Orthotists

Last updated:

3 January 2024

Find the information you need to deliver and claim for orthotic services to Veteran Card holders.

If you’re a member of the veteran community, go to Orthotic services.

DVA Forms

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

Become a DVA health care provider

Services covered by Veteran Cards – Gold and White

Please check What a DVA health card covers for full details about card entitlements to ensure your client’s condition is covered.

A Veteran Card – Gold or White covers orthotic 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.

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

Referrals and treatment cycle

If you are treating a Veteran Card holder, they will need a valid referral from their 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 one 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.

For full details about the treatment cycle and referral arrangements, please check Treatment cycle information for allied health providers.

DVA Provider Notes

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.

Section 1: General notes for allied health providers

Section 2: Specific to orthotists

Please also refer to:

Referrals and treatment cycle
Schedule of Fees
Claiming.

Schedule of Fees

The Schedule of Fees – (Orthotists) defines 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.

For your profession’s up-to-date schedule, visit DVA Fee Schedules.

Claiming

Visit Provider claiming 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 claims on your behalf, you should ensure they do not make any mistakes.

Your provider number cannot be shared, and multiple providers cannot claim under the one provider number. The provider who owns the number will bear the consequences of misuse.

For invoicing and billing enquiries, call 1300 550 017.

Your obligations

Each year we review 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 Schedule of Fees and Notes for full details about limits and restrictions on orthotic services.

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

Limits on supply and repair of orthoses

Limits apply to:

the number of orthoses a DVA client can receive in a 365-day period
the amount you can claim on each item number.

See the Schedule of Fees – Orthotists under item numbers UT13 to UT37 for details about these limits.

If you need to provide orthoses outside of these limits, you must request prior approval from us. Include the reason the treatment is clinically necessary in your request.

Prescribing orthotics under Schedule of Fees or RAP

There are two ways to prescribe orthotics for DVA clients. As an orthotist, you can either:

prescribe and supply items under the Orthotist Schedule of Fees
prescribe (but not supply) items through the Rehabilitation Appliances Program (RAP).

If you supply an orthotic item under the Schedule of Fees, you can claim for the consultation as well as the supply of the item.

If you prescribe an item through RAP, a DVA-contracted provider will supply the item to you as the orthotist, so you can fit the item for the DVA client. In this case, you can only claim the relevant consultation fees.

Consumables

For pre-made or customised orthoses, you must fit the device within 3 weeks of the date you assess and prescribe orthotics for your client.

To prescribe custom items, you need to ask us for prior approval before you start treatment. The request needs to include:

materials
quantities required
manufacturing time and techniques.

Kilometre allowance

We may pay a kilometre allowance if:

you are not a mobile provider
you have a fixed practice location
there is a genuine need to visit a client at home
your client’s home is more than 10 km from their nearest orthotist clinic.

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

Prior approvals

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

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

You must ask us 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)

Orthotists 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 directly to your patient by a DVA-contracted RAP supplier.

Alternatively, you may prescribe and supply orthotics under the Orthotist Schedule of Fees.

Please check the Notes for full details about providing orthotic services to aged care residents.