Occupational therapists

Last updated:

24 May 2024

Find the information you need to deliver and claim for occupational therapy services (general and accredited mental health) to Veteran Card holders.

If you’re a member of the veteran community, see Occupational Therapy services.

DVA Forms
Become a DVA health care provider
Services covered by Veteran Cards – Gold and White
Referrals and the allied health treatment cycle
DVA Notes for occupational therapists – general and mental health
Schedule of Fees for Occupational Therapy – General and Mental Health
Claiming
Your obligations
Common compliance issues
Prior Approvals
Rehabilitation Appliances Program (RAP)
Useful links

DVA Forms

Visit Provider forms to access all the forms you need to do business with DVA. This includes forms for prior approvals, RAP orders and claims.

Become a DVA health care provider

DVA has two provider categories for occupational therapy – ‘general’ and ‘accredited mental health’.

If you are an occupational therapist (general), and you are registered with the Department of Human Services (DHS), you are automatically registered with DVA to provide health services to DVA clients. Find out more at becoming a provider.

If you are an occupational therapist (accredited mental health), you are required to be accredited under Occupational Therapy Australia’s Better Access to Mental Health Program.

Services covered by Veteran Cards – Gold and White

Please check full details about card entitlements to ensure your client’s condition is covered at What DVA health cards cover.

A Veteran Card – Gold or White covers occupational therapy treatment that is clinically necessary:

for all conditions, if the patient holds a Veteran Gold Card
for specific, accepted conditions only, if the patient holds a Veteran White Card. White Card holders can also access treatment for mental health conditions from an accredited mental health occupational therapist, under Non-Liability Health Care arrangements.

If you are unsure whether a DVA client is eligible to receive occupational therapy services, contact us on 1800 550 457.

Referrals and the allied health treatment cycle

If you are treating a Veteran Card holder, they will need a valid referral from their general practitioner (GP). For an initial treatment cycle, the referral could alternatively come from a:

medical specialist
treating hospital doctor
hospital discharge planner.

Under DVA treatment cycle arrangements, a referral to an allied health provider will last up to 12 sessions or 1 year, whichever ends first.

Once a treatment cycle has ended, the client needs a new referral from their GP before you can provide further treatment. The client can have as many treatment cycles as their GP determines are clinically necessary.

Veteran Card holders with severe or complex needs may have tailored referral arrangements through the At Risk Client Framework, approved by their usual GP.

For full details about the treatment cycle and referral arrangements, please check Treatment Cycle Information for Allied Health Providers.

DVA Notes for occupational therapists – general and mental health

By accepting a patient’s Veteran Card – Gold or White, you agree to follow the Notes that apply to your profession.

The Notes are legally binding, and it is your responsibility to become familiar with them. They are divided into two sections and you need to comply with both.

Notes for allied health providers:

Notes for occupational therapists (general):

For occupational therapists (mental health), refer to the following notes:

Also refer to:

Schedule of Fees
Referrals and treatment cycle
Claiming

Schedule of Fees for Occupational Therapy – General and Mental Health

The Schedule of Fees – Occupational Therapists (General) and the Schedule of Fees – Occupational Therapy (Mental Health) define the treatments and services you can provide to DVA clients and the payment amounts you can claim.

By accepting a Veteran Card - Gold or White, you agree to accept the DVA fee as full payment. You cannot charge the Veteran Card holder any ‘gap’ fee.

To access your profession’s Schedule of Fees, please visit the Dental and Allied Health Fee Schedules page on the DVA website.

Claiming

Visit Provider claims for full details on how to claim payment from us.

Please note you are responsible for your provider number and you will be accountable for any claiming errors.

If someone else submits a claims on your behalf, you should ensure the information they enter is accurate.

Your provider number cannot be shared, and multiple providers cannot claim under the one provider number. The provider who owns the number will be responsible for any misuse.

For invoicing and billing enquiries, call 1300 550 017.

Your obligations

Each year, DVA reviews unusual provider claiming, which may result in an education process or financial recoveries.

For full details about complying with DVA requirements, please refer to Provider compliance.

Common compliance issues

Before you treat a DVA client, please check the DVA Notes for Allied Health Providers and the Schedule of Fees – Occupational Therapy (General) or Schedule of Fees – Occupational Therapy (Mental Health), for full details about limits and restrictions on services and treatments.

Some common compliance issues are listed below. Please note these are not exhaustive and you must check the Notes and Schedules for complete details about your profession’s item numbers and compliance requirements.

Consultations

Only one consultation (treatment and/or aids assessment) can be claimed for the same patient on the same day.

Consultations must cover treatment of conditions specifically stated on the medical referral.

