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Workers Comp Psychology Cost NSW: Is It Free?
Short answer: For approved workers compensation claims, psychology sessions cost $0 out-of-pocket. The insurer (icare or self-insurer) pays the psychologist directly at the 2026 SIRA gazetted rate: $284.40 for the initial 60-minute consultation (PSY301 telehealth / PSY001 in-person) and $237.60 for each subsequent 60-minute consultation (PSY302 telehealth / PSY002 in-person), effective 1 February 2026. There is no gap fee, no upfront payment, and no invoice to the worker for approved sessions.
For most eligible workers, nothing at the point of service. Here is how it actually works - and the situations where costs may still arise.
The key difference from Medicare: Under Medicare Better Access, you pay the psychologist's full fee and then claim a partial rebate back. Under NSW workers compensation, icare (or your insurer) pays the psychologist directly at a rate set by SIRA. If your claim is approved and your psychologist bills SIRA, you pay no gap fee at the appointment.
Legal notice: This guide covers general information about the NSW workers compensation framework. It is not legal or financial advice. Fee schedules and rules change. Always verify current rates at sira.nsw.gov.au and confirm billing arrangements with your psychologist before starting treatment.
Which situation are you in?
The cost you pay depends on your claim status. Find your situation below.
| Your situation | What you pay | How it works |
|---|---|---|
| Approved claim, active weekly payments | $0 out-of-pocket | Your insurer (icare or self-insurer) pays your SIRA-approved psychologist directly at the gazetted rate. You attend and pay nothing. See How billing works. |
| Claim lodged, not yet approved or disputed | Possibly self-fund short-term | While the claim is pending, you may need to use Medicare or pay privately and seek reimbursement later. See Pending or disputed claims. |
| No claim yet -- deciding whether to claim | Depends on your choice | If you have a work-related psychological injury, SIRA-funded treatment costs $0 gap. Medicare involves a partial rebate and you pay the gap. See SIRA vs Medicare. |
| Claim ending (approaching 130-week weekly payment cap) | $0 during treatment access period | After weekly payments end, you retain up to 1 year of funded medical treatment (including psychology). After that, Medicare applies. See After the claim. |
| Self-insured employer (not icare) | $0 out-of-pocket | Major employers (transport, banks, some government) self-insure under WorkCover. SIRA gazetted rates still apply; your psychologist bills the employer's insurer directly. Process is the same. |
These are general descriptions. Your specific entitlements depend on your claim status, injury type, and insurer. Ask your treating GP or a workers compensation lawyer if you are unsure.
How Workers Comp Psychology Billing Works
When you see a psychologist for a work-related psychological injury in NSW, the billing pathway under workers compensation is different from private health or Medicare:
- You obtain a GP referral and workers comp certificate of capacity
Your treating GP issues a certificate of capacity (the workers comp equivalent of a sick certificate) and a referral to psychology. This is separate from a Medicare Mental Health Treatment Plan - it is a workers comp document.
- You contact a SIRA-approved psychologist
The psychologist must hold a current SIRA provider number to bill your insurer (icare or GIO/TMF for public sector workers). Only a SIRA-approved provider can access the gazetted fee schedule. Verify SIRA status at sira.nsw.gov.au.
- First session proceeds (provisional liability applies)
Under provisional liability, the insurer covers reasonable treatment costs from early in the claim - before the claim is formally approved. The psychologist sees you for an initial assessment and then submits an Allied Health Treatment Request (AHTR) to your insurer for ongoing sessions.
- Psychologist bills icare directly at the gazetted rate
Once the AHTR is approved, the psychologist invoices icare (or GIO/TMF) directly at the SIRA-set gazetted rate. You are not invoiced. There is no Medicare-style claim to lodge. You simply attend your session.
SIRA Psychology Fees 2026: The Exact Gazetted Rates
SIRA publishes a fee schedule (Workers Compensation Guidelines for Allied Health) that sets the maximum billable rate insurers pay for each psychology item. The current SIRA psychology fees 2026 schedule, effective 1 February 2026 following a 4.57% indexation increase, are:
| Session type | Item code | SIRA gazetted rate (2026) |
|---|---|---|
| Initial consultation, in-person, 60 min | PSY001 | $284.40 |
| Initial consultation, telehealth, 60 min | PSY301 | $284.40 |
| Subsequent consultation, in-person, 60 min | PSY002 | $237.60 |
| Subsequent consultation, telehealth, 60 min | PSY302 | $237.60 |
These rates (sometimes searched as "WorkCover psychology fees 2026" -- WorkCover is the scheme's former name, still used colloquially for what is now the NSW workers compensation/SIRA/icare system) are set in the Workers Compensation (Medical Practitioner Fees) Order and updated periodically via indexation. Telehealth items (PSY301/PSY302) carry the same gazetted rate as their in-person equivalents (PSY001/PSY002) -- the distinction between item codes is delivery mode and initial-vs-subsequent, not a different price. Check the current schedule at sira.nsw.gov.au.
Can a psychologist charge above the gazetted rate? No - SIRA-approved providers must bill at or below the gazetted rate for workers comp sessions. If a psychologist tries to charge you a gap on top of the gazetted rate for a workers comp session, ask them to confirm their SIRA billing status and your insurer's specific agreement. Some insurers have direct agreements with provider networks; the terms vary.
