GEMS Tariff codes 2011 - PG GROUP MEDICAL SCHEME

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GEMS Tariff codes 2011

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Biokinetics 2 Medical Practitioner 83 Psychiatric Medical Practitioner 312

Chinese medicine & Acupuncture 5 Medical Practitioner - Consultative Services 262 Psychology 314

Chiropractor 7 Medical Scientists 265 Psychometry & Registered Counsellors 317

Clinical Technology 9 Medical Technology 267 Radiography 319

Dental Practitioners 15 Mental Health Institutions 285 Radiology 325

Dental Technicians 58 Naturopathy 287 Nursing 380

Dental Therapy 68 Occupational Art Therapy 289 Social Workers 391

Dieticians 71 Orthoptist 297 Speech Therapists & Audiologists 393

Emergency Medical Services 73 Osteopathy 298 Sub-Acute Facilities 400

Hearing Aid Acousticians 75 Physiotherapy 301 Tissue Transportation 402

Homeopaths 77 Phytotherapy 306 Additional GEMS Tariff 403

Hospices 82 Podiatry 307 Glossary 406

Version 4_21. This version replaces all versions that were published previously. Please ensure that you always use the latest version. The latest version is available on www.gems.gov.za


2 • Version 4_21

Biokinetics

GEMS TARIFF FOR SERVICES BY BiOKENETICS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Biokinetics

Code: 37700

source code CF Units Value

R

In calculating the GEMS Tariff , the following rounding method is used: Values R10 and below rounded to the nearest cent, R10+ rounded to the nearest 10cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed. ALL GEMS TARIFFS ARE VAT INCLUSIVE.

- - -

2 GENERAL RULES - - -

2 002The consultation code may be charged only once at the same consultation or visit. Consultation includes history taking, guidance, education, health promotion and/or consultation

2 003A maximum of three diagnostic procedures may be charged at the same consultation or visit. Diagnostic procedures include the full range of diagnostic and evaluation procedures within the scope of practice of the biokineticist, including for example: anthropometric / body composition assessments, ergological testing evaluations and perceptual motor evaluation.

- - -

2 004

A maximum of three treatment procedures may be charged at the same consultation or visit for any single diagnosis. This limitation shall be inclusive of a maximum of one group treatment procedure (code 12), where applicable. Treatment procedures include the full range of rehabilitative or preventive treatment or care procedures within the scope of practice of the biokineticist, including for example: hydrotherapy, callisthenics exercises and programme prescription for individuals with CHD.

- - -

2 005After a series of 12 treatments in respect of one patient for the same condition, the practitioner concerned shall report to the Scheme as soon as possible if further treatment is necessary. Further continuance of treatment should only be considered if recommended by the medical practitioner(s) and others involved in the rehabilitation of the patient.

- - -

2 010

Every biokineticist must acquaint himself with the provisions of the Medical Schemes Act, 1998, and the regulations promulgated under the Act in connection with the rendering of accounts. Every account shall contain the following particulars : · The name and practice code number of the referring practitioner . · The name of the member. · The name of the patient. · The name of the medical scheme. · The membership number of the member. · The date on which the service was rendered. · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered

- - -

2 011It is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by a medical scheme if the appropriate code is supplied on the account.

- - -

2 1. Consultations / Patient Education / Counseling - - -

2 107Appointment not kept (GEMS will not necessarily grant benefits in respect of this item, it will fall into the “By arrangement with the Scheme” or “Patient own account” category).


3 • Version 4_21


Code: 37700


R

2 901Initial consultation including: a problem focused history; a short problem focused examination; and straightforward biokinetic decision making but excluding evaluation. To be charged only once per course of treatment. (inclusive of lung function tests)

340 16.700 81.60

2 903Subsequent consultation for the same condition (global fee covering a problem focused interval history and re-examination; and straightforward biokinetic decision making but excluding physical re-assessment). To be charged only once per course of treatment.

340 11.700 R57.20

2 905Consultation at hospital (global fee including a problem focused history; a problem focused examination; and biokinetic decision making excluding evaluation and physical re-assessment of a patient). To be charged only once per course of treatment.

340 16.700 81.60

2 922 Patient education (based upon the evaluation outcomes) 340 16.300 79.70

2 936 Health promotion and lifestyle modifications 340 - -

2 2. Evaluation / Diagnostic Procedures - - -

2 908 Simple evaluation at the first visit only (to be fully documented) 340 10.000 48.90

2 909 Complex evaluation at the first visit only (to be fully documented). 340 16.700 81.60

2 912 Anthropometric/body composition assessment 340 10.000 48.90

2 913 Ergological testing evaluation of body segment, limb or joint 340 28.500 139.30

2 914 Neurological patients: Ergological evaluation 340 16.700 81.60

2 915 Postural analysis and/or analysis of activities of daily living, gait and specific motor acts 340 16.700 81.60

2 916 Perceptual motor evaluation (perception and gross motor function) 340 16.700 81.60

2 917Physical work capacity (treadmill or bicycle ergometer/other electronic equipment) / Musculoskeletal assessment (strength, endurance, range of motion, posture)

340 28.500 139.30

2 918 Physical work capacity with full ECG 340 28.500 139.30

2 920 Isotonic, isometric or EMG testing by means of specialised electronic equipment 340 28.500 139.30

2 921 Isokinetic testing by means of specialised electronic equipment 340 28.500 139.30

2 3. Therapeutic Procedures (Physical Rehabilitation) - - -

2 Maximum of 3 modalities, per diagnosis, may be charged per visit - - -

2 923 Proprioception, balance and motor co-ordination exercise therapy session with or without equipment 340 16.300 79.70

2 925 Hydrotherapy where the condition of the patient is such that it requires the undivided attention of the Biokineticist 340 16.300 79.70

2 926 Exercise on Isokinetic apparatus/Isotonic/Isometric resistance equipment. 340 16.300 79.70

2 927 Posture, gait and activities of daily living (ADL), with/without equipment use 340 16.300 79.70

2 928 A rehabilitative exercise prescription 340 16.300 79.70

2 929 Callisthenics exercises 340 16.300 79.70

2 930 Group session with high risk patients, per patient (maximum 10 patients) 340 8.800 43.00

2 931 Passive and active range of motion exercise therapy 340 16.300 79.70


4 • Version 4_21


Code: 37700


R

2 933 Programme prescription for an individual with CHD health risks including hyperlipedemia, metabolic disorders, Low-Back pain/ Lumbago etc. - - -

2 934 Group exercise sessions, per patient 340 8.800 43.00


5 • Version 4_21

Chinese Medicine & Acupuncture

GEMS TARIFF FOR SERVICES BY ACUPUNCTURE & CHINESE MEDICINE PRACTITIONERS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Chinese Medicine &

Acupuncture Code: 41000

code CF Units Value

R


- - -

RULES - - -

01

All accounts must be presented with the following information clearly stated: - name of the practitioner - qualifications of the practitioner - PCNS Practice Number - Postal address and telephone number - Date on which the service(s) were provided - Applicable item codes - The nature of the treatment - The surname and initials of the member - The first name of the patient - The name of the medical scheme - The membership number of the patient - The name and practice number of the referring practitioner

- - -

02When two separate acupuncture techniques are used, each treatment shall be regarded as a separate treatment for which fees may be charged for separately.

- - -

03 Not more than two separate techniques may be charged for at each session. - - -

04The maximum number of acupuncture treatments per course to be charged for is limited to ten. If further treatment is required at the end of this period of treatment, it should be negotiated with the patient.

- - -

ITEMS - - -

1. Consultations - - -

Consultation encompasses consultation, history taking, patient examination and assessment, side room diagnostic tests, counseling and/or diagnosis - - -

1100 Consultation (up to 15 mins) 580 10,000 107,80

1101 Consultation (16-30 mins) 580 22,500 242,50

1102 Consultation (31-45 min) 580 37,500 404,20


6 • Version 4_21

GEMS TARIFF FOR SERVICES BY ACUPUNCTURE & CHINESE MEDICINE PRACTITIONERS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Chinese Medicine &

Acupuncture Code: 41000

code CF Units Value

R

1103 Consultation (46-60 min) 580 52,500 565,90

1110 Consultation, each additional full 15 mins beyond 60 mins 580 15,000 161,70

2. Treatments - - -

3100 First treatment (needles, plus maximum of two speciality therapy techniques) 580 39,524 426,00

3200 Follow-up treatment (needles, plus maximum of two speciality therapy techniques) 580 36,145 389,60

3. Speciality Therapy Techniques - - -

4010 Moxibustion 580 22,770 245,40

4020 Cupping 580 19,493 210,10

4030 Dermal needle therapy (plum-blossom or seven-star) 580 18,184 196,00

4040 Auricular therapy (micro acupuncture) 580 32,146 346,50

4050 Scalp acupuncture 580 27,308 294,40

4060 Shilao (diet therapy) 580 23,712 255,60

4070 Tui-Na (massage/pressure) 580 34,226 368,90


7 • Version 4_21

Chiropractic

GEMS TARIFF FOR SERVICES BY CHIROPRACTORS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Chiropractic

Code: 40400

code CF Units Value

R


- - -

GENERAL RULES - - -

001

All accounts must be presented with the following information clearly stated: · name of chiropractor; · qualifications of the chiropractor; · PCNS Practice Number; · postal address and telephone number; · date on which service(s) were provided; · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered; · the surname and initials of the member; · the first name of the patient; · the name of the scheme; · the membership number of the member; · a statement of whether the account is in accordance with the GEMS Tariff; and . the name and practice number of the referring practitioner, if applicable.

- - -

002The consultation code may be charged only once at the same consultation or visit.Consultation includes history taking, guidance, education, health promotion and/or consultation.

- - -

003A maximum of three diagnostic procedures may be charged at the same consultation or visit. Diagnostic procedures include physical examination, neurological examination, orthopaedic examination, ergonomical analysis, postural analysis and radiological examination

- - -

004A maximum of three treatment procedures may be charged at the same consultation or visit for any single diagnosis. Treatment procedures include, inter alia: spinal or extra-spinal manipulation, acupuncture, cold applications, non-heating modalities, deep heating radiation, soft tissue manipulation, superficial heating therapy and therapeutic exercises (other than in relation to preparation or fitting of appliances).

- - -

005After a series of 12 treatments in respect of one patient for the same condition, the practitioner concerned shall report to the Scheme as soon as possible if further treatment is necessary. Payment for treatment in excess of the stipulated number may be granted by the Scheme after receipt of a letter from the practitioner concerned, motivating the need for such treatment.

- - -

006It is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by a medical scheme if the appropriate code is supplied on the account.

- - -

107Appointment not kept (schemes will not necessarily grant benefits in respect of this item, it will fall into the “By arrangement with the Scheme” or “Patient own account” category).

- - -


8 • Version 4_21

GEMS TARIFF FOR SERVICES BY CHIROPRACTORS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Chiropractic

Code: 40400

code CF Units Value

R

301 Consultation 180 25.000 124.20

Only a single item from this section may be charged per patient encounter - - -

Radiation Control Council Certificate number to be on account if X-Rays charged - - -

311 Single diagnostic procedure 180 25.000 124.20

312 Two diagnostic procedures 180 37.500 186.30

313 Three diagnostic procedures 180 50.000 248.40

Only a single item from this section may be charged per patient encounter

321 Single instance of immobilization or therapeutic exercises 180 10.000 49.70

322 Two instances of immobilization or therapeutic exercises 180 15.000 74.50

Only a single item from this section may be charged per patient encounter

331 Single treatment procedure 180 10.000 49.70

332 Two treatment procedures 180 15.000 74.50

333 Three treatment procedures 180 20.000 99.40

334 Four treatment procedures 180 25.000 124.20

335 Five treatment procedures 180 30.000 149.00

336 Six treatment procedures 180 35.000 173.90

The amount charged in respect of medicines and scheduled substances shall not exceed the limits prescribed in the Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances, dated 30 April 2004, made in terms of the Medicines and Related Substances Act, 1965 (Act No 101 of 1965).In relation to all other materials, items are to be charged (exclusive of VAT) at net acquisition price plus -* 30% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; and* a maximum of R30 where the net acquisition price of that material is greater than or equal to one hundred rands.

- - -

100 Medication / material: Charge for medication or material, identified by the appropriate Nappi code. 180 - -

110 X-Ray films 180 - -


9 • Version 4_21

Clinical Technology

GEMS TARIFF FOR SERVICES BY CLINICAL TECHNOLOGISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Clinical Technology

Code: 37500

code CF Units Value

R


- - -

GENERAL RULES - - -


- - -

MODIFIERS - - -

0001 Fee prorated according to number of treatment days;. fee = ([number of treatment days] / 30) X (item fee) - - -

ITEMS - - -

Surgical Support - - -

010 Ablations 190 219.700 2 121.00

011 Preparation of extra-corporeal equipment for surgical procedures. 190 196.700 1 898.90

012 Operation of heart laser during myocardial revascularisation 190 219.700 2 121.00

013Continued operation of extra-corporeal equipment during surgery for a time in excess of one hour in 30 minute increments or part thereof provided that such part comprises 50% or more of the time

190 20.300 196.00

014 Radiofrequency Catheter Ablations 190 219.700 2 121.00

Not to be charged with item 012 - - -

015 Preparation and operation of pre-operative, intra-operative or post operative physiological monitoring per patient, per admission 190 19.400 187.30

May only submit once in theatre and once in catheterisation laboratory - - -

017 Standby with extra-corporeal equipment for surgery within hospital 190 58.800 567.70

Cannot be used with 011 - - -

019 Standby within the hospital for coronary angioplasty. 190 19.400 187.30

021 Preparation and operation of intra-aortic balloon pump in theatre, intensive care unit and catheterisation laboratory. 190 58.800 567.70

085 Each additional 30 minutes or part thereof, provided that such part comprises 50% or more of the time. 190 10.000 96.50

023 Global fee for preparation and operation and removal of cardio assist device (LVAD, RVAD, BVAD) in theatre and intensive care unit. 190 196.700 1 898.90

027 Preparation and operation of a pre- and post-operative blood salvage device. 190 19.400 187.30

029 Preparation and operation of an autotransfusion cell washing system. 190 77.100 744.30


10 • Version 4_21


Code: 37500

code CF Units Value

R

031Determination and monitoring of haemodynamic/pulmonary parameters, metabolism, arterial/venous pressure flow studies in high care/ICU (per patient per multiple procedures per day)

190 61.700 595.70

033 Assistance with bronchoscopy procedures, placement of arterial/venous catheters, ultrasound examinations or photography. 190 14.600 141.00

034 Lymph compression treatment. 190 22.500 217.20

116 Preparation and operation of an artificial heart (Berlin-Heart) 190 219.700 2 121.00

118 Daily monitoring of artificial heart, per hour 190 33.400 322.40

157 Standby with extra corporeal equipment (maximum 4 hours) (per event). 190 26.300 253.90

Pulmonology - - -

Items 035 to 061 apply only to outpatient department and normal wards - Not high care or intensive care, except item 050 which applies to intensive care only.

- - -

035 Nebulization (per one procedure). 190 12.300 118.70

037 Measurement of Lung volumes and capacities by means of closed circuit (He) or (N2) washout or body plethysmography. 190 24.200 233.60

039 Flow-volume determinations. 190 30.600 295.40

041 Flow-volume (Pre-post B-D). 190 50.800 490.40

043 Airways resistance and conductance measurements using plethysmograph or similar apparatus. 190 24.200 233.60

045 Gas distribution measurements. 190 24.200 233.60

047 Diffusion determinations. 190 24.200 233.60

049 Exercise testing (EIA). 190 17.100 165.10

050 ECMO change-out and re-establishment. 190 46.300 447.00

051 Exercise testing with recording of : VT, VO2, HR, RR, ECG and Oximetry 190 24.200 233.60

053 Allergy tests. 190 11.400 110.10

055 If RAST included add (per allergen). 190 11.400 110.10

057 Bronchial provocation testing. 190 40.800 393.90

059 Compliance measurements. 190 24.200 233.60

061 Maximum inspiratory (MIP) and/or expiratory (MEP) pressures and/or Vital Capacity and/or PEFR. 190 6.000 57.90

Cardiology - - -

062 Assist in preparations and operations of Rotablator Procedures 190 29.900 288.70

063 Cardiac catheterisation for the first hour. 190 40.300 389.10

065 Each additional 30 minutes or part thereof provided that such part comprises 50% or more of the time 190 10.000 96.50

064 Intravascular Ultrasound (IVUS) 190 25.700 248.10


11 • Version 4_21


Code: 37500

code CF Units Value

R

This fee can only be charged once, irrespective of how many times this procedure is repeated. The technologist cannot charge for this procedure if a representative of a company or any other person is operating the IVUS machine

- - -

068 Each additional 30 minutes or part thereof provided that such part comprises 50% or more of the time. 190 10.000 96.50

066 Cardiac Cath Right Heart Studies 190 56.000 540.60

067 Cardiac Electro physiology and related procedures for first FOUR hours. 190 67.900 655.50

069 Temporary and single Pacemaker procedures. 190 40.300 389.10

070 Permanent and dual Pacemaker procedures or implantation and testing of ICD devices. 190 46.300 447.00

Not to be charged in conjunction with items 063 or 065 - - -

071 Each additional 30 minutes or part thereof provided that such part comprises 50% or more of the time. 190 10.000 96.50

072 Multisite Pacing (Bi-ventricular pacing) 190 46.300 447.00

073 Dilatation procedures and stents. 190 55.400 534.80

074 Wavemap - Measurement of Fractional Flow Reserve to assess the functional severity of coronary artery stenoses 190 10.000 96.50

075 Pacemaker checking and/or reprogramming. 190 14.000 135.20

077 24 Hour Holter ambulatory monitoring. 190 55.400 534.80

079 Cardiac exercise stress testing. 190 29.100 280.90

081 Recording of twelve lead ECG. 190 7.700 74.30

087 M Mode echocardiogram. 190 16.600 160.30

089 2D echocardiogram. 190 29.400 283.80

091 Doppler flow. 190 32.300 311.80

093 Colour imaging. 190 32.300 311.80

095 ECG signal averaging (Hi-Res). 190 53.700 518.40

097 Ambulatory bloodpressure monitoring. 190 18.600 179.60

099 Vector cardiogram. 190 55.400 534.80

111 Transoesophageal echocardiogram. 190 43.100 416.10

Neurology - - -

Preparation, recording and analyses/technical report of: - - -

178 Short latency brainstem auditory evoked potentials, neurological examination, bilateral 190 74.100 715.40

179 Auditory evoked potentials, full audiological examination, bilateral 190 74.100 715.40

180 Pattern-reversal visual evoked potentials: full evaluation of visual pathways, unilateral 190 37.110 358.30

181 Somatosensory evoked potentials, unilateral, upper limb 190 37.110 358.30

182 Somatosensory evoked potentials, unilateral, lower limb 190 37.110 358.30


12 • Version 4_21


Code: 37500

code CF Units Value

R

115 Additional 2 nerves (used as adjunct with nerve conduction studies, including F-waves, H-reflexes or additional nerves required for diagnosis) 190 14.900 143.80

117 Electroretinography (ERG) - unilateral or Electro-oculography (EOG) 190 43.100 416.10

183 Electronystagmography for spontaneous and positional nystagmus (3253) 190 24.150 233.10

184 Caloric test done with electronystagmography (3255) 190 67.570 652.30

119 Sleep EEG. 190 31.400 303.10

185 Overnight polysomnography 190 264.830 2 556.70

186 Obstructive sleep apnea screening 190 137.170 1 324.20

187Long term EEG monitoring with a minimum of 8 hours (but less than 16 hours) recording time, including preparation (collodion adhesive technique with at least 21 electrodes) and interpretation

190 137.890 1 331.20

188Long term EEG monitoring with 16 to 24 hours recording time, including preparation (collodion adhesive technique with at least 21 electrodes) and interpretation

190 264.830 2 556.70

125 Multiple sleep latency test (MSLT) 190 111.100 1 072.60

127 Overnight CPAP titration. 190 104.200 1 006.00

132 Mobile EEG setup in ICU (to be added to Item 133 if appropriate) 190 17.420 168.20

133 EEG with special activation. 190 49.400 476.90

135 Electromyography : Needle examination per muscle/conduction velocity (motor/sensory) each, to a maximum of 5. 190 14.900 143.80

137 Intra-operative evoked potentials for the 1st hour 190 55.400 534.80

139 Each additional hour or part thereof provided that such part comprises 50% or more of the time. 190 37.100 358.20

141 Intra-operative EEG (carotid endarterectomy). 190 26.300 253.90

143 Transcranial or Carotid Doppler (bilateral). 190 39.400 380.40

Dialysis - - -

145Preparation of extra-corporeal equipment: Haemoperfusion (HP), Haemofiltration (HF), Haemoconcentration (HC), Continuous renal replacement therapy (CRRT), Aphaeresis, Auto transfusion and cell recovery (AT).

190 46.300 447.00

146 Chronic haemodialysis (acetate dialysate) 190 149.400 1 442.30

148 Chronic haemodialysis (bicarbonate dialysate) 190 159.600 1 540.80

In the case of items 146 and 148, routine outpatient dialysis includes dialyser, bloodlines, acetate dialysate, priming set, sodium heparin anticoagulant, saline infusion, dressing pack, fistula needles/catheter dressing, syringes and needles, cleaning materials, equipment set-up, up to 5 hours treatment time, equipment rental

- - -

147 Peritoneal dialysis, per day 190 16.800 162.20


13 • Version 4_21


Code: 37500

code CF Units Value

R

The global fees for Continuous Ambulatory Peritoneal Dialysis (CAPD) (Item 176) and Automated Peritoneal Dialysis (APD) (Item 177) include: consumables; cost of machine and machine disposables; professional fee; initial training; in-centre follow-up visits; and home visits. However, they exclude Tenckhoff catheter and insertion thereof; and disposables required for a transfer set change (usually 6 monthly).These fees are chargeable for each 30 day cycle in which CAPD or APD is provided. If CAPD or APD is provided for less than a 30 days in any one cycle (for example due to complications or death of the patient):a. if the period of treatment is 26 days or more in that cycle, the full fee applies; b. if the period of treatment is up to 25 days in that cycle, the fee should be prorated according to number of actual treatment days. Modifier 0001

should be quoted, and number of treatment days specified.

- - -

176 Global fee for Continuous Ambulatory Peritoneal Dialysis (CAPD), per 30 day period. 190 1700.000 16 411.80

177 Global fee for Automated Peritoneal Dialysis (APD), per 30 day period. 190 2360.000 22 783.40

149 Treatment procedure per 1 hour (excluding acute haemodialysis, chronic haemodialysis and CRRT) 190 33.400 322.40

150 Acute haemodialysis 190 317.200 3 062.30

Emergency dialysis treatment in hospital; includes dialyser, bloodlines, acetate/bicarbonate dialysate, priming set, equipment set-up, up to 5 hours treatment time, equipment rental

- - -

151 Treatment procedures for CRRT up to 6 hours or part thereof provided that such part comprises 50% or more of the time 190 24.800 239.40

152 Treatment procedure for CRRT up to 12 hours or part thereof provided that such part comprises more than 6 hours of the time 190 49.700 479.80



153 Patient training in centre for dialysis, CPAP training and problem-solving, home ventilators and nebulisers, per 30 minutes (to maximum of 24 hours) 190 16.600 160.30

155 Patient training or follow-up at patient’s home, for dialysis, home ventilators and nebulisers, per 30 minutes (to maximum of 24 hours). 190 29.100 280.90

Reproductive Health - - -

As schemes will not necessarily grant benefits in respect of some items below, they fall into the “By arrangement with the Scheme” category - - -

159 Post Vasectomy semen analysis. 190 10.000 96.50

161 Complete semen analysis. 190 31.700 306.00

163 Semen wash for A I. 190 30.300 292.50

165 IVF, GIFT, PROST with semen and serum preparation including ovum and embryo handling and transfer 190 368.700 3 559.40

Cannot be used with items 161, 163, 167 and 169 - - -

167 Ovum and embryo freezing. 190 131.300 1 267.60

169 Semen freezing. 190 30.300 292.50

Miscellaneous - - -

171 Travelling per km in excess of 16km (in own car). 190 0.675 6.50

173 Equipment hire (By arrangement with scheme). 190 - -


14 • Version 4_21


Code: 37500

code CF Units Value

R

175 Medication / Material 190 - -

The amount charged in respect of medicines and scheduled substances shall not exceed the limits prescribed in the Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances, dated 30 April 2004, made in terms of the Medicines and Related Substances Act, 1965 (Act No 101 of 1965).In relation to all other materials, items are to be charged (exclusive of VAT) at net acquisition price plus -* 30% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; and* a maximum of R30 where the net acquisition price of that material is greater than or equal to one hundred rands.

- - -


15 • Version 4_21

Dental Practitioners

GEMS TARIFF FOR SERVICES BY DENTAL PRACTITIONERS, EFFECTIVE FROM 1 JANUARY 2011

Practice Type:

General Dental

Practice Code: 25400

Practice Type:

Maxillo-facial

and Oral Surgery Code: 26200

Practice Type: OrthodonticsCode: 26400

Practice Type: Oral

Medicine and

Periodontics Code: 29200

Practice Type: Prosthodontics

Code: 29400

Practice Type: Oral

Pathology Code: 29800

code Value

R Value

R Value

R Value

R Value

R Value

R


- - - - - -

The schedule includes procedures and services for use by Oral Health Care Providers for purposes of keeping accurate patient records, reporting procedures on patients, and processing oral health care related insurance claims. The procedures are those performed by general dental practitioners, oral pathologists, prosthodontists, periodontists, orthodontists, maxillo-facial and oral surgeons and dental therapists. The procedures codes listed in the schedule have, for the convenience in using the schedule, been divided into categories of services, based on the branches of clinical dental practice. The procedures are grouped under the category of service with which the procedures are most frequently identified and should not be interpreted as excluding certain categories of Oral Health Care Providers from performing such procedures. Individual procedure codes consist of a procedure code, procedure description (nomenclature), and when necessary, a descriptor, that provides further definition and/or guidelines to clarify the intended use of the procedure code.

- - - - - -

I. INTRODUCTION - - - - - -

A. Administrative and invoicing rules - - - - - -

001 Invoices: - - - - - -

a. A practitioner shall render a monthly invoice for every procedure which has been completed irrespective of whether the total treatment plan has been concluded.

- - - - - -

b. An invoice shall contain the following particulars: - - - - - -


16 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

i. The surname and initials of the member; ii. The first name of the patient; iii. The name of the scheme; iv. The membership number of the member; v. The practice number; vi. The date on which every service was rendered; vii. The code number, description and fee/benefit of the procedure or service; viii. The name of the dentist rendering the service; ix. The name of the general dental practitioner/specialist assistant (when applicable); x. The appropriate ICD-10 code(s) for the procedures performed.

- - - - - -

Note: Photocopies of original invoices shall be certified by way of a rubber stamp or the signature of the dentist.

- - - - - -

002

Cost of direct materials: The expenses incurred for direct materials identified in the Schedule may be billed in addition to the procedure code. These expenses are limited to the net acquisition cost of the materials and a handling fee. The price of the materials should be VAT inclusive. Use Modifier 8025 for handling fee.

- - - - - -

003 Dental laboratory services: - - - - - -

Manual submission of invoices. Fees charged by dental technicians for laboratory services (PLUS L) shall be indicated on the dentist’s invoice by reporting code 8099 - Dental laboratory service with the appropriate laboratory fee on the line following the relevant dental procedure code. The technician’s invoice shall be certified by the dentist (or a person appointed by the dentist) for correctness by means of a signature. The original invoice of the dental technician (or a copy thereof) shall accompany the invoice of the dentist and a copy (or the original) shall be filed by the dentist for record purposes.

- - - - - -


17 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

Electronic submission of invoices. Fees charged by dental technicians for laboratory services (PLUS L) shall be indicated on the dentist’s invoice by submitting code 8099 - Dental laboratory service with the appropriate laboratory fee on the line following the relevant dental procedure code on the date on which the dental procedure was rendered. The laboratory fee shall be submitted for payment on the date on which the procedure code is submitted for payment, and the appropriate dental laboratory service codes shall be reported on the lines following code 8099. The technician’s invoice shall be certified by the dentist (or a person appointed by the dentist) for correctness by means of a signature. The original invoice of the dental technician shall be filed by the dentist for record purposes.

- - - - - -

005

Procedure accompanied by unusual circumstances: In exceptional cases where the proposed fee/benefit is disproportionately low in relation to the actual services rendered by a practitioner, such higher fee as may be mutually agreed upon between the dental practitioner and the patient/medical scheme may be billed. Use Modifier 8011 with a narrative description. Under certain circumstances a service or procedure is partially reduced or eliminated at the practitioner’s election. Under these circumstances a lower fee may be billed. The service provided can be identified by its usual procedure code and the addition of Modifier 8012, signifying the service is reduced.

- - - - - -

B. General coding rules - - - - - -

006

The schedule does not prescribe the scope of practice of a particular category of Oral Health Care Provider; neither does it confine the performing of procedures or services to a registered speciality. Fees listed within a column of a particular category of Oral Health Care Provider are customary fees, should the procedure or service be rendered by that provider category. Specialists are however encouraged to confine their practice to the speciality or related specialities in which they are registered. Specialist may charge fees for procedures or services which usually pertain to some other speciality, if such procedures or services are also recognised in their speciality, and if it is carried out only for their bona fide patients. Such fees shall not be higher than those charged by general practitioners for the same procedures or services (HPCSA, Rule 25). Fees for procedures or services not listed within the column of dental therapists that do fall within the field of dental therapy in terms of their scope of practice are regarded as being “by arrangement” until such fees are listed.

- - - - - -

007 Procedures not listed in the Dental Schedule - - - - - -


18 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

When a procedure is performed that is not listed in the schedule, an appropriate procedure code, listed in the NHRPL for medical practitioners may be reported.

- - - - - -

Unlisted procedures. Any procedure that is neither described in the schedule, nor in the medical schedule, should be reported using code 9099 - Unlisted dental procedure or service. The fee for an unlisted dental procedure or service should be based on the fee of a comparable procedure. Code 9099 codes should not be used to report procedures where the fee is determined “by arrangement” with the patient and/or medical scheme.

- - - - - -

C. Services rules - - - - - -

008

Oral evaluations and completion of treatment plans: Oral examinations include an examination, diagnosis and treatment planning (when treatment is required). No further fees/benefits shall be levied for an oral examination (code 8101) or comprehensive examination (code 8102) until the treatment plan resulting from these type of examinations is completed. The completion of a treatment plan effected from an oral examination and/or comprehensive examination should be indicated by reporting code 8120 – Treatment plan completed. Oral diagnosis defined. The determination by the dentist of the oral health condition of an individual patient achieved through the evaluation of data gathered by means of history taking, direct examination, patient conference, and such clinical aids and tests as may be necessary in the judgement of the dentist. Treatment plan defined. The treatment plan is the sequential guide for the patient’s care as determined by the dentist’s diagnosis and is used by the dentists for the restoration and/or maintenance of optimal oral health

- - - - - -

009 Surgery guidelines: - - - - - -

1. Follow-up care for therapeutic surgical procedures: The fee/benefit for an operation shall, unless otherwise stated, include normal post-operative care for a period not exceeding four months. If a practitioner does not him/herself complete the post-operative care, he/she shall arrange for post-operative care without additional charges. A fee/benefit for post-operative treatment of a prolonged or specialised nature may be charged as agreed upon between the practitioner and the scheme.

