Fees paid for workers compensation health services

This includes emergency and non-emergency transfers provided by the Ambulance Service of NSW and other providers.

Current fees orders

• Ambulance service fees order (effective 5 July 2024)

Historical health related fees and rates orders are available from our resource library.

The fees orders set the maximum fee you can charge for treatment and services provided to workers with an injury.

Current fees orders

• 1 February 2024 – Medical Practitioner Fees Order (effective 1 February 2024) (nsw.gov.au)
• 1 February 2024 – Surgeon and Orthopaedic Surgeon Fees Order (effective 1 February 2024) (nsw.gov.au)

Information sheets

• 1 February 2024 – General practitioner rates (effective 1 Feb 2024) (nsw.gov.au)
• 1 February 2024 (Telehealth) – SIRA telehealth item numbers for medical practitioners – effective 1 February 2024 (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker’s insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• provider’s AHPRA number and Medicare provider number (unless not registered with Medicare)
• in the case of private hospital services, the service’s:
  • Medicare Benefits Schedule item (if applicable)
  • theatre banding (if applicable)
  • if the invoice is for a higher-banded procedure which requires a complexity certificate, the certificate of complexity must be included.
  • theatre duration (if applicable)
• in the case of invoices for surgery:
  • a detailed operation report including a description of the injury and how the injury occurred, time surgery commenced and finished, intra-operative findings and the procedures performed, including structures that were repaired (stating the anatomic location) and technique of repair.
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
• service cost for each SIRA payment classification code or AMA Fees List item number and service duration (where applicable)
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

Declined claims

If the insurer declines liability or a treatment request because it does not meet the 'reasonably necessary' criteria, your patient is personally responsible for payment of accounts. Ensure your patient has submitted a workers compensation claim and you have approval from the insurer before providing treatment.

SIRA provider number required

If you’re an accredited exercise physiologist, you must have a SIRA provider number to provide treatment services to people in the NSW Workers Compensation Scheme. Allied health practitioners formerly approved by WorkCover NSW are automatically approved by SIRA and their provider number remains the same.

Find out more about SIRA provider numbers.

Current fees and practice requirements

The fees orders set the maximum fee you can charge for treatment and services provided to workers with an injury.

• 1 February 2024 – Accredited exercise physiology fees & practice requirements (effective 1 February 2024) (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoice

You must provide itemised invoices to the patient's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• provider’s SIRA approval number or
  • provider number INT0000 if the service was provided interstate and the provider does not have a SIRA approval number or
  • provider number EXT0000 if the service was provided to an exempt worker and the provider does not have a SIRA approval number
• provider’s AHPRA number/professional association accreditation/membership number
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
• service cost for each SIRA payment classification code or AMA Fees List item number and service duration (where applicable)
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

Declined claims

If the insurer declines liability or a treatment request because it does not meet the 'reasonably necessary' criteria, your patient is personally responsible for payment of accounts.

SIRA provider number

If you’re a hearing service provider, you must have a SIRA provider number to provide treatment services to people in the NSW Workers Compensation Scheme. Allied health practitioners formerly approved by WorkCover NSW are automatically approved by SIRA and their provider number remains the same.

Find out more about SIRA provider numbers.

Current fees and practice requirements

The fees orders set the maximum fee you can charge for treatment and services provided to workers with an claim.

• 1 February 2024 – Hearing Aid fees & practice requirements (effective 1 February 2024) (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• provider’s SIRA approval number or
  • provider number INT0000 if the service was provided interstate and the provider does not have a SIRA approval number or
  • provider number EXT0000 if the service was provided to an exempt worker and the provider does not have a SIRA approval number
• provider’s AHPRA number/professional association accreditation/membership number
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
• service cost for each SIRA payment classification code or AMA Fees List item number and service duration (where applicable)
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

Declined claims

If the insurer declines liability or a treatment request because it does not meet the 'reasonably necessary' criteria, your patient is personally responsible for payment of accounts.

Current rates orders

• Public hospital rates order (effective 5 July 2024)
• Private Hospital Maximum Rates Order (effective 1 February 2024)

Historical health related fees and rates orders are available from our resource library.

Current fees order

The fees orders set the maximum fee you can charge for treatment and services provided to workers with a claim.

• 1 February 2024 – Independent Consultant Fees Order (effective 1 February 2024) (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• provider’s SIRA approval number or
  • provider number INT0000 if the service was provided interstate and the provider does not have a SIRA approval number or
  • provider number EXT0000 if the service was provided to an exempt worker and the provider does not have a SIRA approval number
• provider’s AHPRA number/professional association accreditation/membership number
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
• service cost for each SIRA payment classification code or AMA Fees List item number and service duration (where applicable)
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

Medical reports

If you’re invoicing for a medical report, it’s important to confirm the purpose of the original request with the referring party.

For routine medical management or return to work information, refer to the medical practitioner fees order published above under 'General practitioners, surgeons and orthopaedic surgeons'.

