ACC and Physiotherapy in New Zealand: How It Works

ACC physiotherapy is physio for an injury caused by an accident in New Zealand, part-funded by the Accident Compensation Corporation (ACC). You can go straight to a physio without a GP referral, and the physio can lodge your ACC45 injury claim at the first visit. ACC pays part of the cost, the clinic can charge you the rest, and the clinic should tell you that charge before treatment starts. ACC covers injuries, not illness, conditions of ageing such as arthritis, or most problems that come on gradually.

Most of what follows is written for New Zealand physios and practice owners. Patients have their own section near the end. None of it is legal, contract or claims advice. ACC revises its schedules and web pages from time to time, so check the current version before relying on a detail here; each source's date is in the reference list.

What does ACC cover for physiotherapy?

ACC covers personal injury caused by an accident. Its "Injuries we cover" page says: "Our no-fault scheme covers everyone, including visitors, who are injured in an accident in Aotearoa New Zealand." The injuries it lists include sprains or strains, such as ankle, back, knee or shoulder sprains, as well as fractures, dislocations, wounds, burns, and concussion. Maternal birth injuries that happened on or after 1 October 2022 are covered too.

Cover goes beyond sport and falls at home. ACC can cover conditions that come on over time when they are caused by the type of work a person does, which it calls gradual process conditions. It can also cover a treatment injury, where treatment from a registered health professional directly caused a new injury that is not a normal side effect of that treatment. Physios see both. They cannot lodge every type of claim themselves, though, as the claims section explains.

ACC pays for treatment when it is the best option for the condition, a generally accepted treatment in New Zealand, and given by a registered and licensed provider in New Zealand. For physios, that means holding a current annual practising certificate. ACC's page on paying providers lists this as one of its conditions for paying, alongside treatment that is clearly documented and "given at the right time and place, with only the necessary number of treatments needed".

What ACC does not cover

ACC's page "Injuries we don't cover" is short and worth reading with patients who are unsure. Among other things, it says ACC does not cover:

Illness, sickness or contagious diseases.
Stress, hurt feelings or other emotional issues, unless they are linked to an injury ACC already covers.
Conditions related to ageing, such as arthritis.
Most hernias.
Injuries that happen over time, unless an activity at work is causing it.

The page also gives "unexplained back pain that gets worse over time" as an example of something ACC does not cover in most cases. That is a common conversation in a physio clinic. Someone with long-standing low back pain or knee osteoarthritis and no accident is unlikely to be covered, and should know what the clinic charges without ACC before the first session.

On the treatment side, ACC's "Treatment we can help pay for" page lists what it will not fund: treatment not related to the covered injury, treatment for pre-existing or underlying conditions not caused by that injury, treatment given outside New Zealand, and treatment from unregistered or unlicensed providers. Visitors are covered for injuries in New Zealand but not for treatment and rehabilitation once they are back home, so ACC tells them to buy travel insurance as well.

How is an ACC claim lodged at the physio?

Physiotherapists can lodge claims. ACC's provider page "Lodging a claim for a patient" lists the providers who can lodge an ACC45 Injury Claim form, and physiotherapists are on it, along with doctors, nurses, paramedics, osteopaths, chiropractors, podiatrists and hand therapists. Dentists use a different form, the ACC42. ACC suggests completing the forms with the patient at their first visit.

There are limits. Each provider type can only lodge claims for certain injuries, set by the Read codes that profession may use. Only medical practitioners can lodge gradual process claims for injuries caused by work. So a physio who suspects a work-related gradual process injury needs to send the patient to a doctor for the claim.

What the claim needs

ACC says that for cover "there must be both an injury and an accident, and the two must have a link." The Allied Health Services operational guidelines put the same idea in clinical terms. The patient must be able to identify an accident event, and the provider must be able to diagnose a personal injury and establish that the accident was the most likely cause.

On the ACC45 you record:

The specific injury, such as a sprain or a contusion, not just the symptoms.
The body site and the side, for example the left ankle.
How it happened, for example "fell off a bike".
The time and date of the accident.
The patient's details: full name, date of birth and postal address, with their National Health Index (NHI) number and mobile number where possible.

The patient, or someone authorised to act for them, must consent to you lodging the claim, and the consent must be recorded. ACC publishes the declaration and three questions to read out and note in the clinical record. The last one asks whether the patient authorises you, as their physiotherapist, to lodge the claim. The operational guidelines add that when you lodge a claim during a telehealth consultation, the consent conversation must be clearly recorded in the notes.