Occupational Therapy (Mental Health): Items US31; US32 – Extended Consultation

Items US31 and US32 only apply when a DVA client clinically requires an extended consultation of 20 to 50 minutes.

Any consultation or other service less than 20 minutes cannot be claimed using these items.

Occupational Therapy (General): Item OT30 - Extended Consultation

Claimable when the condition being treated is complex (acute condition on top of a chronic condition concurrently needing treatment) or because of the item being assessed is complex e.g. mobility scooter, mobile hoist.

Occupational Therapy (General): Item OT40 - Special Consultation

Only to be used for complex home modifications where detailed measurements are taken for major structural home modifications –e.g. level access bathrooms, ramps higher than 190mm, stair climbers etc.

Only one OT40 can be claimed per complex modification.

All other related consultations about the complex modification, such as pre- and post-modification home visits, are claimed under OT41.

Same day claiming

A provider who is both a general and accredited mental health occupational therapist cannot make a claim for both general and mental health items for the same eligible client, on the same day.

Reports

Claimable in association with aids assessment consultations or when submitting a direct order form or post home modifications form.

All reports should be claimed on the same date as the aids or modification assessment to which it relates, not the date of when the report is written.

Only one report is claimable per assessment.

Occupational Therapy (General) Item OT51 – ‘Schematic Report’ – is claimable in association with an OT40 or OT41 only where a detailed diagram/s with measurements are required for a major structural home modification.

Lymphoedema Treatment

Occupational Therapy (General) Item OT26

Only occupational therapists with appropriate training in treating lymphoedema are able to claim this item from DVA. Evidence of certification is required by DVA.

Occupational therapists cannot claim lymphoedema treatment for DVA clients already receiving lymphoedema treatment from a physiotherapist.

Prior approval from DVA is required if more than 20 treatments per calendar year are needed. This treatment frequency is considered outside of the 12 treatment cycle requirements.

Kilometre allowance

DVA may pay a kilometre allowance if you meet all of the following requirements:

you have a fixed practice location i.e. a street address, not a post office box
there is a genuine need to travel e.g. to conduct a home assessment or if the entitled person is physically unable to travel
there is no suitable health care provider located closer to the entitled person.

DVA will only pay the allowance for the part of your trip that is more than 10 kilometres from the practice nearest to the client.

Remote area allowance

The OT80 Remote Area Allowance (RAA), as defined in the Schedule of Fees – Occupational Therapists (General), may be paid in addition to the normal kilometre allowance if the provider:

is the nearest suitable provider
there is a genuine need to see the person in their residence
the distance that needs to be travelled is greater than 50 kilometres one way.

For each kilometre travelled over 50 kilometres, the RAA rate shown in the Fee Schedule is applied. A clear explanation, with examples, related to RAA claiming can be found in Section 2(g) of the Notes for Occupational Therapists.

Prior Approvals

In exceptional circumstances, you may claim payment for treatment not included in the Schedule of Fees, if the treatment:

can be clinically justified for the client’s referred condition
is evidence-based.

You must ask DVA for prior approval before providing the treatment.

To submit a request, please complete the D1328 Treatment Prior Financial Approval Request Form and email it to health.approval [at] dva.gov.au (health[dot]approval[at]dva[dot]gov[dot]au).

For inquiries, contact DVA on 1800 550 457.

Rehabilitation Appliances Program (RAP)

Occupational therapists can prescribe aids and appliances to eligible Veteran Card holders through the RAP National Schedule of Equipment.

The item must be clinically necessary and support the patient’s referred condition.

You cannot supply these items yourself. You need to place an order through RAP, using the relevant RAP Form. The items will be supplied by a DVA-contracted RAP supplier.

Residential Aged Care Facilities

The Australian National - Aged Care Classifications (AN-ACC), applies to residential aged care facilities (RACF). Residents of these facilities will be independently assessed and the RACF will be funded based on the client’s clinical need. This funding will enable RACFs to provide client’s aids and appliances and allied health services to meet their clinical need(s), as specified if Schedule 1 of the Quality of Care Principles.

Where a RACF is funded to provide an aid or appliance or allied health care services, it is expected to do so. DVA does not seek to duplicate these arrangements.

Non-Liability Health Care

Occupational therapists (accredited mental health) can provide and claim for mental health care services to DVA White Card holders eligible to receive treatments under Non-Liability Health Care arrangements.

For further information, please refer to the Non-Liability Health Care page for health providers on the DVA website.

Mental health resources for you and your clients

The health professionals page on the Open Arms website includes a suite of mental health resources and information to support you when treating DVA clients. These include case formulation tools, on-line training courses, and free, CPD accredited webinars on veteran mental health.

Open Arms has also developed innovative self-help tools and resources for veterans and families, including mobile apps, videos, publications, case studies and peer stories.