Do you need a GP referral to see a physio in NSW?

The short answer

No. In NSW you do not need a GP referral to see a physiotherapist. Physiotherapists are university trained, AHPRA registered practitioners you can book directly, and that includes workers compensation and CTP claims, where the myth that you must see a doctor first still delays treatment. You can book in, be assessed, get a diagnosis and start treatment without a referral of any kind.

There are two common exceptions, and both are about funding rather than permission. Medicare Chronic Disease Management plans are arranged by your GP, and DVA Veteran Card treatment needs a current GP referral. For everything else, private, extras, workers comp and CTP, you book directly.

• Private patients: no referral, ever
• Workers comp NSW: no referral under SIRA rules
• CTP motor accident claims: no referral
• Medicare CDM plans: GP referral required
• DVA Veteran Card: current GP referral required

Private patients: no referral, ever

If you are paying privately or claiming through private health extras, there is no referral step at all. You book, you come in, we assess and treat. Nothing about a private physiotherapy appointment requires a doctor to sign off first, and health funds do not generally require a referral to pay extras benefits on physiotherapy.

Our fees are straightforward: $165 for a 60 minute initial consultation and $142 for a 40 minute follow up. With extras cover that includes physiotherapy, most people end up $60 to $100 out of pocket for an initial visit and $40 to $80 for a follow up, and where available we process the claim on the spot.

Booking directly does not mean going it alone. If your assessment turns up something that needs your GP, imaging or a surgical opinion, we say so and refer you on. That is how first contact care is supposed to work: treatment starts sooner, and the right doctor still gets involved when they are needed.

Workers comp: the myth that delays recovery

This is where the referral myth does the most damage. Injured workers routinely hold off on physio while they wait for a GP appointment, believing they cannot start treatment without a referral. Under SIRA rules, which govern workers compensation in NSW, you can see a physiotherapist without a GP referral. Treatment on a claim is approved when it is reasonably necessary for your injury, not when a referral letter says so.

You do still need a doctor for the claim itself. Your nominated treating doctor completes the Certificate of Capacity, the medical certificate that describes your injury and your capacity for work, and it is how your doctor communicates with the insurer. But that is a claim document, not a physio referral, and your physiotherapy does not have to wait for it.

On an accepted claim we can usually begin without waiting for further approval. Where your injury has not been treated by a physiotherapist before and treatment begins within three months of your injury, SIRA allows up to eight sessions before any further approval is needed. That number is not universal and depends on your situation, so we confirm your exact arrangement with your insurer or case manager before we begin. If you need treatment beyond the pre approved sessions, we lodge the Allied Health Treatment Request for you, and reasonably necessary treatment is billed directly to your insurer with nothing for you to pay.

One more right worth knowing: the choice of physiotherapist belongs to you. Your employer or insurer can suggest a clinic, but it is only a suggestion, and you can change physios at any point in your claim. The only requirement is that your physio is SIRA approved so the insurer can be billed directly.

• No GP referral needed for physio on a claim
• Up to 8 pre approved sessions on eligible claims, confirmed with your insurer
• You choose your physiotherapist, not your employer or insurer
• Accepted claims billed direct, nothing to pay at any visit

CTP: injured in a motor accident

The same principle applies if your injury came from a car or motorbike accident rather than work. You do not need a GP referral to book a physiotherapist on a CTP claim, and on an accepted claim your treatment is billed directly to the insurer, so there is nothing for you to pay at your appointment.

Bring your claim number and the insurer name and we handle the rest, confirming your arrangement with the insurer before treatment begins. We work with the CTP insurers including NRMA, QBE, GIO and Allianz. If you are unsure whether your injury sits under CTP or workers compensation, get in touch and we will help you work it out.

The two pathways where a referral genuinely matters

Medicare Chronic Disease Management plans, sometimes called care plans, are the main one. If you have an ongoing condition, your GP can arrange a CDM plan that includes a set number of subsidised allied health visits each calendar year, which can be used for physiotherapy. Your GP decides whether you are eligible and how many visits to allocate, so this pathway starts in their consulting room, not ours. Bring the referral and plan to your appointment and Medicare pays a rebate toward each eligible visit. At PACT, after the $61.80 rebate you pay $103.20 for an initial visit and $80.20 for a follow up.

DVA Veteran Card holders are the other. If you hold a Gold or White card we can treat eligible conditions billed directly to DVA with no gap, and that arrangement requires a current referral from your GP. Bring your card and referral to your first appointment.

Notice what these two have in common: the referral is the funding document that unlocks a Medicare or DVA subsidy. It is never a permission slip you need before a physiotherapist is allowed to treat you.

How to start each pathway

Whichever pathway fits you, starting is simple, and if you are not sure which one applies, call us and we will work it out with you in two minutes.

We see patients at the Miranda clinic seven days a week, serving the Sutherland Shire and southern Sydney, and by telehealth Australia wide through PACT Virtual Care. Under workers compensation, telehealth has its own conditions and generally needs to be combined with in person care unless your insurer approves otherwise, so we confirm that case by case.

• Private or extras: just book
• Workers comp: claim number and insurer name
• CTP: claim number and insurer name
• Medicare: ask your GP about a CDM plan first
• DVA: Veteran Card and current GP referral