Preamble
Rehabilitation services for people with Acquired Brain Injury (ABI) can be complex and intensive. Accordingly, payment for these services is considered beyond the discipline specific fee schedules the WSIB utilizes.
The attached fee schedule for ABI rehabilitation services reflects existing established fees for comparable services, such as social work counseling and psychological services, but also recognizes the unique aspects of ABI interventions. Telephone intervention with a client by a health care professional for crisis management may be reimbursed. Exceptions to this fee schedule must be pre-authorized by the WSIB.
Treatment
ABI clients fatigue easily and are usually able to tolerate approximately four hours of treatment daily. An explanation is required in cases where treatment goes beyond four hours a day. However, in these cases the treatment should not exceed six hours in one day.
Duration of treatment services will be based on achievement of treatment goals. Progress will be monitored by WSIB employees reviewing progress reports at least every three months.
The WSIB does not reimburse for indirect services such as case management, telephone consultation with the WSIB, or reports.
Definitions
A therapy program is a program in which the client receives goal-oriented treatment under the direct care of a health care provider.
A support program is a program in which the client’s activities are self- directed or recreational and are not supervised by a health care provider.
| Assessment services | Service code | Maximum rate | Client maximum |
|---|---|---|---|
| Psychology (neuropsychology and behavioural) (max 12 hrs) | 6300 | $55.85 (per 1/2 hr) | $1,340.40 |
| Physiotherapy (max 4 hrs) | 6301 | $46.55 (per 1/2 hr) | $372.40 |
| Occupational Therapy (max 4 hrs) | 6302 | $46.55 (per 1/2 hr) | $372.40 |
| Speech and Language Therapy (max 4 hrs) | 6303 | $46.55 (per 1/2 hr) | $372.40 |
| Case Management | 6304 | $0 | $0 |
| Vocational Rehabilitation | 6305 | $0 | $0 |
| Home Visit Premium | 6306 | $31.03 | $93.09 |
| Telephone Consultation | 6307 | $0 | $0 |
Total client maximum: $2,550.49
| Treatment | Service code | Maximum rate |
|---|---|---|
| Psychology (includes neuropsychology) | 6330 | $55.85 (per 1/2 hr) |
| Masters Level Psychology | 6331 | $46.55 (per 1/2 hr) |
| Physiotherapy | 6332 | $46.55 (per 1/2 hr) |
| Occupational Therapy | 6333 | $46.55 (per 1/2 hr) |
| Speech and Language Therapy | 6334 | $46.55 (per 1/2 hr) |
| Social Work | 6335 | $46.55 (per 1/2 hr) |
| Group Therapy | 6336 | $31.03 (per hr) |
| Nursing | 6337 | $37.75 (per visit) |
| Non-professional Treatment | 6338 | $20.69 (per 1/2 hr) |
| Home Visit Premium | 6339 | $31.03 |
| Case Management | 6340 | $0 |
| Vocational Rehabilitation | 6341 | $0 |
| Telephone Consultation | 6342 | $0 |
Maximum daily charge (therapy program): $465.41
Maximum daily charge (support program): $186.17
Effective June 4, 2001
Note: These fees include treatment and the time spent to completing clinical reports.
Cancelled/Missed appointments
The WSIB does not pay for cancelled or missed appointments.
Billing of fees
As stated in Section 33 (5) of the Workplace Safety and Insurance Act, “No health care practitioner shall request a worker to pay for health care or any related service provided under the insurance plan.”
Late accounts
Under Section 33 (4) of the Workplace Safety and Insurance Act, the WSIB may impose a percentage reduction penalty for late submissions of accounts. Accounts received after the sixth month from the date of service may be reduced in the following manner:
- 7th – 9th month reduced by 25%
- 10th – 12th month reduced by 50%
- over one year reduced by 100%
The WSIB may waive the late penalty charge if an acceptable reason for the delay is provided.