Fees and payments in the workers compensation system

General practitioners and medical specialists providing treatment to a worker are paid in accordance with SIRA fees and rates orders

This page 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 Australian Medical Association 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 General Practitioners link on the SIRA fees and rates orders page.

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 SIRA website doctors and other medical professionals

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.

To view the fees for surgeons and orthopaedic surgeons visit SIRA fees and rates orders

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

Helping your patients get back to work 

For more information on how to help your patients get back to work, visit SIRA website.

 

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.

Physiotherapy, chiropractic and osteopathy services are paid in accordance with the SIRA fees and rates orders.

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.

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 SIRA fees and rates orders.

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 must be approved by SIRA.

Independent consultants services are paid in accordance with the SIRA fees and rates orders.

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 do not require approval by SIRA to provide services.

Massage therapists services are paid in accordance with the SIRA fees and rates orders.

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.

All medication must be prescribed by a qualified medical practitioner or dentist and supplied by a registered pharmacist.

Where possible, medication should be prescribed and supplied through the Pharmaceutical Benefits Scheme (PBS), unless the medication is not available on the PBS or there are extenuating circumstances.

A pharmacy account can be set up for medications approved under the claim. This allows for payment to be made directly to you by the insurer. For payment to be made directly to you, you should provide the insurer with:

• a dispensary computer generated tax invoice for PBS and private (non-PBS) medications supplied for treatment of the compensable injury
• the statement of account for over the counter and equipment items supplied to the person for treatment of their compensable injury.

Invoices and statements of account should contain the following information:

• pharmacy name, ABN, address, dispensing pharmacist's name
• invoice number and date dispensed
• total amount charged
• PBS item code (for PBS-dispensed medications)
• full description of the medication (including script number, generic name, form)
• quantity and strength of medication dispensed

For more information visit Medication management in the NSW personal injury schemes: Better practice guide - SIRA.

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 SIRA fees and rates orders.

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.

Non-SIRA approved Allied Health Practitioners include all allied health disciplines that do not require SIRA approval. Non SIRA approved Allied Health Practitioners should adhere to the principles and procedures set out in the Workers compensation guide for allied health practitioners.

For services delivered by a non-SIRA approved allied health practitioner that are similar in nature to that of a SIRA approved practitioner (for example 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 Claims Service Provider 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.  When the Claims Service Provider notifies the treatment provider of the approval for treatment or services, the Claims Service Provider should specify the costs approved.

Non-SIRA approved allied health practitioners must also comply with the following sections of the Guidelines for the Provision of Relevant Services (Health and Related Services):

• Part 1: Code of conduct
• Part 2: Requirements for telehealth services
• Part 5: Billing requirements for the provision of relevant services under the workers compensation legislation
• Part 6: Invoicing requirements for relevant services under the workers compensation legislation (excluding pharmaceutical services)
  
  

Interstate allied health practitioners providing treatment services to a NSW worker outside of NSW do not need to be approved by SIRA. They are not required to undertake the NSW allied health practitioner online training either. However, every service practitioner must adhere to the NSW workers compensation scheme requirements. This means:

• meeting the conditions for approval outlined in the guidelines for approval of treating allied health practitioners (excluding completion of the online SIRA training, however SIRA would encourage the completion of this training by interstate practitioners to assist with their knowledge of delivering services in the NSW workers compensation system)
• complying with the following sections of the Guidelines for the Provision of Relevant Services (Health and Related Services)
  • Part 1: Code of conduct
  • Part 2: Requirements for telehealth services
  • Part 5: Billing requirements for the provision of relevant services under the workers compensation legislation
  • Part 6: Invoicing requirements for relevant services under the workers compensation legislation (excluding pharmaceutical services)
• submitting allied health treatment requests for the prior approval of treatment services, and adhering to all policies and procedures set out in the Workers compensation guide for allied health practitioners.

When invoicing, the service provider number for interstate practitioners is INT0000. The payment classification code is the one relevant to the provider’s professional discipline. Any accredited exercise physiology, chiropractic, counselling, osteopathy, massage therapy, physiotherapy or psychological treatment services provided to a NSW worker in a state or territory other than NSW, must be paid in accordance with the fee that would apply to the workers compensation jurisdiction of the state/territory of service, up to the maximum fee specified in the schedule of the relevant NSW Fees Order.