- - - - - -


19 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

2. Multiple Procedures (Maxillo-facial and oral surgery): The fee/benefit for more than one operation or procedure performed through the same incision shall be determined as the fee for the major operation plus fee/benefit for the subsidiary operation to the indicated maximum for each such subsidiary operation or procedure (Modifier 8005). The fee/benefit for more than one operation or procedure performed under the same anaesthetic but through another incision shall be determined on the fee/benefit for the major operation plus: 75% for the second procedure/operation (Modifier 8009). 50% for the third and subsequent procedures/operations (Modifier 8006). This rule shall not apply where two or more unrelated operations are performed by practitioners in different specialities, in which case each practitioner shall be entitled to the full fee/benefit of the operation. If, within four months, a second operation for the same condition or injury is performed, the fee/benefit for the second operation shall be 50% of that of the first operation (Modifier 8006).

- - - - - -

3. Assistant Surgeon (Maxillo-facial and periodontal surgery): The fee payable to a specialist assistant is determined as 1/3 (of the fee of the practitioner performing the procedure (Modifier 8001). The fee payable to a general dental practitioner assistant is determined as 15% (of the fee of the practitioner performing the procedure (Modifier 8007). The patient must be informed beforehand that another dentist/specialist will be assisting at the operation and that a fee will be payable to the assistant. The assistant’s name must appear on the invoice rendered to the patient.

- - - - - -

4. Surgical team (Maxillo-facial and oral surgery): The additional fee to all members of the surgical team for after hours emergency surgery shall be calculated by adding 25% to the fee for the procedure or procedures performed (Modifier 8008).

- - - - - -

010 Orthodontic guidelines: - - - - - -

The documentation and first invoice to the patient/medical scheme regarding orthodontic services will include the following information: a. The treatment plan and type of treatment (treatment code number); b. A diagnostic code (ICD-10) and c. An orthodontic payment plan indicating the following: i. The total fee that will be levied for the treatment; ii. The total months of orthodontic treatment (retention period excluded); iii. The initial fee payable by the patient (approximately 20% of the total fee); and iv. The monthly payments of the balance of the fee.

- - - - - -


20 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

2. The fee for orthodontic treatment does not include a clinical oral evaluation and necessary diagnostic services. The fee for corrective therapy (i.e. codes 8861 to 8888) is an inclusive fee and no additional fees may be levied for intra-operative oral evaluations and preventive services. A pre-orthodontic treatment visit, an orthodontic retention, and an oral evaluation on completion of the treatment plan (retention phase included) are excluded and should be reported in addition to corrective orthodontic treatment as separate procedures (Code 8803 x3). Intra/post orthodontic treatment records consisting of radiographs/diagnostic images (limited to a cephalometric film and 5 oral/facial images) and diagnostic casts may be levied when a corrective orthodontic treatment plan is completed (retention phase included).

- - - - - -

3. The fee for ‘Fixed appliance therapy’ (codes 8861 and 8865 to 8888), as determined by the individual practitioner, will be levied on a monthly manner over the treatment period (retention phase excluded).

- - - - - -

4. When partial fixed appliance or preliminary orthodontic treatment (codes 8858, 8861, 8865 or 8866) is followed by full fixed appliance orthodontic treatment (codes 8873 to 8888) provided by the same orthodontist, the fees levied for the partial fixed appliance therapy or preliminary treatment will be deducted from the fee quoted for the full fixed appliance orthodontic treatment.

- - - - - -

5. The total fee for multiple phases of full fixed appliance orthodontic treatment provided by the same orthodontist may not exceed the most recent fee (determined on commencement date of the final stage of full fixed appliance treatment) for the appropriate full fixed orthodontic procedure.

- - - - - -

6. When the patient transfers to another practitioner during treatment, or treatment is terminated for any reason, the original treating practitioner must report the number of treatment months remaining and determine the balance of the fee by applying the following formula: Total payment (for treatment only) minus 20% of the total fee (for banding - when applicable) multiplied by the percentage of treatment remaining. For example, if the practitioner was paid R 10,000.00 for a 24-month treatment plan and 18 months of treatment were completed. The balance would be R 2,000.00 (or R 10,000.00 - R 2,000.00 x 6/24). The length of the treatment plan from the original request for authorisation will be used to determine the number of treatment months remaining. The practitioner continuing treatment will provide the information stipulated in paragraph 1 above. Report code 8891 (Orthodontic transfer) with the fee that will be levied for continuation of the treatment in addition to the appropriate orthodontic treatment code. The fee for continuous treatment is subject to prior authorisation by the patient’s medical scheme.

- - - - - -


21 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

7. When an established orthodontic patient requires re-treatment, the information stipulated in paragraph 1 above and the cause(s) for re-treatment will be provided. Report code 8892 (Orthodontic re-treatment) with the fee that will be levied for re-treatment in addition to the appropriate orthodontic treatment code. Orthodontic re-treatment is subject to prior authorisation by the patient’s medical scheme.

- - - - - -

011

Dento-legal fees: Practitioners are entitled to remuneration if they are present at Court at the request of an advocate or attorney. Use code 8111 (Dental testimony) to report dento-legal work. The code is listed in the adjunctive general services sections in the code lists.

- - - - - -

D. Modifiers - - - - - -

012

Modifiers: Modifiers should be used with procedures identified throughout the NHRPL. Modifiers provide the means by which the reporting practitioner can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed it its definition or code. The sensible application of modifiers obviates the necessity for separate procedure listings that may describe the modifying circumstance. Modifiers may be used to indicate to the recipient of the report that: a. A service or procedure was performed by more than one practitioner. b. A service or procedure has been increased or reduced. c. Only part of a service was performed. d. An adjunctive service was performed. e. A service or procedure was provided more than once. f. The fee/benefit was altered due to a financial agreement.

- - - - - -

8001 Assistant surgeon - specialist (1/3 of the appropriate benefit) - - - - - -

8003 Minimum assistant surgeon 165.20 165.20 - 165.20 - -

8005 Maximum multiple procedures (same incision) - MFO surgeon 256.50 256.50 - 256.50 - -

8006 Multiple surgical procedures - third and subsequent procedures (50% of the appropriate benefit) - - - - - -

8007 Assistant surgeon - general dental practitioner (15% of the appropriate benefit) - - - - - -

8008 Emergency surgery - after hours (PLUS 25% of the appropriate benefit) - - - - - -


22 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8009 Multiple surgical procedures - second procedure (75% of the appropriate benefit) - - - - - -

8010 Open reduction (PLUS 75% of the appropriate benefit) - - - - - -

8011Procedure accompanied by unusual circumstances (Benefit PLUS X % as determined by the practitioner and agreed upon by patient/medical scheme)

- - - - - -

8012 Reduced services (benefit MINUS X % as determined by the practitioner) - - - - - -

8013 Multiple modifiers - - - - - -

8023 Fabrication of inlay/onlay (PLUS 25% of the appropriate benefit) - - - - - -

8025 Handling fee - direct materials (26% of material cost to a maximum of R26.00) - - - - - -

E. Explanations - - - - - -

Tooth identification and designation of areas of the oral cavity: - - - - - -

Tooth identification and designation of areas of the oral cavity is compulsory for all invoices rendered. Tooth identification is applicable to procedures identified with the letter ( T ), and other designation of areas of the oral cavity with the letter ( Q ) for a quadrant and the letter ( M ) for the maxillary or mandibular area in the mouth part ( MP ) column of the Dental Coding. The International Standards Organisation (ISO) in collaboration with the FDI designated system for teeth and areas of the oral cavity should be used. For supernumeraries, the abbreviation SUP should be used.

- - - - - -

Treatment categories: - - - - - -

Treatment categories (TC) of dental procedures are identified in the TC column of the Dental Coding as follows: Basic dentistry - designated as ( B ) in the treatment category column Advanced dentistry - designated as ( A ) in the treatment category column Surgery - designated as ( S ) in the treatment category column

- - - - - -

Abbreviations used in Dental Coding - - - - - -

DM Direct Material Column +D Add fee/benefit for denture +L Add laboratory fee +M Add material fee

- - - - - -


23 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

MP Mouth Part Column M Maxilla/Mandible Q Quadrant S Sextant T Tooth

- - - - - -

TC Treatment Category Column A Advanced dentistry B Basic dentistry S Surgery

- - - - - -

Practice type codes: 25400 General Dental Practitioner 26200 Specialist Maxillo Facial and Oral Surgeon 26400 Specialist Orthodontist 29200 Specialist in Oral Medicine and Periodontics 29400 Specialist Prosthodontist 29800 Specialist Oral Pathologist 39500 Dental Therapist

- - - - - -

F. Guidelines to medical schemes - - - - - -

Age of a Child. The determination of a child or adult status of the patient should be based on the clinical development of the patient’s dentition. Where administrative constraints preclude the use of clinical development so that the chronological age must be used to determine the child or adult status, the patient is defined as an adult beginning at age 12 with the exclusion of treatment for orthodontics or sealants.

- - - - - -

Frequency of benefits. The South African Dental Association recommends to medical schemes, where considered necessary and appropriate, that contract limitations on the frequency of providing care for certain services be stated as “twice a calendar year” rather than once in every six months.

- - - - - -


24 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

Radiographs and records. Radiographs should be taken only for clinical reasons as determined by the treating dentist. Postoperative radiographs should only be required as part of dental treatment. When a dentist determined it is appropriate to comply with a third-party payer’s request for radiographs, a duplicate set should be submitted and the originals retained by the dentist. Any additional costs incurred by the dentists in copying radiographs and clinical records for claims determination should be reimbursed by the third-party payer or the patient.

- - - - - -

New vs. established patient. A new patient is one who has not received any professional services from the dentist or another dentist of the same speciality who belongs to the same group practice, within the past three years. An established patient (patient of record) is one who has received professional services from the dentist or another dentist of the same speciality who belongs to the same group practice, within the past three years. In the instance where a dentist is on call for or covering for another dentist, the patient’s encounter will be classified as it would have been by the dentist who is not available.

- - - - - -

II. DENTAL PROCEDURES AND SERVICES - - - - - -

A. DIAGNOSTIC SERVICES - - - - - -

The branch of dentistry used to identify and prevent dental disorders and disease. Includes all services/procedures available to the dentist for evaluating existing conditions and determining any further dental care that may be required.

- - - - - -

CLINICAL ORAL EXAMINATIONS - - - - - -

The purpose of oral examinations is to observe and record pertinent information, past and present, necessary to arrive at a diagnosis and treatment plan (when treatment is indicated). A treatment plan is a list of procedures or services the dentist proposes to perform on a dental patient based on the results of the examination and diagnosis. Often more than one treatment plan is presented. Oral examinations may require the integration of information that is acquired through additional diagnostic procedures, which should be reported separately. The oral examination, diagnosis, and treatment planning are the responsibility of the dentist. The collection and recording of some data and components of the oral examination may however be delegated. Oral examinations and consultations include the issuing of prescriptions where medication is required.

- - - - - -

General Dental Practitioner - - - - - -


25 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8101 Oral examination 145.10 - - - - -

8102 Comprehensive oral examination 234.20 - - - - -

8104 Limited oral examination 70.30 - - - - -

8189 Re-examination - existing condition 70.30 - - - - -

8176 Periodontal screening 122.20 - - - - -

8190 Consultation - second opinion or advice 145.10 - - - - -

Maxillo Facial Surgeon - - - - - -

8901 Consultation - MFOS - 184.80 - - - -

8902 Consultation - MFOS (detailed) - 483.70 - - - -

8840 Treatment planning for orthognathic surgery - ALL 417.30 626.10 626.10 - - -

Orthodontist - - - - - -

8801 Consultation - Orthodontist - - 184.80 - - -

8803 Consultation - Orthodontis (subsequent, retention and post treatment) - - 107.60 - - -

8837 Diagnosis and treatment planning - Orthodontist - - 85.90 - - -

Periodontist/Oral Medicine - - - - - -

Codes 8701, 8703, 8705 and 8707 cannot be charged at one and the same visit. - - - - - -

8701 Consultation - periodontist - - - 184.80 - -

8703 Consultation - Periodontist (detailed) - - - 483.70 - -

8705 Re-examination - Periodontist - - - 144.60 - -

8707 Periodontal screening - Periodontist - - - 144.60 - -

8781 Consultation - Oral medicine (simple) - - - 144.60 - -

8782 Consultation - Oral medicine (complex) - - - 254.40 - -

8783 Consultation - Oral medicine (subsequent) - - - 107.60 - -

Prosthodontist - - - - - -

8501 Consultation - Prosthodontis - - - - 184.80 -

8507 Comprehensive consultation - Prosthodontist - - - - 296.80 -

8506 Detailed consultation - Prosthodontist - - - - 483.70 -

Oral Pathologist - - - - - -


26 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

9201 Consultation - oral pathologist - - - - - 184.80

9205 Consultation - oral pathologist (subsequent) - - - - - 107.60

RADIOGRAPHS/DIAGNOSTIC IMAGING - - - - - -

Diagnostic radiographs/diagnostic images include interpretation. Radiographs/diagnostic images should only be taken for clinical reasons as determined by the dentist and practitioners should comply with the Regulations concerning safe radiological practice and take the necessary precaution to minimise radiation of patients. Radiographs/diagnostic images are part of the patient’s clinical record, should be of diagnostic quality, properly identified and dated. The dentist should retain the original images and only copies should be used to fulfil requests made by patients or third party funders. A complete series of intra-oral radiographs/images for diagnostic purposes is required once per treatment plan only. A second series may be required in exceptional cases e.g., following periodontal surgery. The same applies to panoramic films, where additional films may be required for follow-up/re-evaluation purposes. Diagnostic radiographs/diagnostic images preceding endodontic treatment, periodontal treatment, the surgical extraction of teeth or roots and fixed prostheses are fundamental to ethical clinical practice.

- - - - - -

8107 Intraoral radiograph - periapical 58.70 58.70 58.70 58.70 58.70 -

8108 Intraoral radiographs - complete series 454.50 454.50 454.50 454.50 454.50 -

8112 Intraoral radiograph - bitewing 58.70 58.70 58.70 58.70 58.70 -

8113 Intraoral radiograph - occlusal 101.10 101.10 101.10 101.10 101.10 -

8114 Extraoral radiograph - hand-wrist 234.70 234.70 234.70 234.70 234.70 -

8115 Extraoral radiograph - panoramic 234.70 234.70 234.70 234.70 234.70 -

8116 Extraoral radiograph - cephalometric 234.70 234.70 234.70 234.70 234.70 -

8118 Extraoral radiograph - skull/facial bone 234.70 234.70 234.70 234.70 234.70 -

8121 Oral and/or facial image (digital/conventional) 63.10 63.10 63.10 63.10 63.10 -

OTHER DIAGNOSTIC PROCEDURES - - - - - -

8117 Diagnostic models 63.10 63.10 63.10 63.10 63.10 -

8119 Diagnostic models mounted 158.70 158.70 158.70 158.70 158.70 -

8122 Microbiological studies - - - - - -


27 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8123 Caries susceptibility tests (By Arrangement) 65.60 - - - - -

8124 Pulp tests 17.30 - - - - -

8503 Occlusion analysis mounted 197.70 - - - 296.80 -

8505 Pantographic recording 287.00 - - - 430.50 -

8508 Electrognathographic recording 307.30 - - - 460.90 -

8509 Electrognathographic recording with computer analysis 510.20 - - - 765.20 -

8811 Tracing and analysis of extra-oral film 27.30 27.30 27.30 27.30 27.30 -

8839 Diagnostic setup (orthodontics) 121.10 181.60 -

B. PREVENTIVE SERVICES - - - - - -

Services/procedures intended to eliminate or reduce the need for future dental treatment. - - - - - -

DENTAL PROPHYLAXIS - - - - - -

8155 Polishing - complete dentition 89.10 122.70 89.10

8159 Prophylaxis - complete dentition 175.10 246.80 175.10

8160 Removal of gross calculus - - - - - -

8179 Polishing - complete dentition (periodontally compromised patient) 102.20

8180 Prophylaxis - complete dentition (periodontally compromised patient) 190.20

TOPICAL FLUORIDE TEATMENT - - - - - -

Topical fluoride treatment procedures involve the professionally application of topical fluoride within the dental office. Excludes fluoride application as part of prophylaxis paste, fluoride rinses or “swish.” For application of desensitising medicaments, see codes 8166 and 8167 in the supplementary section.

- - - - - -

8161 Topical application of fluoride - child 89.10 - - 89.10 89.10 -

8162 Topical application of fluoride - adult 89.10 - - 89.10 89.10 -

SPACE MAINTENANCE (PASSIVE APPLIANCES) - - - - - -

Passive appliances are designed to prevent tooth movement. - - - - - -

8173 Space maintainer - fixed, per abutment 165.30 - - - - -

8175 Space maintainer - removable 213.10 - - - - -

OTHER PREVENTIVE PROCEDURES - - - - - -


28 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8149 Nutritional counselling - - - - - -

8150 Tobacco counselling - - - - - -

8151 Oral hygiene instruction 89.10 - - 178.30 178.30 -

8153 Oral hygiene instruction - each additional visit 65.30 - - 85.90 85.90 -

8163 Dental sealant 58.70 - - - 58.70 -

8169 Occlusal guard 342.30 - - - - -

8171 Mouth guard 103.60 - - - - -

8177 Oral hygiene instruction (periodontally compromised patient) 134.90 - - - - -

8178 Oral hygiene instruction - each additional visit (periodontally compromised patient) 72.80 - - - - -

C. RESTORATIVE SERVICES - - - - - -

The branch of dentistry that deals with the reconstruction of the hard tissues of a tooth or group of teeth, injured or destroyed by trauma or disease. Restorative services/procedures intend to restore the function of a natural tooth. Anterior teeth include incisors and canines. Posterior teeth include premolars and molars. The number of tooth surfaces restored, i.e. mesial, occlusal (or incisal), distal, lingual, or vestibular (buccal or labial), is used to determine the appropriate procedure code. A one surface restoration for example, involves only one of the surfaces, while a two-surface restoration extends to two of the five surfaces. With a four-or-more-surfaces anterior restoration involving four tooth surfaces and the incisal angle is involved. Limitations on amalgam and resin-based composite restorations: (1) The reporting of two separate restorations of the same material (e.g., a MO and DO amalgam restoration) on the same tooth is appropriate. Some medical schemes however, have a clause in its dental plan(s) that restricts coverage of the same tooth surface, such as an occlusal, twice on the same day and may require the reporting of a MOD restoration instead of a separate MO and DO restoration. (2) The current NHRPL rates include direct pulp capping (code 8301) and rubber dam application (code 8304).

- - - - - -

AMALGAM RESTORATIONS - - - - - -

All adhesives, liners, bases and polishing are included as part of the restoration. If pins are used, they should be reported separately. See codes 8345, 8347 and 8348 for post and/or pin retention.

- - - - - -


29 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8341 Amalgam - one surface 177.20 - - - - -

8342 Amalgam - two surfaces 218.40 - - - - -

8343 Amalgam - three surfaces 266.30 - - - - -

8344 Amalgam - four or more surfaces 296.80 - - - - -

RESIN-BASED COMPOSITE RESTORATIONS - - - - - -

Resin restorations refer to a broad category of materials including but not limited to composites. Report these codes when glass ionomers/compomers are used as restorations. The procedures include acid etching, adhesives (including resin bonding agents) and curing part of the restoration. Resin restorations utilise the direct technique. For the indirect technique, see “Resin inlays/onlays” If pins are used, they should be reported in addition to these codes - See codes 8345, 8347 and 8348 for post and/or pin retention.

- - - - - -

8350 Resin crown - anterior primary tooth (direct) 386.60 - - - - -

8351 Resin - one surface, anterior 194.50 - - - - -

8352 Resin - two surfaces, anterior 244.70 - - - - -

8353 Resin - three surfaces, anterior 292.40 - - - - -

8354 Resin - four or more surfaces, anterior 326.20 - - - - -

8367 Resin - one surface, posterior 210.90 - - - - -

8368 Resin - two surfaces, posterior 260.90 - - - - -

8369 Resin - three surfaces, posterior 315.30 - - - - -

8370 Resin - four or more surfaces, posterior 339.10 - - - - -

GOLD FOIL RESTORATIONS - DELETED FROM GEMS TARIFF 2011 - - - - - -

8561 Gold foil class I or IV - DELETED FROM GEMS TARIFF 2011 - - - - - -

8563 Gold foil class V - DELETED FROM GEMS TARIFF 2011 - - - - - -

8565 Gold foil class III - DELETED FROM GEMS TARIFF 2011 - - - - - -

INLAY/ONLAY RESTORATIONS - - - - - -

Temporary and/or intermediate inlays/onlays, the removal thereof and cementing of the permanent restoration are included as part of the restoration. The cusp tip must be overlaid to be considered an onlay.

- - - - - -

Metal Inlays/Onlays - - - - - -


30 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

Use these codes for single metal inlay/onlay restorations. See the Fixed Prosthodontic Service section for metal inlay/only bridge retainers. Metal components include structures manufactured by means of conventional casting and/or electroforming. The benefits provided by some medical schemes for metal inlays on anterior teeth (incisors and canines) may be subject to pre-authorisation.

- - - - - -

8361 Inlay - metal - one surface 270.70 - - - 533.70 -

8362 Inlay/onlay - metal - two surfaces 395.70 - - - 773.90 -

8363 Inlay/onlay - metal - three surfaces 659.80 - - - 1 200.10 -

8364 Inlay/onlay - metal - four or more surfaces 797.90 - - - 1 200.10 -

Porcelain/Ceramic Inlays/Onlays - - - - - -

Use these codes for single porcelain/ceramic inlay/onlay restorations. See the Fixed Prosthodontic Service section for porcelain/ceramic inlay/only bridge retainers. Porcelain/ceramic inlays/onlays include all indirect ceramic, porcelain and polymer-reinforced porcelain type inlays/onlays. Fees for the application of a rubber dam (8304) may be levied in addition to these codes. TO BE CONFIRMED: When computer generated (CAD-CAM) ceramic restorations are fabricated by the dental practitioner, laboratory costs do not apply. Report codes 8570 (Fabrication of computer generated ceramic restoration) and 8560 for the cost of the ceramic block in addition to the restoration.

- - - - - -

8371 Inlay - porcelain - one surface 326.20 - - - 644.70 -

8372 Inlay/onlay - porcelain - two surfaces 481.50 - - - 928.40 -

8373 Inlay/onlay - porcelain - three surfaces 793.50 - - - 1 442.50 -

8374 Inlay/onlay - porcelain - four or more surfaces 961.00 - - - 1 442.50 -

8560 Cost of ceramic block - - - - - -

8570 Fabrication of computer generated ceramic restoration - - - - - -

Resin-based Inlays/Onlays - - - - - -


31 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

Resin based inlays/onlays usually utilise the indirect technique. Fees for the application of a rubber dam (8304) may be levied in addition to these codes. When the direct technique is used, laboratory costs do not apply. An additional fee may be levied by reporting Modifier 8023 in addition to these codes.

- - - - - -

8381 Inlay - resin - one surface 326.20 - - - 644.70 -

8382 Inlay/onlay - resin - two surfaces 481.50 - - - 928.40 -

8383 Inlay/onlay - resin - three surfaces 793.50 - - - 1 442.50 -

8384 Inlay/onlay - resin - four or more surfaces 961.00 - - - 1 442.50 -

CROWNS – SINGLE RESTORATIONS - - - - - -

Use these codes for single crown restorations. See the Fixed Prosthodontic Service section for crown bridge retainers and the Implant Services section for crowns on osseo-integrated implants. Porcelain/ceramic crowns include all ceramic, porcelain and porcelain fused to metal crowns. Resin crowns and resin metal crowns include all reinforced heat and/or pressure-cured resin materials. Metal components include structures manufactured by means of conventional casting and/or electroforming. Temporary and/or intermediate crowns, the removal thereof (provisional crowns included) and cementing of the permanent restorations are included as part of the restorations. TO BE CONFIRMED: When computer generated (CAD-CAM) ceramic restorations are fabricated by the dental practitioner, laboratory costs do not apply. Report codes 8570 (Fabrication of computer generated ceramic restoration) and 8560 for the cost of the ceramic block in addition to the restoration.

- - - - - -

8401 Crown - full cast metal 1 017.50 - - - 1 498.00 -

8403 Crown - 3/4 cast metal 1 017.50 - - - 1 498.00 -

8404 Crown - 3/4 porcelain/ceramic 960.90 - - - 1 442.50 -

8405 Crown - resin laboratory 960.90 - - - 1 442.50 -

8407 Crown - resin with metal 1 017.50 - - - 1 498.00 -

8409 Crown - porcelain/ceramic 1 017.50 - - - 1 498.00 -

8411 Crown - porcelain with metal 1 017.50 - - - 1 498.00 -

8410 Provisional crown 197.70 - - 197.70 296.80 -


32 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

VENEERS - - - - - -

8355 Veneer - resin (chair-side) 308.80 - - - 308.80 -

8552 Veneer - porcelain (laboratory) 683.30 - - - 1 025.00 -

8554 Veneer - resin (laboratory) 683.30 - - - 1 025.00 -

TEMPORARY RESTORATIONS - - - - - -

8137 Emergency crown (chair-side) 305.50 - - - 305.50 -

8357 Prefabricated metal crown 181.60 - - - 181.60 -

8375 Prefabricated resin crown 181.60 - - - 181.60 -

OTHER RESTORATIVE PROCEDURES - - - - - -

Pin Retention and Cores - - - - - -

8345 Prefabricated post retention, per post (in addition to restoration) 175.10 - - - - -

8347 Pin retention - first pin (in addition to restoration) 88.00 - - - - -

8348 Pin retention - each additional pin (in addition to restoration) 81.50 - - - - -

8366 Pin retention as part of cast restoration (any number of pins) 131.60 - - - 178.30 -

8376 Core build-up with prefabricated posts 484.70 - - - 484.70 -

8379 Cost of prefabricated posts - - - - - -

8391 Cast core with single post 204.50 - - - - -

8392 Cast post (each additional) 121.70 - - - - -

8397 Cast core with pins (any number of pins) 326.20 - - - 424.00 -

8398 Core build-up with or without pins 395.70 - - - 395.70 -

8581 Cast core with single post - - - - 302.10 -

8582 Cast core with double post - - - - 430.50 -

8583 Cast core with triple post - - - - 533.70 -

Unclassified Restorative Procedures - - - - - -

8133 Recement inlay, onlay, crown or veneer 89.10 - - - 113.00 -

8135 Remove inlay, onlay or crown 177.20 - - - 177.20 -

8138 Remove retention post (prefabricated or cast) 116.30 - - - - -

8146 Resin bonding for restorations - - - - - -


33 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8157 Re-burnishing and polishing of restorations - complete dentition 89.10 - - - - -

8349 Carve restoration to accommodate existing removable prosthesis 35.80 - - - - -

8413 Repair crown (permanent or provisional) 197.70 - - - 197.70 -

8414 Additional fee for provision of crown within an existing clasp or rest 58.70 - - - - -

D. ENDODONTIC SERVICES - - - - - -

Services/procedures intended to treat diseases of the dental pulp and their sequelae. - - - - - -

PULP CAPPING - - - - - -

These codes should not be used as a base or liner under a restoration. Certain funders (medical aids) may restrict the placement of the final restoration during the same visit.

- - - - - -

8301 Pulp cap - direct 118.50 - - - - -

8303 Pulp cap - indirect 118.50 - - - - -

PULPOTOMY - - - - -

8307 Pulp amputation (pulpotomy) 116.30 - - - - -

8132 Pulp removal (pulpectomy) 145.60 - - - - -

ENDODONTIC THERAPY - - - - - -

Includes endodontic therapy on primary teeth. Does not include diagnostic evaluation and necessary radiographs/ diagnostic images. Limitation: Intra-operative radiographs/ diagnostic images are limited to three on a single canal tooth and five on a multi-canal tooth for each completed endodontic therapy. Report code 8304 (application of a rubber dam) in addition to these codes.

- - - - - -

Preparatoty Visits - - - - - -

8332 Root canal preparatory visit - single canal tooth 89.10 - - - - -

8333 Root canal preparatory visit - multi canal tooth 124.90 - - - - -

Obtuation of Canals - - - - - -

Codes 8328, 8335, 8336 and 8337 (obturation of root canals at a subsequent visit) are intended to be used in conjunction with codes 8332, 8333 and 8334 (endodontic preparatory visits and re-preparation of previously obturated canal).

- - - - - -

8335 Root canal obturation - anteriors and premolars - first canal 404.40 - - - - -

8328 Root canal obturation - anteriors and premolars - each additional canal 165.30 - - - - -


34 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8336 Root canal obturation - posteriors - first canal 556.50 - - - - -

8337 Root canal obturation - posteriors - each additional canal 165.30 - - - - -

Complete Therapy - - - - - -

Codes 8329, 8338, 8339 and 8340 (endodontic treatment completed at a single visit) may not be used with codes 8332, 8333 and 8334 (endodontic preparatory visits and re-preparation of previously obturated canal).

- - - - - -

8338 Root canal therapy - anteriors and premolars - first canal 618.60 - - - - -

8329 Root canal therapy - anteriors and premolars - each additional canal 206.50 - - - - -

8339 Root canal therapy - posteriors - first canal 850.00 - - - - -

8340 Root canal therapy - posteriors - each additional canal 206.50 - - - - -

8631 Root canal therapy - first canal - - - - 1 050.10 -

8633 Root canal therapy - each additional canal - - - - 264.10 -

ENDODONTIC RETREATMENT - - - - -

8334 Re-preparation of previously obturated root canal 131.60 - - - 158.70 -

APEXIFICATION/RECALCIFICATION PROCEDURES - - - -

8635 Apexification/recalcification – per visit 118.50 - - - 175.10 -

PERIRADICULAR PROCEDURES - - - -

9015 Apicectomy - anteriors (including retrograde filling) 439.20 582.60 582.60 582.60 -

9016 Apicectomy - posteriors (including retrograde filling) 774.70 1 162.10 1 162.10 1 162.10 -

OTHER ENDODONTIC PROCEDURES - - - - -

8330 Removal of root canal obstruction 116.30 - - - - -

8136 Access through a prosthetic crown or inlay to facilitate root canal treatment 79.30 - - - - -

8640 Removal of fractured post or instrument from root canal - - - - 308.80 -

8765 Hemisection of a tooth, resection of a root or tunnel preparation (isolated procedure) 388.50 - - 582.60 582.60 -

E. PERIODONTIC SERVICES - - - - - -

The branch of dentistry used to treat and prevent disease affecting the gingivae, ligaments and bone that supports the teeth.

