information provided for use in the
workplace is in a language and form appropriate for those expected to make use of it.
Qualifications
You must be a fully qualified registered specialist (excluding general practitioners). Copies of all relevant
qualifications must be available upon request, including a copy of a current practising certificate from the Medical
Board of Australia or appropriate registration authority.
You must maintain professional standards and be able to show evidence of continuing medical education upon
request.
Independent medical examiner – short medical report
Item no.
Service description
WMPA1
Consultant physicians: Independent medical examiner short medical report,
expected to be provided within 72 hours of receipt of the initial request or
ReturnToWorkSA - Medical fee schedule 2015-16
Max fee (ex GST)
$126.40
Page 68
examination (where applicable), whichever is the later.
WMSA1
Specialists in a surgical discipline: Independent medical examiner short medical
report, expected to be provided within 72 hours of receipt of the initial request or
examination (where applicable), whichever is the later.
Note 1:
$126.40
A short medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
If a medical practitioner believes the incorrect report type has been requested, this should be
referred back to the case manager and clarified.
Note 4:
Short reports should be concise and focused. The expected length of a short report is
approximately half an A4 page.
Note 5:
Short reports may be faxed to the requestor with the relevant account for services.
Note 6:
Payment will only be made following submission of the report.
Independent medical examiner – medical report (excluding psychiatrists)
Item no.
Service description
WMP29
Consultant physicians: Independent medical examiner report, expected to be
provided within 10 business days of receipt of the initial request or examination
(where applicable), whichever is the later.
$605.50
WMS29
Specialists in a surgical discipline: Independent medical examiner report,
expected to be provided within 10 business days of receipt of the initial request or
examination (where applicable), whichever is the later.
$605.50
Note 1:
Max fee (ex GST)
A medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
If a medical practitioner believes the incorrect report type has been requested, this should be
referred back to the case manager and clarified.
Note 4:
There is an expectation that a consultation will be required for the preparation of a report
and this should be billed in accordance with item number WMP80 or WMS80.
Note 5:
Payment will only be made following submission of the report.
Independent medical examiner – psychiatrists medical report
Item no.
Service description
WMY61
Psychiatrists: Independent medical examiner standard medical report, expected
to be provided within 10 business days of receipt of the initial request or
examination (where applicable), whichever is the later.
ReturnToWorkSA - Medical fee schedule 2015-16
Max fee (ex GST)
$753.60
Page 69
Note 1:
A psychiatrist’s medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The date of request is taken to be two business days after the date the letter of request is
posted, or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays in South Australia.
Note 3:
There is an expectation that a consultation will be required for the preparation of a report
and this should be billed in accordance with item number WMY83.
Note 4:
Occasionally a psychiatrist will require more than one consultation with a patient to write a
report.
We recommend that the psychiatrist contacts the case manager prior to providing a second
consultation, to determine whether this is appropriate in the circumstances of the case (e.g.
time constraints).
Where an additional consultation is required it must be provided within 10 business days of
the first consultation.
Note 5:
Payment will only be made following submission of the report.
Independent medical examiner – consultation, medical review for preparation of a report
Item no.
Service description
WMP80
Consultant physicians: Consultation, medical review for the preparation of an
independent medical examiner report.
$229.60
WMS80
Specialists in a surgical discipline: Consultation, medical review for the
preparation of an independent medical examiner report.
$229.60
WMY83
Psychiatrists: Consultation, medical review for the preparation of an independent
medical examiner report.
$327.90
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Max fee (ex GST)
Page 70
Independent medical examiner – reading time
Item no.
Service description
WMP32
Consultant physicians: Reading time payable to an independent medical examiner
for reading prior reports or other information forwarded or approved by the
requestor in order to prepare a report.
Max fee (ex GST)
DF
Derived fee:
The fee for WMP32 is $118.10 for reading time up to and including 12 pages, plus
$9.30 per page thereafter.
WMS32
Specialists in a surgical discipline: Reading time payable to an independent
medical examiner for reading prior reports or other information forwarded or
approved by the requestor in order to prepare a report.
DF
Derived fee:
The fee for WMS32 is $118.10 for reading time up to and including 12 pages, plus
$9.30 per page thereafter.
WMY32
Psychiatrists: Reading time payable to an independent medical examiner for
reading prior reports or other information forwarded or approved by the
requestor in order to prepare a report.
DF
Derived fee:
The fee for WMY32 is $153.50 for reading time up to and including 12 pages, plus
$9.30 per page thereafter.
Note 1:
Payment for the reading of written material will only be made where the reading is required
in order for the doctor to prepare a report, and where the reading is at the request or
approval of a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
A fee is not payable for the reading of case notes, clinical material or any other material that
is not directly supplied or approved by the parties listed in note 1.
Note 3:
A full page for reading time consists of a whole A4 size page of standard print
(12 point font or smaller) of information, full page letters and detailed reports. Examples
include: hospital treatment notes, medical reports, investigation reports.
A half page of reading time consists of half an A4 page or a full A5 size page of standard print
(12 point font or smaller) of information, brief file notes, scattered file notes on a page,
letters consisting of one or two paragraphs, results and certificates. Examples include:
pathology results, full page of handwritten notes.
Note 4:
The reading of material supplied by the requestor can only be billed once. No additional
charge can be submitted for re-reading of material.
