Private Healthcare Australia and the Australian Podiatry Association have produced a new schedule of services for the thousands of podiatrists delivering health care to health fund members in Australia.
The new schedule has been endorsed by PHA’s ‘General Treatment Community of Interest’, which includes representatives from all of PHA’s member funds. An expert working group convened by PHA collaborated with representatives from the Australian Podiatry Association to deliver a more modern schedule of podiatry services with clearer definitions.
All PHA member funds have updated their claiming systems and are ready to recognise the new schedule from 1 September 2024, along with HICAPS and HealthPoint.
It will remain up to individual health funds to decide whether they pay benefits for the services in the schedule. Based on the requirements of Australia’s competition laws, as well as each fund’s specific commercial imperatives, health funds will not discuss, nor jointly determine, whether they will fund a specific service. Each individual health fund reserves the right to make decisions based on its own commercial needs and customers’ best interests.
To assist podiatrists with the change, here is a list of anticipated questions generated by PHA and the Australian Podiatry Association:
PHA’s new podiatry schedule – Frequently Asked Questions
When does this change take effect?
From 1 September 2024 PHA member funds, HICAPS and HealthPoint, will recognise the new PHA podiatry schedule in their systems.
Will all private health insurers update their podiatry schedules at the same time?
All PHA member funds have updated their systems to work with the new schedule. PHA is communicating with non-member health funds to inform them of the transition, too.
However, as per usual, it will remain up to individual health funds to decide whether they recognise these services and pay benefits for them. Each individual fund reserves the right to make decisions based on its own commercial needs and customers’ best interests.
Will there be a transition period should an older item number be used?
All new services billed from 1 September 2024 must use the new schedule effective from 1 September 2024. If you use item numbers from the older schedule from 1 September 2024 and the consumer claims a benefit from their health insurer, the claim will be invalid.
However, if a consumer receives a podiatry service using older item numbers before 31 August 2024, the claim can be processed within two years of that date. Health funds will typically pay for services up to two years from the date the service occurred.
Does the inclusion of a new item number mean private health insurers will provide rebates?
Not necessarily. It will remain up to individual health funds to decide whether they contribute benefits towards services in the new podiatry schedule. Each individual fund reserves the right to make decisions based on its own commercial needs and customers’ best interests.
If a private health insurer doesn’t recognise the updated schedule, who do we contact?
Contact the relevant health fund. All health funds have been given notice that the new schedule is being implemented from 1 September 2024. When a claim is rejected, HICAPS and HealthPoint terminals should indicate what the issue is. For example, if the terminal says “invalid item”, the item is not set up in the system for claiming. If the terminal says “item not covered”, it means the health fund has made a decision not to cover that item number.
If I have questions regarding the 2024 billing schedule, who do I contact?
Julia Medew at PHA: [email protected]
What has changed from the 2016 to 2024 podiatry billing schedule?
Some of the notable changes highlighted by the Australian Podiatry Association include:
Definitions – The definitions have been revised, broadened, and contemporised.
Length of consultation – High-level guidance has been included to offer transparency on what to expect from the three main consultation types.
Home-based Domiciliary Care – A definition has been added to identify what qualifies as home-based therapies.
PROMs & PREMs – Although not a requirement of any of the items, having access to clear definitions of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) offers greater transparency should a clinician wish to include them in treatment plans.
Travel – A new item number has been created for use when traveling for a non-clinic-based episode of care.
Hospital – A new category has been included to offer transparency for any services provided within a hospital environment.
Updated Description of F145 – The term ‘Electrophysical therapy’ has been updated to ‘Non-Invasive Rehabilitative Functional Therapy’, offering greater scope for therapy utilisation. This item can include, but is not limited to, therapies such as massage, padding and taping, hot/cold treatment, and laser.
Updating of F301 & F302 – These items have been updated to account for the correct terminology and use of digital scans and their resulting images. For example, 3D imaging is now referred to as a positive model rather than a negative model of the foot.
Updating of F303 & F304 – The requirement to identify if a negative impression is weight-bearing or non-weight-bearing has been removed. While this remains an important clinical definition, its removal from the item number offers greater control for the clinician.
Updating of F344 – The full description has been broadened from ‘Nail Brace’ to ‘Minimally Invasive Nail Correction’, allowing the clinician to use a wider range of therapies and treatments.
How do I access the updated podiatry billing schedule?
You can view it here.
How should discrepancies in billing be handled under the new schedule?
Contact the health fund.
How will the changes in the billing schedule impact claims processing times?
There will be no change to processing times. Health funds continue to prefer on the spot electronic claiming when a service is delivered.