- - - - - -

SURGICAL SERVICES - - - - - -


35 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

Surgical services includes usual postoperative care. - - - - - -

8741 Gingivectomy/gingivoplasty - four or more teeth per quadrant 465.30 - - 638.20 - -

8743 Gingivectomy or gingivoplasty - one to three teeth per quadrant 371.70 - - 506.60 - -

8749 Flap procedure, root planing and one to three surgical services - per quadrant 965.90 - - 1 449.10 - -

8751 Flap procedure, root planing and one to three surgical services - per sextant 800.00 - - 1 200.10 - -

8753 Flap procedure, root planing and four or more surgical services - per quadrant 1 197.30 - - 1 795.90 - -

8755 Flap procedure, root planing and four or more surgical services - per sextant 970.30 - - 1 455.60 - -

8756 Clinical crown lengthening (isolated procedure) 588.40 - - 882.60 - -

8759 Pedicle flapped graft (isolated procedure) 442.20 - - 663.10 - -

8761 Masticatory mucosal autograft - one to four teeth (isolated procedure) 480.40 720.70 - 720.70 - -

8762 Masticatory mucosal autograft - four or more teeth (isolated procedure) 721.80 1 082.70 - 1 082.70 - -

8763 Wedge resection (isolated procedure) 282.70 - 424.00 - -

8766 Bone regeneration/repair procedure - as part of a flap operation 231.20 - 346.80 - -

8767 Bone regeneration/repair procedure - at a single site 599.30 899.10 - 899.10 - -

8769 Membrane removal (used for guided tissue regeneration) 282.70 424.00 - 424.00 - -

8770 Cost of bone regenerative/repair material - - - - - -

8772 Submucosal connective tissue autograft (isolated procedure) 485.50 728.40 - 728.40 - -

8995 Gingivectomy - per jaw 689.20 1 033.80 - - - -

NON-SURGICAL PERIODONTAL SERVICES - - - - - -

8723 Provisional splinting - extracoronal (wire) - per sextant 165.30 - - 247.90 247.90 -

8725 Provisional splinting - extracoronal (wire plus resin) - per sextant 239.90 - - 359.80 359.80 -

8727 Provisional splinting - intracoronal - per tooth 75.30 - - 113.00 113.00 -

8737 Root planing - four or more teeth per quadrant 356.60 - - 483.70 - -

8739 Root planing - one to three teeth per quadrant 283.70 - - 385.90 - -

8773 Cost of intrapocket chemotherapeutic agent - - - - - -

OTHER PERIODONTAL SERVICES - - - - - -

8768 Unlisted periodontal procedure 282.70 - - 424.00 - -


36 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8787 Unlisted oral medicine procedure 101.40 - - 152.20 - -

F. REMOVABLE PROSTHODONTICS - - - - - -

The branch of prosthodontics concerned with the replacement of teeth by artificial substitutes that is readily removable. Removable prosthodontic services include routine post-operative care.

- - - - - -

COMPLETE DENTURES - - - - - -

8231 Complete dentures - maxillary and mandibular 1 437.10 - - - 3 000.30 -

8232 Complete denture - maxillary or mandibular 885.90 - - - 2 099.10 -

8244 Immediate denture - maxillary 885.90 - - - 1 329.00 -

8245 Immediate denture - mandibular 885.90 - - - 1 329.00 -

8643 Complete dentures - maxillary and mandibular (with complications) - - - - 3 893.70 -

8645 Complete dentures - maxillary and mandibular (with major complications) - - - - 4 789.60 -

8649 Complete denture - maxillary or mandibular (with complications) - - - - 2 395.90 -

8651 Complete denture - maxillary or mandibular (with major complications) - - - - 2 694.80 -

PARTIAL DENTURES - - - - - -

8233 Partial denture - resin base - one tooth 411.90 - - - - -

8234 Partial denture - resin base - two teeth 411.90 - - - - -

8235 Partial denture - resin base - three teeth 616.40 - - - - -

8236 Partial denture - resin base - four teeth 616.40 - - - - -

8237 Partial denture - resin base - five teeth 616.40 - - - - -

8238 Partial denture - resin base - six teeth 817.60 - - - - -

8239 Partial denture - resin base - seven teeth 817.60 - - - - -

8240 Partial denture - resin base - eight teeth 817.60 - - - - -

8241 Partial denture - resin base - nine or more teeth 817.60 - - - - -

8281 Partial denture - cast metal framework only 961.00 - - - - -

8671 Partial denture - cast metal framework with resin denture base - - - - 2 395.90 -

ADJUSTMENTS TO DENTURES - - - - - -

8275 Adjust complete or partial denture 65.30 - - - 65.30 -


37 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8662 Adjust complete or partial dentures (remounting) 230.60 - - - 345.80 -

REPAIRS TO DENTURES - - - - - -

Professional fees should not be levied for the repair of dentures/intra-oral appliances if the practitioner did not examine the patient. Laboratory costs, however, may be recovered.

- - - - - -

8269 Repair denture or other intra-oral appliance 113.00 - - - 121.70 -

8270 Add clasp to existing partial denture 81.50 - - - -

8271 Add tooth to existing partial denture 81.50 - - - -

8273 Impression to repair or modify a denture or other intra-oral appliance 65.30 - - - 65.30 -

DENTURE REBASE PROCEDURES - - - - - -

Rebase – The partial or complete removal and replacement of the denture base. - - - - - -

8259 Rebase complete or partial denture (laboratory) 335.90 - - - 484.70 -

8261 Remodel complete or partial denture 539.20 - - - -

DENTURE RELINE PROCEDURES - - - - - -

Reline - The addition of material to the fitting surface of a denture base. - - - - - -

8263 Reline complete or partial denture (chair-side) 213.10 - - - 266.30 -

8267 Reline complete or partial denture (laboratory) 490.40 - - - 490.40 -

INTERIM DENTURES - - - - - -

Also known as provisional, temporary, or transitional dentures. Provisional dentures are used for a limited period of time for reasons of aesthetics, function or occlusal support, after which it is replaced by a more definitive prosthesis.

- - - - - -

8658 Interim complete denture 885.90 - - - 1 328.90 -

8659 Interim partial denture 708.70 - - - 1 063.10 -

8661 Diagnostic dentures (including tissue conditioning) - - - - 2 395.90 -

OTHER REMOVABLE PROSTHETIC PROCEDURES - - - - - -

8251 Clasp or rest - cast gold 81.50 - - - - -

8253 Clasp or rest - wrought gold 81.50 - - - - -

8255 Clasp or rest - stainless steel 85.90 - - - - -

8257 Bar - lingual or palatal 101.10 - - - - -


38 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8265 Tissues conditioning per arch (including soft self-cure reline) 139.20 - - - 178.30 -

8277 Inlay in denture - - - - - -

8597 Locks and milled rests 81.20 - - - 121.70 -

8599 Precision attachment (removable denture) 197.70 - - - 296.80 -

8652 Overdenture - complete 1 597.20 - - - 2 395.90 -

8653 Overdenture - partial 1 277.70 - - - 1 916.60 -

8657 Replacement of precision attachment 113.00 - - - 121.70 -

8663 Metal base to complete denture 481.20 - - - 721.80 -

8664 Remount crown or bridge for prosthetics 230.60 - - - 361.20 -

8667 Soft base to denture (heat cured) 481.20 - - - 721.80 -

8672 Altered cast technique (in addition to partial denture) 61.70 - - - 92.50 -

8674 Additive partial denture 724.70 - - - 1 087.10 -

G. MAXILLO-FACIAL PROSTHETICS - - - - - -

The branch of prosthodontics concerned with the restoration of stomatognathic and associated facial structures that have been affected by disease, injury, surgery or congenital defect. Where “+D” appears the practitioner will charge the relevant fee/benefit for the denture in the Where “+D” appears the practitioner will charge the relevant fee/benefit for the denture in the Schedule plus the fee/benefit indicated

- - - - - -

MAXILLIARY PROSTHESIS - - - - - -

9101 Obturator prosthesis, surgical - modified denture 119.00 - - - 178.30 -

9102 Obturator prosthesis, surgical - continuous base 322.40 - - - 483.70 -

9103 Obturator prosthesis, surgical - split base 480.40 - - - 720.70 -

9104 Obturator prosthesis, interim - on existing denture 724.70 - - - 1 087.10 -

9105 Obturator prosthesis, interim - on new denture 2 238.00 - - - 3 356.90 -

9106 Obturator prosthesis, definitive - open/hollow box 724.70 - - - 1 087.10 -

9107 Obturator prosthesis, definitive - silicone glove 1 399.40 - - - 2 099.10 -

MANDIBULAR RESECTION PROSTHESES - - - - - -

9108 Mandibular resection prosthesis w/ guide flange 1 719.00 - - - 2 578.50 -


39 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

9109 Mandibular resection prosthesis w/o guide flange 1 597.20 - - - 2 395.90 -

9110 Mandibular resection prosthesis, palatal augmentation 322.40 - - - 483.70 -

GLOSSAL RESECTION PROSTHESES - - - - - -

9111 Glossal resection prosthesis - simple 672.50 - - - 1 008.90 -

9112 Glossal resection prosthesis - complex 1 007.40 - - - 1 511.00 -

RADIOTHERAPY APPLIANCES - - - - - -

9113 Radiation carrier - simple 724.70 - - - 1 087.10 -

9114 Radiation carrier - complex 2 000.20 - - - 3 000.30 -

9115 Radiation shield - simple 724.70 - - - 1 087.10 -

9116 Radiation shield - complex 2 000.20 - - - 3 000.30 -

9117 Radiation cone locator 724.70 - - - 1 087.10 -

CHEMOTHERAPY APPLIANCES - - - - - -

9118 Chemotherapeutic agent carrier 724.70 - - - 1 087.10 -

CLEFT PALATE PROSTHESES - - - - - -

8855 Consultation - cleft palate therapy (house or hospital) 165.30 - 247.90 - 247.90 -

8856 Consultation - cleft palate (subsequent) 81.20 - 121.70 - 121.70 -

8857 Consultation - cleft palate (maximum) 564.50 - 846.80 - 846.80 -

NEONATAL PROSTHESES - - - - - -

9119 Feeding aid prosthesis, neonatal 641.40 - 962.20 - 962.20 -

9120 Orthopaedic appliance, active presurgical - minor 641.40 - 962.20 - 962.20 -

9121 Orthopaedic appliance, active presurgical - moderate 949.30 - 1 424.00 - 1 424.00 -

9122 Orthopaedic appliance, active presurgical - severe 1 597.20 - 2 395.90 - 2 395.90 -

9123 Orthopaedic appliance, active presurgical - modification 81.20 - 121.70 - 121.70 -

INTERMEDIATE/DEFINITIVE PROSTHESES - - - - - -

9125 Speech aid/obturator prosthesis - palatal alteration 323.20 - - - 484.70 -

9126 Speech aid/obturator prosthesis - velar alteration 724.70 - - - 1 087.10 -

9127 Speech aid/obturator prosthesis - pharyngeal alteration 1 597.20 - - - 2 395.90 -

9128 Speech aid/obturator prosthesis - modification 81.20 - - - 121.70 -


40 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

9129 Speech aid/obturator prosthesis - surgical 641.40 - - - 962.20 -

SPEACH APPLIANCES - - - - - -

9130 Speech aid appliance - palatal lift 322.40 - - - 483.70 -

9131 Speech aid appliance - palatal stimulating 724.70 - - - 1 087.10 -

9132 Speech aid appliance - bulb 1 597.20 - - - 2 395.90 -

9133 Speech aid appliance - modification 81.20 - - - 121.70 -

9134 Unspecified speech aid appliance - - - - - -

EXTRA-ORAL APPLIANCES - - - - - -

9135 Auricular prosthesis - simple 2 000.20 - - - 3 000.30 -

9136 Auricular prosthesis - complex 2 609.70 - - - 3 893.70 -

9137 Nasal prosthesis - simple 2 000.20 - - - 3 000.30 -

9138 Nasal prosthesis - complex 2 609.70 - - - 3 893.70 -

9139 Ocular prosthesis - interim 724.70 - - - 1 087.10 -

9140 Ocular prosthesis - modified stock appliance 1 797.90 - - - 2 697.00 -

9141 Ocular prosthesis - custom appliance 2 609.70 - - - 3 893.70 -

9142 Orbital prosthesis - simple 1 797.90 - - - 2 697.00 -

9143 Orbital prosthesis - complex 2 609.70 - - - 3 893.70 -

9144 Facial prosthesis, combination - small - - - - - -

9145 Facial prosthesis, combination - medium - - - - - -

9146 Facial prosthesis, combination - large - - - - - -

9147 Facial prosthesis, combination - complex - - - - - -

9148 Unspecified body prosthesis - simple 1 797.90 - - - 2 697.00 -

9149 Unspecified body prosthesis - complex 2 609.70 - - - 3 893.70 -

9150 Facial prosthesis, surgical - simple 1 399.40 - - - 2 099.10 -

9151 Facial prosthesis, surgical - complex 1 797.90 - - - 2 697.00 -

9152 Extraoral appliance - additional prosthesis - - - - - -

9153 Extraoral appliance - replacement prosthesis - - - - - -

9155 Cranial prosthesis 724.70 - - - 1 087.10 -


41 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

CUSTOM IMPLANTS - - - - - -

9156 Cranial implant prosthesis, custom made 874.80 - - - 1 312.00 -

9157 Facial implant prosthesis, custom made - simple 437.00 - - - 655.40 -

9158 Facial implant prosthesis, custom made - complex 874.80 - - - 1 312.00 -

9159 Ocular implant prosthesis, custom made 437.00 - - - 655.40 -

9160 Body implant prosthesis - custom made 1 945.10 - - - 2 917.70 -

SURGICAL APPLIANCES - - - - - -

9161 Surgical splint - simple 197.70 - - - 296.80 -

9162 Surgical splint - complex 724.70 - - - 1 087.10 -

9163 Surgical template - simple 197.70 - - - 296.80 -

9164 Surgical template - complex 724.70 - - - 1 087.10 -

9165 Surgical conformer - simple 197.70 - - - 296.80 -

9166 Surgical conformer - complex 724.70 - - - 1 087.10 -

TRISMUS APPLIANCES - - - - - -

9167 Trismus appliance (simple) 81.20 - - - 121.70 -

9168 Trismus appliance (complex) 724.70 - - - 1 087.10 -

9169 Orthoses appliance 1 597.20 - - - 2 395.90 -

9170 Facial palsy appliance 480.40 - - - 720.70 -

9171 Commissure splint 197.70 - - - 296.80 -

9172 Oral retractor, dynamic - per arm 197.70 - - - 296.80 -

9173 Hand splint - - - - - -

9174 Unspecified burn appliance - - - - - -

ATTENDANCE IN THEATRE - - - - - -

9175 Theatre attendance (MaxFac prosthod) /hour 267.30 - - - 401.20 -

H. IMPLANT SERVICES - - - - - -

Services/procedures concerned with the surgical insertion of materials and devices into, onto and about the jaws and oral cavity for purposes of oral maxillofacial or oral occlusal rehabilitation or cosmetic corrections.

- - - - - -


42 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

SURGICAL IMPLANT PROCEDURES - - - - - -

The codes in this subsection are intended to report surgical procedures for the placement of implants to be used as prosthetic abutments. The surgical phase includes all procedures concerned with placing the implant into or onto the bone and preparation for the prosthetic phase.

- - - - - -

9180 Surgical placement of sub-periosteal implant - preparatory stage 1 172.60 1 759.00 - - - -

9181 Surgical placement of sub-periosteal implant - placement stage 1 172.60 1 759.00 - - - -

9182 Surgical placement of endosteal implant plate 587.00 880.50 - 880.50 - -

9183 Surgical placement of endosteal implant - first per jaw 826.10 1 122.90 - 1 122.90 - -

9184 Surgical placement of endosteal implant - second per jaw 618.60 842.40 - 842.40 - -

9185 Surgical placement of endosteal implant - third and subsequent per jaw 414.10 564.20 - 564.20 - -

9190 Surgical placement of abutment - first per jaw 306.50 415.10 - 415.10 415.10 -

9191 Surgical placement of abutment - second per jaw 230.40 312.10 - 312.10 312.10 -

9192 Surgical placement of abutment - third and subsequent per jaw 154.30 209.90 - 209.90 209.90 -

IMPLANT SUPPORTED PROSTHETICS - - - - - -

Services/procedures concerned with the construction and placement of fixed or removable prosthesis on any implant device. Prosthetic devices which are not listed in this subsection should be reported using existing fixed or removable prosthetic codes.

- - - - - -

Abutments and Bars - - - - - -

These codes are intended to report the placement of final restorations and should not be used to report the placement of temporary/provisional components e.g., healing abutments/collars, temporary abutments, caps, cylinders, etc.Abutments as part of one-piece endosteal implants (incorporating both the implant and integral fixed abutment) are considered being part of the implant body and should not be reported in addition to the surgical placement of the implant.See Codes 9187 to 9189 located in the “Other implant services” section to submit the cost of implant components.

- - - - - -

8584 Connector bar - implant supported 1 597.20 - - - 2 395.90 -

8578 Prefabricated abutment 165.30 - - - 247.90 -

8579 Custom abutment 753.70 - - - 1 130.60 -

Removable Dentures - - - - - -


43 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8533 Implant supported removable complete overdenture 1 597.20 - - - 2 395.90 -

8534 Implant supported removable partial overdenture 1 277.70 - - - 1 916.60 -

Fixed-detachable Dentures - - - - - -

8654 Implant supported fixed-detachable complete overdenture 1 796.50 - - - 2 694.80 -

8655 Implant supported fixed-detachable partial overdenture 1 437.20 - - - 1 846.60 -

8660 Additional fee to implant supported fixed-detachable denture - per implant 247.90 - - - 247.90 -

Crowns - Single Restorations - - - - - -

8536 Crown - implant/abutment supported - porcelain/ceramic 1 320.70 - - - 1 746.90 -

8537 Crown - implant/abutment supported - porcelain with metal 1 320.70 - - - 1 746.90 -

8538 Crown - implant/abutment supported - cast metal 1 320.70 - - - 1 746.90 -

8592 Crown - implant/abutment supported - - - - 1 746.90 -

Bridge Retainers - Crowns - - - - -

8546 Crown retainer - implant/abutment supported - porcelain/ceramic 1 320.70 - - - 1 746.90 -

8547 Crown retainer - implant/abutment supported - porcelain with metal 1 320.70 - - - 1 746.90 -

8548 Crown retainer - implant/abutment supported - cast metal 1 320.70 - - - 1 746.90 -

OTHER IMPLANT SERVICES - - - - -

8590 Implant maintenance procedures - per implant 73.20 - - - 109.80 -

8594 Repair of implant supported prosthesis 81.20 - - - 121.70 -

8595 Repair of implant abutment 81.20 - - - 121.70 -

8600 Cost of implant components - - - - - -

9187 Cost of endosteal implant body - - - - - -

9188 Cost of prefabricated abutment - - - - - -

9189 Cost of other implant compnts - - - - - -

9198 Surgical removal of implant 381.90 572.90 - 572.90 - -


44 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

I. FIXED PROSTHODONTICS - - - - - -

The branch of prosthodontics concerned with the replacement or restoration of teeth by artificial substitutes that are not readily removable. A prosthetic retainer (e.g., crown/inlay/onlay retainer) in this section is defined as a part of a bridge that attaches a pontic to the abutment tooth. A pontic is that part of a bridge which replaces a missing tooth or teeth. Each retainer and each pontic constitutes a unit in a bridge. Porcelain/ceramic retainers and pontics presently include all ceramic, porcelain and porcelain fused to metal retainers and pontics. Resin retainers and pontics and resin metal retainers and pontics include all reinforced heat and/or pressure-cured resin materials. Metal components include structures manufactured by means of conventional casting and/or electroforming.

- - - - - -

PONTICS - - - - - -

Comment: Codes 8415, 8416, 8417and 8418 include ovate pontic designs. The nomenclatures of the pontics have been revised to coincide with the nomenclature used for crowns, which improves accurate record keeping. A similar approach has been followed for crowns and inlays/onlays utilised as bridge retainers.

- - - - - -

8415 Pontic - porcelain/ceramic 830.50 - - - - -

8416 Pontic - cast metal 659.80 - - - - -

8417 Pontic - resin with metal 830.50 - - - - -

8418 Pontic - porcelain fused to metal 830.50 - - - - -

8419 Provisional pontic 197.70 - - - 296.80 -

8611 Pontic - sanitary - - - - 905.50 -

8613 Pontic - posterior - - - - 1 107.80 -

8615 Pontic - anterior/premolar - - - - 1 196.90 -

BRIDGE RETAINERS – INLAYS/ONLAYS - - - - - -

An inlay/onlay retainer for a bridge that gains retention, support and stability from a tooth. The cusp tip must be overlayed to be considered an onlay. See inlay/onlay restorations in the Restorative Services Section for inlay/onlay retainers.

- - - - - -

8432 Inlay/onlay retainer - metal - two surfaces 395.70 - - - 773.90 -


45 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8433 Inlay/onlay retainer - metal - three surfaces 659.80 - - - 1 200.10 -

8434 Inlay/onlay retainer - metal - four or more surfaces 797.90 - - - 1 200.10 -

8436 Inlay/onlay retainer - porcelain - two surfaces 481.50 - - - 928.40 -

8437 Inlay/onlay retainer - porcelain - three surfaces 793.50 - - - 1 442.50 -

8438 Inlay/onlay retainer - porcelain - four or more surfaces 961.00 - - - 1 442.50 -

8617 Retainer cast metal (Maryland type retainer) 395.70 - - - 773.90 -

BRIDGE RETAINERS – CROWNS - - - - - -

A crown retainer for a bridge that gains retention, support and stability from a tooth. - - - - - -

8441 Crown retainer - full cast metal 1 017.50 - - - 1 498.00 -

8442 Crown retainer - 3/4 cast metal 1 017.50 - - - 1 498.00 -

8443 Crown retainer - porcelain/ceramic 1 017.50 - - - 1 498.00 -

8444 Crown retainer - 3/4 porcelain/ceramic 1 017.50 - - - 1 498.00 -

8445 Crown retainer - porcelain with metal 1 017.50 - - - 1 498.00 -

8446 Crown retainer - resin with metal 1 017.50 - - - 1 498.00 -

8447 Provisional crown retainer 197.70 - - - 296.80 -

OTHER FIXED PROSTHODONTIC PROCEDURES - - - - - -

See “other restorative services” for procedures related to fixed prosthesis not listed in this sub-section.

- - - - - -

8514 Recement bridge 89.10 - - - 113.00 -

8516 Remove bridge 177.20 - - - 177.20 -

8518 Repair bridge 197.70 - - - 197.70 -

8585 Connector bar 1 597.20 - - - 2 395.90 -

8586 Stress breaker 595.80 - - - 893.60 -

8587 Coping metal 132.70 - - - 247.90 -

J. ORAL AND MAXILLO-FACIAL SURGERY - - - - - -

The branch of dentistry using surgery to treat disorders/diseases of the mouth. Surgical procedures include routine postoperative care.

- - - - - -

EXTRACTIONS - - - - - -


46 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8201 Extraction - tooth or exposed tooth roots (first per quadrant) 89.10 133.60 - - - -

8202 Extraction - each additional tooth or exposed tooth roots 35.80 53.80 - - - -

SURGICAL EXTRACTIONS - - - - - -

Report code 8220 when sutures are provided by the practitioner. - - - - - -

8213 Surgical removal of residual roots, first tooth - per tooth 384.90 - - - - -

8214 Surgical removal of residual roots, second and subsequent teeth’s roots 296.80 - - - - -

8937 Surgical removal of tooth 384.90 519.50 - - - -

8941 Surgical removal of impacted tooth - first tooth 638.20 839.20 - - - -

8943 Surgical removal of impacted tooth - second tooth 342.30 452.10 - - - -

8945 Surgical removal of impacted tooth - third and subsequent teeth 194.50 256.60 - - - -

8953 Surgical removal of residual roots, first tooth - per tooth - 519.50 - - - -

OTHER SURGICAL PROCEDURES - - - - - -

8517 Reimplantation of avulsed tooth (include stabilisation) 205.90 - - - 308.80 -

8909 Oral antral fistula closure 902.30 1 353.40 - - - -

8911 Caldwell-Luc procedure 353.10 529.50 - - - -

8917 Biopsy of oral tissue - soft 225.00 300.00 - 300.00 - -

8919 Biopsy of bone - needle 346.30 519.50 - - - -

8921 Biopsy – extra-oral bone/soft tissue 566.70 850.00 - - - -

8961 Tooth transplantation 774.70 1 162.10 - - - -

8965 Peripheral neurectomy 774.70 1 162.10 - - - -

8966 Repair of oronasal fistula (local flaps) 1 077.70 1 616.60 - - - -

8981 Surgical exposure of impacted or unerupted teeth to aid eruption 711.00 968.60 - 968.60 - -

8983 Corticotomy - first tooth 514.50 771.80 - - - -

8984 Corticotomy - each additional tooth 260.90 391.30 - - - -

ALVEOLOPLASTY - - - - - -

8957 Alveolotomy or alveolectomy (including extractions) 472.60 708.80 - - - -

9003 Reposition mental foramen and nerve - per side 1 076.20 1 614.40 - - - -

9004 Lateralization of inferior dental nerve 1 734.10 2 601.40 - - - -


47 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

VESTIBULOPLASTY - - - - - -

Any of a series of surgical procedures designed to increase relative alveolar ridge height. - - - - - -

8997 Sulcoplasty / Vestibuloplasty 1 776.30 2 664.50 - 2 664.50 - -

SURGICAL EXCISION OF SOFT TISSUE LESIONS - - - - - -

8971 Excision of tumour of the soft tissue 346.30 519.50 - 519.50 - -

SURGICAL EXCISION OF INTRA-OSSEOUS LESIONS - - - - - -

8967 Surgical removal of jaw cyst - intra-oral approach 1 076.20 1 614.40 - - - -

8969 Surgical removal of jaw cyst - extra-oral approach 1 724.00 2 586.00 - - - -

8973 Surgical excision of tumours of the jaw 1 724.00 2 586.00 - - - -

9290 Maxillectomy - Alveolus only, Level I - - - - - -

9292 Maxillectomy - Alveolus and sinus or nasal floor, Level II - - - - - -

9294 Maxillectomy - Alveolus, sinus, nasal floor and zygoma excluding orbital rim Level III - - - - - -

9296 Maxillectomy - Alveolus, sinus, nasal floor and zygoma including orbital rim Level IV - - - - - -

9298 Maxillectomy - Alveolus, sinus, nasal floor, zygoma, orbital rim and pterygoid plates Level V - - - - - -

9300 Hemiresection of jaw including condyle and coronoid process - - - - - -

EXCISION OF BONE TISSUE - - - - - -

8975 Hemiresection of jaw excluding condyl 1 811.10 2 716.60 - - - -

8987 Reduction of mylohyoid ridges - per side 774.70 1 162.10 - - - -

8989 Removal torus mandibularis 774.70 1 162.10 - - - -

8991 Removal of torus palatinus 774.70 1 162.10 - - - -

8993 Surgical reduction of osseous tuberosity - per side 346.30 519.50 - - - -

SURGICAL INCISION - - - - - -

8731 Incision & drainage of abscess - intra-oral 142.10 - - 213.10 - -

8908 Surgical removal of roots from maxillary antrum 1 176.90 1 765.40 - - - -

9011 Incision & drainage of abscess - intra-oral (pyogenic) 220.40 330.40 - - - -

9013 Incision & drainage of abscess - extra-oral (pyogenic) 301.30 452.10 - - - -

9017 Decortication, saucerisation and sequestrectomy 1 595.00 2 392.60 - - - -

9019 Sequestrectomy - intra oral per sextant and or ramus 346.30 519.50 - - - -


48 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

TREATMENT OF FRACTURES - - - - - -

Alveolus Fractures - - - - - -

9024 Dento-alveolar fracture - per sextant 388.50 582.60 - - - -

Mandibular Fractures - - - - - -

9025 Mandible fracture - closed reduction 860.30 1 290.40 - - - -

9027 Mandible fracture - compound, with eyelet wiring 1 208.20 1 812.10 - - - -

9029 Mandible fracture - splints 1 337.70 2 006.60 - - - -

9031 Mandible fracture - open reduction 1 982.80 2 974.20 - - - -

Maxilliary Fractures - - - - - -

9035 Maxilla fracture - Le Fort I or Guerin 1 210.30 1 815.40 - - - -

9037 Maxilla fracture - Le Fort II or middle third face 1 982.80 2 974.20 - - - -

9039 Maxilla fracture - Le Fort III or craniofacial disjunction 2 843.90 4 265.70 - - - -

Zygoma/Orbital/Antral Fractures - - - - - -

9041 Zygomatic arch fracture - closed reduction 860.30 1 290.40 - - - -

9043 Zygomatic arch fracture - open reduction 1 724.00 2 586.00 - - - -

9045 Zygomatic arch fracture - open reduction (requiring osteosynthesis and/or grafting) 2 582.80 3 874.30 - - - -

9046 Placement of Zygomaticus fixture, per fixture 1 706.10 2 559.00 - - - -

Nasal Fractures - - - - - -

9280 Open reduction and fixation of nasal fractures - - - - - -

9282 Manipulation and immobilisation of nasal fracture - - - - - -

TEMPOROMANDIBULAR JOINT - - - - - -

Procedures which are an integral part of a primary procedure should not be reported separately. - - - - - -

8172 Cost of orthotic appliance - - - - - -

8850 Treatment of MPDS - first visit 136.20 - 204.50 204.50 -

8851 Treatment of MPDS - subsequent visit 71.80 - 107.60 107.60 -

8852 Occlusal orthotic appliance 342.30 451.10 451.10 451.10 451.10 -

9053 Coronoidectomy (intra-oral approach) 1 075.50 1 613.20 - - - -

9074 Tmj arthroscopy diagnostic 855.90 1 283.80 - - - -


49 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

9075 Condylectomy, coronoidectomy or both 2 150.20 3 225.30 - - - -

9076 TMJ artrocentesis 472.60 708.80 - - - -

9077 TMJ intra-articular injection 128.90 193.50 - - - -

9079 Trigger point injection 100.60 151.10 - - - -

9081 Condylectomy (Ward/Kostecka) 860.30 1 290.40 - - - -

9083 TMJ srthroplasty 2 150.20 3 225.30 - - - -

9085 Reduction of TMJ disloc w/o anaesthetic 171.00 256.60 - - - -

9087 Reduction of TMJ disloc w/ anaesthetic 346.30 519.50 - - - -

9089 Reduction of TMJ disloc w/ anaesthetic and immobobilisation 860.30 1 290.40 - - - -

9091 Reduction of TMJ dislocation - open reduction 2 150.20 3 225.30 - - - -

9092 Joint reconstruction 5 740.50 8 610.60 - - - -

REPAIR OF TRAUMATIC WOUNDS - - - - - -

8192 Suture - minor 439.20 - - - - -

COMPLICATED SUTURING - - - - - -

Reconstruction requiring delicate handling of tissues and undermining for meticulous closure. Excludes the closure of surgical incisions.