How to send it and what happens next

ACC says the best way to lodge a claim is through a practice management system or its online system, and paper forms are still available for clinics that cannot work electronically. Straightforward online claims are assessed automatically, and ACC says a decision can often be made on the same day. The patient may get a text message with the cover decision. Complex or manual claims take longer.

ACC's "Injuries we cover" page says claims can be made up to 12 months after the injury. ACC will still consider a claim lodged 12 months or more after the accident, but its provider page asks you to include any supporting clinical records and details of other providers who treated the patient.

If the patient was hurt at work, check whether their employer is an ACC Accredited Employer. Accredited Employers manage their own employees' work injury claims. You still complete the ACC45 as usual, but you send the forms and invoices to the employer or its third-party administrator, not to ACC. Sending them to ACC instead can delay both cover and your payment.

What will the patient pay?

ACC pays physios in two ways, and what the patient pays depends on which applies. ACC's operational guidelines say it buys allied health services through the Cost of Treatment Regulations and through the Allied Health Services contract. Under the regulations, ACC contributes an amount set in the regulations to the cost of treatment, and a physio can choose to be paid by time or per treatment. Under the contract, a supplier, such as a private practice owner or Health New Zealand Te Whatu Ora, agrees to the service schedule, and ACC pays the price set in that schedule for each service item.

ACC's patient page puts the regulations route simply: "If the injury is covered, we pay part of the health provider appointment fees. You'll need to pay the rest." Under the contract, clause 19.2 of the Allied Health Services Service Schedule says: "Physiotherapy and Podiatry Suppliers may set and charge a Client a co-payment for Services provided." Clause 19.3 adds that charges must be clearly displayed and the client made aware of them before receiving the services.

So the co-payment is set by each clinic. There is no single ACC physio fee for patients, and this guide does not quote one. The schedule also allows separate charges for materials used in treatment, such as strapping or orthoses (clause 19.7), and for travel to see the client (clause 19.8), again only if the client knows about the charge beforehand. Physiotherapy specialist services are the exception: clause 19 does not apply to them, and the schedule price is the whole amount, with nothing extra charged to the client (Part C, clauses 5.4 and 8.5).

The Physiotherapy Board of New Zealand expects the same openness whichever route you work under. Its informed consent standard says that if any fees are involved, the physiotherapist should make sure, through the informed consent process, that the patient has been told about them before treatment. The standard also cautions against prejudging whether a patient can afford a treatment.

For patients, ACC suggests asking the clinic three things: how much you will need to pay and whether it is due upfront, how much ACC will pay, and whether approval is needed before treatment. You can also pay the full cost yourself and ask ACC to pay you back its share.

What the Allied Health Services contract asks of each visit

The Allied Health Services Service Schedule covers physiotherapy, hand therapy and podiatry. The version on ACC's website on 28 September 2026 is dated 1 November 2026 and applies from that date, within a contract term that now runs from 1 November 2021 to 31 October 2027. The operational guidelines (1 November 2024, described as a living document) explain how to work under it. Clinics under the Cost of Treatment Regulations follow the regulations instead, but many of the clinical expectations below are good practice either way.

Who can be treated

Under Part B, clause 5.1.1, a client is entitled to services when they have a personal injury for which a claim has been accepted, or is likely in the provider's experience to be accepted. The same clause says the client will not be entitled to services if the claim is declined. Clause 5.3.1 allows three ways in: referral from a medical practitioner or treatment provider, referral from ACC, or self-referral by the client.

Treating before ACC has made its decision is the risky part for a clinic owner. You can start treating while cover is being decided, but once a claim is declined the contract gives no ACC funding. What follows is suggested practice, not a contract rule: at the first visit, tell the patient what your clinic will charge if the claim is declined, and note in the record that you did. That fits clause 19.3 and the Physiotherapy Board's expectation that patients hear about fees before treatment.

The first visit and follow-ups

The operational guidelines list what an initial assessment should include:

A documented treatment plan with the expected number of visits, the aims of treatment and their timeframes.
Baseline measurements using an evidence-based outcome measure.
Referral to other services where clinically needed, with ACC's prior approval when that is required.
Education on self-management of the injury and on injury prevention.
Clinical records that meet the standard of your professional body.

