⚠️ Important: Workers' compensation and CTP schemes are state-based — fees, forms, and rules differ. This page covers general principles that apply nationally. For specific rules, use the state links below.
🏗️ WorkCover (Workers' Compensation)
General principles — billing
1.Work injury → bill WorkCover, not Medicare. WorkCover is the primary payer for accepted compensable injuries.2.Same visit, two issues? You can bill WorkCover for the work injury and Medicare for an unrelated condition. Keep separate clinical notes for each.3.Claim not yet accepted? The patient may need to pay upfront or bill Medicare initially. Once accepted, WorkCover takes over. Medicare may recover benefits paid for the compensable injury.4.Claim denied? Bill Medicare as normal. No recovery by Medicare if the claim is denied.5.Same condition, same service → only one payer. You cannot bill both WorkCover and Medicare for the same service on the same condition. That's double-dipping.
Fees and item numbers
Most state schemes use MBS item numbers but have their own fee schedule (often based on AMA rates, which are higher than MBS). Check your state's Table of Costs. WorkCover typically pays more than Medicare for the same item.
WorkCover may also pay for supplementary services not in the MBS — certificates, reports, case conferences, workplace visits. These have separate item codes specific to each state scheme.
What you need to do
📋Issue a Work Capacity Certificate (or equivalent for your state) at the first visit📝Document the injury clearly — mechanism, diagnosis, work restrictions, treatment plan📞Communicate with the insurer and employer about return-to-work capacity🧾Include claim number, date of injury, and worker's name on every invoice
🚗 CTP (Motor Vehicle Accident / Compulsory Third Party)
General principles — billing
1.CTP covers injury costs for people hurt in motor vehicle accidents. Coverage depends on fault rules in your state.2.Medicare is often used initially. Unlike WorkCover, many GPs bill Medicare for MVA consultations while the CTP claim is being lodged and assessed. The CTP insurer reimburses or pays directly once the claim is accepted.3.Settlement >$5,000 → Medicare recovers. Under the Health and Other Services (Compensation) Act 1995, if a CTP claim settles for more than $5,000, Medicare will recover benefits it paid for the compensable injury.4.Complete the CTP medical certificate early. Each state has its own form. In QLD it's the MAIC CTP Medical Certificate (PDF).5.Bill using standard MBS items (23, 36, 44) for consultations. Some states have additional supplementary item codes for reports and certificates.
⚠️ CTP varies more by state than WorkCover
QLD is fault-based (only the not-at-fault party can claim). NSW is no-fault (everyone gets 12 months treatment). VIC has TAC which is included in rego. Always check your state scheme for the specific rules on who can claim, how to bill, and what forms to use.
Under the Health and Other Services (Compensation) Act 1995, when a patient receives compensation for an injury (WorkCover or CTP), Medicare can recover any benefits it paid for treatment related to that injury.
This applies when a claim settles for more than $5,000. The insurer is required to notify Services Australia, and Medicare recovers from the compensation payout — not from the GP.
As a GP, you don't need to manage this process. Bill the appropriate payer (WorkCover, CTP, or Medicare) correctly at the time of service. The recovery happens between the insurer, Medicare, and the patient.