- - - - - -

9021 Suture - reconstruction, minor (excludes closure of surgical incisions) 439.20 582.60 - - - -

9023 Suture - reconstruction, major (excludes closure of surgical incisions) 817.60 1 226.30 - - - -

OTHER REPAIR PROCEDURES - - - -

8958 Emergency tracheotomy 397.00 595.70 - - - -

8959 Pharyngostomy 397.00 595.70 - - - -

8962 Harvest iliac crest graft 285.70 351.00 - - - -

8963 Harvest rib graft 327.70 491.40 - - - -

8964 Harvest cranium graft 256.60 384.90 - - - -

8977 Surgical repair of maxilla or mandible - major 1 809.70 2 714.40 - - - -

8979 Harvesting of autogenous grafts (intra-oral) 149.20 223.90 - 223.90 - -

8985 Frenulectomy/frenulotomy 472.60 708.80 - 708.80 - -

9005 Alveolar ridge augmentation - total (by bone graft) 1 811.10 2 716.60 - 2 716.60 - -


50 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

9007 Alveolar ridge augmentation - total (by alloplastic material) 1 140.00 1 709.90 - - - -

9008 Alveolar ridge augmentation - one to two tooth sites 352.40 644.70 - 644.70 - -

9009 Alveolar ridge augmentation - three across 3 or more tooth sites 783.30 1 175.10 - 1 175.10 - -

9010 Sinus lift procedure 1 176.90 1 765.40 - 1 765.40 - -

9032 Reduction of masseter muscle and bone - extra-oral approach - - - - - -

9033 Reduction of masseter muscle and bone - intra-oral approach - - - - - -

9048 Surgical removal of internal fixation devices, per site 331.20 496.90 - - - -

Functional Correction of Malocclusion - - - - - -

For Codes 9047 to 9072 the full fee may be charged. - - - - - -

9047 Osteotomy - open with stabilisation 3 614.80 5 422.40 - - - -

9049 Osteotomy - mandible body, anterior segmental 3 012.70 4 518.90 - - - -

9050 Osteotomy - total subapical 5 510.70 8 266.00 - - - -

9051 Genioplasty 1 724.00 2 586.00 - - - -

9052 Midfacial exposure 2 729.30 4 093.80 - - - -

9055 Osteotomy - segmented, posterior 3 012.70 4 518.90 - - - -

9057 Osteotomy - segmented, anterior 3 012.70 4 518.90 - - - -

9059 Reconstruct maxilla - Le Fort I osteotomy, one piece 5 668.70 8 503.00 - - - -

9060 Reconstruct maxilla - Le Fort I osteotomy w/ repositioning and graft 6 363.70 9 545.40 - - - -

9061 Palatal osteotomy 1 982.80 2 974.20 - - - -

9062 Reconstruct maxilla - Le Fort I osteotomy, multiple segments 7 236.30 10 854.30 - - - -

9063 Reconstruct maxilla - Le Fort 2 osteotomy (facial and post-traumatic deformities) 7 239.90 10 859.70 - - - -

9065 Reconstruct maxilla - Le Fort 3 osteotomy (severe congenital deformities) 10 850.30 16 275.40 - - - -

9066 Surgical expansion - maxilliary or mandibular 1 724.00 2 586.00 - - - -

9069 Glossectomy - partial 1 291.30 1 937.00 - - - -

9071 Geniohyoidotomy 774.70 1 162.10 - - - -

9072 Close secondary oro-nasal fistula w/ bone grafting (complete procedure) 5 668.70 8 503.00 - - - -

Salivary Glands - - - - - -

9093 Removal of salivary stone (Sialolithotomy) 388.50 582.60 - - - -


51 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

9095 Excision of sublinglual salivary gland 957.30 1 436.00 - - - -

9096 Excision of salivary gland - extra oral approach 1 418.30 2 127.40 - - - -

Pedicle Flaps - - - - - -

Report codes 9284, 9286 and 9288 for flaps taken for repair of post –cancer/ trauma/ tumour surgery. These are not vestibuloplasty procedures. The use of the codes are not subject to modifier use.

- - - - - -

9284 Musculofascial flap - - - - - -

9286 Musculocranial flap - - - - - -

9288 Buccal fat pad (major repair) - - - - - -

Repair of Frontal Bones - - - - - -

The use of codes 9274, 9275 and 9278 imply the bicoronal/ hemicoronal approach. - - - - - -

9274 Repair anterior table, frontal sinus and/or supraorbital rim - - - - - -

9276 Repair anterior and posterior wall w/ obturation and/or cranialisation of frontal sinus - - - - - -

9278 Repair medial canthal ligament (canthopexy), per side - - - - - -

Cleft lip and Palat - - - - - -

9220 Repair cleft hard palate - unilateral 3 166.30 4 749.40 - - - -

9222 Repair cleft hard palate - bilateral (one procedure) 4 019.20 6 028.80 - - - -

9224 Repair cleft hard palate - bilateral (two procedures) 5 989.10 8 982.60 - - - -

9226 Repair cleft soft palate - w/o muscle reconstruction 2 653.10 3 979.70 - - - -

9228 Repair cleft soft palate - w/ muscle reconstruction 3 852.50 5 778.80 - - - -

9230 Repair submucosal cleft and/or bifid uvula - w/ muscle reconstruction 2 868.40 4 302.70 - - - -

9232 Velopharyngeal reconstruction - uncomplicated 2 951.70 4 427.60 - - - -

9234 Velopharyngeal reconstruction - complicated 3 156.20 4 734.20 - - - -

9238 Repair oronasal fistula (one procedure) 1 805.40 2 707.90 - - - -

9240 Repair oronasal fistula (two procedures) 3 149.60 4 724.30 - - - -

9246 Secondary periosteal flaps 1 574.00 2 361.10 - - - -

9248 Lipadhesion 588.40 882.60 - - - -

9250 Repair cleft lip - unilateral w/o muscle reconstruction 1 036.30 1 554.50 - - - -


52 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

9252 Repair cleft lip - unilateral w/ muscle reconstruction 1 405.10 2 107.80 - - - -

9254 Repair cleft lip - bilateral w/o muscle reconstruction 1 447.20 2 170.90 - - - -

9256 Repair cleft lip - bilateral w/ muscle reconstruction 2 235.80 3 353.70 - - - -

9258 Repair anterior nasal floor 564.50 846.80 - - - -

9260 Revision of secondary cleft lip deformity - partial 564.50 846.80 - - - -

9262 Revision of secondary cleft lip deformity - total w/ muscle reconstruction 1 275.50 1 913.20 - - - -

9264 Abbe-flap - two stages 1 444.40 2 166.60 - - - -

9266 Reconstruct columella 853.70 1 280.50 - - - -

9268 Reconstruct nose due to cleft deformity - partial 1 084.90 1 627.30 - - - -

9270 Reconstruct nose due to cleft deformity - complete 1 714.70 2 572.00 - - - -

9272 Paranasal augmentation for nasal base deviation 853.70 1 280.50 - - - -

K. ORTHODONTIC SERVICES - - - - - -

The branch of dentistry used to correct malocclusions of the mouth and restore it to proper alignment and function. Includes all services/procedures concerned with the supervision, guidnance and correction of the growing and mature dentofacial structures.

- - - - - -

REMOVABLE APPLIANCE THERAPY - - - - - -

Removable indicates patient can remove; includes appliances for limited orthodontic treatment (e.g., partial treatment to open spaces or upright of a tooth) and minor orthodontic treatment to control harmful habits (e.g., thumb sucking and tongue trusting).

- - - - - -

8862 Ortho Tx - removable appliance 999.40 - 1 499.00 - - -

8863 Ortho Tx - each additional removable appliance 502.30 - 753.30 - - -

FUNCTIONAL APPLIANCE THERAPY - - - - - -


53 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

A removable functional appliance is an appliance with no fixed dental component which is designed to harness the forces generated by the muscles of mastication and the associated soft tissues of the oro-facial region. This appliance incorporates components which act on both the maxillary and mandibular arches and should be differentiated from a simple removable appliance including appliances incorporating an anterior and posterior bite plane. Orthodontic treatment by means of a functional appliance is usually followed by comprehensive orthodontic treatment utilising fixed orthodontic appliances. When both phases of orthodontic treatment is provided by the same practitioner, the fees levied for treatment by means of the functional appliance, will be deducted from the fee quoted for comprehensive orthodontic treatment.

- - - - - -

8858 Ortho Tx - functional appliance 1 800.20 - 2 700.30 - - -

FIXED APPLIANCE THERAPY - - - - - -

Fixed Appliance Therapy - Partial - - - - - -

The intention of this phase in treatment is to intercept and modify the development of skeletal, dental and functional components of developing malocclusion usually in the mixed dentition. When the preliminary/interceptive phase(s) of orthodontic treatment is followed by comprehensive orthodontic treatment and both phases of orthodontic treatment is provided by the same practitioner, the fees levied for preliminary/interceptive orthodontic treatment will be deducted from the fee quoted for comprehensive orthodontic treatment.

- - - - - -

8861 Ortho Tx - partial fixed appliance - minor 1 197.30 - 1 795.90 - - -

8865 Ortho Tx - partial fixed appliance - one arch 3 193.70 - 4 790.60 - - -

8866 Ortho Tx - partial fixed appliance - both arches 4 392.40 - 6 588.60 - - -

Fixed Appliance Therapy - Comprehensive: Single Arch - - - - - -

This form of therapy requires the placement of fixed bands and or brackets on the majority of teeth within an arch and the subsequent placement of active arch wires to treat the case through to completion of active treatment excluding the retention phase.

- - - - - -

8867 Ortho Tx - fixed appliance - one arch 3 433.00 - 5 149.40 - - -

8868 Ortho Tx - fixed appliance - one arch, modeate 4 234.40 - 6 351.70 - - -

8869 Ortho Tx - fixed appliance - one arch, severe 4 952.70 - 7 429.00 - - -

Fixed Appliance Therapy - Comprehensive: Both Arches - - - - - -


54 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

This form of therapy requires the placement of fixed bands and or brackets on the majority of teeth within both arches and the subsequent placement of active arch wires to treat the case through to completion of active treatment excluding the retention phase.

- - - - - -

8873 Ortho Tx - fixed appliance - both arches, Class 1 mild 6 282.50 - 9 423.70 - - -

8875 Ortho Tx - fixed appliance - both arches, Class 1 moderate 7 712.50 - 11 568.40 - - -

8877 Ortho Tx - fixed appliance - both arches, Class 1 severe 8 990.70 - 13 486.10 - - -

8879 Ortho Tx - fixed appliance - both arches, Class 1 severe w/ complications 10 104.00 - 15 155.70 - - -

8881 Ortho Tx - fixed appliance - both arches, Class 2/3 mild 8 990.70 - 13 486.10 - - -

8883 Ortho Tx - fixed appliance - both arches, Class 2/3 moderate 10 104.00 - 15 155.70 - - -

8885 Ortho Tx - fixed appliance - both arches, Class 2/3 severe 11 342.50 - 17 013.60 - - -

8887 Ortho Tx - fixed appliance - both arches, Class 2/3 severe w/ complications 12 779.60 - 19 169.20 - - -

Lingual Orthodontics - Comprehensive: Single Arch - - - - - -

This form of therapy requires the placement of bands and or brackets on the lingual aspect of the majority of teeth within at least one arch and must include the placement of active arch wires.

- - - - - -

8841 Ortho Tx - fixed lingual appliance - one arch 6 452.20 - 9 678.10 - - -

8842 Ortho Tx - fixed lingual appliance - one arch, modeate 7 582.60 - 11 373.90 - - -

8843 Ortho Tx - fixed lingual appliance - one arch, severe 8 639.20 - 12 958.80 - - -

Lingual Orthodontics - Comprehensive: Both Arches - - - - -

8874 Ortho Tx - fixed lingual appliance - both arches, Class 1 mild 12 308.60 - 18 462.70 - - -

8876 Ortho Tx - fixed lingual appliance - both arches, Class 1 moderate 14 410.90 - 21 616.30 - - -

8878 Ortho Tx - fixed lingual appliance - both arches, Class 1 severe 16 354.50 - 24 531.70 - - -

8880 Ortho Tx - fixed lingual appliance - both arches, Class 1 severe w/ complications 18 146.70 - 27 220.00 - - -

8882 Ortho Tx - fixed lingual appliance - both arches, Class 2/3 mild 15 023.20 - 22 534.70 - - -

8884 Ortho Tx - fixed lingual appliance - both arches, Class 2/3 moderate 16 806.10 - 25 208.90 - - -

8886 Ortho Tx - fixed lingual appliance - both arches, Class 2/3 severe 18 717.80 - 28 076.60 - - -

8888 Ortho Tx - fixed lingual appliance - both arches, Class 2/3 severe w/ complications 20 827.50 - 31 241.00 - - -

OTHER ORTHODONTIC SERVICES - - - - -

8846 Repair orthodontic appliance - removable 81.70 - 122.70 - - -


55 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8847 Replace orthodontic appliance - removable 282.70 - 424.00 - - -

8848 Repair orthodontic appliance - fixed 121.10 - 181.60 - - -

8849 Retainer (orthodontic) 282.70 - 424.00 - - -

8890 Monthly instalment ortho tx - - - - - -

8891 Orthodontic transfer - - - - - -

8892 Orthodontic re-treatment - - - - - -

L. SUPPLEMENTARY SERVICES - - - - - -

The branch of dentistry for unclassified treatment including palliative care and anaesthesia. - - - - - -

ANAESTHESIA - - - - - -

8499 General anaesthetic - - - - - -

8141 Inhalation sedation - first 15 minutes or part thereof 65.30 - - - - -

8143 Inhalation sedation - each addnl 15 minutes 33.70 - - - - -

8144 Intravenous sedation 39.20 - - - - -

8145 Local anaesthetic - per visit 56.60 - - - - -

8147 Monitoring equipment for intravenous sedation 139.20 - - - - -

PROFESSIONAL VISITS - - - - - -

8129 Office/hospital visit – after regularly scheduled hours 218.40 - - - - -

8140 House/extended care facility/hospital call 144.60 - - 144.60 - -

8903 House/Hosp/Nursing home consultation - MFOS - 161.90 - - - -

8904 House/Hosp/Nursing home consultation (subsequent) - MFOS - 107.60 - - - -

8905 After regularly hours consultation - MFOS - 237.10 - - - -

8907 House/Hosp/Nursing home consultation (maximum per week) - MFOS - 269.50 - - - -

9203 House/Hosp/Nursing home consultation - Oral pathologist - - - - - 161.90

9207 After hours visit - Oral pathologist - - - - - 237.10

DRUGS, MEDICAMENTS AND MATERIALS - - - - - -

8109 Infection control/barrier techniques 13.10 - - - - -

8110 Sterilized instrumentation 33.70 - - - - -

8183 Therapeutic drug injection 39.20 - - - - -


56 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8220 Cost of suture material - - - - - -

8304 Rubber dam per arch 69.60 - - - - -

8306 Cost of MTA - - - - - -

8310 Supply of bleaching materials - - - - - -

ADMINISTRATIVE AND LABORATORY SERVICES - - - - - -

8099 Dental laboratory service - - - - - -

8106 Special report 149.00 149.00 149.00 149.00 149.00 -

8111 Dental testimony - - - - - -

8120 Treatment plan completed - - - - - -

8139 Appointment not kept /30min - - - - - -

MISCELLANEOUS SERVICES - - - - - -

Palliative Treatment - - - - - -

8131 Emergency dental treatment 89.10 - - - 181.60 -

8166 Application of desensitising resin, per tooth 58.70 - - - - -

8167 Application of desensitising medicament, per visit 68.50 - - - - -

8165 Sedative filling 89.10 - - - - -

Post Surgical Complications - - - - - -

8931 Treatment of post-extraction haemorrhage 65.30 391.30 - - - -

8933 Treatment of haemorrhage (blood dyscracias) 902.30 1 353.40 - - - -

8935 Treatment of septic socket 65.30 102.20 - - - -

Bleaching - - - - - -

8308 External bleaching - per arch - - - - - -

8309 Home bleaching - instructions and applicator - - - - - -

8311 Home bleaching - subsequent visit - - - - - -

8325 Internal bleaching - per tooth 210.90 - - - 316.40 -

8327 Internal bleaching - each additional visit 101.10 - - - 151.70 -

Unclassified Treatment - - - - - -

8158 Enamel microabrasion 81.50 - - - - -


57 • Version 4_21


Practice Type:

General Dental


Practice Type:

Maxillo-facial



Practice Type: Oral

Medicine and



Code: 29400

Practice Type: Oral


code Value

R Value

R Value

R Value

R Value

R Value

R

8168 Behavior management - - - - - -

8551 Occlusal adjustment - major 563.70 - 845.70 - 845.70 -

8553 Occlusal adjustment - minor 196.70 - 269.50 269.50 269.50 -

9099 Unlisted dental procedure or service (By report) - - - - - -

MODIFIERS - - - - - -

8001 Assistant surgeon - specialist (1/3 of the appropriate benefit) - - - - - -

8003 Minimum assistant surgeon 165.20 165.20 - 165.20 - -

8005 Maximum multiple procedures (same incision) - MFO surgeon 256.50 256.50 - 256.50 - -

8006 Multiple surgical procedures - third and subsequent procedures (50% of the appropriate benefit) - - - - - -

8007 Assistant surgeon - general dental practitioner (15% of the appropriate benefit) - - - - - -

8008 Emergency surgery - after hours (PLUS 25% of the appropriate benefit) - - - - - -

8009 Multiple surgical procedures - second procedure (75% of the appropriate benefit) - - - - - -

8010 Open reduction (PLUS 75% of the appropriate benefit) - - - - - -

8011Procedure accompanied by unusual circumstances (Benefit PLUS X % as determined by the practitioner and agreed upon by patient/medical scheme)

- - - - - -

8012 Reduced services (benefit MINUS X % as determined by the practitioner) - - - - - -

8013 Multiple modifiers - - - - - -

8023 Fabrication of inlay/onlay (PLUS 25% of the appropriate benefit) - - - - - -

8025 Handling fee - direct materials (26% of material cost to a maximum of R26.00) - - - - - -


58 • Version 4_21

Dental Technology

GEMS TARIFF FOR DENTAL TECHNICIANS, EFFECTIVE FROM 1 JANUARY 2011Practice Type: Dental Technology

Code: 49300

code CF Units Value

R


- - -

1 Preparatory Work - - -

The following section includes comsumables, however it excludes materials - -

9301 Casting and trimming of model in plaster (yellow/white), per model 560 2.714 25.50

9303 Casting and trimming of model in super-hard stone (die-stone) per model 560 3.857 36.20

9305 Casting and trimming of study model, per model 560 7.143 67.00

9307 Casting and trimming of gnathostatic model, per model. 560 9.286 87.20

9309 New trimmed base to supplied model, per model 560 3.286 30.80

9311 Trimming of supplied model, per model 560 2.000 18.80

9312 Gingival tissue mask per implant 560 15.429 144.80

9313 Duplicating model, per model 560 8.286 77.80

9314 Refractory model, per unit 560 8.143 76.40

9315 Models and duplicate models (virgin model) for crown and bridge, work inclusive of one removable die 560 11.286 105.90

9317 Sectional models for crown and bridge, work inclusive of one removable die 560 10.000 93.90

9319 Each additional removable die for items 9315 and 9317 per die 560 2.571 24.10

9320 Indexed or model tray per die (not more than 9319) 560 2.571 24.10

9321 Occlusion block, per block 560 9.857 92.50

9323 Occlusion block on baseplate, per block 560 12.429 116.70

9327 Infection control per impression, denture (wax or acrylic) or any item in contact with body fluids 560 1.857 17.40

9329 Fit and supply of disposable articulator 560 4.857 45.60

9330 Delivery / Collection fee per completed procedure (maximum 4) 560 5.143 48.30

The tariff under all sections excludes the fees for models - occlusion blocks and delivery charge. - - -

2 Prosthetic Services Using Acrylic - - -

The tariff under this section excludes the fees for models and occlusion blocks. - - -

The following section includes consumables, however it excludes materials - - -

A Full Dentures - - -


59 • Version 4_21


Code: 49300

code CF Units Value

R

9331 Full upper and lower dentures 560 132.571 1 244.20

9333 Full upper or lower denture 560 77.571 728.00

9335 Set-up and waxing of full upper and lower dentures 560 45.714 429.00

9337 Set-up and waxing of full upper or lower denture 560 30.571 286.90

9339 Waxing and finishing of full upper and lower dentures 560 81.286 762.90

9341 Waxing and finishing of full upper or lower denture 560 45.429 426.40

9343 Additional fee for dentures on fully adjustable articulator at request of dentist 560 129.429 1 214.70

9345 Additional fee for immediate dentures, or tooth socketed 560 1.857 17.40

9346 Additional fee for immediate dentures, per tooth not socketed. 560 1.000 9.40

9347 Additional fee for each retry from the third and upwards at an agreed quantum of time to be calculated at hourly rate 560 29.429 276.20

B Partial Dentures - - -

9351 Set-up and finish of one-tooth denture 560 35.571 333.80

9352 Set-up and finish of two-tooth denture 560 37.857 355.30

9353 Set-up and finish of three-tooth denture 560 40.571 380.80

9354 Set-up and finish of four-tooth denture 560 42.857 402.20

9355 Set-up and finish of five-tooth denture 560 46.286 434.40

9356 Set-up and finish of six-tooth denture 560 55.286 518.90

9357 Set-up and finish of seven-tooth denture 560 65.714 616.70

9358 Set-up and finish of eight-tooth denture 560 69.714 654.30

9359 Set-up and finish nine or more tooth denture 560 71.429 670.40

9361 Set-up and waxing of one-tooth denture 560 10.143 95.20

9362 Set-up and waxing of two-tooth denture 560 12.286 115.30

9363 Set-up and waxing of three-tooth denture 560 14.000 131.40

9364 Set-up and waxing of four-tooth denture 560 16.286 152.80

9365 Set-up and waxing of five-tooth denture 560 18.000 168.90

9366 Set-up and waxing of six-tooth denture 560 21.286 199.80

9367 Set-up and waxing of seven-tooth denture 560 23.429 219.90

9368 Set-up and waxing of eight-tooth denture 560 25.143 236.00

9369 Set-up and waxing of nine or more tooth denture 560 26.857 252.10

9371 Waxing and finishing of one-tooth denture 560 27.857 261.40

9372 Waxing and finishing of two-tooth denture 560 28.429 266.80


60 • Version 4_21


Code: 49300

code CF Units Value

R

9373 Waxing and finishing of three-tooth denture 560 28.857 270.80

9374 Waxing and finishing of four-tooth denture 560 29.429 276.20

9375 Waxing and finishing of five-tooth denture 560 30.571 286.90

9376 Waxing and finishing of six-tooth denture 560 31.714 297.60

9377 Waxing and finishing of seven-tooth denture 560 39.571 371.40

9378 Waxing and finishing of eighth-tooth denture 560 41.143 386.10

9379 Waxing and finishing of nine or more tooth denture 560 43.429 407.60

9383 Additional fee for finishing denture in tooth colour material, per tooth 560 6.857 64.40

9385 Additional fee for supplying finished denture on duplicate model 560 13.000 122.00

C Repair Service - - -

9391 Basic charge which includes repair of one fracture, or addition of one tooth, or addition of one clasp 560 22.571 211.80

9393 Additional charge for each additional fracture, or tooth, or clasp 560 7.000 65.70

9395 Additional fee for using wire strengthener 560 8.000 75.10

9397 Additional fee for using pre-formed strengthener 560 8.571 80.40

9398 Additional fee for using mesh strengthener in repair procedure 560 13.571 127.40

D Additional Services - - -

9401 Clear base 560 10.000 93.90

9403 Dox grinding of upper and lower dentures 560 12.714 119.30

9405 Inlay to artificial tooth, one surface only, per inlay 560 21.857 205.10

9406 Inlay to artificial tooth, multi-surfaces e.g. horseshoe or L-type inlay, per inlay 560 28.000 262.80

9407 Heka base technique per upper or lower denture 560 30.000 281.60

9409 Frego frame 560 13.000 122.00

9410 Bleaching tray 560 14.429 135.40

9411 Template per upper or lower denture 560 35.857 336.50

9413 Reline/rebase of single denture 560 45.143 423.70

9415 Remodel of single denture 560 69.429 651.60

9417 Soft base reline per denture 560 114.000 1 069.90

9419 Soft base to new denture, per denture 560 114.000 1 069.90

9421 Gum tinting per denture 560 21.143 198.40

9423 Lingual or palatal bar 560 17.000 159.60

9425 Cleaning and polishing of existing denture, per denture 560 13.857 130.10


61 • Version 4_21


Code: 49300

code CF Units Value

R

9427 Mesh strengthener 560 11.857 111.30

9429 Theatre/ Consultation out of Laboratory per hour or part thereof 560 29.429 276.20

9431 Special Tray, acrylic, each 560 11.143 104.60

9432 Special Tray Light Cure, each 560 12.143 114.00

9433 Special Tray in base plate material, each 560 11.429 107.30

9435 Provision of single arm clasp, to partial denture 560 5.857 55.00

9437 Provision of double arm clasp, to partial denture 560 10.143 95.20

9439 Provision of single arm clasp with rest, to partial denture 560 13.143 123.40

9441 Provision of double arm clasp with rest, to partial denture 560 17.714 166.30

9443 Provision of preformed Roach clasp, to partial denture 560 7.571 71.10

9445 Provision of rest only to partial denture 560 7.571 71.10

9447 Cast Clasp 560 26.571 249.40

9448 Casting and trimming of Model from impression inside occlusion block or wax try in 560 4.857 45.60

9450 Finishing of acrylic work on any chrome cobalt or gold prosthesis 560 10.143 95.20

3 Cobalt Chrome / Gold Prosthetic Services - - -

The tariffs under this section excludes the tariff for models. - - -


A Full Metal Dentures - - -

9451 Metal base for full upper or full lower denture each 560 91.000 854.00

B Partial Metal Dentures - - -

9453 Basic charge - which excludes models and any special trays which may be required by the dentist, but includes refractory model 560 79.571 746.80

9455 Additional charge for each one arm clasp 560 3.286 30.80

9457 Additional charge for each Roach clasp 560 5.571 52.30

9459 Additional charge for each rest 560 3.000 28.20

9461 Additional charge for continuous clasp, per tooth 560 3.286 30.80

9463 Additional charge for lingual bar, per tooth passed 560 7.714 72.40

9465 Additional charge for palatal bar 560 12.286 115.30

9467 Additional charge for onlay 560 32.714 307.00

9469 Additional charge for saddle with finishing line, per tooth 560 5.429 51.00

9471 Additional charge for saddle without finishing line, per tooth 560 3.143 29.50

9473 Additional charge for horseshoe saddle, per tooth 560 5.429 51.00


62 • Version 4_21


Code: 49300

code CF Units Value

R

9475 Additional charge for fitting of tooth to metal backing, per tooth 560 3.714 34.90

9479 Additional charge for fitting one distal-extension hinge 560 11.000 103.20

9480 Additional charge per milled edge per tooth 560 9.571 89.80

9481 Additional charge for each soldering joint 560 13.429 126.00

9483 Additional charge for soldering retention 560 16.286 152.80

9485 Additional charge for each additional retention soldering joint 560 5.000 46.90

9487 Additional charge for each welding joint 560 16.429 154.20

9489 Additional charge for fitting swing lock 560 13.429 126.00

9491 Additional charge for each backing cast 560 13.143 123.40

9493 Additional charge for each Steels backing or pontic cast (Plastic work to be charged in addition) 560 14.286 134.10

C Chrome Cobalt and Repairs - - -

9495 Basic fee for the repairing of or addition to any appliance necessitating the casting of a model (9301) 560 20.714 194.40