Independent medical examiner – medical report clarification
Item no.
Service description
Max fee (ex GST)
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Page 71
WMP33
Consultant physicians: Clarification of a medical report, re-examination not
required.
$105.30
WMS33
Specialists in a surgical discipline: Clarification of a medical report,
re-examination not required.
$105.30
Note 1:
A clarification of a medical report must be requested in writing and may be requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
The requestor must specify that he or she is seeking a clarification of a previous medical
report.
Note 3:
A medical report clarification fee is not payable if the clarification is sought as a result of
failure by the doctor to address the original questions in the letter of request.
Note 4:
The intention of this fee is to provide facilities for follow-up questions or issues relating to
prior independent medical examinations and additional consultations may not be required.
The decision to undertake a further consultation is at the discretion of the doctor. If
required, please refer to item numbers WMP80, WMS80 or WMY83.
Note 5:
Payment will only be made following submission of the report.
Independent medical examiner – travel time: worksite assessment, case conference, dispute
resolution or third party consultation
Item no.
Service description
Max fee (ex GST)
MP940
Consultant physicians: Travel time for the purpose of a worksite assessment, case
conference, dispute resolution or third party consultation.
$505.00 per hour
MS940
Specialists in a surgical discipline: Travel time for the purpose of a worksite
assessment, case conference, dispute resolution or third party consultation.
$505.00 per hour
Note 1:
Travel will be approved for independent medical examiner services requested by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
All accounts must include the total time spent travelling as well as the distance travelled.
Note 3:
Where more than one service is conducted, the travel fee is to be apportioned accordingly.
Note 4:
Any part of an hour should be billed proportionately and rounded to the nearest six minutes.
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Independent medical examiner – non-attendance or cancellation of an appointment
Item no.
Service description
WMP34
Consultant physicians: non-attendance at, or cancellation less than 48 hours
(excluding weekends and public holidays in South Australia) before an
appointment.
$229.60
WMS34
Specialists in a surgical discipline: non-attendance at, or cancellation less than 48
hours (excluding weekends and public holidays in South Australia) before an
appointment.
$229.60
WMY88
Psychiatrists: non-attendance at, or cancellation less than 48 hours (excluding
weekends and public holidays in South Australia) before an appointment.
$327.90
Note 1:
Max fee (ex GST)
Fees apply only to the cancellation of medical appointments arranged by a:
- case manager or self-insured employer
- worker, worker’s representative or advocate.
Note 2:
If the cancelled appointment or non-attendance is subsequently filled with any other earning
activity, no cancellation fee will be payable.
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Independent medical examiner – travel for examinations
Item no.
Service description
Max fee (ex GST)
WMP64
Consultant physicians: A full day attendance at a venue more than 100 kilometres
from the Adelaide GPO for the purpose of providing an independent medical
examiner report.
$147.70
WMS64
Specialists in a surgical discipline: A full day attendance at a venue more than 100
kilometres from the Adelaide GPO for the purpose of providing an independent
medical examiner report.
$147.70
WMP65
Consultant physicians: Cancellation of an attendance at a venue more than 100
kilometres from the Adelaide GPO.
$236.20
WMS65
Specialists in a surgical discipline: Cancellation of an attendance at a venue more
than 100 kilometres from the Adelaide GPO.
$236.20
WMP66
Consultant physicians: Overnight accommodation including meals and
incidentals.
$312.90
WMS66
Specialists in a surgical discipline: Overnight accommodation including meals and
incidentals.
$312.90
WMP67
Consultant physicians: Travel by motor vehicle, to and from a venue for the
purpose of an appointment made by the report requestor.
ATO rates
WMS67
Specialists in a surgical discipline: Travel by motor vehicle, to and from a venue for
the purpose of an appointment made by the report requestor.
ATO rates
WMP68
Consultant physicians: Travel by aircraft, to and from a venue for the purpose of
an appointment made by the report requestor.
Economy Airfare
WMS68
Specialists in a surgical discipline: Travel by aircraft, to and from a venue for the
purpose of an appointment made by the report requestor.
Economy Airfare
Note 1:
The first 50 kilometres of any travel is not billable.
Note 2:
If more than one organisation has requested services from the provider at the travel
destination then items WMP/S64, WMP/S66, WMP/S67 and/or WMP/S68 must be
apportioned accordingly.
Note 3:
A full day pursuant to item WMP/S64 refers to a stay of more than six hours at the venue
including travel time.
Note 4:
ATO rates means the rate, applicable to the type of motor vehicle in which the medical
expert travelled, published by the Australian Taxation Office as the rate per kilometre that
may be claimed as a deduction for business travel expenses incurred in the previous financial
year.
Note 5:
Economy airfare means the amount determined by ReturnToWorkSA to be the reasonable
cost of undertaking the travel using a standard economy airfare.
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Permanent impairment services
These services are to assess whole body permanent impairment in accordance with Section 22 of the Return to Work
Act 2014. An impairment assessor means a person registered under the Health Practitioner Regulation National Law
(South Australia) Act 2010, to practice in the medical profession (other than a student) and, who holds a current
accreditation issued by the Minister for Industrial Relations for the Return to Work scheme. Only those accredited are
entitled to payment for the services listed below.
The Impairment Assessment Guidelines relates to the guidelines published by the Minister in the South Australian
Government Gazette for the Return to Work scheme.
