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Is There a Gap Fee for Psychology Under NSW Workers Compensation?

For insurer-approved sessions, no: you typically pay nothing out of pocket. Here is exactly how it works.

How Payment Works Under Workers Compensation

NSW workers compensation psychology works differently from Medicare-funded psychology. Under Medicare, you typically pay the psychologist's fee upfront and receive a partial rebate back from Medicare, leaving you with a gap to pay. Under workers compensation, the payment structure is:

1. Your insurer (icare or a self-insurer) approves a treatment request (AHTR: Allied Health Treatment Request)
2. Your psychologist bills the insurer directly at the SIRA gazetted rate
3. The insurer pays the psychologist
4. You, as the worker, pay nothing for approved sessions

The SIRA gazetted rates (effective February 2026) are the maximum rates insurers are required to pay for psychology services. Psychologists who treat workers compensation clients bill at these rates and cannot charge workers an additional amount on top for approved sessions.

When You Might Have a Cost

There are situations where a cost may apply:

• Before approval is confirmed: if you attend psychology appointments before your insurer has formally approved the treatment request, you may be liable for the full session fee. Always confirm approval is in place before your first appointment.
• Disputed or denied claims: if your workers compensation claim is disputed or rejected, insurer funding does not apply. In that situation, you would need to either use Medicare (if eligible) or pay privately.
• Sessions beyond the approved number: if your psychologist requests additional sessions and the insurer has not yet approved them, those sessions may not yet be funded. Your psychologist should handle the treatment request process, but it is worth knowing where your current approval stands.
• Treating under a different funding pathway: if for any reason you are seeing the psychologist outside the workers compensation pathway (for example, separately through Medicare), those sessions would have the usual Medicare gap fee.

What to Ask Your Insurer

Before your first psychology appointment under workers compensation, confirm with your insurer or case manager:

• Is the treatment request (AHTR) approved?
• How many sessions have been approved?
• Which psychologist (or which practice) is approved, or is approval open to any SIRA-registered psychologist?
• Is telehealth approved (if that is your preferred format)?

If you have a case manager through icare, they should be able to confirm this directly. Keep a record of approval confirmation in writing.

How Workers Comp Compares to Medicare on Costs

Feature	Workers Comp (icare/SIRA)	Medicare (Better Access)
Out-of-pocket cost	Typically nil (approved claims)	Gap fee applies (rebate is partial)
How you are billed	Insurer pays psychologist directly	You pay; Medicare rebates you
Session limit	Determined by insurer based on treatment needs	Up to 10 sessions per calendar year
Referral type	GP workers comp certificate + AHTR	GP Mental Health Treatment Plan
Eligibility	Accepted workers comp claim	Medicare eligibility; any qualifying condition