9497 Basic fee if a new section is to be fabricated and where item 9495 does not apply (9301) 560 23.571 221.20

4 Crown and Bridge Prosthetic Services - - -



A Porcelain (Ceramic) Services - - -

9501 Ceramic jacket crown/Ceromer crown or pontic 560 90.429 848.70

9502 Ceramic metal substitute coping 560 73.000 685.10

9505 Ceramic Bonded crown or pontic 560 119.429 1 120.80

9507 Post-solder invested joint, per joint 560 24.429 229.30

9511 Inlay in porcelain veneer crown 560 39.429 370.00

9512 Ceramic, inlay/onlay, bridge retainer 560 92.714 870.10

9515 Porcelain shoulder per unit (not applicable to pontics) 560 8.000 75.10

9520 Additional fee for crown- & bridge work performed on a movable condyle articulator per unit 560 3.857 36.20

B Gold and Acrylic Veneer Services - - -

9521 Full metal crown, MOD, three-quarter crown 560 73.857 693.20

9524 Indirect Composite Resin inlay 560 20.000 187.70

9525 Class IV, MO, DO, cervical/occlusal inlay 560 60.857 571.10

9526 Additional fee for one piece casting of crown or inlay on post 560 18.571 174.30

9531 Pin-ledge inlay 560 69.000 647.60


63 • Version 4_21


Code: 49300

code CF Units Value

R

9533 Full metal pontic 560 54.571 512.20

9535 Abutment thimble cast 560 51.143 480.00

9537 Precision lock and rest cast 560 72.571 681.10

9538 Lock and rest cast 560 34.714 325.80

9539 Casting of rest only 560 20.714 194.40

9541 Metal inlay or post, cast direct 560 22.000 206.50

9543 Gold/pre-solder invested joint 560 21.857 205.10

9545 Cast post with thimble, indirect 560 36.429 341.90

9546 Multiple Post 560 60.286 565.80

9547 Manufacture cast post and core to existing crown 560 47.571 446.50

9549 C.S.P. attachment (Steiger) 560 160.571 1 507.00

9550 Milling milled edge per unit 560 51.143 480.00

9551 Telescope crown 560 126.000 1 182.50

9553 Composite/acrylic veneer crown/pontic, indirect 560 100.714 945.20

9557 Composite/acrylic jacket crown, indirect 560 71.143 667.70

9559 Composite/acrylic veneer post crown 560 99.571 934.50

9560 Indirect Composite Resin Veneer 560 42.143 395.50

9561 Composite/acrylic jacket crown, direct 560 48.571 455.80

9563 Temporary acrylic/composite crown per unit 560 34.714 325.80

9564 Heat formed template supplied to dentist for the manufacture of temporary restorations 560 17.429 163.60

9565 Composite/acrylic-facing replaced 560 40.429 379.40

9566 Porcelain/ Ceromer facing replaced 560 73.286 687.80

9569 Waxing of crown to existing denture 560 28.571 268.10

9570 Additional fee for each remake at an agreed quantum of time to be calculated at an hourly rate 560 29.429 276.20

5 Orthodontic Appliances - - -



A Orthodontic Services - - -

9571 Basic charge which includes acrylic base 560 36.143 339.20

9572 Basic charge non acrylic base 560 17.429 163.60

9573 Additional charge for fitting first expansion screw 560 6.857 64.40


64 • Version 4_21


Code: 49300

code CF Units Value

R

9575 Additional fee for fitting subsequent expansion screws 560 5.857 55.00

9576 Additional fee for full aclusal bite plate 560 20.286 190.40

9577 Additional fee for bite plate anterior 560 6.857 64.40

9578 Additional fee for bite plate posterior 560 6.857 64.40

9579 Additional fee for fitting tongue guard 560 8.571 80.40

9581 Additional fee for flat or inclined plane 560 5.286 49.60

9583 Additional fee for Adams Crib 560 6.286 59.00

9585 Additional fee for Jackson Crib 560 6.571 61.70

9587 Additional fee for ball clasp 560 7.429 69.70

9589 Additional fee for single arm clasp 560 5.714 53.60

9591 Additional fee for double arm clasp 560 10.000 93.90

A.1 Springs - - -

9593 Additional fee for fitting single loop finger spring 560 4.714 44.20

9595 Additional fee for fitting double loop finger spring 560 5.571 52.30

9597 Additional fee for fitting Buccal retraction spring 560 4.143 38.90

9599 Additional fee for fitting apron spring 560 10.714 100.60

9603 Additional fee for fitting coffin spring 560 10.286 96.50

9605 Additional fee for fitting Quad Helix 560 11.429 107.30

9607 Additional fee for fitting flapper or “T”-spring 560 8.571 80.40

9609 Additional fee for fitting all springs with tubing, each 560 9.571 89.80

A.2 Arches - - -

9611 Additional fee for fitting labial arch 560 5.429 51.00

9613 Additional fee for fitting buccal arch 560 6.429 60.30

9615 Additional fee for fitting Roberts retractor 560 12.000 112.60

9617 Invisible Retainer 560 15.857 148.80

9619 Additional fee for fitting twin wire arch extra-oral arch 560 15.000 140.80

9620 Additional fee Lip bumper 560 6.286 59.00

9621 Additional fee for fitting extra-oral arch 560 14.286 134.10

9622 Additional fee for fitting space maintainer arch 560 6.286 59.00

A.3 Welding And Soldering - - -

9623 Additional fee for each spot-welding joint 560 2.857 26.80


65 • Version 4_21


Code: 49300

code CF Units Value

R

9625 Additional fee for each soldering joint 560 4.571 42.90

9627 Additional fee for each invested soldering joint 560 12.714 119.30

9629 Additional fee for each hook for elastic traction 560 4.143 38.90

B Mouth Protectors and MYO Functional Appliances - - -

9631 Mouth protector (gum guard) 560 26.857 252.10

9633 Oral Screen 560 33.000 309.70

9635 Andresen or Norwegian appliance 560 59.000 553.70

9637 Tooth positioner 560 68.000 638.20

9639 Gunning splint 560 90.571 850.00

9641 Frankel appliance 560 87.429 820.50

9643 Chin cap 560 29.000 272.20

9645 Bionator 560 59.143 555.10

9646 Diagnostic set-up 560 56.857 533.60

9647 Snoring Appliance 560 53.714 504.10

C Fixed Appliances - - -

9651 Pinched or swaged band with welded attachment (excluding cost of attachment) 560 17.429 163.60

9653 Pinched or swaged band with soldered attachment 560 22.857 214.50

D Additional Services - - -

9662 Additional fee for each remake at an agreed quantum of time to be calculated at an hourly rate 560 29.429 276.20

6 Materials - - -

A Prosthetic/Restorative Services - - -

9700 Diatorics 1 X 6/8 560 - -

9702 Diatorics, odds, anterior 560 - -

9704 Diatorics, odds, posterior 560 - -

9706 Cost of Bleaching tray material 560 - -

9720 Soft base material per denture 560 - -

9722 Acrylic per denture 560 - -

9724 Cost of precision attachment, per attachment 560 - -

9726 Preformed Ball or Roach Clasp 560 - -

9728 Cost of lingual / palatal bar 560 - -

9729 Cost of mesh strengthener 560 - -


66 • Version 4_21


Code: 49300

code CF Units Value

R

9730 Cost of pre-fabricated burn-out component, per component 560 - -

9732 Cost of other attachment components e.g. Nylon caps, sleeves etc 560 - -

9734 Cost of dolder bar and clips, per gram or per clip 560 - -

9736 Cost of implant components 560 - -

9738 Cost of preformed strengthener 560 - -

9739 Additional Charge Gold plating 560 - -

B Metal - - -

9740 Cost of gold wire, per gram 560 - -

9741 Cost of Cobalt Chrome casting alloy 560 - -

9742 Cost of specialised Cobalt Chrome casting metal e g Vitallium, Titanium 560 - -

9744 Cost of precious casting alloy 560 - -

9746 Cost of semi-precious casting alloy 560 - -

9748 Cost of non-precious casting alloy 560 - -

9752 Cost of platinum foil 560 - -

9754 Cost of gold solder, per gram 560 - -

9755 Etching For bonding (metal or Ceramic) 560 - -

9756 Cost of silver solder, per gram 560 - -

9757 Ceromer material - per unit 560 - -

9758 Fiber re-enforced material per unit 560 - -

9760 Composite restoration material 560 - -

9761 Ceramic material 560 - -

C Orthodontic Services - - -

9762 Cost of anterior orthodontic attachment, per attachment 560 - -

9763 Orthodontic material 560 - -

9764 Cost of posterior orthodontic attachment, per attachment 560 - -

9765 Preformed components 560 - -

9766 Cost of expansion screw, per screw 560 - -

9767 Soldering material 560 - -

9768 Cost of buccal tube/transfer tube, per tube 560 - -

9770 Cost of J-hook, per hook 560 - -

9772 Cost of lingual buttons, per button 560 - -


67 • Version 4_21


Code: 49300

code CF Units Value

R

9774 Cost of invisible retainer material 560 - -

9775 R/A case 560 - -

9776 Cost of mouth protector material 560 - -

9778 Cost of arch wire 560 - -

9779 Dual laminate material 560 - -

7 Precision Attachments and Implant Services - - -


9780 Positioning and finishing of complete (male and female) prefabricated burn-out attachment 560 45.000 422.30

9782 Positioning and soldering of complete (male and female) precision attachment 560 37.571 352.60

9783 Implant stent per unit 560 34.714 325.80

9784 Alignment of dolder bar and clips 560 47.429 445.10

9786 Trimming, waxing and finishing of implant abutment - crown and bridge work only, per abutment 560 20.429 191.70

9787 Waxing, milling and finishing of a custom abutment 560 39.857 374.10

9788 Implant superstructure (edentulous cases) including placing of preformed parts, per section cast 560 217.857 2 044.60

9789 Finishing of prosthesis on implant structure per arch 560 79.571 746.80


68 • Version 4_21

Dental Therapy

GEMS TARIFF FOR SERVICES BY DENTAL THERAPISTS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Dental Therapy

Code: 39500

code CF Units Value

R


- - -

GENERAL RULES - - -

001Item 001 refers to a Full Mouth Examination, charting and treatment planning and no further fee shall be chargeable until the treatment plan resulting from this consultation is completed.

- - -

002

(a) Every dental therapist shall render a monthly account for every procedure which has been completed irrespective of whether the total treatment plan has been.

(b) Every account shall contain the following particulars : (i) the surname and initials of the member; (ii) the first name of the patient; (iii) the name of the scheme; (iv) the membership number of the member; (v) the practice number; (vi) date on which every service was rendered; (vii) where the account is a photocopy of the original, certification by way of a rubberstamp or the signature of the dental therapist ; (viii) a statement of whether the account is in accordance with the GEMS Tariff ; (ix) the name of the dental therapist rendering the service must be shown on the account;and (x) the relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered;.

- - -


- - -

ITEMS - - -

8139 Appointment not kept /30min 210 - -

8109 Infection control/barrier techniques 210 1.730 13.10

8110 Sterilized instrumentation 210 4.460 33.80

8120 Treatment plan completed 210 - -

Diagnostic services - - -

8101 Oral examination 210 10.000 75.80

8102 Comprehensive oral examination 210 16.147 122.30

8104 Limited oral examination 210 7.791 59.00


69 • Version 4_21


Code: 39500

code CF Units Value

R

8189 Re-examination - existing condition 210 7.791 59.00

8129 Office/hospital visit – after regularly scheduled hours 210 24.000 181.80

8140 House/extended care facility/hospital call 210 15.875 120.30

8190 Consultation - second opinion or advice 210 - -

Radiographs/diagnostic imaging - - -

8107 Intraoral radiograph - periapical 210 7.500 56.80

8108 Intraoral radiographs - complete series 210 60.187 455.90

8112 Intraoral radiograph - bitewing 210 7.500 56.80

8113 Intraoral radiograph - occlusal 210 12.894 97.70

8114 Extraoral radiograph - hand-wrist 210 - -

8115 Extraoral radiograph - panoramic 210 30.000 227.30

8116 Extraoral radiograph - cephalometric 210 30.000 227.30

8118 Extraoral radiograph - skull/facial bone 210 - -

8121 Oral and/or facial image (digital/conventional) 210 8.044 60.90

Preventive services - - -

Note : Items 8159, 8155, 8161 and 8162 may not be charged more than once in six months per patient. Where item 8159 is applied, item 8155 may not be charged. Item 8151 and 8153 may not be charged to patients under 9 years of age.

- - -

8151 Oral hygiene instruction 210 7.850 59.50

8153 Oral hygiene instruction - each additional visit 210 5.746 43.50

8155 Polishing - complete dentition 210 9.603 72.70

8159 Prophylaxis - complete dentition 210 17.491 132.50

8161 Topical application of fluoride - child 210 9.603 72.70

8162 Topical application of fluoride - adult 210 9.603 72.70

8163 Dental sealant 210 7.109 53.90

Note : 8163 chargeable once only in respect of a tooth per annum.8163 apply to individuals below 21 years of age. Fee for patients over 21 years of age by arrangement with scheme.

- - -

Extractions during a single visit. - - -

8201 Extraction - tooth or exposed tooth roots (first per quadrant) 210 11.200 84.80

8202 Extraction - each additional tooth or exposed tooth roots 210 4.324 32.80

8145 Local anaesthetic - per visit 210 1.700 12.90

8220 Cost of suture material 210 - -


70 • Version 4_21


Code: 39500

code CF Units Value

R

8931 Treatment of post-extraction haemorrhage 210 7.304 55.30

8935 Treatment of septic socket 210 7.304 55.30

9011 Incision & drainage of abscess - intra-oral (pyogenic) 210 13.790 104.50

8303 Pulp cap - indirect 210 14.200 107.60

Amalgam restorations (including polishing). - - -

8341 Amalgam - one surface 210 20.491 155.20

8342 Amalgam - two surfaces 210 25.263 191.40

8343 Amalgam - three surfaces 210 30.795 233.30

8344 Amalgam - four or more surfaces 210 34.301 259.80

Only one of the above items may be charged per tooth within a year. - - -

Resin restorations (using resin bonding technique) - - -

8351 Resin - one surface, anterior 210 24.795 187.80

8352 Resin - two surfaces, anterior 210 31.165 236.10

8367 Resin - one surface, posterior 210 26.880 203.60

8369 Resin - three surfaces, posterior 210 40.164 304.20

8370 Resin - four or more surfaces, posterior 210 43.202 327.30

8368 Resin - two surfaces, posterior 210 33.249 251.90

8353 Resin - three surfaces, anterior 210 37.242 282.10

8354 Resin - four or more surfaces, anterior 210 41.566 314.90

8350 Resin crown - anterior primary tooth (direct) 210 44.683 338.50

Note: Only one of the above codes may be charged per tooth within a year. - - -

Palliative Treatment - - -

8131 Emergency dental treatment 210 10.000 75.80

8165 Sedative filling 210 10.000 75.80

8166 Application of desensitising resin, per tooth 210 6.603 50.00

8167 Application of desensitising medicament, per visit 210 7.694 58.30


71 • Version 4_21

Dietetics

GEMS TARIFF FOR SERVICES BY DIETICIANS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Dietetics

Code: 38400

code CF Units Value

R


- - -

GENERAL RULES - - -

003 Dietary services are per individual patient. - - -

004

Each practitioner must acquaint him-/herself with the provisions of the Medical Schemes Act, as amended, and the regulations promulgated under the Act and shall render a monthly account in respect of any service rendered during the month, irrespective of whether or not the treatment has been completed. NB. Every account shall contain the following particulars · The name and practice code number of the referring practitioner. · The name of the member. · The name of the patient. · The name of the medical scheme. · The membership number of the member. · The nature of the treatment. · The date on which the service was rendered. · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - -

005 When multiple diagnoses apply every applicable diagnosis shall be specified on the statement. - - -


- - -

011Compilation of reports is only to be included within billable time if these reports are for purposes of motivating for therapy and/or giving a progress report and/or a pre-authorisation report, and where such a report is specifically required by the medical scheme. Maximum billable time for such a report is 15 minutes.

- - -

MODIFIERS - - -

0021 Services to hospital inpatients: Quote modifier 0021 on all accounts for services performed on hospital inpatients. - - -

ITEMS - - -

1. INDIVIDUAL ASSESSMENT, COUNSELLING AND/OR TREATMENT - - -


- - -

200 Nutritional assessment, counselling and/or treatment. Duration: 1-10min. 200 0.500 30.70



72 • Version 4_21

GEMS TARIFF FOR SERVICES BY DIETICIANS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Dietetics

Code: 38400

code CF Units Value

R











2. GROUP ASSESSMENT, COUNSELLING AND/OR TREATMENT - - -

Group nutritional assessment, counselling and/or treatment items are chargeable to a maximum of 12 patients. - - -

300 Group nutritional assessment, counselling and/or treatment, per patient. Duration: 1-10min. 200 0.100 6.20













73 • Version 4_21

Emergency Medical Services GEMS TARIFF IN SERVICES RENDERED BY EMERGENCY MEDICAL SERVICES EFFECTIVE FROM 1 MAY 2011

Code DescriptionInter-Hospital Transfer(IHT)

Primary Response

All services for Emergency Medical Services are subjected to pre-authorisation . Please contact GEMS Emergency Medical Evacuation Dispatch Centre at 0800 44 4367 to be supplied with the applicable service provider as well as pre-authorisation approval.

Basic Life Support

100 Up to 45 minutes 1 072,04 1 218,23

102 Up to 60 minutes 1 428,12 1 622,87

103 Every additional 15 minutes 357,35 406,08

111 Long distance (>100km) travelled with patient 17,82 20,25

112 Long distance (>100km) travelled without patient 6,26 7,11

Intermediate Life Support

125 Up to 45 minutes 1 447,34 1 644,70

127 Extra 15 minutes 482,49 548,28



Advanced Life Support/ Intensive Care Unit

131 Up to 60 minutes 2 545,29 2 892,37

133 Extra 15 minutes 636,32 723,09



151 Resuscitation fee, per incident 2 841,71 3 229,21

153 Doctor per hour 813,67 924,62

Aeromedical Transfers 500 Basic Call Cost(Start up) - -

Flying Time

531 30 minutes - -

533 45 minutes - -

535 60 minutes - -

537 75 minutes - -

539 90 minutes - -

541 105 minutes - -

543 120 minutes - -

Staff And Consumables

581 30 minutes - -

583 45 – 75 minutes - -

585 90 – 105 minutes - -

587 120 minutes - -


74 • Version 4_21

GEMS TARIFF IN SERVICES RENDERED BY EMERGENCY MEDICAL SERVICES EFFECTIVE FROM 1 MAY 2011

Code DescriptionInter-Hospital Transfer(IHT)

Primary Response

Aircraft Type D 591 Hourly rate plus 20% - -

Winching 595 Winching, per lift - -

Staff Costs Per Hour

621 Doctor - -

623 ICU Sister - -

625 Paramedic - -

Equipment Cost 631 Per patient, per hour - -

Aircraft Cost (Per Km)

651 Beechcraft Duke - -

653 Lear 24F - -

655 Lear 35 - -

657 Falcon 10 - -

659 King Air 200 - -

661 Mitsubishi MU2 - -

663 Cessna 402 - -

665 Beechcraft Baron - -

667 CitationII - -

669 Pilatus PC12 - -


75 • Version 4_21

Hearing Aid Accousticians

GEMS TARIFF FOR SERVICES BY HEARING AID ACOUSTICIANS EFFECTIVE FROM 1 JANUARY 2011Practice Type:

Hearing Aid Acousticians Code: 38300

codes CF Units Value

R


- - -

GENERAL RULES - - -

003The fee in respect of more than one evaluation shall be the full fee for the first evaluation plus half the fee in respect of each additional evaluation, but under no circumstances may fees be charged for more than three evaluations carried out.

- - -

004

Each practitioner shall render a monthly account in respect of any service rendered during the month, irrespective of whether or not the treatment has been completed. NB. Every account shall contain the following particulars : · The practice code number of the supplier of service · The name of the collaborating medical practitioner or audiologist. · The name of the member. · The name of the patient. · The name of the medical scheme. · The membership number of the member. · The nature of the treatment. · The date on which the service was rendered. · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - -


- - -

ITEMS - - -

001 First consultation (comprehensive) 220 15.700 95.30

003 Consultation (screening interview) 220 10.000 60.70

021 Test - air conduction 220 10.000 60.70

023 Test - bone conduction 220 10.000 60.70

025 Test - speech hearing tests 220 14.000 84.90

027 Test - free field 220 12.800 77.70

029 Test - insertion gain (per ear) 220 10.900 66.10

031 Test - binaural loudness balance test, per ear 220 12.800 77.70

051 Global charge for supply and fitting of hearing aid and follow-up (By arrangement with scheme) 220 - -


76 • Version 4_21

GEMS TARIFF FOR SERVICES BY HEARING AID ACOUSTICIANS EFFECTIVE FROM 1 JANUARY 2011Practice Type:

Hearing Aid Acousticians Code: 38300

codes CF Units Value

R

053 Hearing Aid Evaluation, per ear (refer to General Rule 003) 220 12.800 77.70

055 Technical adjustment or replacement of earmolds 220 21.100 128.00

057 Repairs/service per instrument (3 X services/4 year cycle) 220 - -

059 Tympanogram 220 10.000 60.70

061 Reflex test (stapedial reflex) 220 10.000 60.70


220 - -


77 • Version 4_21

Homeopathy

GEMS TARIFF FOR SERVICES BY HOMOEOPATHS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Homoeopathy

Code: 40800

code CF Units Value

R


- - -

GENERAL RULES - - -

1

All accounts must be presented with the following information clearly stated: · name of homoeopath; · qualifications of the homoeopath; · PCNS Practice Number; · postal address and telephone number; · date on which service(s) were provided; · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered; · the nature of treatment; · the surname and initials of the member; · the first name of the patient; · the name of the scheme; · the membership number of the member; · where the account is a photocopy of the original, certification by way of a rubberstamp or the signature of the homoeopath; and · a statement of whether the account is in accordance with the GEMS Tariff.

- - -


- - -

Definition: Consultations - - -

Consultation: A situation where a Homoeopathic Practitioner takes down a patient’s full history and (where applicable) performs an appropriate examination, and repertorisation of the case and study of Materia Medica and/or prescribes or administers treatment and/or medicine or assists the patient with advice. (The method of repertorisation and selection of medicine is determined by the practitioner). or A voluntary scheduled consultation for the same condition within four (4) months (although the symptoms may differ from those presented during the first consultation). It may imply taking down a history and/or repertorisation of the case and study of Materia Medica and/or examination and/or prescribing or administering of treatment and/or medicine and/or counselling.Multiple complaints attended to during same visit: Only one consultation fee is chargeable although the patient may present with a number of complaints. If the patient has an unrelated complaint at the time of administering e.g. a homoeopathic injection as part of a course only a fee for a visit is appropriate. Hospital visits: at hospital or nursing home (all hours). By arrangement with the Scheme/patient.

- - -


78 • Version 4_21


Code: 40800

code CF Units Value

R

Definition: Medicines - - -

Prescribed medicine: Homoeopathic medicines are prescribed in accordance with the homoeopathic principles and philosophy. The philosophy may consist of a classical, a clinical or a combined classical/clinical approach. The prescription may include proprietary homoeopathic medicine, or patient specific compounded medicine or a combination of both. The prescription may also include specially imported medicine. The medicine may be prescribed in the form of a tablet, capsules, ampoules, liquid drops, liquid syrup, eardrops, nose drops, eye drops, pillules, granules, powders, ointments, creams, suppositories, stickers, etc. The medicine may be prescribed in a simplex potency, mother tincture (Æ), low potency, multi-potency, etc and/or complex form.Proprietary medicine: These are registered medicines (consonant with the homoeopathic scope of practice) that are available in the open market or trade, or which are bought in bulk from manufacturers or wholesalers and dispensed to patients in smaller volumes without any compounding or manipulation. The dispensing of such medicine requires the appropriate NAPPI Code provided by the Manufacturer/Distributor.Non-proprietary homoeopathic medicine: These are homoeopathic medicines (consonant with the homoeopathic scope of practice) which are formulated and/or prepared and/or manipulated, and/or compounded in-house by the registered homoeopathic practitioner, and/or by a registered homoeopathic medicine manufacturer in accordance with the prescription and/or formula of the registered homoeopathic practitioner and which is not available in the market/trade.Dispense/Dispensing: in terms of Act 101 of 1965 means in the case of a medical practitioner, dentist, practitioner, nurse or any prescriber authorised to dispense medicines. i. the interpretation and evaluation of a prescription; ii. the selection, reconstitution, dilution, labelling, recording and supply of the medicine in an appropriate container; or iii. the provision of information and instructions to ensure safe and effective use of a medicine by a patient.Compound/Compounding: means to prepare, mix, combine, package and label a medicine for dispensing as a result of a prescription for an individual patient by a pharmacist or a person authorised in terms of Act 101 of 1965.Proprietary Materials: To be used for all material and/or unregistered/unscheduled products used in treatment. The appropriate NAPPI code(s), where applicable, must be provided.

- - -

General Rules on Medicines, supplies, material and use of own equipment in treatment and procedures - - -


79 • Version 4_21


Code: 40800

code CF Units Value

R

MEDICINE CODE USAGE:Licensed Practitioners201: as medicine dispensed to patients may only be used by a practitioner licensed to dispense medicine. 202-204: as compounded medicines which are dispensed to patients may only be used by a practitioner licensed to compound and dispense medicine 221-224: may be used by a licensed practitioner in the administration or usage of a medicine or material during the consultation. Items 222-224 specifically require a compounding license. 209: the use or administration of proprietary materials during a consultation.Unlicensed Practitioners:221: administered proprietary medicine (consonant with the homoeopathic scope of practice) to patients during the consultation as administration does not warrant a dispensing license as per Regulation 18, Act 101 of 1965, which states:Regulation 18, Act 101 (8) For the purposes of this regulation, “compounding and dispensing” does not refer to a medicine requiring preparation for a once-off administration to a patient during a consultation. 209: the use or administration of proprietary materials during a consultation400: a dispensing code allowing the dispensing of proprietary Homoeopathic medicine to a patient for an emergency medical condition on a once-off basis by an unlicensed practitioner. This should only be used bearing in mind the understanding of the term “emergency medical condition” where failure to such an act would prove a danger to the patient or community or as defined by the Regulations to the Medical Schemes Act, 1998 (Act 131 of 1998):“Emergency Medical Condition” means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy.Reflection of NAPPI/GEMS Tariff codes on electronic and paper claims: 1. NAPPI Codes are only relevant for Items 201, 221 and, if applicable, 209 2. Due to the nature of non-proprietary medicine, no NAPPI codes exist for items 202-204 and 222-224 and the inclusion of the GEMS Tariff

codes should be regarded as sufficient3. For electronic claims each GEMS Tariff and/or NAPPI code should be reflected on its own line followed by consecutive columns: the Single

Exit Price (SEP) or GEMS Tariff value (VAT inclusive) of the specific medicine and the total amount reflecting a VAT inclusive amount.

- - -


80 • Version 4_21


Code: 40800

code CF Units Value

R

Items 201 and 209 provide for the charge of material and medicine used in treatment.· All materials used should be specified on all accounts.· Medicine, bandages and other essential materials for home-use by the patient must be obtained from a chemist on prescription or, if a

chemist is not readily available, the practitioner may supply it from own stock provided a relevant prescription is attached to the account. · Not appropriate for items such as spatulas that are normally used in examinations in the rooms.· Not appropriate for items such as syringes, needles and gloves, etc.· Practitioners are not allowed to sell sphygmomanometers (blood pressure meters) or electro-medical devices to patients.· For side room testing by practitioners no extra charge in terms of item 201 is applicable for material or kits used.The amount charged in respect of proprietary medicines shall be at net acquisition price.In relation to all other materials, items are to be charged (exclusive of VAT) at net acquisition price plus -* 30% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; and* a maximum of R30 where the net acquisition price of that material is greater than or equal to one hundred rands.

- - -

ITEMS - - -


301 Consultation (initial or follow up). Duration 5 - 15 mins 231 10.000 62.70




004 Consultation, each additional full 15 mins, to a maximum of 60 mins 231 15.000 94.00

003 Hospital visit (BY ARRANGEMENT) 230 - -


230 - -

2. Medicines and Materials - - -

2.1 Licensed practitioner in licensed area: - - -

Dispensed Medicine: - - -

Codes 201 - 204 are to allow for the dispensing of medicine - either proprietary or non-proprietary. Code 201 requires only a Dispensing License Codes 202 - 204 require a combined Compounding and Dispensing license

- - -

201Proprietary (dispensed) medicine, all forms related to homoeopathic scope of practice. The amount charged in respect of proprietary homeopathic medicines shall be at cost using appropriate NAPPI code.

230 - -

202 Non-proprietary (compounded and dispensed) Homoeopathic Medicine - Tablets & Capsules (each) 230 0.100 1.30

203 Non-proprietary (compounded and dispensed) Homoeopathic Medicine - Liquid drops (per ml) 230 0.230 2.90

204 Non-proprietary (compounded and dispensed) Homoeopathic Medicine - Pillules & granules (per ml) 230 0.230 2.90


81 • Version 4_21


Code: 40800

code CF Units Value

R

Administered Medicine/Materials: - - -

221Proprietary (administered) medicine, all forms related to homoeopathic scope of practice. The amount charged in respect of proprietary homeopathic medicines shall be at cost using appropriate NAPPI code.

- - -

222 Non-proprietary (compounded and administered) Homoeopathic Medicine - Tablets & Capsules (each) 230 0.100 1.30

223 Non-proprietary (compounded and administered) Homoeopathic Medicine - Liquid drops (per ml) 230 0.230 2.90

224 Non-proprietary (compounded and administered) Homoeopathic Medicine - Pillules & granules (per ml) 230 0.230 2.90

209 Proprietary Materials (administered) - - -

2.2 Unlicensed practitioner OR licensed practitioner in unlicensed area: - - -

Dispensed Medicine: - - -

400Once off dispensing: Once off dispensing of proprietary homeopathic medicine, all forms, by unlicensed Homoeopathic practitioners or licensed homoeopathic practitioner in an unlicensed area. The amount charged in respect of proprietary homeopathic medicines shall be at cost using appropriate NAPPI code. To be used as emergency only.

230 - -

Administered Medicine: - - -

221Proprietary (administered) medicine, all forms related to homoeopathic scope of practice. The amount charged in respect of proprietary homeopathic medicines shall be at cost using appropriate NAPPI code.

- - -

209 Proprietary Materials (administered) - - -


82 • Version 4_21

HospicesGEMS TARIFF IN RESPECT OF HOSPICE OR SIMILAR APPROVED FACILITIES WITH A PRACTICE NUMBER COMMENCING WITH “79” WITH

EFFECT FROM 1 JANUARY 2011Practice Type: Hospices

Code: 57900

code CF Units Value

R


- - -

GENERAL RULES - - -

AIt is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by a medical scheme if the appropriate code is supplied on the account.

- - -

SCHEDULE - - -

10 HOSPICE OR SIMILAR APPROVED FACILITIES WITH A PRACTICE NUMBER COMMENCING WITH “79” - - -

950 Ward fee, per day (Inclusive of professional fees and disposables, except for pharmacy dispensed medication). 550 30.552 853.70

955 Home health care, per visit 550 10.000 279.40

960 Global fee for a terminally ill patient - By arrangement with medical scheme/patient 550 - -


83 • Version 4_21

Medical Practitioners

GEMS TARIFF FOR SERVICES BY MEDICAL PRACTITIONERS, EFFECTIVE FROM 1 JANUARY 2011

Practice Type: SpecialistsCode: 10000

Practice Type: General Medical Practice

Code: 11400

Practice Type: Anaesthesiology

Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R


- - - - - - - - -

RULES GOVERNING THE STRUCTURE - - - - - - - - -

A.

Consultations: Definitions: (a) New and established patients: A consultation/visit refers to a clinical situation where a medical practitioner personally obtains a patient’s medical history, performs an appropriate clinical examination and, if indicated, administers treatment, prescribes or assists with advice. These services must be face-to-face with the patient and excludes the time spent doing special investigations which receive additional remuneration. (b) Subsequent visits: Refers to a voluntarily scheduled visit performed within four (4) months after the first visit. It may imply taking down a medical history and/or a clinical examination and/or prescribing or administering of treatment and/or counselling. (c) Hospital visits: Where a procedure or operation was done, hospital visits are regarded as part of the normal after-care and no fees may be levied (unless otherwise indicated). Where no procedure or operation was carried out, fees may be charged for hospital visits according to the appropriate hospital or inpatient follow-up visit code.

- - - - - - - - -

B.

Normal hours and after hours: After-hours services are paid at the same rate as benefits for normal hours services. Bona fide emergency medical services rendered to a patient, at any time, may attract a fee as specified in modifier 0011 and items 0146 or 0147 (which should be added to the appropriate consultative services code selected from items 0190-0192, 0173-0175, 0161-0164, 0166-0169)

- - - - - - - - -


84 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

C.

Comparable services: A service may be rendered that is not listed in this edition of the coding structure. The fee that may be charged in respect of the rendering of a service not listed in this coding structure shall be based on the fee in respect of a comparable service. For these procedure(s)/service(s), item 6999: Unlisted procedure or service code, should be used. Please contact the SA Medical Association (SAMA) Private Practice Unit via e-mail on [email protected] to obtain a comparable code for the unlisted procedure/service which will be based on the fee for a comparable service in the coding structure. When item 6999 is used to indicate that an unlisted service was rendered, the use of the item must be supported by a special report. This report must include: (1) An adequate definition or description of the nature, extent and need for the procedure/service or “medical necessity”; (2) In which respect is this service unusual or different in technique, compared to available procedures/services listed in the coding structure? Information regarding the nature and extent of the procedure/service, time and effort, special/dedicated equipment needed to provide this service, must be included in the report; (3) Is this procedure/service medically appropriate under the circumstances? Explain why another procedure/service listed in the coding structure will not be appropriate in this case; (4) A description of the complexity of the symptoms and concurrent problems must be supplied; (5) Final diagnosis supported by the appropriate ICD-10 code(s); (6) Pertinent physical findings (size, location and number of lesions if applicable); (7) Mention any other diagnostic or therapeutic procedure(s)/service(s) provided at the same session; (8) Any further diagnostic or therapeutic procedure(s)/service(s) to be provided in the follow-up period; and (9) Description of the follow-up care needed. Please note: This comparable service code may not be used for a period longer than six months for a particular procedure/service after which time an application has to be made for the addition of a specific code for this procedure

- - - - - - - - -

D.