When Might Costs Still Arise?
Most eligible workers pay nothing out-of-pocket for psychology under workers comp. However, there are situations where costs can arise:
- Your claim is disputed or denied: If liability is not accepted, the insurer is not obligated to fund treatment. You would be responsible for session costs during any dispute period. Legal advice from a workers comp solicitor (many offer free initial consultations) is strongly advisable if your claim is disputed.
- The psychologist is not SIRA-approved: If you see a psychologist who does not hold a SIRA provider number, they cannot bill icare/SIRA directly. You would pay privately and may not be able to claim the cost back. Always verify SIRA status before booking.
- You use Medicare instead of workers comp: If you attend a psychologist under a Medicare Mental Health Treatment Plan while a valid workers comp claim is active for the same injury, this is incorrect billing. Use workers comp - it typically provides more sessions without a cap and with no gap.
- Sessions beyond the AHTR-approved number: Each AHTR approval covers a set number of sessions. If you have used your approved sessions and your psychologist has not yet submitted a renewal AHTR, there may be a gap period. Your psychologist manages this process; ask them to flag upcoming renewal timing.
Workers Comp Psychology vs Medicare: Cost Comparison
| Feature | Workers comp (SIRA/icare) | Medicare Better Access |
|---|---|---|
| Who pays the psychologist? | icare/GIO pays directly | You pay, then claim rebate |
| Your out-of-pocket (if eligible) | $0 gap (usually) | $50–$165 per session (typical) |
| Session limit per year | No fixed cap - AHTR-based | 10 sessions per calendar year |
| GP referral needed? | Yes (certificate of capacity) | Yes (MHTP) |
| Telehealth covered? | Yes (same rate) | Yes (same rebate) |
This comparison applies to NSW workers with a valid psychological injury claim under the icare/SIRA scheme. Public sector workers may be under a different scheme (GIO/TMF). Always confirm your scheme before starting treatment.
Public Sector Workers: icare vs GIO/TMF
Not all NSW workers are covered by icare. NSW public sector workers (including teachers at NSW public schools, nurses in NSW Health, and other government departments) are covered under a different arrangement:
- NSW public schools teachers and some education workers: GIO scheme (administered by SIRA but separate from icare)
- NSW Health workers: NSW Health Treasury Managed Fund (TMF) - not icare
- Police (NSW Police Force): Separate PIEF arrangement
- Private sector and most other workers: icare
The billing process and fee schedule may differ slightly between these schemes. Your employer's HR/WHS team can confirm which scheme applies to you.
No Fixed Cap on Sessions
One of the most significant practical differences between workers comp and Medicare is the session limit. Medicare covers up to 10 individual psychology sessions per calendar year. Workers compensation has no equivalent hard cap. Instead, your treating psychologist submits treatment requests (AHTRs) to your insurer, which are approved based on clinical need and recovery progress. Sessions continue as long as treatment is clinically appropriate and approved.
This matters for complex presentations (severe PTSD, complex trauma, high-symptom chronic anxiety) where 10 sessions are not always sufficient for functional recovery. Workers comp can fund substantially more sessions if the clinical case supports it.
Cost Questions
Do I pay anything out-of-pocket for psychology under workers comp in NSW?
For eligible workers with an approved Recovery Plan and a SIRA-approved psychologist, there is no gap fee. The psychologist bills icare (or GIO/TMF for some public sector workers) directly at the SIRA gazetted rate. You pay nothing at the point of service. If the psychologist charges above the gazetted rate, some agreements include a worker co-payment - ask your psychologist before starting.
What are the SIRA psychology fees 2026 rates?
The SIRA psychology fees 2026 schedule, effective from 1 February 2026, sets the gazetted rate at $284.40 for the initial 60-minute consultation (PSY001 in-person / PSY301 telehealth) and $237.60 for each subsequent 60-minute consultation (PSY002 in-person / PSY302 telehealth) -- a 4.57% indexation increase on the 2025 rates. The item code distinction is initial-vs-subsequent and in-person-vs-telehealth, not psychologist credential level; telehealth carries the same rate as in-person. These are set in the Workers Compensation (Medical Practitioner Fees) Order. Check the current schedule at sira.nsw.gov.au.
Is workers comp psychology different from Medicare for cost?
Yes. Under Medicare Better Access, you pay the psychologist's fee and claim a rebate back - leaving an out-of-pocket gap ($50–$165 per session typically). Under workers compensation, icare or GIO pays the psychologist directly at the gazetted SIRA rate. If your claim is approved and your psychologist accepts SIRA billing, you have no upfront cost and no gap to claim back.
What if my claim is not approved yet - do I have to pay upfront?
The first session can generally proceed before formal treatment request approval, as provisional liability covers early treatment. Your psychologist submits the funding request (AHTR) after that first assessment. Check with your psychologist, as practices vary. If your claim is disputed and liability is denied, you would be responsible for session costs during any dispute period.
Can I use Medicare instead of workers comp for psychology?
No. If you have a valid workers compensation claim, the insurer is the primary payer and Medicare does not apply to the same injury. Using Medicare when a workers comp claim is active would be incorrect billing. If your workers comp claim is rejected or not yet made, you can access psychology under Medicare while you determine next steps.
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