For information to become an accredited assessor, please refer to the ReturnToWorkSA website at www.rtwsa.com
http://www.workcover.com/health-provider/the-workcover-system/permanent-impairment or contact
ReturnToWorkSA on 13 18 55.
Permanent impairment assessor – standard report
Item no.
Service description
Max fee (ex GST)
PIA10
General practitioners: permanent impairment assessor standard report, simple
assessment of one body system - reading, examination and report in accordance
with the Impairment Assessment Guidelines.
$515.30
PIA30
Specialists (excluding psychiatrists): permanent impairment assessor standard
report, simple assessment of one body system - reading, examination and report
in accordance with the Impairment Assessment Guidelines.
$1,010.00
PIA40
Psychiatrists: permanent impairment assessor standard report for the assessment
of psychiatric disorders; assessment where there is one disorder or condition
related to the work injury – reading, examination and report in accordance with
the Impairment Assessment Guidelines and using the Guidelines to the Evaluation
of Psychiatric Impairment by Clinicians (GEPIC).
$1,262.50
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the relevant guidelines stated
above.
Note 5:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
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Permanent impairment assessor – moderately complex report
Item no.
Service description
PIA11
General practitioners: permanent impairment assessor moderately complex
report, simple assessment of two body systems or more than one injury to a single
body system - reading, examination and report in accordance with the Impairment
Assessment Guidelines.
PIA31
Specialists: permanent impairment assessor moderately complex report, simple
assessment of two body systems or more than one injury to a single body system
- reading, examination and report in accordance with the Impairment Assessment
Guidelines.
Max fee (ex GST)
$644.10
$1,262.70
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the Impairment Assessment
Guidelines.
Note 5:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
Permanent impairment assessor – complex report
Item no.
Service description
Max fee (ex GST)
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PIA12
General practitioners: permanent impairment assessor complex report, complex
assessment on a single body system or multiple injuries involving more than one
body system – reading, examination and report in accordance with the
Impairment Assessment Guidelines.
$816.00
PIA32
Specialists (excluding psychiatrists): permanent impairment assessor complex
report, complex assessment on a single body system or multiple injuries involving
more than one body system – reading, examination and report in accordance with
the Impairment Assessment Guidelines.
$1,599.40
PIA42
Psychiatrists: permanent impairment assessor complex report for the assessment
of psychiatric disorders or conditions; assessment where there is more than one
disorder related to the work injury or pre-existing or non-work-related and/or
neurological considerations – reading, examination and report in accordance with
the Impairment Assessment Guidelines and using the Guidelines to the Evaluation
of Psychiatric Impairment by Clinicians (GEPIC).
$1,767.00
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the relevant guidelines stated
above.
Note 5:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
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Permanent impairment assessor – ENT report
Item no.
Service description
PIA50
ENT specialists: permanent impairment assessor ENT report – reading,
examination of ear, nose and/or throat only, including audiometric testing and
report in accordance with the Impairment Assessment Guidelines.
Max fee (ex GST)
$1,010.00
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the Impairment Assessment
Guidelines.
Note 5:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
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Permanent impairment assessor – standard report where an examination is conducted with
the assistance of an interpreter
Item no.
Service description
Max fee (ex GST)
PIA13
General practitioners: permanent impairment assessor standard report with
interpreter, simple assessment of one body system – reading, examination
conducted with the assistance of an interpreter and report in accordance with the
Impairment Assessment Guidelines.
PIA33
Specialists (excluding psychiatrists): permanent impairment assessor standard
report with interpreter, simple assessment of one body system - reading,
examination conducted with the assistance of an interpreter and report in
accordance with the Impairment Assessment Guidelines.
$1,262.70
PIA43
Psychiatrists: permanent impairment assessor standard report with interpreter,
for the assessment of psychiatric disorders; assessment where there is one
disorder or condition related to the work injury – reading, examination and report
in accordance with the Impairment Assessment Guidelines and using the Guidelines
to the Evaluation of Psychiatric Impairment by Clinicians (GEPIC).
$1,578.10
$644.10
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
If an interpreter is present at the examination, the medical fee payable is in accordance with
the fees set out above.
Note 5:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the relevant guidelines stated
above.
Note 6:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
Permanent impairment assessor – moderately complex report where an examination is
conducted with the assistance of an interpreter
Item no.
Service description
Max fee (ex GST)
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PIA14
General practitioners: permanent impairment assessor moderately complex
report with interpreter, simple assessment of two body systems or more than one
injury to a single body system – reading, examination conducted with the
assistance of an interpreter and report in accordance with the Impairment
Assessment Guidelines.
PIA34
Specialists: permanent impairment assessor moderately complex report with
interpreter, simple assessment of two body systems or more than one injury to a
single body system – reading, examination conducted with the assistance of an
interpreter and report in accordance with the Impairment Assessment Guidelines.
$772.80
$1,515.20
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
If an interpreter is present at the examination, the medical fee payable is in accordance with
the fees set out above.
Note 5:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the Impairment Assessment
Guidelines.
Note 6:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
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Permanent impairment assessor – complex report where an examination is conducted with
the assistance of an interpreter
Item no.
Service description
Max fee (ex GST)
PIA15
General practitioners: permanent impairment assessor complex report with
interpreter, complex assessment on a single body system or multiple injuries
involving more than one body system – reading, examination conducted with the
assistance of an interpreter and report in accordance with the Impairment
Assessment Guidelines.