Cancellation of appointments: Unless timely steps are taken to cancel an appointment for a consultation, the relevant consultation fee may be charged. In the case of a general practitioner “timely” shall mean two hours and in the case of a specialist 24 hours prior to the appointment. Each case shall, however, be considered on merit and, if circumstances warrant, no fee shall be charged. If a patient has not turned up for a procedure, each member of the surgical team is entitled to charge for a visit at or away from doctor’s rooms as the case may be

- - - - - - - - -


85 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

E.Pre-operative visits: The appropriate fee may be charged for all pre-operative visits with the exception of a routine pre-operative visit at the hospital

- - - - - - - - -

F.Administering of injections and/or infusions: Where applicable, fees for administering injections and/or infusions may only be charged when done by the practitioner himself

- - - - - - - - -

G.

Post-operative care: (a) Unless otherwise stated, the fee in respect of an operation or procedure shall include normal after-care for a period not exceeding ONE month (after-care is excluded from pure diagnostic procedures during which no therapeutic procedures were performed). (b) If the normal after-care is delegated to any other registered health professional and not completed by the surgeon, it shall be his/her own responsibility to arrange for this to be done without extra charge. (c) When post-operative care/treatment of a prolonged or specialised nature is required, such fee as may be agreed upon between the surgeon and the scheme or the patient (in case of a private account) may be charged. (d) Normal after-care refers to an uncomplicated post-operative period not requiring any further incisions

- - - - - - - - -

H.Removal of lesions: Items involving removal of lesions include follow-up treatment for 10 days

- - - - - - - - -

J.

Disproportionately low fees: In exceptional cases where the fee is disproportionately low in relation to the actual services rendered by a medical practitioner, a higher fee may be negotiated. The use of this rule is not intended merely to increase the Medical Schemes Benefits.

- - - - - - - - -

K.

Practice of specialists: In terms of the conditions in respect of the practice of specialists as published in Government Gazette No. 12958 of 11 January 1991, a specialist may treat any person who comes to him direct for consultation. A specialist who is consulted by a patient or who treats a patient, shall take all reasonable steps to ensure the collaboration of the patient’s general practitioner. Medical practitioners referring cases to other medical practitioners shall indicate in the reference whether the patient is a member of a medical scheme or a dependant of such member. This also applies in respect of specimens sent to pathologists

- - - - - - - - -

L.Procedures performed at time of visits: If a procedure is performed at the time of a consultation/visit, the fee for the visit PLUS the fee for the procedure is charged

- - - - - - - - -


86 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

M.Procedure planned to be performed later: In cases where, during a consultation/visit, a procedure is planned to be performed at a later occasion, a visit may not be charged for again, at such a later occasion

- - - - - - - - -

N.

“Per consultation”: No additional fee may be charged for a service for which the fee is indicated as “per consultation”. Such services are regarded as part of the consultation/visit performed at the time the condition is brought to the doctor’s attention

- - - - - - - - -

O.

Costly or prolonged medical services or procedures: In the case of costly or prolonged medical services or procedures, the medical practitioner shall first ascertain from the medical scheme for what amount the medical scheme will accept responsibility in respect of such treatment, should the practitioner wish any direct payment from the scheme

- - - - - - - - -

P.

Travelling fees: (a) Where, in cases of emergency, a practitioner was called out from his residence or rooms to a patient’s home or the hospital, travelling fees can be charged according to the section on travelling expenses (section IV) if he had to travel more than 16 kilometres in total. (b) If more than one patient would be attended to during the course of a trip, the full travelling expenses must be divided between the relevant patients. (c) A practitioner is not entitled to charge for any travelling expenses or travelling time to his rooms. (d) Where a practitioner’s residence would be more than 8 kilometres away from a hospital, no travelling fees may be charged for services rendered at such hospitals, except in cases of emergency (services not voluntarily scheduled). (e) Where a practitioner conducts an itinerant practice, he is not entitled to charge fees for travelling expenses except in cases of emergency (services not voluntarily scheduled). (f) For voluntarily scheduled services, fees for travelling expenses may only be charged where the patient and the practitioner have entered into an agreement to this effect. Medical scheme benefits will not be applicable in such instances.

- - - - - - - - -


87 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

Q.

Intensive care/High Care: Units in respect of items 1204 to 1210 (Categories 1 to 3) EXCLUDE the following: (a) Anaesthetic and/or surgical fees for any condition or procedure, as well as a first consultation/visit, which is, regarded as the assessment of the patient, while the daily intensive care/high care fee covers the daily care in the intensive/high care unit. (b) Cost of any drugs and/or materials. (c) Any other cost which may be incurred before, during or after the consultation/visit and/or the therapy. (d) Blood gases and chemistry tests, including the arterial puncture to obtain the specimen. (e) Procedural items 1202 and 1212 to 1221. but INCLUDE the following: (f) Performing and interpretation of a resting ECG. (g) Interpretation of chemistry tests and x-rays. (h) Intravenous treatment (items 0206 and 0207), except intravenous infusion in patients under the age of three years (item 0205) that does not form a part of the daily ICU/High Care fee and may be charged for separately on a daily basis (fee includes the introduction of the cannula as well as the daily management)

- - - - - - - - -

R.Multiple organ failure: Units for items 1208, 1209 and 1210 (Category 3: Cases with multiple organ failure) include resuscitation (i.e. item 1211: Cardio-respiratory resuscitation)

- - - - - - - - -

S.

Ventilation: Units for items 1212, 1213 and 1214 (ventilation) include the following: (a) Measurement of minute volume, vital capacity, time- and vital capacity studies. (b) Testing and connecting the machine. (c) Putting patient on machine: setting machine, synchronising patient with machine. (d) Instruction to nursing staff. (e) All subsequent visits for 24 hours.

- - - - - - - - -

T.Ventilation (items 1212 to 1214) does not form a part of normal post-operative care, but may not be added to item 1204: Catogory 1: Cases requiring intensive monitoring

- - - - - - - - -


88 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

U.

Obstetric procedures: (a) When a general practitioner treats a patient in the ante-natal period and, after starting the confinement, requests an obstetrician to take over the case, the general practitioner shall be entitled to charge for all the ante-natal consultations he/she has performed. (i) If the patient has been in labour for less than 6 hours, the general practitioner shall charge 50,00 clinical procedure units according to item 2614: Global obstetric care. (ii) If the patient has been in labour for more than 6 hours, the general practitioner shall charge 80,00 clinical procedure units according to item 2614: Global obstetric care. (b) When a general practitioner calls an obstetrician to help with a confinement, take over the management of a confinement, and treats the patient until after the post-partum visit, the obstetrician shall charge according to item 2614: Global obstetric care. (c) When a general practitioner calls an obstetrician (specialist or general practitioner) to help with a confinement, or take over the management of a confinement, but the general practitioner treats the patient until after the post-partum visit, the obstetrician shall charge according to item 2616: Intrapartum obstetric care by obstetrician in consultation, and the general practitioner according to item 2614: Global obstetric care.

- - - - - - - - -

V.

(a) Electro-convulsive treatment: Visits at hospital or nursing home during a course of electro-convulsive treatment are justified and may be charged for in addition to the fees for the procedure. (b) Except where otherwise indicated, the duration of a medical psychotherapeutic session is set at 20 minutes or part thereof, provided that such a part comprises 50% or more of the time of a session. This set duration is also applicable for psychiatric examination methods

- - - - - - - - -

Y.Except where otherwise indicated, radiologists are entitled to charge for contrast material used

- - - - - - - - -

Z. No fee is subject to more than one reduction - - - - - - - - -

AA. Procedures to exclude cost of isotope - - - - - - - - -

BB.The fees in this section (radiation oncology) do NOT include the cost of radium or isotopes

- - - - - - - - -


89 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

CC.

Acupuncture: (a) When two separate acupuncture techniques are used, each treatment shall be regarded as a separate treatment for which fees may be charged for separately. (b) Not more than two separate techniques may be charged for at each session. (c) The maximum number of acupuncture treatments per course to be charged for is limited to 20. If further treatment is required at the end of this period of treatment, it should be negotiated with the patient. (d) Item 0380 refers to scalp acupuncture as a treatment in its own right and not to the use of acupuncture points on the scalp

- - - - - - - - -

EE.

Ultrasound examinations: The international norm approved for use in South Africa for NORMAL PREGNANCY is two ultrasound exams: (a) The first scan should preferably include a nuchal thickness estimation and be performed between 10 and 14 weeks gestation. The second scan should be performed between 20 and 24 weeks and should include a full anatomical report. All subsequent ultrasound scans are excluded from the benefits of medical schemes unless accompanied by proper motivation. An ultrasound scan to assess an abnormal early pregnancy may be formed before 10 weeks but this scan may not be used to diagnose a normal uncomplicated pregnancy. Item 3618 is a gynaecological scan and its use is not approved for use in pregnancy. (b) In cases where the scan is performed by the attending practitioner, a clear indication for such a scan must be entered on the account rendered, or a letter of motivation must be attached to the account (the practitioner must elect one of the two options). (c) In case of a referral, the referring doctor must submit a letter of motivation to the radiologist or other practitioner doing the scan. A copy of the letter of motivation must be attached to the first account rendered to the patient (by the radiologist or the other practitioner doing the scan) and must be attached to the first account submitted to the medical scheme by the patient or the doctor, as the case may be. (d) In case of a referral to a radiologist, no motivation should be required from the radiologist

- - - - - - - - -

FF.

(a) When a cystoscopy precedes a related operation, Modifier 0013: Endoscopic examination done at an operation, applies, e.g. cystoscopy followed by transurethral (TUR) prostatectomy. (b) When a cystoscopy precedes an unrelated operation, Modifier 0005: Multiple procedures/operations under the same anaesthetic, applies, e.g. cystoscopy for urinary tract infection followed by inguinal hernia repair. (c) No modifier applies to item 1949: Cystoscopy, when performed together with any of items 1951 to 1973.

- - - - - - - - -


90 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

GG.

Capturing and recording of examinations: Images from all radiological, ultrasound and magnetic resonance imaging procedures must be captured during every examination and a permanent record generated by means of film, paper, or magnetic media. A report of the examination, including the findings and diagnostic comment, must be written and stored for five years

- - - - - - - - -

RR.

The radiology section in this price list is not for use by registered specialist radiology practices (Pr No “038”) or nuclear medicine practices (Pr No “025”), but only for use by other specialist practices or general practitioners. A separate radiology schedule is for the exclusive use of registered specialist radiology practices (Pr No “038”) and nuclear medicine practices (Pr No “025”).

- - - - - - - - -

XX.Diagnostic services rendered to hospital inpatients: Quote Modifier 0091 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients officially admitted to hospital or day clinic

- - - - - - - - -

YY.

Diagnostic services rendered to outpatients: Quote Modifier 0092 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients NOT officially admitted to hospital or day clinic (could be within the confines of a hospital)

- - - - - - - - -

MODIFIERS GOVERNING THE STRUCTURE - - - - - - - - -

0002

Written report on X-rays: The lowest level code for a new patient office (consulting rooms) visit, is applicable only where a radiologist is requested to give a written report on X-rays taken elsewhere and submitted to him. The above mentioned item and the lowest level initial hospital visit code, as appropriate are not to be used for routine reporting of X-rays taken elsewhere

- - - - - - - - -

0004

Procedures performed in own procedure rooms: Procedures performed in doctors’ own procedure rooms instead of in a hospital theatre or unattached theatre unit: as per fee for procedure + 100% (the value of modifier 0004 equals 100% of the value of the procedure performed). See Section V (Section G in SAMA’s DBT) for a list of procedures, which are often done in rooms to which Modifier 0004 should not be applied. Please note: Only the medical practitioner who owns the facility and the equipment may charge modifier 0004. Only one person may claim this modifier for procedures performed in doctors’ own procedure rooms

- - - - - - - - -


91 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0005

Multiple therapeutic procedures/operations under the same anaesthetic:

a) Unless otherwise identified in the tariff when multiple therapeutic procedures/operations add significant time and/or complexity, and when each procedure/operation is clearly identified and defined, the following values shall prevail: 100% (full value) for the first or major procedure/operation, 75% for the second procedure/operation, 50% for the third procedure/operation, 25% for the fourth and subsequent procedures/operations. This modifier does not apply to purely diagnostic procedures.

b) In the case of multiple fractures and/or dislocations the above values shall prevail.

c) When purely diagnostic endoscopic procedures or diagnostic endoscopic procedures unrelated to any therapeutic procedures performed, are performed under the same general anaesthetic, Modifier 0005 is not applicable to the fees for such diagnostic endoscopic procedures as the fees for endoscopic procedures do not provide for after-care. Specify unrelated endoscopic procedure and provide diagnosis to indicate diagnostic endoscopic procedure(s) unrelated to other (therapeutic) procedures performed under the same anaesthetic.

d) Please note: When more than one small procedure is performed and the tariff makes provision for items for “subsequent” or “maximum for multiple additional procedures” (see Section 2. Integumentary System) Modifier 0005 is not applicable as the fee is already a reduced fee.

e) “+” Means that this item is used in addition to another definitive procedure and is therefore not subject to reduction according to Modifier 0005 (see also Modifier 0082)

- - - - - - - - -


92 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0006

Visiting specialists performing procedures: Where specialists visit smaller centres to perform procedures, fees for these particular procedures are exclusive of after-care. The referring practitioner will then be entitled to subsequent hospital visits for after-care. If the referring practitioner is not available, the specialist shall, on consultation with the patient, choose an appropriate locum tenens. Both the surgeon and the practitioner who handled the after-care, must in such instances quote Modifier 0006 with the particular items which they use

- - - - - - - - -

0007

a) Use of own monitoring equipment in the rooms: Remuneration for the use of any type of own monitoring equipment in the rooms for procedures performed under intravenous sedation - 15,00 clinical procedure units irrespective of the number of items of equipment provided. b) Use of own equipment in hospital theatre or unattached theatre unit: Remuneration for the use of any type of own equipment for procedures performed in a hospital theatre or unattached theatre unit when appropriate equipment is not provided by the hospital - 15,00 clinical procedure units irrespective of the number of items of equipment provided.

20 15.000 134.10 20 15.000 134.10 - - -

0008Specialist surgeon assistant: Where a procedure requires a registered specialist surgeon assistant, the fee is 33,33% (1/3) of the fee for the specialist surgeon

- - - - - - - - -

0009Assistant: The fee for an assistant is 20% of the fee for the specialist surgeon, with a minimum of 36,00 clinical procedure units. The minimum fee payable may not be less than 36,00 clinical procedures units

- - - - - - - - -


93 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0010

Local anaesthesic: (a) A fee for a local anaesthetic administered by the operator may only be charged for (1) an operation or procedure having a value greater than 30,00 clinical procedure units (i.e. 31,00 or more clinical procedure units allocated to a single item) or (2) where more than one operation or procedure is done at the same time with a combined value greater than 50,00 clinical procedure units. (b) The fee shall be calculated according to the basic anaesthetic units for the specific operation. Anaesthetic time may not be charged for, but the minimum fee as per Modifier 0036: Anaesthetic administered by a general practitioner, shall be applicable in such a case. (c) Not applicable to radiological procedures (such as angiography and myelography. (d) No fee may be levied for topical application of local anaesthetic. (e) Please note: Modifier 0010: Local anaesthetic administered by the operator, may not be added on the surgeon’s account for procedures that were performed under general anaesthetic.

- - - - - - - - -

0011

Emergency procedures: Any bona fide, justifiable emergency procedure (all hours) undertaken in an operating theatre and/or in another setting in lieu of an operating theatre, will attract an additional 12,00 clinical procedure units per half-hour or part thereof of the operating time for all members of the surgical team. Modifier 0011 does not apply in respect of patients on scheduled lists. (A medical emergency is any condition where death or irreparable harm to the patient will result if there are undue delays in receiving appropriate medical treatment)

- - - - - - - - -

0013

Endoscopic examinations done at operations: Where a related endoscopic examination is done at an operation by the operating surgeon or the attending anaesthesiologist, only 50% of the fee for the endoscopic examination may be charged

- - - - - - - - -

0014

Operations previously performed by other surgeons: Where an operation is performed which has been previously performed by another surgeon, e.g. a revision or repeat operation, the fee shall be calculated according to the tariff for the full operation plus an additional fee to be negotiated under general Rule J: In exceptional cases where the fee is disproportionately low in relation to actual service rendered, except where already specified in the tariff

- - - - - - - - -


94 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0015

Intravenous infusions: Where intravenous infusions (including blood and blood cellular products) are administered as part of the after-treatment after the operation or confinement, no extra fees shall be charged as this is included in the global operative or maternity fees. Should the practitioner doing the operation or attending to the maternity case prefer to ask another practitioner to perform post-operative or post-confinement intravenous infusions, then the practitioner himself (and not the patient) shall be responsible for remunerating such practitioner for the infusions

- - - - - - - - -

0017

Injections administered by practitioners: When desensitisation, intravenous, intramuscular or subcutaneous injections are administered by the practitioner him-/herself to patients who attend the consulting rooms, a first injection forms part of the consultation/visit and only all subsequent injections for the same condition should be charged at 7.50 consultative services units using modifier 0017 to reflect the amount (not chargeable together with a consultation item)

10 7.500 108.30 10 7.500 108.30 - - -

0018Surgical modifier for persons with a BMI of 35> (calculated according to kg/m2): Fee for procedure +50% for surgeons and a 50% increase in anaesthetic time units for anaesthesiologists

- - - - - - - - -

0019

Surgery on neonates (up to and including 28 days after birth) and low birth weight infants (less than 2500g) under general anaesthesia (excluding circumcision): per fee for procedure + 50% for surgeons and a 50% increase in anaesthetic time units for anaesthesiologists

- - - - - - - - -

0046

Where in the treatment of a specific fracture or dislocation (compound or closed) an initial procedure is followed within one month by an open reduction, internal fixation, external skeletal fixation or bone grafting on the same bone, the fee for the initial treatment of that fracture or dislocation shall be reduced by 50%. Please note: This reduction does not include the assistant’s fee where applicable. After one month, a full fee as for the initial treatment, is applicable

- - - - - - - - -

0047 A fracture NOT requiring reduction shall be charged on a fee per service basis - - - - - - - - -

0048

Where in the treatment of a fracture or dislocation, an initial closed reduction is followed within one month by further closed reductions under general anaesthesia, the fee for such subsequent reductions will be 27,00 clinical procedure units (not including after-care)

20 27.000 241.40 20 27.000 241.40 - - -

0049Except where otherwise specified, in cases of compound fractures, 77,00 clinical procedure units (specialists) and 77,00 clinical procedure units (general practitioners) are to be added to the units for the fractures including debridement

20 77.000 688.50 20 77.000 688.50 - - -


95 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0050

In cases of a compound fracture where a debridement is followed by internal fixation (excluding fixation with Kirschner wires, as well as fractures of hands and feet), the full amount according to either Modifier 0049: Cases of compound fractures, or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting, may be added to the fee for the procedure involved, plus half of the amount according to the second modifier (either Modifier 0049: Cases of compound fractures or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting, as applicable)

20 115.500 1 032.70 20 115.500 1 032.70 - - -

0051Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting: Specialists add 77,00 clinical procedure units. General practitioners add 77,00 clinical procedure units

20 77.000 688.50 20 77.000 688.50 - - -

0053Fracture requiring percutaneous internal fixation [insertion and removal of fixatives (wires) in respect of fingers and toes included]: Specialists and general practitioners add 32,00 clinical procedure units

20 32.000 286.10 20 32.000 286.10 - - -

0055Dislocation requiring open reduction: Units for the specific joint plus 77,00 clinical procedure units for specialists. General practitioners add 77,00 clinical procedure units

20 77.000 688.50 20 77.000 688.50 - - -

0057

Multiple procedures on feet: In multiple procedures on feet, fees for the first foot are calculated according to Modifier 0005: Multiple procedures/operations under the same anaesthetic. Calculate fees for the second foot in the same way, reduce the total to 75% and add to the total for the first foot

- - - - - - - - -

0058Revision operation for total joint replacement and immediate re-substitution (infected or non-infected): per fee for total joint replacement + 100%

- - - - - - - - -

0061Combined procedures on the spine: In cases of combined procedures on the spine, both the orthopaedic surgeon and the neurosurgeon are entitled to the full fee for the relevant part of the operation performed

- - - - - - - - -

0063Where two specialists work together on a replantation procedure, each shall be entitled to two-thirds of the fee for the procedure

- - - - - - - - -

0064Where the replantation is unsuccessful, no further surgical fee is payable for amputation of the non-viable parts

- - - - - - - - -

0065Additional operative procedures by same surgeon, under section 3.8.6: Spinal deformities, within a period of 12 months: 75% of scheduled fee for the lesser procedure, except where otherwise specified elsewhere

- - - - - - - - -


96 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0066Microsurgery of the fallopian-tubes and ovaries: Where micro-surgical techniques are used, with the aid of a microscope, 25% may be added to the fee

- - - - - - - - -

0067

Microsurgery of the larynx: Add 25% to the fee of the operation performed (òFor other operations requiring the use of an operation microscope, the fee include the use of the microscope, except where otherwise specified elsewhare in the Tariff)

- - - - - - - - -

0069When endoscopic instruments are used during intranasal surgery: Add 10% of the fee of the procedure performed. Only applicable to items 1025, 1027, 1030, 1033, 1035, 1036, 1039, 1047, 1054 and 1083

- - - - - - - - -

0070Add 45,00 clinical procedure units to procedure(s) performed through a thorascope

20 45.000 402.40 20 45.000 402.40

0072Non invasive peripheral vascular tests: The number of tests in a single case is restricted to two (2) per diagnosis. Tests are not justified in cases of uncomplicated varicose veins

- - - - - - - - -

0073

When item 1288 (Cardiac catheterisation for congenital heart disease: All ages above 1 year old) or item 1289 (Paediatric cardiac catheterisation: Infants below the age of one year) is performed by paediatric cardiologists (‘33’): fee for procedure + 100%

- - - - - - - - -

0074Endoscopic procedures performed with own equipment: The basic procedure fee plus 33.33% (1/3) of that fee (“+” codes excluded) will apply where endoscopic procedures are performed with own equipment.

- - - - - - - - -

0075

Endoscopic procedures performed in own procedure room: The fee plus 21,00 clinical procedure units will apply where endoscopic procedures are performed in rooms with own equipment. This fee is chargeable by medical practitioners who own or rent the facility. Please note: Modifier 0075 is not applicable to any of the items for diagnostic procedures in the otorhinolaryngology sections of the tariff.

20 21.000 187.80 20 21.000 187.80

0077

Physical treatment: When two separate areas are treated simultaneously for totally different conditions, such treatment shall be regarded as two treatments for which separate fees may be charged. (Only applicable if services are provided by a specialist in physical medicine)

- - - - - - - - -

0078When a testis biopsy is done combined with vasogram or seminal vesiculogram or epididymogram, add 50% of the units for the appropriate procedure

- - - - - - - - -


97 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0079

When a first consultation/visit proceeds into, or is immediately followed by a medical psychotherapeutic procedure, fees for the procedure are calculated according to the appropriate individual psychotherapy code (items 2957, 2974 or 2975)

- - - - - - - - -

0080 Multiple examinations: Full Fee - - - - - - - - -

0081 Repeat examinations: No reduction - - - - - - - - -

0082“+” Means that this item is complementary to a preceding item and is therefore not subject to reduction

- - - - - - - - -

0083A reduction of 33,33% (1/3) in the fee will apply to radiological examinations as indicated in section 19: Radiology where hospital equipment is used

- - - - - - - - -

0084

Film costs: In the case of radiological items where films are used, practitioners should adjust the fee upwards or downwards in accordance with changes in the price of films in comparison with November 1979; the calculation must be done on the basis that film costs comprise 10% of the monetary value of the unit (This information is obtainable from the Radiological Society of SA)

- - - - - - - - -

0085Left Side’ modifier to be added to when items 6500 to 6519 are used when the left side is examined. Please note that the absence of this modifier indicates that the right side was examined

- - - - - - - - -

0086Vascular groups: “Film series” and “Introduction of Contrast Media” are complementary and together constitute a single examination: neither fee is therefore subject to increase in terms of Modifier 0080: Multiple examinations

- - - - - - - - -

0090

Radiologist’s fee for participation in a team: 30,00 radiology units per ½ hour or part thereof for all interventional radiological procedures, excluding any pre- or post-operative angiography, catheterisation, CT-scanning, ultrasound-scanning or x-ray procedures. (Only to be charged if radiologist is hands-on, and not for interpretation of images only)

- - - - - - - - -

0091Diagnostic services rendered to hospital inpatients: Quote Modifier 0091 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients officially admitted to hospital or day clinic (refer to Rule XX)

- - - - - - - - -

0092

Diagnostic services rendered to outpatients: Quote Modifier 0092 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients NOT officially admitted to hospital or day clinic (could be within the confines of a hospital) (refer to Rule YY)

- - - - - - - - -


98 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0095

Radiation materials: Exclusively for use where radiation materials supplied by the practice are used by clinical and radiation oncologists, modifier 0095 should be used to identify these materials. A material code list with descriptions and guideline costs for these materials, maintained and updated on a regular basis, will be supplied by the Society of Clinical and Radiation Oncology. This modifier is only chargeable by the practice responsible for the cost of this material and where the hospital did not charge therefore. Please note that item 0201 should not be used for these materials

- - - - - - - - -

0096Radio-isotope therapy patients who fail to keep their appointments: Fee will include cost of isotope

- - - - - - - - -

0097

Pathology tests performed by non-pathologists: Where items under Clinical Pathology (section 21) and Anatomical Pathology (section 22) fall within the province of other specialists or general practitioners, the fee is to be charged at two-thirds of the pathologists fee

- - - - - - - - -

0160Aspiration of biopsy procedure performed under direct ultrasound control by an ultrasound aspiration biopsy transducer (Static Realtime): Fee for part examined plus 30% of the units

- - - - - - - - -

0165 Use of contrast during ultrasound study: add 6.00 ultrasound units 60 6.000 51.10 60 6.000 51.10

5104 Ultrasound in pregnancy, multiple gestation, after twenty weeks: plus 30% - - - - - - - - -

6100

In order to charge the full fee (600,00 magnetic resonance units) for an examination of a specific single anatomical region, it should be performed with the applicable radio frequency coil including T1 and T2 weighted images on at least two planes

- - - - - - - - -

6101

Where a limited series of a specific anatomical region is performed (except bone tumour), e.g a T2 weighted image of a bone for an occult stress fracture, not more than two-thirds (2/3) of the fee may be charged. Also applicable to all radiotherapy planning studies, per region

- - - - - - - - -

6102All post-contrast studies (except bone tumour), including perfusion studies, to be charges at 50% of the fee

- - - - - - - - -

6103 Post-contrast study: Bone tumour: 100% of the fee - - - - - - - - -

6104Limited examination of the hypophysis e.g. where a coronal T1 and sagittal T1 series are performed, two-thirds (2/3) of the fee is applicable

- - - - - - - - -


99 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

6105Where, in a limited hypophysis examination, Gadolinium is administered and coronal T1 and sagittal T1 series are repeated, a single full fee for the entire examination is applicable + cost of Gadolinium + disposable items

- - - - - - - - -

6106

Where a magnetic resonance angiography (MRA) of large vessels is performed as primary examination, 100% of the fee is applicable. This modifier is only applicable if the series is performed by use of a recognised angiographic software package with reconstruction capability

- - - - - - - - -

6107

Where a magnetic resonance angiography (MRA) of the vessels is performed additional to an examination of a particular region, 50% of the fee is applicable for the angiography. This modifier is only applicable if the series is performed by use of a recognised angiographic software package with reconstruction capability

- - - - - - - - -

6108Where only a gradient echo series is performed with a machine without a recognised angiographic software package with reconstruction ability, 20% of the full fee is applicable specifying that it is a “flow sensitive series”

- - - - - - - - -

6109Very limited studies to be charged at 33,33% of the full fee e.g. MR urography for renal colic, diffusion studies of the brain additional to routine brain

- - - - - - - - -

6110 MRI spectroscopy: 50% of fee - - - - - - - - -

6300If a procedure lasts less than 30 minutes, only 50% of the machine fees for items 3536-3550 will be allowed (specify time of procedure on account)

- - - - - - - - -

6301If a procedure is performed by a radiologist in a facility not owned by himself, the fee will be reduced by 40% (i.e. 60% of the fee will be charged)

- - - - - - - - -

6302When the procedure is performed by a non-radiologist, the fee will be reduced by 40% (i.e. 60% of the fee will be charged)

- - - - - - - - -

6303When a procedure is performed entirely by a non-radiologist in a facility owned by a radiologist, the radiologist owning the facility may charge 55% of the procedure units used. Modifier 6302 applies to the non radiologist performing the procedure

- - - - - - - - -

6305

When multiple catheterisation procedures are used (items 3557, 3559, 3560, 3562) and an angiogram investigation is performed at each level, the unit value of each such multiple procedure will be reduced by 20,00 radiological units for each procedure after the initial catheterisation. The first catheterisation is charged at 100% of the unit value

- - - - - - - - -

- - - - - - - - -

I. Consultative Services ( Refer to Psychiatrists consultative service guide) - - - - - - - - -


100 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

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Value R

CF Units Value

R

I.a General Practitioner visits - - - - - - - - -

I.b Specialists tiered consultation structure - - - - - - - - -

I.b.1 New and established patients: Consultations/visits by psychiatrists (22) only - - - - - - - - -

0161

Psychiatry (‘22’): New and established patients: Consultation/visit of new or established patient with problem focused history, clinical examination and straightforward decision making for minor problem. Typically occupies the doctor personally with the patient between 10 and 20 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

- - - - - - - - -

0162

Psychiatry (‘22’): New and established patients: Consultation/visit of new or established patient with detailed history, clinical examination and straightforward decision making and counselling. Typically occupies the doctor personally with the patient between 21 and 35 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

- - - - - - - - -

0163

Psychiatry (‘22’): New and established patients: Consultation/visit of new or established patient with detailed history, complete clinical examination and moderately complex decision making and counselling. Typically occupies the doctor personally with the patient between 36 and 45 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

- - - - - - - - -

0164

Psychiatry (‘22’): New and established patients: Consultation/visit of new or established patient with comprehensive history and clinical examination for complex problem requiring complex decision making and counselling. Typically occupies a doctor personally with the patient between 46 and 60 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

- - - - - - - - -

0166

Psychiatry (22): First hospital consultation/visit with problem focused history, clinical examination and straightforward decision making for minor problem. Typically occupies the doctor personally with the patient for between 10 and 20 minutes

- - - - - - - - -

0167Psychiatry (22): First hospital consultation/visit with detailed history, clinical examination and straightforward decision making and counselling. Typically occupies the doctor personally with the patient for between 21 and 35 minutes

- - - - - - - - -

0168

Psychiatry (22): First hospital consultation/visit with detailed history, complete clinical examination and moderately complex decision making and counselling. Typically occupies the doctor personally with the patient for between 36 and 45 minutes

- - - - - - - - -


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0169

Psychiatry (22): First hospital consultation/visit with comprehensive history and clinical examination for complex problem requiring complex decision making and counselling. Typically occupies a doctor personally with the patient for between 46 and 60 minutes

- - - - - - - - -

I.cGeneral practitioner and specialist services (Refer to the Medical Practitioner Consultative service guide)

- - - - - - - - -

0190

New and established patient: Consultation/visit of new or established patient of an average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to item 0173-0175 or item 0109) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure

- - - - - - - - -

0191

New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to item 0173-0175 or item 0109) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure

- - - - - - - - -

0192

New and established patient: Consultation/visit of new or established patient of long duration and/or high complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to item 0173-0175 or item 0109) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure

- - - - - - - - -

0173

First hospital consultation/visit of an average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

- - - - - - - - -

0174

First hospital consultation/visit of a moderately above average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

- - - - - - - - -


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0175

First hospital consultation/visit of long duration and/or high complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

- - - - - - - - -

0109Hospital follow-up visit to patient in ward or nursing facility - Refer to general rule G(a) for post-operative care) (may only be charged once per day) (not to be used with items 0111, 0145, 0146, 0147 or ICU items 1204-1214)

- - - - - - - - -

0111

Paediatric hospital follow-up visits (excluding neonates) by paediatricians or paediatric cardiologists (may only be charged once per day) (not to be used with items 0109 or ICU items 1204-1214). For a healthy neonate please use item 0109 for a hospital follow-up visit

- - - - - - - - -

0129

Prolonged face-to-face attendance to a patient: ADD to either item 0192, item 0175, item 0164 or item 0169 as appropriate, for each 15-minute period only if service extends 10 minutes or more into the next 15-minute period following on the first 60 minutes

- - - - - - - - -

0145

For consultation/visit away from the doctor’s home or rooms (non-emergency): ADD only to the consultation/visit items 0190-0192, items 0173-0175, items 0161-0164 or items 0166-0169, as appropriate. Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

- - - - - - - - -

0146

For an unscheduled emergency consultation/visit at the doctors’ home or rooms, all hours: ADD only to the consultation/visit items 0190-0192, items 0161-0164 or items 0151-0153, as appropriate (refer to general rule B). Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

- - - - - - - - -

0147

For an emergency consultation/visit away from the doctor’s home or rooms, all hours: ADD only to the consultation/visit items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or items 0151-0153, as appropriate. Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

- - - - - - - - -


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0148

For elective after-hours services on request of the patient or family (non emergency) (refer to general rule B): ADD 50% of the fee for the appropriate consultation/visit item (only to be used with items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or items 0151-0153) and reflect this as a separate item 0148. Usage: This item is used when, for example, a patient or the family request the doctor for a non-emergency consultation/visit outside of the normal hours period as reflected in general rule B.

