Selection And/or Manufacture Of Customised Or Wearable Technology

When to use this code

Use this code for customised prosthetic or orthotic devices. These are individually designed and fitted items such as artificial limbs, spinal braces, or custom foot orthoses. They require specialist assessment, fitting, and ongoing review to make sure they function correctly.

Common billing scenarios

• A provider delivers 2 hours of this support. They claim 2 hours at $193.99, totalling $387.98.
• A participant receives this support on an ongoing weekly basis. The provider submits claims at the end of each service period, documenting the hours delivered.

Provider notes

• Non-face-to-face delivery is allowed for this code. This means you can bill for activities like report writing, care coordination calls, or progress notes, provided your service agreement with the participant covers these activities. Keep clear records of what non-face-to-face work was done and how long it took.
• Provider travel can be claimed under this code. You can bill for reasonable travel time to reach the participant, but only for the portion of travel that exceeds normal commuting. Travel costs should be shared proportionally if you are seeing multiple participants in one trip.
• Short notice cancellation fees apply. If a participant cancels with less than 7 clear days notice (or 2 clear business days for some supports), you can charge up to 90% of the agreed fee. You must document the cancellation and have the cancellation policy in your service agreement.
• Capacity Building funding is time-limited and goal-oriented. Document how the support contributes to the participant’s plan goals, as this will be reviewed at plan reassessment. Unlike Core funding, Capacity Building budgets are usually not flexible across categories.