SIRA Logo

2016 SIRA rates for general practitioners

State Insurance Regulatory Authority (SIRA) payment classification system information – professional medical services.

This summarises the most commonly used GP codes. For more information, refer to the 2016 Workers Compensation (Medical Practitioner Fees) Order.

Payment classification code Type of service Fee Service description

AA010

Level A consultation

$37.50

AMA codes must be used for all consultations and medical treatment services.

The rate for consultation fee applies for services provided on or after 1 January 2016. GST should not be charged on the consultation fee.

For further information on the criteria for Level A, B, C & D consultation services, please consult the AMA List of Medical Services and Fees (1 November 2015).

Out-of-hours fees are only payable for emergency attendance and emergency treatment of a worker at a time when the practice is not usually open.

AA020

Level B consultation

$76.00

AA030

Level C consultation

$140.00

AA040

Level D consultation

$215.00

WCO001

Certificate of capacity

$44.50 (plus GST)

One certification fee may be charged for the initial certificate only. No fee is payable for subsequent certificates. To order certificates of capacity call SIRA on 13 10 50.

WCO002

Maximum hourly rate payable to General Practitioner

$272.40

or

$22.70 per 5 minutes

This fee is to remunerate for any time spent by the medical practitioner, in addition to the usual medical management, to assist the worker to recover at or return to work. These rates may cover, for example, discussions with employers, case conferences (see definition below), visits to worksites, time spent reviewing injury management or return to work plans and providing additional reports requested from treating doctors (where it was pre-approved by the insurer). These should be billed to reflect the time taken (to the nearest five minutes) to deliver the service.

Case conference

$22.70 per 5 minutes (plus GST)

$272.40 per hour (plus GST)

Case conference means a face-to-face meeting, video conference or teleconference with any or all of the following parties – workplace rehabilitation provider, employer, insurer or other treatment provider(s) delivering services to the worker. Discussion must seek to clarify the worker’s capacity for work, barriers to return to work, and strategies to overcome these barriers via an open forum to ensure parties are aligned with respect to expectations and direction of the injured worker’s recovery at work or return to suitable employment. If the discussion is with the worker, it must involve a third party to be considered a case conference. Discussions between the worker’s nominated treating doctor and other treating practitioners (eg allied health practitioners, medical specialists/surgeons) relating to treatment are considered a normal interaction between referring doctor and practitioner. This is not to be charged as a case conference.

WCO004

Other medical items

Cost price

The cost of all bandages and dressings etc.

PHS001

Pharmaceutical services

Cost price

Payments for pharmaceutical services.

WCO005

Medical records

$37 (for 33 pages or less). An additional $1.35 per additional page (plus GST).

Fee for providing copies of medical records (including treating general practitioner, specialist or consulting surgeon notes and reports).

If the clinical records are provided electronically, a flat fee of $37 applies.

Download a PDF version of the 2016 rates for general practitioners.