- - - - - - - - -

0149

After-hours bona fide emergency consultation/visit (21:00-6:00 daily): ADD 25% of the fee for the appropriate consultation/visit item (only to be used with items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or items 0151-0153) and reflect this as a separate item 0149. Note: The after-hour period applicable to this item is from Monday to Sunday 21:00-6:00

- - - - - - - - -

I.e Pre-anaesthetic assessment - - - - - - - - -

0151

Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient (all hours). Problem focused history and clinical examination and straightforward decision making for minor problem. Typically occupies the doctor face-to-face with the patient for between 10 and 20 minutes

- - - - - - - - -

0152

Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient (all hours). Detailed history and clinical examination and straightforward decision making and counselling. Typically occupies the doctor face-to-face with the patient for between 20 and 35 minutes

- - - - - - - - -

0153

Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient or other consultative service. Consultation with detailed history, complete examination and moderate complex decision making and counselling. Typically occupies the doctor face-to-face for between 30 and 45 minutes

- - - - - - - - -

I.f Prenatal visits and new born attendance - - - - - - - - -

0107New born attendance: Exclusive attendance to baby at Caesarean section, normal delivery or visit in the ward (once per patient) (items 0109, 0111, 0113, 0145, 0146 and/or 0147 may not be added to item 0107)

- - - - - - - - -

Item 0107 can be used once only for given confinement - - - - - - - - -

0113New born attendance: Emergency attendance to newborn at all hours (once per patient) (items 0107, 0109, 0111, 0145, 0146 and/or 0147 may not be added to item 0113)

- - - - - - - - -

I.g Consultative services: Miscellaneous - - - - - - - - -


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0130 Telephone consultation (all hours) - - - - - - - - -

0132Consulting service e.g. writing of repeat scripts or requesting routine pre-authorisation without the physical presence of the patient (needs not be face-to-face contact) (“Consultation” via SMS or electronic media included)

- - - - - - - - -

0133Writing of special motivations for procedures and treatment without the physical presence of a patient (includes report on the clinical condition of a patient) requested by or on behalf of a third party funder or its agent

- - - - - - - - -

0199Completion of chronic medication forms by medical practitioners with or without the physical presence of the patient requested by or on behalf of a third party funder or its agent

- - - - - - - - -

II. Medicine, material, supplies and use of own equipment - - - - - - - - -

II.a Medicine codes - - - - - - - - -

II.a.1 Dispensing of medicine by licensed dispensing medical practitioners - - - - - - - - -

0197

Licenced dispensing medical practitioners: Dispensing cost - R16.00 for medicine with a cost of R100,00 or more (VAT inclusive), or 16% for medicine costing less than R100,00 (VAT inclusive). Add to each Nappi code to provide for the dispensing cost.

- - - - - - - - -

II.a.2 Once-off administration of medicine used during a consultation - - - - - - - - -

0198

Once-off administration of medicines: This item provides for medicines used at a consultation, viz, once off administration of medicine, special medicine used in treatment, or emergency dispensing. Charge for medicine used according to the Single Exit Price (SEP) PLUS R16,00 for medicine with a cost of R100,00 or more, or 16% for medicine costing less than R100,00 PLUS VAT on the 16%/R16,00. (Where applicable, VAT should be added to the 16%/R 16,00 only and not to the SEP, since the SEP is VAT inclusive). [According to Section 18(8) of the Medicines and Related Substances Act (Act 101 of 1965) compounding and dispensing does not refer to a medicine requiring preparation for a once-off administration to a patient during a consultation]. The appropriate Ethical Medicine Nappi code(s), selected from those codes commencing with 7, 8 or 9 (provided that it is not a reference code), should be added applicable to the medicine used. Please note: Refer to item 0201 for cost of material used in treatment.

- - - - - - - - -

II.a.3 Cost of chemotherapy drugs - - - - - - - - -


105 • Version 4_21




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0212

Cost of chemotherapy drugs: This item provides for a charge for chemotherapy drugs used in treatment. Charge for chemotherapy drugs used in treatment at cost price PLUS 16% (with a maximum of R16,00). (Where applicable, VAT should be added to the above). The appropriate Ethical Medicine Nappi code(s), selected from those codes commencing with 7, 8 or 9 (provided that it is not a reference code), should be added applicable to the chemotherapy drugs used.

- - - - - - - - -

II.b Material codes - - - - - - - - -

II.b.1 Prosthesis and/or internal fixation - - - - - - - - -

0200

Prosthesis and/or internal fixation: This item provides for a charge for prosthesis and/or internal fixation. Charge for prosthesis and/or internal fixation at cost price PLUS 26% (up to a maximum of R 26,00). (Where applicable, VAT should be added to the above). The appropriate Nappi code(s), where applicable, for the prosthesis and/or internal fixation used, must be provided.

- - - - - - - - -

II.b.2 Material used during a consultation - - - - - - - - -

0201

Cost of material in treatment: This item provides for a charge for material used in treatment. Charge for material at cost price PLUS 26% (up to a maximum of R26,00). (Where applicable, VAT should be added to the above). The appropriate Surgical and Material Nappi code(s), selected from those codes commencing with 4, 5, 6, where applicable, for the material used, must be provided. Please note: Refer to item 0198 for once off administration of medicine.

- - - - - - - - -

II.c Setting of sterile tray - - - - - - - - -

0202

Setting of sterile tray: A fee of 10,00 clinical procedure units may be charged for the setting of a sterile tray where a sterile procedure is performed in the rooms. Cost of stitching material, if applicable, shall be charged for according to item 0201, as appropriate

20 10.000 89.40 20 10.000 89.40

II.d Own equipment used in treatment - - - - - - - - -

5930 Surgical laser apparatus: Hire fee for own equipment 20 109.000 974.60 20 109.000 974.60

5932Candella laser apparatus: Hire fee for own equipment (Rates by arrangement with the scheme concerned)

- - - - - - - - -

III. PROCEDURES - - - - - - - - -

6999Unlisted procedure/service: A procedure/service may be provided that is not listed in this edition of the coding structure. Refer to General Rule C for the criteria to use item 6999

- - - - - - - - -


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GENERAL MODIFIERS GOVERNING THIS SECTION - - - - - - - - -

0011

Emergency procedures: Any bona fide, justifiable emergency procedure (all hours) undertaken in an operating theatre and/or in another setting in lieu of an operating theatre, will attract an additional 12,00 clinical procedure units per half-hour or part thereof of the operating time for all members of the surgical team. Modifier 0011 does not apply in respect of patients on scheduled lists. (A medical emergency is any condition where death or irreparable harm to the patient will result if there are undue delays in receiving appropriate medical treatment)

- - - - - - - - -

0013

Endoscopic examinations done at operations: Where a related endoscopic examination is done at an operation by the operating surgeon or the attending anaesthesiologist, only 50% of the fee for the endoscopic examination may be charged

- - - - - - - - -

0014

Operations previously performed by other surgeons: Where an operation is performed which has been previously performed by another surgeon, e.g. a revision or repeat operation, the fee shall be calculated according to the tariff for the full operation plus an additional fee to be negotiated under general Rule J: In exceptional cases where the fee is disproportionately low in relation to actual service rendered, except where already specified in the tariff

- - - - - - - - -

MODIFIERS GOVERNING SECTION 1 - - - - - - - - -

0015

Intravenous infusions: Where intravenous infusions (including blood and blood cellular products) are administered as part of the after-treatment after the operation or confinement, no extra fees shall be charged as this is included in the global operative or maternity fees. Should the practitioner doing the operation or attending to the maternity case prefer to ask another practitioner to perform post-operative or post-confinement intravenous infusions, then the practitioner himself (and not the patient) shall be responsible for remunerating such practitioner for the infusions

- - - - - - - - -

0017

Injections administered by practitioners: When desensitisation, intravenous, intramuscular or subcutaneous injections are administered by the practitioner him-/herself to patients who attend the consulting rooms, a first injection forms part of the consultation/visit and only all subsequent injections for the same condition should be charged at 7.50 consultative services units using modifier 0017 to reflect the amount (not chargeable together with a consultation item)

10 7.500 108.30 10 7.500 108.30

1 General - - - - - - - - -


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1.1 Injections, Infusions and Inhalation Sedation Treatment - - - - - - - - -

0203Inhalation sedation: Use of analgesic nitrous oxide for alcohol and other withdrawal states: First quarter-hour or part thereof

20 6.000 53.70 20 6.000 53.70

0204 Inhalation sedation: Per additional quarter-hour or part thereof 20 3.000 26.80 20 3.000 26.80

0205Intravenous treatment: Intravenous infusions (cut-down or push-in) (patients under three years): Cut-down and/or insertion of cannula - chargeable once per 24 hours

20 12.000 107.30 20 12.000 107.30

0206Intravenous treatment: Intravenous infusions (push-in) (patients over three years): Insertion of cannula - chargeable once per 24 hours

20 6.000 53.70 20 6.000 53.70

0207Intravenous treatment: Intravenous infusions (cut-down) (patients over three years): Cut-down and insertion of cannula - chargeable once per 24 hours

20 8.000 71.50 20 8.000 71.50

0208Venesection: Therapeutic venesection (Not to be used when blood is drawn for the purpose of laboratory investigations)

20 6.000 53.70 20 6.000 53.70

0209 Umbilical artery cannulation at birth 20 18.000 160.90 20 18.000 160.90

0210Collection of blood specimen(s) by medical practitioner for pathology examination, per venesection (not to be used by pathologists)

20 3.250 29.10 20 3.250 29.10

0211 Exchange transfusion: First and subsequent (including after-care) 20 80.000 715.30 20 80.000 715.30

Note: HOW TO CHARGE FOR INTRAVENOUS INFUSIONS: Practitioners are entitled to charge according to the appropriate item whenever they personally insert the cannula (but may only charge for this service once every 24 hours). For managing the infusion as such, e.g. checking it when visiting the patient or prescribing the substance, no fee may be charged since this service is regarded as part of the services the doctor renders during consultations (not applicable to item 0205)

- - - - - - - - -

1.2 Chemotherapy treatment (not in chemotherapy facilities) - - - - - - - - -

0213

Treatment with cytostatic agents: Administering of Chemotherapy: Intramuscular or subcutaneous: Per injection. For use by providers who do not make use of recognised chemotherapy facilities and/or who are not primarily responsible for managing the chemotherapy treatment

20 5.000 44.70 20 5.000 44.70


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0214

Intravenous treatment with cytostatic agents: Administering of Chemotherapy: Intravenous bolus technique: Per injection. For use by providers who do not make use of recognised chemotherapy facilities and/or who are not primarily responsible for managing the chemotherapy treatment

20 9.000 80.50 20 9.000 80.50

0215

Intravenous treatment with cytostatic agents: Administering of Chemotherapy: Intravenous infusion technique: Per injection. For use by providers who do not make use of recognised chemotherapy facilities and/or who are not primarily responsible for managing the chemotherapy treatment

20 14.000 125.20 20 14.000 125.20

1.3 Oncology related services in non-oncology facilties - - - - - - - - -

5780Interstitial implants: Placing of guide tubes for interstitial implants under local or general anaesthetic. The cost of materials is not included

20 394.860 3 530.40 20 315.890 2 824.40

5781Intracavitary applications: Placing of guide tubes under local or general anaesthetic for manual or remote afterloading brachytherapy. The cost of materials is not included

20 262.410 2 346.20 20 209.930 1 877.00

5782Isotope Therapy: Administration of low dose surface applicators, up to five applications. Typically an out patient procedure. The cost of materials is not included

20 77.810 695.70 20 77.810 695.70

5783Infusional pharmacotherapy: Fee for the treatment of non cancerous conditions with bolus or infusional pharmacotherapy per treatment day (consultations to be charged separately)

20 42.650 381.30 20 42.650 381.30

MODIFIERS GOVERNING THE ADMINISTRATION OF ANAESTHETICS FOR ALL PROCEDURES AND OPERATIONS

- - - - - - - - -

0020

Conscious sedation: Any case that is conducted outside of a hospital theatre shall be coded with the relevant procedure code. To identify these cases, the above modifier should be used to indicate to the medical scheme that there will be no hospital/theatre account.

- - - - - - - - -

0021

Determination of anaesthetic fees: Anaesthetic fees are determined by obtaining the sum of the basic anaesthetic units (allocated to each procedure that might be performed under anaesthetic as indicated in the “Anaesthetic Performed” column) plus the time units (calculated according to the formula in Modifier 0023) and the appropriate modifers (see Modifiers 0037-0044). In cases of operative procedures on the musculoskeletal system, open fractures and open reduction of fractures or dislocations add units as laid down by Modifiers 5441 to 5448

- - - - - - - - -


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0023

The basic anaesthetic units are laid down in the tariff and are reflected in the anaesthetic column. These basic anaesthetic units reflect the additional anaesthetic risk, the technical skill required of the anaesthesiologist/anaesthetist and the scope of the surgical procedure, but exclude the value of the actual time spent administering the anaesthetic. The time units (indicated by “T”) will be added to the listed basic anaesthetic units in all cases on the following basis: Anaesthetic time: The remuneration for anaesthetic time shall be per 15 minute period or part thereof, calculated from the commencement of the anaesthetic, i.e. 2,00 anaesthetic units per 15 minute period or part thereof, provided that should the duration of the anaesthetic be longer than one (1) hour the number of units shall, after one (1) hour, be 3,00 anaesthetic units per 15 minute period or part thereof.

- - - - - - - - -

0024

Pre-operative assessments not followed by procedures: If a pre-operative assessment of a patient by the anaesthesiologist/anaesthetist is not followed by an operation, it will be regarded as a visit at hospital or nursing home and the appropriate hospital visit item should be charged.

- - - - - - - - -

0025

Calculation of anaesthetic time: Anaesthetic time is calculated from the time the anaesthesiologist/anaesthetist begins to prepare the patient for the induction of anaesthesia in the operating theatre or in a similar equivalent area and ends when the anaesthesiologist/anaesthetist is no longer required to give his/her personal professional attention to the patient, i.e. when the patient may, with reasonable safety, be placed under the customary post-operative supervision. Where prolonged personal professional attention is necessary for the well-being and safety of such patient, the necessary time will be valued on the same basis as indicated above for the anaesthetic time. The anaesthesiologist/anaesthetist must show on his/her account the exact anaesthetic time, including the supervision time spent with the patient.

- - - - - - - - -

0027More than one procedure under the same anaesthetic: Where more than one operation is performed under the same anaesthetic, the basic anaesthetic units will be that of the major operation with the highest number of units

- - - - - - - - -

0028Indicator for use of low flow anaesthetic technique less than 1litre/minute: Fresh gas flow of less than 1 litre/minute

- - - - - - - - -


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0029

Assistant anaesthesiologists: When rendered necessary by the scope of the anaesthetic, an assistant anaesthesiologist may be employed. The remuneration of the assistant anaesthesiologist shall be calculated on the same basis as in the case where a general practitioner administers the anaesthetic

- - - - - - - - -

0030Indicator for use of low flow anaesthetic technique 1-2 litre/minute: Fresh gas flow of 1 to 2 litre/minute

- - - - - - - - -

0031

Intravenous drips and transfusions: Treatment with intravenous drips and transfusions is considered part of the normal treatment in administering an anaesthetic. No additional fees may be charged for such services when rendered either prior to, or during actual theatre or operating time

- - - - - - - - -

0032

Patients in prone position: Anaesthesia administered to patients in the prone position shall have a minimum of 4,00 basic anaesthetic units. When the basic anaesthetic units for the procedure is 3,00, one extra anaesthetic unit should be added. If the basic anaesthetic units for the procedure is 4,00 or more, no extra units should be added

- - - - - - - - -

0033

Participating in general care of patients: When an anaesthesiologist/anaesthetist is required to participate in the general care of a patient during a surgical procedure, but does not administer the anaesthetic, such services may be remunerated at full anaesthetic rate, subject to the provisos of modifier 0035: Anaesthetic administered by an anaesthesiologist/anaesthetist. and modifier 0036: Anaesthetic administered by general practitioners.

- - - - - - - - -

0034

Head and neck procedures: All anaesthetics administered for diagnostic, surgical or X-ray procedures on the head and neck shall have a minimum of 4,00 basic anaesthetic units. When the basic anaesthetic units for the procedure is 3,00, one extra anaesthetic unit should be added. If the basic anaesthetic units for the procedure is 4,00 or more, no extra units should be added

- - - - - - - - -

0035Anaesthetic administered by an anaesthesiologist/anaesthetist: No anaesthetic administered shall have a total value of less than 7,00 anaesthetic units (basic units, time units plus appropriate modifiers).

- - - - - - - - -


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0036

Anaesthetic administered by general practitioners: The units (basic units plus time plus the appropriate modifiers) used to calculate the fee for an anaesthetic administered by a general practitioner lasting one hour or less, shall be the same as that for an anaesthesiologist. For anaesthetic lasting more than one hour, the units used to calculate the fee for an anaesthetic administered by a general practitioner will be 4/5 (80%) of the total number of units (basic units plus time [refer to modifier 0023] plus the appropriate modifiers) applicable to an anaesthesiologist. Please note that the 4/5 (80%) principle will be applied to all anaesthetics administered by general practitioners with the proviso that no anaesthetic with a total number of units higher than 11.00 will be reduced to less than 11,00 units in total. The monetary value of the unit is the same for both an anaesthesiologist/anaesthetist.

- - - - - - - - -

0037Body hypothermia: Utilisation of total body hypothermia: Add 3,00 anaesthetic units

30 3.000 168.30

0038Peri-operative blood salvage: Add 4,00 anaesthetic units for intra-operative blood salvage and 4,00 anaesthetic units for post-operative blood salvage

- - - - - - - - -

0039Control of blood pressure: Deliberate control of the blood pressure: All cases up to one hour: Add 3,00 anaesthetic units, thereafter add 1,00 (one) additional anaesthetic unit per quarter hour or part thereof

- - - - - - - - -

0040Phaeochromocytoma: The basic anaesthetic units for procedures performed for phaeochromocytoma shall be 15,00 anaesthetic units

- - - - - - - - -

0041Hyperbaric pressurisation: Utilisation of hyperbaric pressurisation: Add 3,00 anaesthetic units

30 3.000 168.30

0042Extracorporeal circulation: Utilisation of extracorporeal circulation: Add 3,00 anaesthetic units

30 3.000 168.30

0043Patients under one year of age: For all cases where the patient is under one year of age – 3,00 anaesthetic units to be added

30 3.000 168.30

0044Neonates (i.e up to and including 28 days after birth): 3,00 anaesthetic units to be added to the basic anaesthetic units for the particular procedure. This modifier is charged in addition to Modifier 0043: Cases under one year of age

30 3.000 168.30

0100Intra-aortic balloon pump: Where an anaesthesiologist would be responsible for operating an intra-aortic balloon pump, a fee of 75,00 clinical procedure units is applicable.

- - - - - - - - -


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Modifiers 5441 to 5448

Modification of the anaesthetic fee in cases of operative procedures on the musculo-skeletal system, open fractures and open reduction of fractures and dislocations is governed by adding units indicated by modifiers 5441 to 5448. (The letter “M” is annotated next to the number of units of the appropriate items, for facilitating identification of the relevant items)

- - - - - - - - -

5441Add one (1,00) anaesthetic unit, except where the procedure refers to the bones named in Modifiers 5442 to 5448

30 1.000 56.10

5442Shoulder, scapula, clavicle, humerus, elbow joint, upper 1/3 tibia, knee joint, patella, mandible and tempero-mandibular joint: Add two (2,00) anaesthetic units

30 2.000 112.20

5443 Maxillary and orbital bones: Add three (3,00) anaesthetic units 30 3.000 168.30

5444 Shaft of femur: Add four (4,00) anaesthetic units 30 4.000 224.50

5445Spine (except coccyx), pelvis, hip, neck of femur: Add five (5,00) anaesthetic units

30 5.000 280.60

5448Sternum and/or ribs and musculo-skeletal procedures which involve an intra-thoracic approach: Add eight (8,00) anaesthetic units

30 8.000 448.90

POST-OPERATIVE ALLEVIATION OF PAIN

0045

Post-operative alleviation of pain: (a) When a regional or nerve block procedure is performed, the appropriate procedure item to patient in ward or nursing facility, can be charged, provided that it is not the primary anaesthetic technique (b) When a second medical practitioner has administered the regional or nerve block for post-operative alleviation of pain, it shall be charged according to the particular procedure for instituting therapy. Revisits shall be charged according to the appropriate hospital follow-up visit to patient in ward or nursing facility. (c) None of the above is applicable for routine post-operative pain management i.e. intramuscular, intravenous or subcutaneous administration of opiates or NSAID (non-steroidal anti-inflammatory drug)

- - - - - - - - -

2 Integumentary System - - - - - - - - -


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R

2.1 Allergy - - - - - - - - -

0217 Allergy: Patch tests: First patch 20 4.000 35.80 20 4.000 35.80

0218 Allergy: Skin-prick tests: Skin-prick testing: Insect venom, latex and drugs 20 2.800 25.00 20 2.800 25.00

0219 Allergy: Patch tests: Each additional patch 20 2.000 17.90 20 2.000 17.90

0220Allergy: Skin-prick tests: Immediate hypersensitivity testing (Type I reaction): Per antigen: Inhalant and food allergens

20 1.900 17.00 20 1.900 17.00

0221Allergy: Skin-prick tests: Delayed hypersensitivity testing (Type IV reaction): Per antigen

20 2.800 25.00 20 2.800 25.00

2.2 Skin (general) - - - - - - - - -

0222 Intralesional injection into areas of pathology e.g. Keloid: Single 20 4.000 35.80 20 4.000 35.80

0223 Intralesional injection into areas of pathology e.g. Keloids: Multiple 20 8.000 71.50 20 8.000 71.50

0225 Epilation: Per session 20 8.000 71.50 20 8.000 71.50

0227Special treatment of severe acne cases, including draining of cysts, expressing of cleaning of Comedones and/or steaming, abrasive cleaning of skin and UVR per session

20 8.000 71.50 20 8.000 71.50 30 4.000 224.50

0228 PUVA Treatment: Maximum of 21 treatments 20 20.000 178.80 20 20.000 178.80

0229 PUVA: Follow-up or maintenance therapy once a week 20 20.000 178.80 20 20.000 178.80

0230 UVR-Treatment 20 20.000 178.80 20 20.000 178.80

0231UVR-Follow-up - for use of ultraviolet lamp (applied personally by the dermatologist). No charge to be levied if a nurse or physiotherapist applies the ultraviolet lamp

20 5.500 49.20 20 5.500 49.20

0233 Biopsy without suturing: First lesion 20 6.000 53.70 20 6.000 53.70 30 3.000 168.30

0234 Biopsy without suturing: Subsequent lesions (each) 20 3.000 26.80 20 3.000 26.80 30 3.000 168.30

0235 Biopsy without suturing: Maximum for multiple additional lesions 20 18.000 160.90 20 18.000 160.90 30 3.000 168.30

0237 Deep skin biopsy by surgical incision with local anaesthetic and suturing 20 12.000 107.30 20 12.000 107.30 30 3.000 168.30

0241 Treatment of benign skin lesion by chemo-cryotherapy: First Lesion 20 6.000 53.70 20 6.000 53.70 30 3.000 168.30

0242Treatment of benign skin lesion by chemo-cryotherapy: Subsequent lesions (each)

20 3.000 26.80 20 3.000 26.80 30 3.000 168.30

0243Treatment of benign skin lesion by chemo-cryotherapy: Maximum for multiple additional lesions

20 42.000 375.50 20 42.000 375.50 30 3.000 168.30

0244 Repair of nail bed 20 30.000 268.20 20 30.000 268.20 30 3.000 168.30


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R

0245Removal of benign lesion by curretting under local or general anaesthesia followed by diathermy and curretting or electrocautery: First lesion

20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

0246Removal of benign lesion by curretting under local or general anaesthesia followed by diathermy and curretting or electrocautery: Subsequent lesions (each)

20 7.000 62.60 20 7.000 62.60 30 3.000 168.30

0251Removal of malignant lesions by curretting under local or general anaesthesia followed by electrocautery: First lesion

20 30.000 268.20 20 30.000 268.20 30 3.000 168.30

0252Removal of malignant lesions by curretting under local or general anaesthesia followed by electrocautery: Subsequent lesions (each)

20 15.000 134.10 20 15.000 134.10 30 3.000 168.30

0255Drainage of subcutaneous abscess onychia, paronychia, pulp space or avulsion of nail

20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

0257Drainage of major hand or foot infection: Drainage of major abscess with necrosis of tissue, involving deep fascia or requiring debridement; complete excision of pilonidal cyst or sinus

20 87.000 777.90 20 87.000 777.90 30 3.000 168.30

0259 Removal of foreign body superficial to deep fascia (except hands) 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

0261 Removal of foreign body deep to deep fascia (except hands) 20 31.000 277.20 20 31.000 277.20 30 3.000 168.30

0271 Kurtin planing for acne scarring: Whole face 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

0273 Kurtin planing for acne scarring: Extensive 20 70.000 625.90 20 70.000 625.90 30 4.000 224.50

0275 Kurtin planing for acne scarring: Limited 20 30.000 268.20 20 30.000 268.20 30 4.000 224.50

0277Kurtin planing for acne scarring: Subsequent planing of whole face within 12 months

20 103.000 920.90 20 103.000 920.90 30 4.000 224.50

0279 Surgical treatment for axillary hyperhidrosis 20 64.000 572.20 20 64.000 572.20 30 4.000 224.50

0280 Laser treatment for small skin lesions: First lesion 20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

0281 Laser treatment for small skin lesions: Subsequent lesions (each) 20 7.000 62.60 20 7.000 62.60 30 3.000 168.30

0282 Laser treatment for small skin lesions: Maximum for multiple additional lesions 20 56.000 500.70 20 56.000 500.70 30 3.000 168.30

0283 Laser treatment for large skin lesions: Limited area 20 30.000 268.20 20 30.000 268.20 30 4.000 224.50

0284 Laser treatment for large skin lesions: Extensive area 20 70.000 625.90 20 70.000 625.90 30 4.000 224.50

0285Laser treatment for large skin lesions: Whole face or other areas of equivalent size or larger

20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

0286 Photo-dynamic therapy for malignant skin lesions: Equipment fee for PDT lamp 20 56.630 506.30 20 56.630 506.30 - - -

0287 Scanning of pigmented skin lesions: Equipment fee for Molemax or similar device 20 43.440 388.40 20 43.440 388.40 - - -

2.3 Major plastic repair - - - - - - - - -


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R

0289 Large skin grafts, composite skin grafts, large full thickness free skin grafts 20 234.000 2 092.20 20 187.200 1 673.80 30 4.000 224.50

0290Reconstructive procedures (including all stages) and skin graft by myo-cutaneous or fascio-cutaneous flap

20 410.000 3 665.80 20 328.000 2 932.70 30 4.000 224.50

0291Reconstructive procedures (including all stages) grafting by micro-vascular re-anastomosis

20 800.000 7 152.80 20 640.000 5 722.20 30 4.000 224.50

0292 Distant flaps: First stage 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

0293 Contour grafts (excluding cost of material) 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

0294Vascularised bone graft with or without soft tissue with one or more sets of micro-vascular anastomoses

20 1200.000 10 729.20 20 960.000 8 583.40 30 6.000 336.70

0295 Local skin flaps (large, complicated) 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

0296 Other procedures of major technical nature 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

0297 Subsequent major procedures for repair of same lesion 20 104.000 929.90 20 104.000 929.90 30 4.000 224.50

0298 Lower abdominal dermo-lipectomy 20 170.000 1 520.00 20 136.000 1 216.00 30 5.000 280.60

0299 Major abdominal lipectomy with repositioning of umbilicus 20 275.000 2 458.80 20 220.000 1 967.00 30 5.000 280.60

2.4 Lacerations, scars, tumours, cysts and other skin lesions - - - - - - - - -

0300Stitching of soft-tissue injuries: Stitching of wound (with or without local anaesthesia): Including normal after-care)

20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

0301Stitching of soft-tissue injuries: Additional wounds stitched at same session (each)

20 7.000 62.60 20 7.000 62.60 30 3.000 168.30

0302 Stitching of soft-tissue injuries: Deep laceration involving limited muscle damage 20 64.000 572.20 20 64.000 572.20 30 4.000 224.50