PIA35
Specialists (excluding psychiatrists): permanent impairment assessor complex
report with interpreter, complex assessment on a single body system or multiple
injuries involving more than one body system – reading, examination conducted
with the assistance of an interpreter and report in accordance with the Impairment
Assessment Guidelines.
$1,851.90
PIA45
Psychiatrists: permanent impairment assessor complex report, with interpreter,
for the assessment of psychiatric disorders; assessment where there is more than
one disorder related to the work injury or pre-existing or non-work-related and/or
neurological considerations – reading, examination and report in accordance with
the Impairment Assessment Guidelines and using the Guidelines to the Evaluation
of Psychiatric Impairment by Clinicians (GEPIC).
$2,208.80
$945.00
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
If an interpreter is present at the examination, the medical fee payable is in accordance with
the fees set out above.
Note 5:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the relevant guidelines stated
above.
Note 6:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
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Permanent impairment assessor – ENT report where an examination is conducted with the
assistance of an interpreter
Item no.
Service description
PIA51
ENT specialists: permanent impairment assessor ENT report with interpreter,
reading, examination of ear, nose and/or throat only, conducted with the
assistance of an interpreter, including audiometric testing and report in
accordance with the Impairment Assessment Guidelines.
Max fee (ex GST)
$1,262.70
Note 1:
Reports will be requested by a case manager or self-insured employer.
Note 2:
Permanent impairment assessment reports must be requested in writing, specifying
whether a standard, moderately complex, complex or supplementary report is required.
Note 3:
Reports are to be provided to ReturnToWorkSA within 10 business days of the examination
unless the assessor believes there are reasonable grounds for an extension of time and has
sought the requestor’s prior consent for an extension of time.
Note 4:
If an interpreter is present at the examination, the medical fee payable is in accordance with
the fees set out above.
Note 5:
Payment will only be made following submission of the report which is prepared in
accordance with, and conforms with, the requirements of the Impairment Assessment
Guidelines.
Note 6:
‘Specialist’ means a specialist in a surgical discipline or a consultant physician.
Permanent impairment assessor – non-attendance or cancellation of an appointment
Item no.
Service description
Max fee (ex GST)
PIA16
General practitioners: permanent impairment assessor non-attendance at, or
cancellation with less than 48 hours’ notice (excluding weekends or public
holidays in South Australia) before an appointment.
$185.40
PIA36
Specialists (including psychiatrists): permanent impairment assessor nonattendance at, or cancellation with less than 48 hours’ notice (excluding weekends
or public holidays in South Australia) before an appointment.
$363.80
Note 1:
A fee for a cancellation with more than 48 hours’ notice (excluding weekends and public
holidays in South Australia) is not payable.
Note 2:
A fee for a cancellation or non-attendance does not apply if the appointment is subsequently
filled with any other earning activity.
Permanent impairment assessor – supplementary report
Item no.
Service description
Max fee (ex GST)
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PIA17
General practitioners: permanent impairment assessor supplementary report,
where additional information is requested by the report requestor.
$128.80
PIA37
Specialists (including psychiatrists): permanent impairment assessor
supplementary report, where additional information is requested by the report
requestor.
$252.50
Note 1:
Supplementary report fees are not payable if additional work is required as a result of an
obvious error or omission on the part of the assessor.
Permanent impairment assessor – additional reading time
Item no.
Service description
PIA18
General practitioners: permanent impairment assessor additional reading time in
conjunction with a standard or moderately complex report. This fee is only to be
charged if there are more than 25 pages of reading material supplied by the report
requestor. The first 25 pages are included in the report fee and are therefore not
chargeable under this item.
Max fee (ex GST)
DF
Derived fee: $5.10 per page over 25 pages.
PIA38
Specialists (including psychiatrists): permanent impairment assessor additional
reading time in conjunction with a standard or moderately complex report. This
fee is only to be charged if there are more than 25 pages of reading material
supplied by the report requestor. The first 25 pages are included in the report fee
and are therefore not chargeable under this item.
DF
Derived fee: $9.30 per page over 25 pages.
PIA19
General practitioners: permanent impairment assessor additional reading time in
conjunction with a complex report. This fee is only to be charged if there are more
than 51 pages of reading material supplied by the report requestor. The first 51
pages are included in the report fee and are therefore not chargeable under this
item.
DF
Derived fee: $5.10 per page over 51 pages.
PIA39
Specialists (including psychiatrists): permanent impairment assessor additional
reading time in conjunction with a complex report. This fee is only to be charged if
there are more than 51 pages of reading material supplied by the report
requestor. The first 51 pages are included in the report fee and are therefore not
chargeable under this item.
DF
Derived fee: $9.30 per page over 51 pages.
Note 1:
Reading fees are only payable where the material has been directly supplied by the report
requestor. A fee is not payable for the reading of case notes, clinical material or any other
material that is not directly supplied by the report requestor.
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Note 2:
The reading of material supplied by the requestor can only be charged once. No additional
charge can be submitted for re-reading of material.
Note 3:
A full page for reading time consists of a whole A4 size page of standard print (12 point font
or smaller) of information, full page letters and detailed reports. Examples include: hospital
treatment notes, medical reports, investigation reports.
