Practice fees

Following the 1 July 2025 funding uplift announcement, please find the information below to support your practice with updating your patient consult fees for the 2025-26 Annual Statement of Reasonable Fee Increase (ASRFI).

Part of the funding uplift is Contingent Capitation (based on agreed data sharing with Te Whatu Ora Health NZ). Your practice is automatically opted in, but you may choose to opt out if you wish. If you are considering opting out you may increase your fees until you out opt-out, notify us of your decision, after which you revert to the Annual Statement Fees Increase fixed at 6.43% and follow the process as normal.

Please note: At this stage, while the details are still being worked through, no additional data is being shared with Te Whatu Ora Health NZ. Your practice has the choice to opt in or opt out, and you can change your decision closer to the time when more information becomes available. We will reconfirm your position later this year.

For more information please see 'Primary Care Annual Funding FAQs 2025/26', also found under the Files and links section, below.

Opted-in

Receive the additional contingent uplift based on the data share agreement.

Non- CSC holder fees

• Adults 18+ - you can increase your co-payment up to $67.00 max. without triggering a fees review.
• If you wish to exceed this, use the Annual Statement co-payment templates to apply 3% ASFRI (based on a 50/50 co-payment/capitation ratio), plus any unused carry-over from previous years.
• 14-17 years - your annual statement template increase percentage applies.

Opt-out

Do not receive the additional contingent uplift. If you are considering opting out, you may increase your fees until you out opt-out.

Non- CSC holder fees

• Adults 18+ - the $67.00 cap does NOT apply
• Instead, follow the Annual Statement process for all age groups, using the co-payment templates to apply a 6.43% increase, plus any unused carry-over from previous years.

CSC holder fees

Regardless of opt-in or opt-out, maximum fees for your CSC holders are as follows (GST incl):

• For patients aged 14 to 17 years (CSC and non-CSC), the maximum fee is $13.50.
• For CSC holders aged 18 years and older, the maximum fee is $20.00.

If you decide to change your fees, please complete the Interim (non-VLCA) Practice Fee change Notification Form 2025-26 (download below) and email it to practice.support@pinnacle.health.nz. 

For Very Low-Cost Access (VLCA) practices the ASRFI does not apply. VLCA practices receive higher capitation funding for their enrolled patient base to keep healthcare more affordable for patients in high-need communities. In return they are required to set their fees at or below a threshold set nationally by Health NZ/Te Whatu Ora.

From 1 July 2025 the maximum thresholds for standard GP consult fees are as follows (GST incl):

• For patients aged 14 to 17 years (CSC and non-CSC), the maximum fee is $13.50.
• For CSC holders aged 18 years and older, the maximum fee is $20.00.
• For non-CSC holders aged 18 years and older, the maximum fee is $30.50.

If you decide to change your fees, please complete the VLCA Practice Fee Change Notification Form 2025-26 (also found under the Files and links section, below) and email it to practice.support@pinnacle.health.nz.

We ask you to notify us of your fee changes because the PHO agreement requires us to notify Te Whatu Ora/Health NZ.

Please also remember to update your fees on Healthpoint as this feeds through to our website listing for your practice.