ACC expects only one initial consultation to be invoiced per claim per supplier. A second one can be invoiced after a significant change in function, such as surgery, or when the client comes back after more than a year without treatment. Each follow-up needs a clinical rationale that links the treatment directly to the covered injury, with outcomes recorded as you go.

Goals and outcome measures

The guidelines require individual, client-centred goals written in the SMART format: specific, measurable, achievable, relevant and time-bound. Worked examples are in the guide to SMART goals in physiotherapy. Outcome measures should be collected at the initial assessment, regularly during treatment and at discharge.

The examples ACC gives include the Lower Extremity Functional Scale, the Oswestry Disability Index, the Neck Disability Index, the Roland-Morris Disability Questionnaire and a global pain scale. For hand therapy, ACC prefers the DASH or QuickDASH. If you are unsure which suits a patient, see outcome measures in physiotherapy.

Treatment limits and prior approval (ACC32)

Every ACC claim has a point where further treatment needs ACC's prior approval, and the trigger depends on how you work with ACC. ACC's prior approval page gives these triggers:

	Cost of Treatment Regulations	Allied Health Services contract
Number of treatments	The treatment trigger number of 16 has been, or is about to be, reached	The treatment trigger number of 50 has been, or is about to be, reached
Time	It has been more than a year since an allied health provider first treated the patient	The operational guidelines say prior approval is not required at the 52-week post-injury milestone
Diagnosis	You are adding or changing a diagnosis	You are adding or changing a diagnosis

Clause 13.3 of the schedule is blunt about the cost of missing it: "ACC will not pay for treatment provided without prior approval beyond the applicable Treatment Limit." Requests go on the ACC32 form, which the operational guidelines say must be sent electronically, through ACC's online form or your practice management system.

ACC sorts requests into standard and non-standard. A standard request is, among other things, the first request from your clinic for that claim, for an injury ACC already covers, and for the original diagnosis or a changed or added one on ACC's standard Read code list. For regulated providers it must also come within 12 months of the injury or the most recent surgery. Standard requests need no medical evidence, and one option is to contact ACC for an immediate decision. Non-standard requests, including going past 50 treatments under the contract, need supporting notes, outcome measures and the treatment plan.

Reporting and discharge

Under clauses 15.1 and 15.4 of the schedule, you must give ACC information about the services when it reasonably asks, and you cannot charge ACC a fee for providing it. At discharge, clause 14.2 requires a discharge summary with outcome measures, and clause 14.3 requires a summary to go to any provider who referred the client.

The operational guidelines list what the discharge record must show. It must say whether the client was discharged by the provider, self-discharged or was lost to follow-up, and whether they met the goals set at the start. It also needs a numerical pain rating at baseline and at discharge, and an 11-point Global Rating of Change score at discharge. A clear SOAP note at every visit makes all of this quicker to pull together.

Missed appointments

Clause 19.5 of the schedule says: "The Supplier may not charge ACC if a Client fails to attend an appointment." The patient is a different matter. If someone misses a booked appointment without letting you know first, clause 19.6 allows a "did not attend" fee, as long as they were told beforehand that you charge one. Late cancellations do not come up in the clause at all. Help with the wording of the policy is in the cancellation and no-show policy guide.

Telehealth

Clause 8.1.1 allows services by telehealth where clinically appropriate. The client must consent, with an in-person option if they prefer, and the consultation must follow an initial risk assessment and meet the same standard of care as an in-person visit. Both the client and the physio must be physically in New Zealand at the time, and the client must live where they would normally attend your clinic.

The operational guidelines add that a telehealth consultation replaces an in-person one. You should not hold a video initial consultation and then book an in-person visit to do the physical examination, and a quick triage or check-in phone call is not a telehealth consultation. Setting up and running video sessions is covered in the telehealth guide.

How referral to other services works

A physio is often the first to notice that an injured patient needs more than physio. The schedule (Part B, clause 6.1.5) says the supplier will advise ACC if the client needs to be referred to other services. The operational guidelines say to notify ACC by email at claims@acc.co.nz when the service needs ACC approval. Their examples include vocational services, pain specialists and social rehabilitation services.