A half page of reading time consists of half an A4 page or a full A5 size page of standard print
(12 point font or smaller) of information, brief file notes, scattered file notes on a page,
letters consisting of one or two paragraphs, results and certificates. Examples include:
pathology results, full page of handwritten notes.
Permanent impairment assessor – travel for examinations
Item no.
Service description
Max fee (ex GST)
PIA60
General practitioners or specialists (including psychiatrists): permanent
impairment assessor travel, a full day attendance at a venue more than 100
kilometres from the Adelaide GPO for the purpose of providing a permanent
impairment report.
$147.70
PIA62
General practitioners or specialists (including psychiatrists): permanent
impairment assessor – cancellation of an attendance at a venue more than 100
kilometres from the Adelaide GPO.
$236.20
PIA64
General practitioners or specialists (including psychiatrists): permanent
impairment assessor accommodation – overnight accommodation including
meals and incidentals.
$312.90
PIA66
General practitioners or specialists (including psychiatrists): permanent
impairment assessor motor vehicle travel – travel by motor vehicle, to and from a
venue for the purpose of an appointment made by the report requestor.
ATO Rates
PIA68
General practitioners and specialists (including psychiatrists): permanent
impairment assessor aircraft travel – travel by aircraft, to and from a venue for the
purpose of an appointment made by the report requestor.
Economy Airfare
Note 1:
The first 50 kilometres of any travel is not chargeable.
Note 2:
If an assessor is travelling for the purpose of conducting more than one permanent
impairment assessment, the travel fees must be apportioned accordingly.
Note 3:
‘A full day’ as per item PIA60 refers to a stay of more than five hours at the venue including
travel time.
Note 4:
ATO rates means the rate, applicable to the type of motor vehicle in which the assessor
travelled, published by the Australian Taxation Office as the rate per kilometre that may be
claimed as a deduction for business travel expenses incurred in the previous financial year.
Note 5:
Economy airfare means the amount determined by ReturnToWorkSA to be the reasonable
cost of undertaking the travel using a standard economy airfare.
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General information
Appropriately qualified providers
The following list is a guide to the services and service providers for which ReturnToWorkSA will consider
reimbursement:
 Registered medical practitioners
 Registered dentist
 Registered psychologist
 Registered optician
 Registered physiotherapist
 Registered chiropractor
 Registered podiatrist
 Registered occupational therapist
 Registered speech pathologist
 Registered osteopaths
 Exercise physiologists accredited with Exercise and Sports Science Australia (ESSA)
 Remedial therapy/massage provider.
Acupuncture
Acupuncture services provided by medical practitioners now reflect the same descriptions and rules as the Medicare
Benefits Schedule.
Social work/counselling services
Services can only be delivered by a registered psychologist or psychiatrist.
Dietician services
Services can only be delivered by a tertiary qualified dietician as part of a Recovery/return to work plan.
Hypnotherapy
Services are paid on an attendance basis only, and the medical practitioner must be appropriately qualified. (See
Schedule 1B for service description and item numbers).
Emergency admission of workers to a psychiatric facility
The case manager must approve admission of a worker to a hospital when a medical practitioner believes that a
worker is at risk of harming themselves or others.
Where the psychiatric facility cannot obtain approval from the case manager (e.g. the incident occurs after business
hours) the facility must admit the person immediately. If this occurs the admitting psychiatric facility is required to
advise the case manager of the admission within two business days.
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Frequently asked questions
General questions
1.
Who do I contact when I need advice on a claim or when following up payment of a service?
Please telephone the worker’s case manager at either Employers Mutual SA, Gallagher Bassett Services,
ReturnToWorkSA’s EnABLE Unit or the self-insured employer.
2.
Which service item numbers does GST apply to?
Most health services are exempt of GST, but you should contact the Australian Tax Office or your tax advisor for
specific advice. Our fees do not include GST, so any services attracting GST will require you to calculate and
insert the additional charge on your invoice.
3.
Will the existing WorkCoverSA Medical Certificate still be available in hard copy pads?
No. ReturnToWorkSA will no longer distribute pads of hard copy WorkCoverSA Medical Certificates. Where
requests for hard copy certificates are received, ReturnToWorkSA will issue a pad of the new Work Capacity
Certificates.
4. Will the existing WorkCoverSA Medical Certificate still be accepted?
Yes. ReturnToWorkSA and its agents will continue to accept the old WorkCoverSA Medical Certificate until 30
June 2016. After this date, only the new Work Capacity Certificates will be accepted.
5.
Where can I get a copy of the new Work Capacity Certificate?
ReturnToWorkSA introduced a new Work Capacity Certificate on 1 July 2015. It is currently available in hard copy
and electronic smart PDF formats.


The smart PDF certificate can be downloaded from our website rtwsa.com/service providers/supporting
recovery. The smart PDF can be edited and saved on a computer for ease of use and re-use.
The pads of hard copy certificates can be ordered from ReturnToWorkSA by calling 13 18 55, emailing
info@rtwsa.com or faxing (08) 8233 2466.
Certificates will only be mailed to a medical practice address so please provide the following information in
your request:
- The name, address and contact details for the medical practice
- The number of pads needed (50 medical certificates per pad)
6. How do I submit an electronic WorkCoverSA Medical Certificate (eWMC) from my computer?
ReturnToWorkSA has an electronic facility for the existing WorkCoverSA Medical Certificate in the following
patient software programs: Medical Director, Medtech, Genie, Zedmed, Best Practice and Direct Control.
