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What Does Workers Comp Psychology Cost in NSW?

For most eligible workers, nothing at the point of service. Here is how it actually works — and the situations where costs may still arise.

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.

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:

1. 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.

2. 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.

3. 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.

4. 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.

What Are the SIRA Gazetted Rates for Psychology?

SIRA publishes a fee schedule (Workers Compensation Guidelines for Allied Health) that sets the maximum billable rate for each item. For psychology, the relevant item codes for individual sessions (50 minutes) are:

Exact dollar amounts are set in the Workers Compensation (Medical Practitioner Fees) Order, updated periodically. Check the current schedule at sira.nsw.gov.au. Telehealth rates (PSY301/PSY302) carry the same gazetted rate as in-person equivalents.

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

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.