Paying for patient treatment

If you’re treating a patient for an injury we cover, we’ll contribute to the cost of treatment. Find out what treatment services we’ll pay for and how much.

On this page

    When we’ll pay for your services

    We'll pay you for treating a patient’s injury as long as it’s:

    • the most suitable option for their condition
    • of acceptable quality
    • given at the right time and place, with only the necessary number of treatments needed
    • given by a provider with appropriate qualifications and a current annual practicing certificate
    • clearly documented
    • pre-approved by us (if needed).

    When we decide what we’ll pay for, we also look at:

    • the type of injury and its severity
    • if it's a generally accepted form of treatment in New Zealand
    • other options available in New Zealand to treat the injury
    • the cost and benefit to the client of each treatment option.

    If we need more information about the injury or treatment

    We may ask you for more information before we can pay you for your services, eg your clinical records.

    How we’ll pay for your services

    You can work with us in three different ways. How and how much we’ll pay for your services depends on how you work with us.

    If you work under the Cost of Treatment Regulations

    The Cost of Treatment Regulations set out:

    • who we'll pay
    • how much we'll contribute to the cost of treatment
    • the types of treatment we'll pay for.

    Liability to Pay or Contribute to Cost of Treatment Regulations 2003

    We’ve developed a set of expectations and responsibilities to make sure we work together to provide our clients with treatment that helps them to return to work and everyday life as safely and quickly as possible.

    Working together - A handbook for providers working under the Cost of Treatment Regulations

    If you work under contract

    Your contract will set out the:

    • service we're purchasing
    • amount we'll pay for the service.
    • how to invoice us electronically

    If we ask for your services by purchase order

    We may ask you to provide a service that's not included in Regulations or a contract. In this case, we'll send you a purchase order that includes the:

    • purchase order number
    • type of service and the service item code
    • date range we’ll need the service
    • amount of the service we need.

    How much we’ll pay under the Cost of Treatment Regulations

    How much we can pay towards your treatment services depends on:

    • the type of services you provide
    • if it includes procedures 
    • the type of provider you are.

    General practitioners, nurses and nurse practitioners

    If you're a general practitioner, nurse or nurse practitioner, we can contribute to two parts of your treatment services:

    1. A consultation rate – including joint consultations 

    We pay a higher rate for clients under 14 years to compensate you for providing them with free visits.

    Sometimes both a nurse and a general or nurse practitioner treat a patient during the same visit. If they make relevant patient notes, we'll contribute to both of these through a joint consultation rate.

    2. Specific treatments or procedures a patient might get during a visit

    We'll only contribute to the cost of the treatment or procedures set out in the Regulations.

    For services from 1 December 2018, use these rates:

    ACC1520 General practitioners', nurse practitioners' and nurses' costs

    Medical specialists

    If you're a medical practitioner who practices in one or more of the recognised branches of medicine, we'll pay the amount set out in the Regulations.

    For services from 1 December 2018, use these rates:

    ACC1519 Registered specialist costs

    Specified treatment providers

    Specified treatment providers include:

    • acupuncturists
    • chiropractors
    • occupational therapists
    • osteopaths
    • physiotherapists
    • podiatrists
    • speech-language therapists.

    As a specified treatment provider, you can choose to be paid per hour or per treatment.

    For services from 1 December 2018, use these rates:

    ACC1523 Specified treatment provider costs

    Paid per hour

    If you're invoicing us for per hour of treatment, we'll pay for the time you spend face to face with the client.

    You can't invoice us for more than 60 minutes in any hour that you are treating our clients. For example, if you see three patients in an hour and spend 20 minutes with each client, we expect to see invoicing for three clients at 20 minutes each.

    Paid per treatment

    This is a fixed rate per treatment. If you're treating a patient with more than one injury, you can't combine the number of treatments of the different injuries.

    If the client needs more treatment for those injuries, you'll need to get pre-approval from us first.

    Getting pre-approval for patient treatment

    ACC generally only pays for one treatment from one specified treatment provider per client per day. We may pay for more than one treatment from a specified treatment provider(s) per client, per day if this meets our legislative requirements and is also clinically justified.

    Multiple same day treatment position statement


    If you're a counsellor, or a counsellor who's a medical practitioner, we'll pay you a fixed hourly rate set out in the Regulations.

    For services from 1 December 2018, use these rates: 

    CTRIS02 Counsellor costs


    If you're a radiologist, we'll pay at a fixed rate for imaging services and treatments or procedures. How much we pay is set out in the Regulations.

    High-tech imaging services are only paid under contract.

    For services from 1 December 2018, use these rates:

    ACC1521 Radiologists' costs


    If you provide dental services, we can pay for a client's consultation and treatment. How much we pay is set out in the Regulations.

    Paying for your treatment

    For services from 1 December 2018, use these rates:

    ACC1522 Dentist costs

    How we'll pay pharmaceutical costs

    We pay for prescribed medications: 

    • by contract - if the contract includes providing medications, patients shouldn’t be charged any costs for prescribed pharmaceuticals
    • via Public Health Acute Services (PHAS) bulk payment that we pay to the Crown. This covers pharmaceuticals that are:
      • required by clients during acute hospital admissions or emergency department visits 
      • given as part of the treatment associated with clients’ outpatient follow-ups for up to six weeks from discharge or treatment
      • used during treatment given by medical practitioners less than seven days after referrals by other medical practitioners 
      • listed on the Pharmaceutical Schedule, meet its subsidy criteria and are used in the community.

    If prior-approved, we reimburse clients or pay pharmacies:

    • for co-payments on community pharmaceuticals
    • a contribution towards part-charges for partly subsidised pharmaceuticals or pharmaceuticals that aren’t on the Pharmaceutical Schedule.

    When assessing funding requests, we’ll look at:

    • best practice prescribing protocols
    • rehabilitation pathways
    • generic alternatives listed in the Pharmaceutical Schedule
    • the approved use of the medicine in New Zealand.

    If there isn’t enough information to support the request, we may ask you for more information. 

    Pharmaceutical Schedule

    Pharmaceutical costs we don't cover

    We don’t cover:

    • any administration charges added by you or the dispensing pharmacy
    • the cost of substances not considered pharmaceuticals, such as herbal remedies and complementary medications. 

    When to seek prior approval for pharmaceuticals

    If your patient needs long-term pharmaceuticals or non-subsidised pharmaceuticals not already covered by the PHAS time period or under another contract, you’ll need to seek funding approval from us by completing the ACC1171 Request for pharmaceutical funding form before prescribing the medicine. This will help to tell us why the pharmaceutical is needed for injury management.

    ACC1171 Request for pharmaceutical funding

    Medicines Regulations 1984 (PDF 877KB)

    Misuse of Drugs Act 1975

    How we fund providers in training

    We only pay for treatment given by qualified providers.

    If you’re a provider in training, eg an intern or a university or polytechnic student undertaking practical work for study, we can offer to fund you if you're:

    • already a qualified practitioner undertaking further study
    • unqualified but have gained consent from the patient and are supervised by a qualified practitioner who:
      • is present throughout the treatment delivery
      • takes responsibility for assuring treatment is up to standard.

    Contact us

    If you have a problem with your invoicing or we haven’t paid you, contact us.

    Phone 0800 222 070 (Monday to Friday 8:30am – 5pm)

    Last reviewed: 8 November 2018