Billing & Codes

DVA, WorkCover & TAC billing

Three separate third-party payers — each with its own rules, referral requirements and fee schedule. Patients on these schemes should not pay out-of-pocket when the claim is valid and the paperwork is right.

DVA — Gold Card & White Card

Treated like Medicare for billing — no out-of-pocket to the patient when the MBS item is valid and the DVA file number is recorded on the invoice.

Gold Card: covers all conditions.
White Card: covers only the accepted conditions listed on the card. If the scan isn't for an accepted condition, it bills as private.
Ask for the DVA file number shown on the card — we need it on the invoice.
DVA-specific MRI item codes (VC20 for a scan on a machine that isn't MBS-eligible, VC21 for a GP-referred MRI that would otherwise require a specialist referral under MBS) don't apply here — United Radiology doesn't offer MRI. For any other modality we offer, billing a DVA patient is essentially the same as a bulk-billed Medicare patient, with the DVA file number in place of / alongside the Medicare number.
Out of schedule / out of MBS? Anything where the fee charged exceeds the DVA schedule fee, or the service isn't a straight MBS item, needs prior financial authorisation (DVA form D9292). Escalate rather than guessing. DVA Health Provider Line: 1800 550 457.

Patient does not pay. We bill WorkCover directly.

Referral must include: WorkCover claim number, date of injury, employer details, and the insurer's name.
Scans for injuries outside the accepted claim: patient-pay (Medicare/private). Do not default to billing WorkCover unless the indication matches the claim.
Pre-approval — less often required than people assume for imaging close to the date of injury:
- WorkSafe VIC: prior approval is not required for MRI/CT when the scan investigates symptoms or signs directly arising from the work injury.
- icare NSW: plain X-ray within the first 2 weeks of injury, and CT/MRI referred by a specialist within 3 months of injury, don't need insurer approval. GP-referred MRI still has to meet MBS criteria.
- Outside those windows, or if the indication is borderline, ring the insurer first before booking.
Fee schedule: WorkCover uses its own fee schedule, typically indexed against MBS items. Use the WorkCover-specific fee item, not the Medicare item.

TAC — transport accident (Victoria)

Similar structure to WorkCover. Patient does not pay if the claim is accepted.

Referral must include: TAC claim number and date of accident.
90-day rule: imaging within 90 days of the accident is auto-covered when there's a valid claim number and a doctor's referral for accident-related injury. Beyond 90 days (or if more than 6 months have passed since the last TAC-covered service) TAC needs to approve the scan in writing first.
Fee schedule: TAC adopts MBS items, explanations and rules, with TAC-specific rates and policies layered on top. Use the TAC fee item.
Gap warning: if our fee is above the TAC rate, the patient may owe a gap and TAC generally won't reimburse it. Confirm at booking.

Common trap

When to escalate

DVA — Gold Card & White Card

Treated like Medicare for billing — no out-of-pocket to the patient when the MBS item is valid and the DVA file number is recorded on the invoice.

Gold Card: covers all conditions.

White Card: covers only the accepted conditions listed on the card. If the scan isn't for an accepted condition, it bills as private.

Ask for the DVA file number shown on the card — we need it on the invoice.

DVA-specific MRI item codes (VC20 for a scan on a machine that isn't MBS-eligible, VC21 for a GP-referred MRI that would otherwise require a specialist referral under MBS) don't apply here — United Radiology doesn't offer MRI. For any other modality we offer, billing a DVA patient is essentially the same as a bulk-billed Medicare patient, with the DVA file number in place of / alongside the Medicare number.

Out of schedule / out of MBS? Anything where the fee charged exceeds the DVA schedule fee, or the service isn't a straight MBS item, needs prior financial authorisation (DVA form D9292). Escalate rather than guessing. DVA Health Provider Line: 1800 550 457.

WorkCover — work-related injury

Patient does not pay. We bill WorkCover directly.

Referral must include: WorkCover claim number, date of injury, employer details, and the insurer's name.

Scans for injuries outside the accepted claim: patient-pay (Medicare/private). Do not default to billing WorkCover unless the indication matches the claim.

Pre-approval — less often required than people assume for imaging close to the date of injury:

WorkSafe VIC: prior approval is not required for MRI/CT when the scan investigates symptoms or signs directly arising from the work injury.
icare NSW: plain X-ray within the first 2 weeks of injury, and CT/MRI referred by a specialist within 3 months of injury, don't need insurer approval. GP-referred MRI still has to meet MBS criteria.
Outside those windows, or if the indication is borderline, ring the insurer first before booking.

Fee schedule: WorkCover uses its own fee schedule, typically indexed against MBS items. Use the WorkCover-specific fee item, not the Medicare item.

TAC — transport accident (Victoria)

Similar structure to WorkCover. Patient does not pay if the claim is accepted.

Referral must include: TAC claim number and date of accident.

90-day rule: imaging within 90 days of the accident is auto-covered when there's a valid claim number and a doctor's referral for accident-related injury. Beyond 90 days (or if more than 6 months have passed since the last TAC-covered service) TAC needs to approve the scan in writing first.

Fee schedule: TAC adopts MBS items, explanations and rules, with TAC-specific rates and policies layered on top. Use the TAC fee item.

Gap warning: if our fee is above the TAC rate, the patient may owe a gap and TAC generally won't reimburse it. Confirm at booking.