Some referrals work differently:

Pain management triage assessment. ACC's pain management services are for pain from the covered injury that has lasted three months or more and is not settling as expected, or for complex regional pain syndrome (CRPS), diagnosed or suspected. ACC's rehabilitation referral page says a registered health professional currently treating the patient can refer them for a triage assessment without ACC's approval first, using the ACC6273 referral form.
Rehabilitation programmes and home support. These need ACC's pre-approval. ACC says a provider can ask the patient's recovery team to refer, complete the right referral form, or record the need on an ACC18 medical certificate. Only doctors and nurse practitioners issue the ACC18, so a physio uses the first two. On the ACC45 itself you can tick "Rehabilitation assistance required", and the patient can fill in an ACC1 Request for assistance form.
Time off work. ACC's claims page names medical practitioners and nurse practitioners as the people who issue the medical certificate with an injury claim. If your patient needs time off work certified, point them to their GP or a nurse practitioner.
Physiotherapy specialist. Under Part C of the schedule (clause 3.1.2), this service needs a referral from a registered health practitioner, and the operational guidelines say the same. The schedule allows at most one initial consultation and one follow-up per claim (Part C, clause 2.2).

When care moves to another provider, the ACC service is complete for your clinic (clause 14.1). Send the discharge summary, and if another provider referred the patient to you, make sure they get a copy too.

For patients: getting physiotherapy through ACC

If you are hurt in an accident in New Zealand, ACC's advice is to get treatment first, for example from your doctor, a physiotherapist, an after hours medical centre or an emergency department. The provider fills in the forms and makes the claim for you. You do not need to see a GP before you see a physio. Ask the clinic about its fees before you start, because you may need to pay part of the cost.

ACC will text you if your claim is covered, and may send a letter, usually within a week. If the claim is declined, ACC does not fund the treatment, so ask your physio what that would mean for your fees. If you are not sure whether an injury counts, ACC says your doctor, physio or other health provider will tell you whether ACC is likely to cover it.

If the injury stops you working, ACC may pay weekly compensation, up to 80% of what you earned before the injury. It does not start automatically; you apply through MyACC or by phoning ACC.

When to get urgent help instead of booking a physio

Physio appointments are planned care. Some injuries cannot wait for one. In New Zealand, "call emergency services" means dialling 111, and Health New Zealand's emergency department page says: "In any critical or life-threatening emergency call 111 for an ambulance." For health advice that cannot wait but is not an emergency, Healthline is a free phone service open 24 hours a day, 7 days a week, on 0800 611 116.

The ten lines below are the warning signs used on this site's condition pages, unchanged. Where a line says get medical advice the same day, contact your GP or usual healthcare provider, an after-hours doctor or urgent care clinic, or Healthline, that day.

Emergency: neck pain straight after a high-energy accident, such as a crash at high speed, a car that rolled over, being thrown from a vehicle, being hit by a vehicle while walking or cycling, a motorbike or quad bike accident, a horse riding accident, a diving injury, or a fall from a height or down several stairs. Keep still and call emergency services. If the neck pain only starts later and nobody has checked your neck since, go to an emergency department straight away, and do not drive yourself.
Emergency: after a knock to the head, being very drowsy or finding it hard to keep your eyes open, confusion, a fit (seizure), new weakness or numbness anywhere in your body, new trouble understanding, speaking, walking or keeping your balance, new problems seeing or hearing, clear fluid coming from your ears or nose, bleeding from your ears or bruising behind them, a black eye when your eye was not hit, a dent in your head or a wound with something stuck in it, or a change in behavior. Call emergency services straight away. These can be signs of an injury to the brain.
Emergency: after a knock to the head, you were knocked out, even for a moment, you cannot remember what happened just before or after, you have had a headache ever since, or you are being sick (vomiting). The same applies, even if you feel fine, if you take medicine that thins your blood, other than aspirin on its own, have a bleeding or clotting condition, have had brain surgery in the past, or had been drinking alcohol or taking drugs when it happened. Go to an emergency department straight away, and do not drive yourself.
Emergency: back or leg pain that started after a serious accident, such as a car crash or a fall from a height, or back pain with chest pain. Call emergency services.
Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
A leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
A calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
The knee is hot, red and swollen, or you have knee pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
The shoulder is hot, red and swollen, or you have a fever or feel unwell. This can be a joint infection. Go to an emergency department the same day.

This is not the full list. The ankle sprain page and the whiplash page, like every condition page, carry the complete set for that body area. Clinicians who want the screening questions, and when to refer, can use the guide to red flags in physiotherapy screening. Having an ACC claim open is never a reason to wait with any of these.

