ACC Cover for Medical Treatment

What Treatment Does ACC Cover?

Once your ACC claim is accepted, ACC covers the cost of treatment that is necessary and appropriate for your covered injury. This includes a wide range of medical services.

GP Visits

If you have an accepted ACC claim, the cost of GP visits related to that injury is covered by ACC. You should tell the receptionist the visit is an ACC visit — your GP is not allowed to charge you for the consultation or treatment for the covered ACC injury.

Physiotherapy and Chiropractic

ACC funds up to a certain number of physiotherapy or chiropractic sessions for acute injuries. Typically, ACC will fund the first few visits without needing prior approval (under the "Treatment Profile" system). Your physio or chiropractor can lodge the claim directly.

• For many acute injuries (e.g., sprains, strains): up to 6 sessions funded without prior approval.
• Beyond that: your practitioner needs to request approval from ACC for further sessions.

Surgery and Hospital Treatment

If you need surgery for your covered injury, ACC covers the full cost — including surgeon fees, anaesthetist fees, hospital stay, and follow-up care. This applies to both public and private hospitals (subject to ACC's approval).

ACC has an Elective Surgery programme: if you need surgery and would otherwise wait in the public system, ACC may fund it in a private hospital to reduce wait times.

Specialist Consultations

If your GP refers you to a specialist (e.g., orthopaedic surgeon, neurologist, pain specialist), ACC covers the cost of the consultation if it relates to your covered injury. The specialist needs to be registered with ACC to claim directly.

Diagnostic Tests

ACC covers the cost of diagnostic imaging and tests related to your injury, including X-rays, CT scans, MRI scans, and blood tests, when deemed clinically necessary.

Prescription Medications

Prescriptions related to your ACC injury are covered at the standard New Zealand prescription charge ($5 per item as of 2025). In some cases, if a medication is not fully funded by Pharmac, ACC may cover the full cost if it is necessary for your injury.

What is NOT Covered?

ACC covers treatment directly related to the covered injury only. It does not cover:

• Treatment for unrelated medical conditions
• Preventive care
• Treatment that is not deemed "necessary and appropriate" for the injury
• Experimental or unproven treatments (without specific approval)

How the Treatment Profile System Works

For many acute injuries — sprains, strains, simple fractures — ACC operates a Treatment Profile system that lets health providers deliver a defined package of care without case-by-case approval. Typically this covers the first few physiotherapy or chiropractic sessions (commonly up to 6), the initial GP visits, and diagnostic tests, all billed directly to ACC. Once the profile is exhausted, your provider requests approval for further treatment, supported by clinical notes. The system exists to make the first weeks of care frictionless; the approval step afterwards is where ACC reviews whether ongoing treatment is "necessary and appropriate" for the covered injury. If further sessions are declined, ask your provider to appeal with more clinical detail — a well-documented request is very often approved.

Avoiding Surprise Bills

• Tell every provider it is an ACC visit — GP receptionists, physios, radiology clinics, and specialists need your claim number.
• Confirm the injury is covered first — treatment for an injury ACC has not accepted (or for an unrelated condition) is your own cost.
• Ask before you book — private surgery, specialist consultations, and ongoing physio should be confirmed as ACC-funded before you commit.
• Know the co-payments: prescription items carry the standard $5 charge, and some providers charge for services outside ACC's schedule — clarify these upfront.
• Hospital care: public hospital treatment for covered injuries is free; ACC can also fund private surgery (its elective surgery programme) when public waits are long.

What to Do If Treatment Is Declined

If ACC declines to fund a treatment you and your clinician believe is necessary, you have options. First, ask the clinician to request a clinical review — ACC's clinical advisors reconsider decisions where new evidence is provided. Second, apply for a formal review within 3 months of the decision; the reviewer can consider whether the treatment is necessary and appropriate under the Accident Compensation Act 2001. Third, for disputes about the quality of treatment received, the Health and Disability Commissioner is the right channel. Keep every letter, prescription and clinical note — treatment disputes are won on paper trails.

What Treatment Costs You in 2026

ACC pays your treatment provider directly, but "covered" does not always mean "free at the counter":

• GP visits may still carry a practice fee even for an ACC consultation, depending on the practice and whether the visit relates to the covered injury. Enrolled adults typically pay around $45–$75 for a standard non-ACC consult; ACC-funded injury consults are usually lower or free.
• Prescriptions carry a $5 co-payment per subsidised item — free for under-14s, over-65s and Community Services Card holders, and free after 20 new items in a year.
• Physiotherapy, chiropractic, and specialist consults should be billed to ACC under the treatment profile, with any surcharge disclosed to you before treatment.
• Surgery and hospital treatment for a covered injury is funded through ACC, including the follow-up rehabilitation.

How the Treatment Profile Controls What You Get

ACC does not approve physiotherapy "indefinitely". Each injury type has an expected treatment pathway — roughly how many weeks of treatment and how many consultations are reasonable — and that pathway is what your provider bills against. Two practical consequences follow. First, if you are nearing the end of the profile and still improving, your provider should request an extension before the last approved session, not after. Second, if a provider says ACC has declined further treatment, ask to see the decision in writing, because a decision communicated verbally cannot be reviewed — and the review clock only starts when you have it in writing.

When Treatment Is Declined or Ends Early

The fastest route to a fix is almost always your treating provider, not ACC's phone line. Longer-term, look at the pathway issues ACC scrutinises hardest:

• Does the file document ongoing functional limitation? If your notes only say "improving", the profile will close on schedule.
• Has a specialist weighed in? A specialist review frequently reopens a stalled treatment pathway.
• Is the request specific? "Six more weeks of physio to restore overhead range for [job task]" is fundable; "more physio" is not.

You can request an independent review of a treatment decision within three months, and treatment decisions are among the more commonly overturned ones when the clinical evidence supports it.