For reports related to disputes or potential disputes in respect of a claim, refer to the below fees order for applicable rates for general practitioners and specialists.

Current fees order

The fees orders set the maximum fee you can charge for services provided to workers with an injury.

• 1 February 2024 – Medical Examinations and Reports Fees Order (effective 1 February 2024) (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• in the case of medical practitioner services, the provider’s AHPRA number and Medicare provider number (unless not registered with Medicare)
• in the case of private hospital services, the service’s:
  • Medicare Benefits Schedule item (if applicable)
  • theatre banding (if applicable)
  • if the invoice is for a higher-banded procedure which requires a complexity certificate, the certificate of complexity must be included.
  • theatre duration (if applicable)
• in the case of invoices for surgery:
  • a detailed operation report including a description of the injury and how the injury occurred, time surgery commenced and finished, intra-operative findings and the procedures performed, including structures that were repaired (stating the anatomic location) and technique of repair.
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
• service cost for each SIRA payment classification code or AMA Fees List item number and service duration (where applicable)
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

Current fees order

The fees orders set the maximum fee you can charge for services provided to workers with an injury.

• 1 February 2024 – Injury Management Consultant Fees Order (effective 1 February 2024) (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker’s insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• in the case of medical practitioner services, the provider’s AHPRA number and Medicare provider number (unless not registered with Medicare)
• relevant SIRA payment classification code
• service cost for each SIRA payment classification code
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

SIRA provider number

As of 1 January 2016, massage therapists do not need a SIRA provider number to provide treatment services to people in the NSW Workers Compensation Scheme.

Current fees order

The fees orders set the maximum fee you can charge for services provided to workers with an injury.

• 1 March 2024 – Workers Compensation (Massage Therapy Fees) Order No.2 (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• the massage therapist’s professional association accreditation/membership number
• relevant SIRA payment classification code
• service cost for each SIRA payment classification code
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice.

Invoices must be submitted within 30 calendar days of the service being provided.

Current fees order

The fees orders set the maximum fee you can charge for services provided to workers with an injury.

• 1 February 2024 – Medical Examinations and Reports Fees Order (effective 1 February 2024) (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• in the case of medical practitioner services, the provider’s AHPRA number and Medicare provider number (unless not registered with Medicare)
• relevant SIRA payment classification code
• service cost for each SIRA payment classification code
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

SIRA provider number

If you’re a psychologist, counsellor or an accredited mental health social worker, you must have a SIRA provider number to provide services to people in the NSW Workers Compensation Scheme.

Clinical neuropsychologists assessing workers do not require SIRA approval.

Find out more about SIRA provider numbers.

Current fees and practice requirements

The fees orders set the maximum fee you can charge for services provided to workers with an injury.

• 1 February 2024 – Psychology and counselling fees & practice requirements (effective 1 February 2024) (nsw.gov.au)

Historical health related fees and rates orders are available from our resource library.

Invoices

You must provide itemised invoices to the worker's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• provider’s SIRA approval number or
  • provider number INT0000 if the service was provided interstate and the provider does not have a SIRA approval number or
  • provider number EXT0000 if the service was provided to an exempt worker and the provider does not have a SIRA approval number
• provider’s AHPRA number/professional association accreditation/membership number
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
• service cost for each SIRA payment classification code or AMA Fees List item number and service duration (where applicable)
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

Treatment approval

You must obtain insurer approval before providing services.

Insurers will only refer to SIRA approved workplace rehabilitation providers.

SIRA provider number

If you’re a workplace rehabilitation provider, you need to submit an application to SIRA, following the process outlined in the Workplace rehabilitation provider approval framework.

Once you can demonstrate compliance with the Conditions of Approval, you are granted a Certificate of Approval for up to 3 years.

Fees

There is no fees order for workplace rehabilitation providers in the NSW Workers Compensation Scheme.

The provider and insurers should negotiate an appropriate fee before the start of treatment, more information is available in the Workers Compensation Claims Management Guide.

Invoices

You must provide itemised invoices to the worker's insurer before payment can be made.

Invoices must include:

• patient’s full name and claim number
• payee name, address, telephone number and email address
• payee ABN
• name of the relevant service provider
• provider’s SIRA approval number (where applicable) and AHPRA number/professional association accreditation/membership number
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fees List item number (where applicable)
• service cost for each SIRA payment classification code or AMA Fees List item number and service duration (where applicable)
• date of service
• date of invoice, which must fall on the day of or after the last date of the service listed on the invoice

Invoices must be submitted within 30 calendar days of the service being provided.

Interstate workplace rehabilitation providers must also meet these requirements. If you are an approved provider in your home jurisdiction or under Comcare, you may manage a one-off case under the NSW Workers Compensation Scheme with insurer confirmation, without full application approval. In these circumstances, use payment classification code 999 on your invoice to the insurer.