The eWMC is completed by the medical practitioner in their patient software program and submitted to
ReturnToWorkSA electronically. Please contact the software companies directly for set up instructions.
The new Work Capacity Certificate will replace the existing WorkCoverSA Medical Certificate in these software
programs by 30 June 2016. Medical practitioners will be informed when this has occurred.
7.
How do I submit the new Work Capacity Certificate?
There are several ways to submit the new Work Capacity Certificate depending on the format you are using.


The patient - The certificate can be handed to the patient for them to deliver to their case manager and
employer. This is the ideal method of submitting the certificate.
Email or fax – Should the medical practitioner wish to submit the certificate on behalf of their patient, they
can do so by faxing or emailing it to the relevant agent – please refer to the ‘Useful contacts’ in this
schedule.
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

Mail – Should the medical practitioner wish to submit the certificate on behalf of their patient they may do so by
mailing it directly to the relevant claims agent – please refer to the ‘Useful contacts’ in this schedule.
Electronic transfer – Currently this method is not available for the new Work Capacity Certificate. Medical
practitioners will be advised once this becomes available.
Note: A lodged medical/capacity certificate does not mean that a claim has been made. To lodge a claim the worker
must complete a Claim form and submit it to Employers Mutual SA, Gallagher Bassett Services or the self-insured
employer. This can also be done over the phone.
For further information, please visit our website at www.rtwsa.com.
Schedule 1A
8. How can I find out what fees apply for new Medicare (MBS) services that are introduced after
ReturnToWorkSA prints this booklet?
You can visit our website at www.rtwsa.com under the fees section to locate the ‘medical supplementary fee
schedule incorporating MBS updates’ or contact ReturnToWorkSA on 13 18 55. All relevant new Medicare item
numbers will be included in ReturnToWorkSA’s next gazetted fee schedule.
Schedule 1B
9. Can I be paid in advance for medical reports or other services?
No. Payment will only be made following submission of the report or delivery of the service. ReturnToWorkSA’s
policy states that we will not pay for services in advance.
10. I have been asked to provide a report on one of my patients and I believe that the report will be complex.
Can I charge a higher fee due to this additional complexity?
The report requestor (e.g. case manager, worker’s advocate etc.) should specify in their letter to you which type
of report they require. If you believe the incorrect report type has been requested, this should be referred back to
the case manager or self-insured employer and clarified prior to writing your report.
11. If I receive a request from a worker’s solicitor to provide a medical report, do I still charge ReturnToWorkSA
fees?
Yes. Schedule B fees apply in this case as the legal representative is requesting the report on behalf of the
worker.
12. I have participated in a teleconference with a case manager, a return to work consultant and an employer
regarding a patient’s recovery and return to work strategies. How can I charge for this?
Essentially this is a case conference conducted over the telephone, so you may charge for a case conference.
13. I am a general practitioner/specialist/physician who attended a case conference (or any hourly rate service
e.g. worksite attendance, dispute resolution etc.) for 45 minutes. How do I charge for this?
For any service charged at an hourly rate, you apportion your charge according to the time spent, using the
hourly rate for your speciality. The formula is: Hourly rate ÷ 60 multiplied by the number of minutes rounded to
the nearest 6 minutes.
The pro rata calculation is based on the application of an hourly rate across ten, 6 minute intervals (6, 12, 18, 24,
30, 36, 42, 48, 54, 60 minutes).
Example based on a 45 minute service which is rounded to the nearest 6 minutes = 48minutes):
- general practitioners, $257.70 ÷ 60 x 48 minutes = $206.16
- specialists/physicians, $505.00 ÷ 60 x 48 minutes = $404.00
14. I have been asked to watch a video of a worker. Can I charge for this?
Yes. You can use the third party consultation item and charge at a pro-rata hourly rate, using the formula
provided in question 13.
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15. Does the 24 or 48 hour rule include weekends when billing for a cancellation fee for a case conference,
worksite assessment, dispute resolution or third party consultation?
No. A cancellation fee is payable only if the cancellation occurs less than 24 or 48 hours (excluding weekends and
public holidays) before the time of the proposed attendance.
16. Can an independent medical examiner charge for a subsequent consultation in order to complete a medical
report?
No. Only one consultation fee is payable. Occasionally a psychiatrist will require more than one consultation with
a patient to write a report. We recommend that the psychiatrist contacts the case manager or self-insured
employer prior to providing a second consultation, to determine whether this is appropriate in the circumstances
of the case (e.g. time constraints). Where an additional consultation is required it must be provided within 10
business days of the first consultation.
If you have any further questions please call ReturnToWorkSA on 13 18 55.
Key sections of the Return to Work Act 2014
ReturnToWorkSA work together with medical practitioners to maintain its commitment to provide cost effective and
appropriate medical services ensuring that timely, sustainable and safe return to work outcomes are achieved. We
have reprinted some sections of the Return to Work Act 2014 that may be useful to you.
A worker is entitled to be compensated for costs of a kind, set out in section 33(1), reasonably incurred through
having suffered a work injury. These are more fully described in sections 7, 9, and 33 of the Act.