Home exercise between ACC visits

Most of an injured patient's rehab happens between appointments, and the operational guidelines ask for self-management education from the first visit. Put the home exercise programme in your treatment plan with its dose, and give the patient exactly that programme. For picking exercises and setting the dose, see how to write a home exercise programme. If patients are not doing them, why patients skip their home exercises looks at what helps.

With PocketPhysio, the dose you wrote in the treatment plan is the dose the patient sees. Choose the exercises, set sets, reps and hold times, and type your own cue under any of them. The patient watches a video of each exercise while a voice guide talks them through it. Send it by SMS, email or link, or through Pocket Physio Care, the patient app, with WhatsApp as another option. Next visit, open what you sent last time and move it on.

The short version

ACC physiotherapy covers treatment for an injury caused by an accident in New Zealand, for New Zealanders and visitors alike. Illness is not covered, and neither are ageing-related conditions or most problems that come on gradually, unless work caused them. Patients can see a physio directly, and the physio can lodge the ACC45 at the first visit once the patient's consent is recorded. ACC pays part of the cost. Any co-payment is the clinic's to set, and the patient should hear the amount before treatment starts.

Under the Allied Health Services contract, set SMART goals and track outcome measures from the first visit. Get ACC32 prior approval before the treatment limit, and send a discharge summary when care ends. A "did not attend" fee is allowed only when the patient knew about it in advance, and under the contract ACC does not pay for a missed visit. Anything that looks like an emergency goes to 111, not to the next physio slot.

References

Accident Compensation Corporation. Allied Health Services Service Schedule, 1 November 2026 (applies from 1 November 2026; contract term 1 November 2021 to 31 October 2027). Accessed 28 September 2026. https://www.acc.co.nz/assets/contracts/allied-health-services-service-schedule.pdf
Accident Compensation Corporation. Allied Health Services Operational Guidelines, 1 November 2024. Accessed 28 September 2026. https://www.acc.co.nz/assets/provider/allied-health-services-operational-guidelines.pdf
Accident Compensation Corporation. Lodging a claim for a patient. No date shown. Accessed 28 September 2026. https://www.acc.co.nz/for-providers/lodging-claims/lodging-a-claim-for-a-patient
Accident Compensation Corporation. Getting prior approval for further treatment for allied health providers. Last published 16 June 2026. Accessed 28 September 2026. https://www.acc.co.nz/for-providers/treatment-recovery/prior-approval-treatment
Accident Compensation Corporation. Paying you for your services. No date shown. Accessed 28 September 2026. https://www.acc.co.nz/for-providers/invoicing-us/paying-patient-treatment
Accident Compensation Corporation. Referring a patient for rehabilitation. Last published 22 July 2025. Accessed 28 September 2026. https://www.acc.co.nz/for-providers/treatment-recovery/referring-to-rehabilitation
Accident Compensation Corporation. What to do if you're injured. Last published 13 February 2026. Accessed 28 September 2026. https://www.acc.co.nz/im-injured/what-to-do
Accident Compensation Corporation. Injuries we cover. No date shown. Accessed 28 September 2026. https://www.acc.co.nz/im-injured/what-we-cover/injuries-we-cover
Accident Compensation Corporation. Injuries we don't cover. Last published 13 August 2025. Accessed 28 September 2026. https://www.acc.co.nz/im-injured/what-we-cover/injuries-we-dont-cover
Accident Compensation Corporation. Treatment we can help pay for. Last published 18 March 2025. Accessed 28 September 2026. https://www.acc.co.nz/im-injured/what-we-cover/treatment-we-pay-for
Accident Compensation Corporation. If you're a visitor injured in New Zealand. Last published 9 December 2022. Accessed 28 September 2026. https://www.acc.co.nz/im-injured/what-we-cover/if-youre-a-visitor-injured-in-new-zealand
Physiotherapy Board of New Zealand. Informed consent standard. May 2018. Accessed 28 September 2026. https://physioboard.org.nz/standards/physiotherapy-standards/informed-consent-standard
Health New Zealand Te Whatu Ora. Emergency departments (ED). Last updated 5 August 2026. Accessed 28 September 2026. https://info.health.nz/hospitals-services/services-support/emergency-departments
Health New Zealand Te Whatu Ora. Healthline. Last updated 22 July 2026. Accessed 28 September 2026. https://info.health.nz/online-phone-healthcare/healthline

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-28.

ACC and physiotherapy in New Zealand: claims, co-payments and the contract rules