Fees and payments in the workers compensation system

As a medical practitioner, the amount you can charge for medical treatment and services are determined by fees orders under Workers Compensation legislation.

Diagnostic Imaging Service Providers

As of Friday 1 June 2018, icare will implement a new maximum fees list for diagnostic imaging services provided to workers compensation patients covered by icare.

To be reimbursed for services provided, you'll need to submit an invoice to the insurer within 30 days of providing the service. The relevant MBS code/s should be included on all invoices for diagnostic imaging services.

In addition, all practices providing diagnostic imaging services to workers compensation patients covered by icare will need to meet accreditation standards in accordance with Diagnostic Imaging Accreditation Scheme (DIAS) requirements.

Practices must meet DIAS entry-level accreditation standards by 1 October 2018. DIAS full suite accreditation standards must be met by 1 October 2020. Details on requirements for DIAS accreditation is available on the Australian Government Department of Health website.

Introduction of accreditation requirements and maximum fees list does not impact on injured workers’ access to, or eligibility for, diagnostic imaging services in accordance with the NSW Workers Compensation Legislation. Also, there are no changes to the GP referral processes currently in place.

General practitioners, medical specialists and consulting surgeons

General practitioners and medical specialists providing treatment to a worker are paid in accordance with the Workers Compensation Medical Practitioner Fees Order.

This document includes details of rates that can be charged; for what purposes payment can be sought; and invoicing requirements. 

GPs and medical specialists can claim for:

  • The initial certificate of capacity (WCO001)
  • Patient consultations based on the length of the consult and the complexity and nature of the visit (as per the applicable AMA rates for GPs and medical specialists).

Payment can be claimed for additional work that you do to support the worker to return to and recover at work including:

  • Case conferences
  • Discussions with employers
  • Visits to work sites
  • Review of injury management or return to work plans
  • Providing additional reports requested from treating doctors (where it was pre-approved by the insurer)
  • Other medical items such as bandages and dressings
  • Provision of clinical notes to the insurer

For a summary of the most commonly used GP codes, refer to the SIRA rates for general practitioners.

To be reimbursed for treatment provided to someone with a work-related injury, you’ll need to submit an invoice to the insurer within 30 days of providing the service. Your patient is ultimately responsible for paying for treatment if it will not be funded by the insurer. It is usual practice for the insurer to notify you if they will no longer be approving medical expenses.

For more information visit the SIRA website doctors and other medical professionals page.

Surgeons and orthopaedic surgeons

In the event that the worker requires surgery as a result of their work-related injury, approval will be required from the insurer.

View the SIRA fees for Surgeons and Orthopaedic Surgeons.

To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

For more information visit the SIRA website doctors and other medical professionals page.

    Allied Health Professionals

  • Chiropractors, osteopaths and physiotherapists

    Chiropractors, osteopaths and physiotherapists are registered with the Australian Health Practitioner Regulation Agency (AHPRA) and, except in relations to the treatment of police officers, fire fighters and paramedics, must be approved by SIRA to provide treatment and facilitate a safe and durable recovery at work.

    Services are paid in accordance with the Physiotherapy, Chiropractic and Osteopathy Fees Order.

    To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

    For more information visit the relevant page on the SIRA website;

  • Exercise physiologists
    Accredited exercise physiologists must be approved by SIRA to deliver services in the NSW workers compensation system (except in relation to the treatment of police officers, fire fighters and paramedics).

    Exercise physiology services are paid in accordance with the exercise physiology fees order.

    To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

    For more information visit the SIRA website exercise physiologists page.
  • Independent consultants
    Independent consultants must be approved by SIRA.

    Independent consultants services are paid in accordance with the Independent consultant fees order.

    To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

    For more information visit the SIRA website independent consultants page.
  • Massage therapists
    Massage therapists do not require approval by SIRA to provide services.

    Massage therapists services are paid in accordance with the massage therapy fees order.

    To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

    For more information visit the SIRA website massage therapists page.
  • Psychologists, social workers and counsellors
    Psychologists, social workers and counsellors must be approved by SIRA to provide services in the workers compensation system (except in relation to the treatment of police officers, fire fighters and paramedics).

    Psychologists, social workers and counsellors services are paid in accordance with the psychology and counselling fees order.

    To be reimbursed for treatment provided, you’ll need to submit an invoice to the insurer within 30 days of providing the service.

    For more information visit the SIRA website psychologists, counsellor and social workers page.

  • Non SIRA approved allied health practitioners
    The SIRA workers compensation guide for allied health practitioners states that: "With the exception of massage therapy, treatment delivered by non SIRA approved allied health practitioners is not governed by Workers Compensation Fees Orders. For services delivered by a non SIRA approved allied health practitioner that are similar in nature to that of a SIRA approved practitioner (eg hand therapy by an occupational therapist), it is recommended the relevant gazetted Fees Order be used as a guide for the cost of services. Non SIRA approved allied health practitioners are to discuss their fees with the insurer and agree upon an appropriate charge at the time of requesting approval to deliver services. The fee should be similar to the amount customarily paid within the community for that type of treatment or service (except for massage therapists who have their own Fees Order). When the insurer notifies the treatment provider of the approval for treatment or services, the insurer should specify the costs approved."