3—Objects of Act
(1) The object of this Act is to establish a scheme that supports workers who suffer injuries at work and that has as
its primary objective to provide early intervention in respect of claims so as to ensure that action is taken to
support workers—
(a) in realising the health benefits of work; and
(b) in recovering from injury; and
(c) in returning to work (including, if required, after retraining); and
(d) in being restored to the community when return to work is not possible.
(2) In connection with subsection (1), the other objectives that apply with respect to this Act are—
(a) to ensure that workers who suffer injuries at work receive high-quality service, are treated with dignity, and
are supported financially; and
(b) to ensure that employers' costs are contained within reasonable limits so that the impact of work injuries on
South Australian businesses is minimised; and
(c) to provide a reasonable balance between the interests of workers and the interests of employers; and
(d) to reduce the overall social and economic cost of work injuries to the State and to the community; and
(e) to support activities that are aimed at reducing the incidence of work injuries; and
(f) to reduce disputation when workers are injured at work by improving the quality of decision-making and by
reducing adversarial contests to the greatest possible extent.
(3) A person exercising judicial, quasi-judicial or administrative powers must interpret this Act in the light of its
objects and these objectives without bias towards the interests of employers on the one hand, or workers on the
other.
(4) The Corporation, the worker and the employer from whose employment a work injury arises must seek to
achieve an injured worker's return to work (taking into account the objects and requirements of this Act).
Division 3—Fundamental principles, rights and obligations
13—The Corporation
(1) The Corporation, in acting under and for the purposes of this Act, must—
(a) adopt a service-orientated approach that is focused on early intervention and
(b) the interests of workers and employers; and
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(c) seek to act professionally and promptly in everything that it does; and
(d) be responsible and accountable in its relationships with others; and
(e) without limiting a preceding paragraph, take reasonable steps to comply with any request made by a worker
under section 15(2).
(2) The Corporation must, in connection with subsection (1), develop and maintain plans or strategies that are
designed to establish practices and procedures under which the specific circumstances of an injured worker and
his or her employer will be addressed and with the objective of—
(a) ensuring early and timely intervention occurs to improve recovery and return to work outcomes including
after retraining (if required); and
(b) achieving timely, evidence based decision-making that is consistent with the requirements of this Act; and
(c) wherever possible, providing a face to face service where there is a need for significant assistance, support or
services; and
(d) ensuring regular reviews are taken in relation to a worker's recovery and, where possible, return to work; and
(e) ensuring the active management of all aspects of a worker's injury and any claim under this Act; and
(f) encouraging an injured worker and his or her employer to participate actively in any recovery and return to
work processes; and
(g) minimising the risk of litigation.
(3) The policies and principles set out in this section do not give rise to substantive rights or liabilities (compared to
rights or liabilities established or prescribed under other relevant provisions of this Act).
Section 4 of the Act defines ‘medical services’ as:
(a)
(b)
(c)
attendance, examination or treatment by a health practitioner (including the obtaining of a certificate or
report); or
any diagnostic examination or test required for the purposes of treatment by a health practitioner; or
any services of a class prescribed for the purposes of this definition.
Section 33(2)
The costs referred to in subsection (1) are as follows:
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
medical services;
hospitalisation and all associated medical, surgical and nursing services;
approved recovery/return to work services;
travelling, or being transported, to and from any place for the purpose of receiving medical services,
hospitalisation or approved recovery/return to work services (but not where the worker travels in a private
vehicle);
where it is necessary for the worker to be accommodated away from home for the purpose of receiving medical
services or approved recovery/return to work services—such accommodation (but not exceeding limits
prescribed by regulation);
attendance by a registered or enrolled nurse, or by some other person approved by the Corporation or of a class
approved by the Corporation, where the injury is such that the worker must have nursing or personal
attendance;
the provision, maintenance, replacement or repair of therapeutic appliances;
medicines and other material purchased on the prescription or recommendation of a health practitioner;
other services (or classes of services) authorised by the Corporation.
Section 33(3)
Compensation in respect of costs to which this section applies may be paid
(a)
to the worker; or
(b)
directly to the person to whom the worker is liable for those costs.
Section 33(7)
If the Corporation disallows or reduces a charge under this section—
(a)
it must give to the provider of the service a notice setting out—
(i) the basis of the Corporation's decision to disallow or reduce the charge; and
(ii) where the charge has been disallowed under subsection (6) the provider's right to have the decision
reviewed under this section; and
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(b)
the worker is not liable to the provider for the disallowed charge, or for more than the reduced charge, (as the
case requires) and, if the worker has in fact paid an amount for which he or she is not liable, the Corporation will
reimburse the worker for that amount and may recover it from the provider as a debt.
Section 33(16)
A person who provides a service for an injured worker, knowing the worker to be entitled to compensation for the
service under this section, must not charge for the service an amount exceeding the amount allowed under a scale of
charges published under this section. Maximum penalty: $2500.
For further information regarding the Act, visit the ReturnToWorkSA website, www.rtwsa.com.
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Account process for patients with a work injury
This is an overview of the account process for medical practitioners.
Patient is injured at work and is treated by a medical practitioner at your practice.
Has a claim been made or intended to be made? (Confirm with patient).
Yes
No
Has the claim been accepted?
(Confirm with patient).
Payment
Patient should be billed as a private patient.
Yes
No, not yet determined
No, claim rejected
Payment
Payment
Payment
Directly bill the
employer, claims
agent,
ReturnToWorkSA
EnABLE Unit, selfinsured employer or
patient in accordance
with the gazetted scale
of charges.
