Summarises the most commonly used medical codes and fees for general practitioners working in the workers compensation system.
This summarises the most commonly used codes by general practitioners (GPs). Medical practitioners treating workers compensation patients should refer to the 2017 Workers Compensation (Medical Practitioner Fees) Order for further information.
A PDF of this information is available.
|Payment classification code||Type of service||Fee||Service description|
Level A consultation
Australian Medical Association (AMA) codes must be used for all consultations and medical treatment services.
The rate for consultation fees applies to services provided on or after 1 January 2017. GST should not be charged on the consultation fee.
For further information on the criteria for Level A, B, C and D consultation services, please refer to the AMA List of Medical Services and Fees (1 November 2016).
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.
Level B consultation
Level C consultation
Level D consultation
Certificate of capacity
$45.40 (plus GST)
Initial certificate of capacity only.
One certification fee may be charged for the initial certificate only.
No fee is payable for subsequent certificates.
To order certificates of capacity call us on 13 10 50.
Maximum hourly rate payable to GP
$23.20 per 5 minutes
This fee remunerates any time spent by the medical practitioner (in addition to usual medical management) to assist the worker to recover at/return to work.
These rates may cover discussions with employers, case conferencing (see definition over), visits to worksites, time spent reviewing injury management or return to work plans, and providing additional reports (where report was requested and pre-approved by the insurer).
Invoices should reflect the time taken (to the nearest five minutes).
$23.20 per 5 minutes (plus GST)
$278.40 per hour (plus GST)
A case conference is a face-to-face meeting, video conference or teleconference with any or all of the following parties – the worker, employer, workplace rehabilitation provider, insurer or other treatment practitioner(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. If discussion is with the worker, it must involve a third party in order to be considered a case conference.
Discussions between the nominated treating doctor and other treating practitioners (eg allied health practitioners, medical specialists or surgeons) regarding treatment are considered a normal interaction between the referring doctor and practitioner. This is not to be charged as a case conference.
Other medical items
The cost of all bandages and dressings etc.
Payments for pharmaceutical services.
$38 (for 33 pages or less).
An additional $1.40 per page if more than 33 pages (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 $38 applies.
Download a PDF version of the 2017 rates for general practitioners.