Directly bill the employer,
claims agent,
ReturnToWorkSA EnABLE
Unit, self-insured
employer or patient in
accordance with the
gazetted scale of charges.
However, the liability for
payment rests solely with
the patient until the claim
is accepted.
Provider has the option to
re-bill the patient as a
private patient.
(please refer to the
Medical Schedule 1A
guidelines regarding time
restrictions)
Note: If the worker requires time off work, a Work Capacity Certificate (WCC) must be issued.
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Accounts and invoicing standards
All amounts listed in this booklet are exclusive of GST. If applicable, ReturnToWorkSA will pay to the provider an
amount on account of the provider’s GST liability in addition to the GST exclusive fee. Suppliers should provide
ReturnToWorkSA with a tax invoice where the amounts are subject to GST.
For all invoices, whether a tax invoice or not, the following information should be provided:
 provider details – name, Medicare provider number (if applicable) and/or ReturnToWorkSA provider number (if
known), practice and address details
 invoice number and invoice date
 Australian Business Number (ABN)
 worker’s surname and given name(s)
 claim number (if known)
 brief description of the injury to which the services relate
 employer name (if known)
 each service itemised separately in accordance with this fee schedule including:
- date of service and commencement time
- service item number and service description
- duration of service in hours/minutes rounded to the nearest six minutes for hourly rate services
- charge for the service
- total charge for invoiced items plus any GST that may be applicable.
 bank account details for electronic funds transfer (EFT).
Invoices are to be submitted within six weeks of service. Invoices for services displaying the information set out above
will allow for prompt and efficient processing. Invoices that do not meet these standards may be returned to the
provider for amendment.
ReturnToWorkSA or their claims agents are unable to pay on ‘account rendered’ or statement invoices. Payment will
be made where appropriate, on an original invoice or duplicate/copy of the original. Payment for services, including
reports, will not be made in advance.
GST
For all GST-related queries, please contact the Australian Tax Office or your tax advisor.
Changes to provider details
For changes to provider details, such as Australian Business Numbers, change of address or electronic funds transfer
details, please complete the Provider registration form available on our website. Once completed either email to
prov.main@rtwsa.com or fax to ReturnToWorkSA on (08) 8238 5690.
For any queries relating to this form, please contact ReturnToWorkSA on 13 18 55.
Where payment is outstanding
Please contact ReturnToWorkSA’s EnABLE Unit, claims agent or self-insured employer if the claim has been
accepted and the payment is outstanding. If the claim has not been accepted, responsibility for payment of accounts
rests with the worker.
General medical queries, MBS quarterly updates, services outside of the Medical Benefits Schedule
Contact ReturnToWorkSA on 13 18 55.
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Useful contacts
Claims agents
All work injury claims (that are not self-insured or serious injury) are managed by Employers Mutual or Gallagher
Bassett. To identify which claims agent is managing a worker’s claim, refer to the ‘Claims agent lookup’ function on
our website at www.rtwsa.com.
Employers Mutual SA
Phone:
Fax:
(08) 8127 1100 or free call 1300 365 105
(08) 8127 1200
Address:
Postal address:
26 Flinders Street, Adelaide SA 5000
GPO Box 2575, Adelaide SA 5001
Online:
www.employersmutualsa.com.au
Gallagher Bassett Services Pty Ltd
Phone:
Fax:
(08) 8177 8450 or free call 1800 664 079
(08) 8177 8451
Address:
Postal address:
Ground Floor, 25 Franklin Street, Adelaide SA 5000
GPO Box 1772, Adelaide SA 5001
Online:
www.gallagherbassett.com.au
ReturnToWorkSA EnABLE Unit
For claims relating to severe traumatic injuries, please contact this unit directly.
Phone:
Fax:
13 18 55
(08) 8233 2051
Address:
Postal address:
400 King William Street, Adelaide SA 5000
GPO Box 2668, Adelaide SA 5001
Online:
www.rtwsa.com
Self-insured employers
For matters relating to self-insured claims, please contact the employer directly.
Allianz Australia SA Compulsory Third Party (CTP)
For claims relating to motor vehicle crashes that are managed by Allianz Australia SA CTP on behalf of the insurer,
the Motor Accident Commission, please contact them directly.
Phone:
Fax:
1300 137 331
1300 137 431
Address:
Postal address:
89 Pirie Street, Adelaide SA 5000
GPO Box 219, Adelaide SA 5001
Email:
SACTPClaims@allianz.com.au
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The following free information support services are available:
If you are deaf or have a hearing or speech impairment you can call ReturnToWorkSA through the National Relay Service (NRS):



TTY users can phone 13 36 77 and ask for 13 18 55.
Speak & Listen (speech-to-speech) users can phone 1300 555 727 and ask for 13 18 55.
Internet Relay users connect to NRS on www.relayservice.com and ask for 13 18 55.
For languages other than English call the Interpreting and Translating Centre on 1800 280 203 and ask for an interpreter to call ReturnToWorkSA on 13
18 55. For Braille, audio or e-text call 13 18 55.
ReturnToWorkSA
Enquiries: 13 18 55
400 King William Street, Adelaide SA 5000
info@rtwsa.com
© ReturnToWorkSA 2015
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