0303Stitching of soft-tissue injuries: Deep laceration involving extensive muscle damage

20 128.000 1 144.50 20 120.000 1 072.90 30 4.000 224.50

0304 Major debridement of wound, sloughectomy or secondary suture 20 50.000 447.10 20 50.000 447.10 30 3.000 168.30

0305 Needle biopsy - soft tissue 20 25.000 223.50 20 25.000 223.50 30 3.000 168.30

0307Excision and repair by direct suture; excision nail fold or other minor procedures of similar magnitude

20 27.000 241.40 20 27.000 241.40 30 3.000 168.30

0308 Each additional small procedure done at the same time 20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

0310 Radical excision of nailbed 20 38.000 339.80 20 38.000 339.80 30 3.000 168.30

0311 Excision of large benign tumour (more than 5 cm) 20 55.000 491.80 20 55.000 491.80 30 3.000 168.30

0313 Extensive resection for malignant soft tissue tumour including muscle 20 283.900 2 538.40 20 227.120 2 030.70 30 4.000 224.50


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0314Requiring repair by large skin graft or large local flap or other procedures of similar magnitude

20 104.000 929.90 20 104.000 929.90 30 4.000 224.50

0315Requiring repair by small skin graft or small local flap or other procedures of similar magnitude

20 55.000 491.80 20 55.000 491.80 30 3.000 168.30

2.5 Breasts - - - - - - - - -

0316 Fine needle aspiration for soft tissue (all areas) 20 15.000 134.10 20 15.000 134.10

0317 Aspiration of cyst or tumour 20 9.000 80.50 20 9.000 80.50 30 3.000 168.30

0319 Mastotomy with exploration, drainage of abscess or removal of mammary implant 20 42.000 375.50 20 42.000 375.50 30 3.000 168.30

0321 Biopsy or excision of cyst, benign tumour, aberrant breast tissue, duct papilloma 20 94.200 842.20 20 94.200 842.20 30 3.000 168.30

0323 Subareolar cone excision of ducts of wedge excision of breast 20 90.000 804.70 20 90.000 804.70 30 3.000 168.30

0324 Wedge excision of breast and axillary dissection 20 225.000 2 011.70 20 180.000 1 609.40 30 5.000 280.60

0325 Total mastectomy 20 155.000 1 385.90 20 124.000 1 108.70 30 5.000 280.60

0327 Total mastectomy with axillary gland biopsy 20 185.000 1 654.10 20 148.000 1 323.30 30 5.000 280.60

0329 Total mastectomy with axillary gland dissection 20 275.000 2 458.80 20 220.000 1 967.00 30 5.000 280.60

0330 Nipple and areola reconstruction 20 95.000 849.40 20 95.000 849.40 30 4.000 224.50

0331Subcutaneous mastectomy for disease of breast; including reconstruction but excluding cost of prosthesis: Unilateral

20 234.000 2 092.20 20 187.200 1 673.80 30 4.000 224.50

0333Subcutaneous mastectomy for disease of breast; including reconstruction but excluding cost of prosthesis: Bilateral

20 410.000 3 665.80 20 328.000 2 932.70 30 4.000 224.50

0334 Removal of breast implant by means of capsulectomy: Per breast 20 234.000 2 092.20 20 187.200 1 673.80 30 4.000 224.50

0335Implantation of internal subpectoral mammary prosthesis in post mastectomy patients

20 150.000 1 341.20 20 120.000 1 072.90 30 4.000 224.50

0337 Reduction: Mammoplasty for pathological hypertrophy: Unilateral 20 234.000 2 092.20 20 187.200 1 673.80 30 5.000 280.60

0339 Reduction: Mammoplasty for pathological hypertrophy: Bilateral 20 410.000 3 665.80 20 328.000 2 932.70 30 5.000 280.60

0341 Gynaecomastia: Unilateral 20 92.000 822.60 20 92.000 822.60 30 3.000 168.30

0343 Gynaecomastia: Bilateral 20 161.000 1 439.50 20 128.800 1 151.60 30 3.000 168.30

2.6 Burns - - - - - - - - -

0351Major Burns: Resuscitation (including supervision and intravenous therapy - first 48 hours)

20 276.000 2 467.70 20 220.800 1 974.20 30 5.000 280.60

0353 Tangential excision and grafting: Small 20 100.000 894.10 20 100.000 894.10 30 5.000 280.60

0354 Tangential excision and grafting: Large 20 200.000 1 788.20 20 160.000 1 430.60 30 5.000 280.60


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R

2.7 Hands (skin) - - - - - - - - -

0355Skin flap in acute hand injuries where a flap is taken from a site remote from the injured finger or in cases of advancement flag e.g. Cutler

20 147.400 1 317.90 20 120.000 1 072.90 30 4.000 224.50

0357 Small skin graft in acute hand injury 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

0359Release of extensive skin contracture and/or excision of scar tissue with major skin graft resurfacing

20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0361 Z-plasty 20 220.100 1 967.90 20 176.080 1 574.30 30 3.000 168.30

0363 Local flap and skin graft 20 150.000 1 341.20 20 120.000 1 072.90 30 3.000 168.30

0365 Cross finger flap (all stages) 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0367 Palmar flap (all stages) 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0369 Distant flap: First stage 20 158.000 1 412.70 20 126.400 1 130.10 30 3.000 168.30

0371 Distant flap: Subsequent stage (not subject to general modifier 0007) 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0373 Transfer neurovascular island flap 20 230.500 2 060.90 20 184.400 1 648.70 30 3.000 168.30

0374Syndactyly: Separation of, including skin graft for one web (with skin flap and graft)

20 242.400 2 167.30 20 193.920 1 733.80 30 3.000 168.30

0375 Dupuytren’s contracture: Fasciotomy 20 51.000 456.00 20 51.000 456.00 30 3.000 168.30

0376 Dupuytren’s contracture: Fasciectomy 20 218.000 1 949.10 20 174.400 1 559.30 30 3.000 168.30

2.8 Acupuncture - - - - - - - - -

Please note: General Rule M not applicable to section 2.8 of this price list - - - - - - - - -

0377 Standard acupuncture 20 10.000 89.40 20 10.000 89.40 - - -

0378 Laser acupuncture using more than 6 points 20 14.000 125.20 20 14.000 125.20 - - -

0379 Electro-acupuncture 20 14.000 125.20 20 14.000 125.20 - - -

0380 Scalp acupuncture 20 10.000 89.40 20 10.000 89.40 - - -

0381 Micro-acupuncture (ear, hand) 20 10.000 89.40 20 10.000 89.40 - - -

RULES GOVERNING THE SECTION ACUPUNCTURE - - - - - - - - -


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R

CC.

Acupuncture: (a) When two separate acupuncture techniques are used, each treatment shall be regarded as a separate treatment for which fees may be charged for separately. (b) Not more than two separate techniques may be charged for at each session. (c) The maximum number of acupuncture treatments per course to be charged for is limited to 20. If further treatment is required at the end of this period of treatment, it should be negotiated with the patient. (d) Item 0380 refers to scalp acupuncture as a treatment in its own right and not to the use of acupuncture points on the scalp

- - - - - - - - -

3 Musculo-skeletal System - - - - - - - - -

MODIFIERS GOVERNING ORTHOPAEDIC OPERATIONS AND ANAESTHETIC FEES FOR ORTHOPAEDIC OPERATIONS

- - - - - - - - -

0047 A fracture NOT requiring reduction shall be charged on a fee per service basis - - - - - - - - -

0048

Where in the treatment of a fracture or dislocation, an initial closed reduction is followed within one month by further closed reductions under general anaesthesia, the fee for such subsequent reductions will be 27,00 clinical procedure units (not including after-care)

20 27.000 241.40 20 27.000 241.40 - - -

0049Except where otherwise specified, in cases of compound fractures, 77,00 clinical procedure units (specialists) and 77,00 clinical procedure units (general practitioners) are to be added to the units for the fractures including debridement

20 77.000 688.50 20 77.000 688.50 - - -

0050

In cases of a compound fracture where a debridement is followed by internal fixation (excluding fixation with Kirschner wires, as well as fractures of hands and feet), the full amount according to either Modifier 0049: Cases of compound fractures, or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting, may be added to the fee for the procedure involved, plus half of the amount according to the second modifier (either Modifier 0049: Cases of compound fractures or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting, as applicable)

20 115.500 1 032.70 20 115.500 1 032.70 - - -

0051Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting: Specialists add 77,00 clinical procedure units. General practitioners add 77,00 clinical procedure units

20 77.000 688.50 20 77.000 688.50 - - -

0053Fracture requiring percutaneous internal fixation [insertion and removal of fixatives (wires) in respect of fingers and toes included]: Specialists and general practitioners add 32,00 clinical procedure units

20 32.000 286.10 20 32.000 286.10 - - -


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R

0055Dislocation requiring open reduction: Units for the specific joint plus 77,00 clinical procedure units for specialists. General practitioners add 77,00 clinical procedure units

20 77.000 688.50 20 77.000 688.50 - - -

0057

Multiple procedures on feet: In multiple procedures on feet, fees for the first foot are calculated according to Modifier 0005: Multiple procedures/operations under the same anaesthetic. Calculate fees for the second foot in the same way, reduce the total to 75% and add to the total for the first foot

- - - - - - - - -

0058Revision operation for total joint replacement and immediate re-substitution (infected or non-infected): per fee for total joint replacement + 100%

- - - - - - - - -

3.1 Bones - - - - - - - - -

3.1.1 Bones: Fractures (reduction under general anaesthetic - refer to modifier 0047) - - - - - - - - -

0383 Fracture (reduction under general anaesthetic): Scapula 20 - - 20 - - 30 3.000 168.30

0387 Fracture (reduction under general anaesthetic): Clavicle 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0388 Percutaneous pinning of supracondylar fracture: Elbow - stand alone procedure 20 175.700 1 570.90 20 140.560 1 256.80 30 3.000 168.30

0389 Fracture (reduction under general anaesthetic): Humerus 20 111.600 997.80 20 111.600 997.80 30 3.000 168.30

0391 Fracture (reduction under general anaesthetic): Radius and/or Ulna 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0392Fracture (reduction under general anaesthetic): Open reduction of both radius and ulna (modifier 0051 not applicable)

20 210.000 1 877.60 20 168.000 1 502.10 30 3.000 168.30

0402 Fracture (reduction under general anaesthetic): Carpal bone 20 64.000 572.20 20 64.000 572.20 30 3.000 168.30

0403 Fracture (reduction under general anaesthetic): Bennett fracture-dislocation 20 51.000 456.00 20 51.000 456.00 30 3.000 168.30

0405Fracture (reduction under general anaesthetic): Open treatment of metacarpal: Simple

20 118.300 1 057.70 20 118.300 1 057.70 30 3.000 168.30

0409 Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Simple 20 - - 20 - - 30 3.000 168.30

0411 Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Compound 20 52.000 464.90 20 52.000 464.90 30 3.000 168.30

0413 Fracture (reduction under general anaesthetic): Proximal or middle: Simple 20 48.000 429.20 20 48.000 429.20 30 3.000 168.30

0415 Fracture (reduction under general anaesthetic): Proximal or middle: Compound 20 102.000 912.00 20 102.000 912.00 30 3.000 168.30

0417 Fracture (reduction under general anaesthetic): Pelvis fracture: Closed 20 - - 20 - - 30 3.000 168.30

0419Fracture (reduction under general anaesthetic): Pelvis: Operative reduction and fixation

20 320.000 2 861.10 20 256.000 2 288.90 30 3.000 168.30

0421 Fracture (reduction under general anaesthetic): Femur: Neck or Shaft 20 237.000 2 119.00 20 189.600 1 695.20 30 3.000 168.30

0425 Fracture (reduction under general anaesthetic): Patella 20 51.000 456.00 20 51.000 456.00 30 3.000 168.30


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R

0429 Fracture (reduction under general anaesthetic): Tibia with or without fibula 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

0433 Fracture (reduction under general anaesthetic): Fibula shaft 20 - - 20 - - 30 3.000 168.30

0435 Fracture (reduction under general anaesthetic): Malleolus of ankle 20 58.000 518.60 20 58.000 518.60 30 3.000 168.30

0437 Fracture (reduction under general anaesthetic): Fracture-dislocation of ankle 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

0438Fracture (reduction under general anaesthetic): Open reduction Talus fracture (modifier 0051 not applicable)

20 198.700 1 776.60 20 158.960 1 421.30 30 3.000 168.30

0439Fracture (reduction under general anaesthetic): Tarsal bones (excluding talus and calcaneus)

20 64.000 572.20 20 64.000 572.20 30 3.000 168.30

0440Fracture (reduction under general anaesthetic): Open reduction Calcaneus fracture (modifier 0051 not applicable)

20 403.500 3 607.70 20 322.500 2 883.50 30 3.000 168.30

0441 Fracture (reduction under general anaesthetic): Metatarsal 20 41.800 373.70 20 41.800 373.70 30 3.000 168.30

0443 Fracture (reduction under general anaesthetic): Toe phalanx: Distal Simple 20 - - 20 - - 30 3.000 168.30

0445 Fracture (reduction under general anaesthetic): Toe phalanx: Compound 20 32.000 286.10 20 32.000 286.10 30 3.000 168.30

0447 Fracture (reduction under general anaesthetic): Other: Simple 20 26.000 232.50 20 26.000 232.50 30 3.000 168.30

0449 Fracture (reduction under general anaesthetic): Other: Compound 20 52.000 464.90 20 52.000 464.90 30 3.000 168.30

0451 Fracture (reduction under general anaesthetic): Sternum and/or ribs: Closed 20 - - 20 - - 30 3.000 168.30

0452Fracture (reduction under general anaesthetic): Sternum and/or ribs: Open reduction and fixation of multiple fractured ribs for flail chest

20 230.000 2 056.40 20 184.000 1 645.10 30 3.000 168.30

0455Fracture (reduction under general anaesthetic): Spine: With or without paralysis: Cervical

20 - - 20 - - 30 3.000 168.30

0456Fracture (reduction under general anaesthetic): Spine: With or without paralysis: Rest

20 - - 20 - - 30 3.000 168.30

0461 Fracture (reduction under general anaesthetic): Compression fracture: Cervical 20 - - 20 - - 30 3.000 168.30

0462 Fracture (reduction under general anaesthetic): Compression fracture: Rest 20 - - 20 - - 30 3.000 168.30

0463Fracture (reduction under general anaesthetic): Spinous or transverse processes: Cervical

20 - - 20 - - 30 3.000 168.30

0464Fracture (reduction under general anaesthetic): Spinous or transverse processes: Rest

20 - - 20 - - 30 3.000 168.30

3.1.1.1Bones: Fractures (reduction under general anaesthetic - refer to modifier 0047): Operations for fractures

- - - - - - - - -

0465Fractures involving large joints (includes the item for the relative bone) (this item may not be used as a modifier)

20 288.000 2 575.00 20 230.400 2 060.00 30 3.000 168.30


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R

0473Percutaneous insertion plus subsequent removal of Kirschner wires or Steinmann pins (no after-care) (modifier 0005 not applicable)

20 43.000 384.50 20 43.000 384.50 30 3.000 168.30

0475Bonegrafting or internal fixation for malunion or non-union: Femur, Tibia, Humerus, Radius and Ulna

20 282.000 2 521.40 20 225.600 2 017.10 30 3.000 168.30

0479 Bonegrafting or internal fixation for malunion or non-union: Other bones 20 154.000 1 376.90 20 123.200 1 101.50 30 3.000 168.30

3.1.2 Bony operations - - - - - - - - -

3.1.2.1 Bony operations: Bone grafting - - - - - - - - -

0497 Resection of bone or tumour with or without grafting (benign) 20 282.000 2 521.40 20 225.600 2 017.10 30 3.000 168.30

0498Resection of bone or tumour with or without grafting (malignant) - does not include digits

20 340.000 3 039.90 20 272.000 2 432.00 30 3.000 168.30

0499 Grafts to cysts: Large bones 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0501 Grafts to cysts: Small bones 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

0503 Grafts to cysts: Cartilage graft 20 206.000 1 841.90 20 164.800 1 473.50 30 3.000 168.30

0505 Grafts to cysts: Inter-metacarpal bone graft 20 147.000 1 314.30 20 120.000 1 072.90 30 3.000 168.30

0507 Removal of autogenous bone for grafting (not subject to general modifier 0005) 20 50.000 447.10 20 50.000 447.10 30 3.000 168.30

3.1.2.2 Bony operations: Acute or chronic osteomyelitis - - - - - - - - -

0509 Acute or chronic osteomyelitis: Conservative treatment 20 - - 20 - -

0511Acute or chronic osteomyelitis: Operation: Tariff which would be applicable for compound fracture of the bone involved, including six weeks post-operative care

- - - - - - - - -

0512Acute or chronic osteomyelitis: Sternum sequestrectomy and drainage: Including six weeks after-care

20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

3.1.2.3 Bony operations: Osteotomy - - - - - - - - -

0514 Osteotomy: Sternum: Repair of pectus excavatum 20 330.000 2 950.50 20 264.000 2 360.40 30 3.000 168.30

0515 Osteotomy: Sternum: Repair of pectus carinatum 20 330.000 2 950.50 20 264.000 2 360.40 30 3.000 168.30

0516 Osteotomy: Pelvic 20 320.000 2 861.10 20 256.000 2 288.90 30 3.000 168.30

0521 Osteotomy: Femoral: Proximal 20 320.000 2 861.10 20 256.000 2 288.90 30 3.000 168.30

0527 Osteotomy: Knee region 20 320.000 2 861.10 20 256.000 2 288.90 30 3.000 168.30

0528 Osteotomy: Os Calcis (Dwyer operation) 20 115.000 1 028.20 20 115.000 1 028.20 30 3.000 168.30

0530 Osteotomy: Metacarpal and phalanx: Corrective for malunion or rotation 20 120.000 1 072.90 20 120.000 1 072.90 30 3.000 168.30

0531 Rotational osteotomy of tibia and fibula - stand alone procedure 20 278.900 2 493.60 20 223.120 1 994.90 30 3.000 168.30

0532 Osteotomy: Rotation osteotomy of the Radius, Ulna or Humerus 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30


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R

0533 Osteotomy: Single metatarsal 20 60.000 536.50 20 60.000 536.50 30 3.000 168.30

0534 Osteotomy: Multiple metatarsal osteotomies 20 150.000 1 341.20 20 120.000 1 072.90 30 3.000 168.30

3.1.2.4 Bony operations: Exostosis - - - - - - - - -

0535 Exostosis: Excision: Readily accessible sites 20 60.000 536.50 20 60.000 536.50 30 3.000 168.30

0537 Exostosis: Excision: Less accessible sites 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

3.1.2.5 Bony operations: Biopsy - - - - - - - - -

0539 Needle Biopsy: Spine (no after-care) (modifier 0005 not applicable) 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

0541 Needle Biopsy: Other sites (no after-care) (modifier 0005 not applicable) 20 32.000 286.10 20 32.000 286.10 30 4.000 224.50

0543 Biopsy: Open (modifier 0005 not applicable): Readily accessible site 20 64.000 572.20 20 64.000 572.20 - - -

0545 Biopsy: Open (modifier 0005 not applicable): Less accessible site 20 96.000 858.30 20 96.000 858.30 - - -

3.2 Joints - - - - - - - - -

3.2.1 Joints: Dislocations - - - - - - - - -

0547 Joint: Dislocation: Clavicle either end 20 38.000 339.80 20 38.000 339.80 30 3.000 168.30

0549 Joint: Dislocation: Shoulder 20 51.000 456.00 20 51.000 456.00 30 3.000 168.30

0551 Joint: Dislocation: Elbow 20 51.000 456.00 20 51.000 456.00 30 3.000 168.30

0552 Joint: Dislocation: Wrist 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0553 Joint: Dislocation: Perilunar trans-scaphoid fracture dislocation 20 130.000 1 162.30 20 120.000 1 072.90 30 3.000 168.30

0555 Joint: Dislocation: Lunate 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0556 Joint: Dislocation: Carpo-metacarpo dislocation 20 51.000 456.00 20 51.000 456.00 30 3.000 168.30

0557 Joint: Dislocation: Metacarpo-phalangeal or interphalangeal (hand) 20 26.000 232.50 20 26.000 232.50 30 3.000 168.30

0559 Joint: Dislocation: Hip 20 109.000 974.60 20 109.000 974.60 30 3.000 168.30

0561 Joint: Dislocation: Knee 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0563 Joint: Dislocation: Patella 20 32.000 286.10 20 32.000 286.10 30 3.000 168.30

0565 Joint: Dislocation: Ankle 20 90.000 804.70 20 90.000 804.70 30 3.000 168.30

0567 Joint: Dislocation: Sub-Talar dislocation 20 90.000 804.70 20 90.000 804.70 30 3.000 168.30

0569 Joint: Dislocation: Intertarsal or Tarsometatarsal or Mid-tarsal 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0571 Joint: Dislocation: Meta-tarsophalangeal or interphalangeal joints (foot) 20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

0573 Joint: Dislocation: Spine with or without paralysis 20 - - 20 - - - - -

3.2.2 Joints: Operations for dislocations - - - - - - - - -

0578 Operations for dislocations: Recurrent dislocation of shoulder 20 200.000 1 788.20 20 160.000 1 430.60 30 3.000 168.30


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R

0579 Operations for dislocations: Recurrent dislocation of all other joints 20 161.000 1 439.50 20 128.800 1 151.60 30 3.000 168.30

3.2.3 Joints: Capsular operations - - - - - - - - -

0582Capsulotomy or arthrotomy or biopsy or drainage of joint: Small joint (including three weeks after-care)

20 51.000 456.00 20 51.000 456.00 30 3.000 168.30

0583Capsulotomy or arthrotomy or biopsy or drainage of joint: Large joint (including three weeks after-care)

20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0585 Capsulectomy digital joint 20 64.000 572.20 20 64.000 572.20 30 3.000 168.30

0586 Multiple percutaneous capsulotomies of metacarpophalangeal joints 20 90.000 804.70 20 90.000 804.70 30 3.000 168.30

0587 Release of digital joint contracture 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

3.2.4 Joints: Synovectomy - - - - - - - - -

0589 Synovectomy: Digital joint 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0592 Synovectomy: Large joint 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0593 Tendon synovectomy 20 203.700 1 821.30 20 162.960 1 457.00 30 3.000 168.30

3.2.5 Joints: Arthrodesis - - - - - - - - -

0597 Arthrodesis: Shoulder 20 224.000 2 002.80 20 179.200 1 602.20 30 3.000 168.30

0598 Arthrodesis: Elbow 20 180.000 1 609.40 20 144.000 1 287.50 30 3.000 168.30

0599 Arthrodesis: Wrist 20 180.000 1 609.40 20 144.000 1 287.50 30 3.000 168.30

0600 Arthrodesis: Digital joint 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

0601 Arthrodesis: Hip 20 320.000 2 861.10 20 256.000 2 288.90 30 3.000 168.30

0602 Arthrodesis: Knee 20 180.000 1 609.40 20 144.000 1 287.50 30 3.000 168.30

0603 Arthrodesis: Ankle 20 180.000 1 609.40 20 144.000 1 287.50 30 3.000 168.30

0604 Arthrodesis: Sub-talar 20 130.000 1 162.30 20 120.000 1 072.90 30 3.000 168.30

0605 Arthrodesis: Stabilisation of foot (triple-arthrodesis) 20 180.000 1 609.40 20 144.000 1 287.50 30 3.000 168.30

0607 Arthrodesis: Mid-tarsal wedge resection 20 180.000 1 609.40 20 144.000 1 287.50 30 3.000 168.30

3.2.6 Joints: Arthroplasty - - - - - - - - -

0614 Arthroplasty: Debridement large joints 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0615 Arthroplasty: Excision medial or lateral end of clavicle 20 116.000 1 037.20 20 116.000 1 037.20 30 3.000 168.30

0617 Shoulder: Acromioplasty 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0619 Shoulder: Partial replacement 20 277.000 2 476.70 20 221.600 1 981.30 30 5.000 280.60

0620 Shoulder: Total replacement 20 416.000 3 719.50 20 332.800 2 975.60 30 5.000 280.60


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R

0621 Elbow: Excision head of radius 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0622 Elbow: Excision 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0623 Elbow: Partial replacement 20 188.000 1 680.90 20 150.400 1 344.70 30 3.000 168.30

0624 Elbow: Total replacement 20 282.000 2 521.40 20 225.600 2 017.10 30 3.000 168.30

0625 Wrist: Excision distal end of ulna 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0626 Wrist: Excision single bone 20 110.000 983.50 20 110.000 983.50 30 3.000 168.30

0627 Wrist: Excision proximal row 20 166.000 1 484.20 20 132.800 1 187.40 30 3.000 168.30

0631 Wrist: Total replacement 20 249.000 2 226.30 20 199.200 1 781.10 30 3.000 168.30

0635 Digital Joint: Total replacement 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0637 Hip: Total replacement 20 416.000 3 719.50 20 332.800 2 975.60 30 3.000 168.30

0641 Hip: Prosthetic replacement of femoral head 20 288.000 2 575.00 20 230.400 2 060.00 30 3.000 168.30

0643 Hip: Girdlestone 20 320.000 2 861.10 20 256.000 2 288.90 30 3.000 168.30

0645 Knee: Partial replacement 20 277.000 2 476.70 20 221.600 1 981.30 30 3.000 168.30

0646 Knee: Total replacement 20 416.000 3 719.50 20 332.800 2 975.60 30 3.000 168.30

0649 Ankle: Total replacement 20 290.400 2 596.50 20 232.320 2 077.20 30 3.000 168.30

0650 Ankle: Astragalectomy 20 154.000 1 376.90 20 123.200 1 101.50 30 3.000 168.30

3.2.7 Joints: Miscellaneous (joints) - - - - - - - - -

0661Aspiration of joint or intra-articular injection (not including after-care) (modifier 0005 not applicable)

20 9.000 80.50 20 9.000 80.50 30 3.000 168.30

0663Multiple intra-articular injections for rheumatoid arthritis (excluding after-care) (modifier 0005 not applicable): First joint

20 7.500 67.10 20 7.500 67.10 30 3.000 168.30

0665Multiple intra-articular injections for rheumatoid arthritis (excluding after-care) (modifier 0005 not applicable): Additional (each)

20 4.000 35.80 20 4.000 35.80 30 3.000 168.30

0667 Arthroscopy (excluding after-care) (modifiers 0005 and 0013 not applicable) 20 60.000 536.50 20 60.000 536.50 30 3.000 168.30

0669Manipulation knee or shoulder joint under general anaesthetic (not including after-care) (modifier 0005 not applicable)

20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

0669AManipulation hip joint under general anaesthetic (not including after-care) (modifier 0005 not applicable)

20 14.000 125.20 20 14.000 125.20 30 4.000 224.50

Only the consultation fee should be charged when manipulation of a large joint is performed without general anaesthetic

- - - - - - - - -

0673 Meniscectomy or operation for other internal derangement of knee 20 109.000 974.60 20 109.000 974.60 30 3.000 168.30


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3.2.8 Joints: Joint ligament reconstruction or suture - - - - - - - - -

0675 Joint ligament reconstruction or suture: Ankle: Collateral 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0677 Joint ligament reconstruction or suture: Knee: Collateral 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0678 Joint ligament reconstruction or suture: Knee: Cruciate 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0679Joint ligament reconstruction or suture: Ligament augmentation procedure of knee

20 280.000 2 503.50 20 224.000 2 002.80 30 3.000 168.30

0680 Joint ligament reconstruction or suture: Digital joint ligament 20 165.000 1 475.30 20 132.000 1 180.20 30 3.000 168.30

3.3 Amputations - - - - - - - - -

3.3.1 Amputations: Specific Amputations - - - - - - - - -

0682 Amputation: Fore-quarter amputation 20 294.000 2 628.70 20 235.200 2 102.90 30 9.000 505.00

0683 Amputation: Through shoulder 20 148.000 1 323.30 20 120.000 1 072.90 30 5.000 280.60

0685 Amputation: Upper arm or fore-arm 20 116.000 1 037.20 20 116.000 1 037.20 30 3.000 168.30

0687 Partial amputation of the hand: One ray 20 102.000 912.00 20 102.000 912.00 30 3.000 168.30

0691 Amputation: Whole or part of finger 20 116.800 1 044.30 20 116.800 1 044.30 30 3.000 168.30

0693 Hindquarter amputation 20 420.000 3 755.20 20 336.000 3 004.20 30 6.000 336.70

0695 Amputation: Through hip joint region 20 192.000 1 716.70 20 153.600 1 373.30 30 6.000 336.70

0697 Amputation: Through thigh 20 205.000 1 832.90 20 164.000 1 466.30 30 6.000 336.70

0699 Amputation: Below knee, through knee or Syme 20 194.000 1 734.60 20 155.200 1 387.60 30 5.000 280.60

0701 Amputation: Trans-metatarsal or trans-tarsal 20 142.000 1 269.60 20 120.000 1 072.90 30 3.000 168.30

0703 Amputation: Foot: One ray 20 97.000 867.30 20 97.000 867.30 30 3.000 168.30

0705 Amputation: Toe 20 66.000 590.10 20 66.000 590.10 30 3.000 168.30

3.3.2 Amputations: Post-amputation reconstruction - - - - - - - - -

0706Post-amputation reconstruction: Skin flap taken from a site remote from the injured finger or in cases of an advanced flap e.g. Cutler

20 75.000 670.60 20 75.000 670.60 30 3.000 168.30

0707 Post-amputation reconstruction: Krukenberg reconstruction 20 206.000 1 841.90 20 164.800 1 473.50 30 3.000 168.30

0709 Post-amputation reconstruction: Metacarpal transfer 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0711 Post-amputation reconstruction: Pollicisation of the finger (to include all stages) 20 282.000 2 521.40 20 225.600 2 017.10 30 3.000 168.30

0712 Post-amputation reconstruction: Toe to thumb transfer 20 800.000 7 152.80 20 640.000 5 722.20 30 3.000 168.30

3.4 Muscles, tendons and fasciae - - - - - - - - -

3.4.1 Muscles, tendons and fasciae: Investigations - - - - - - - - -


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R

0713 Electromyography 20 75.000 670.60 20 75.000 670.60 30 3.000 168.30

0714Electro-myographic neuromuscular junctional study, including edrophonium response (not to be used with item 2730)

20 57.000 509.60 20 57.000 509.60 30 3.000 168.30

0715 Strength duration curve per session 20 10.500 93.90 20 10.500 93.90 30 3.000 168.30

0717 Electrical examination of single nerve or muscle 20 9.000 80.50 20 9.000 80.50 30 3.000 168.30

0718 Oxidative study for mitochondrial function 20 64.000 572.20 20 64.000 572.20

0721 Voltage integration during isometric contraction 20 12.000 107.30 20 12.000 107.30 30 3.000 168.30

0723 Tonometry with edrophonium 20 8.000 71.50 20 8.000 71.50 30 3.000 168.30

0725 Isometric tension studies with edrophonium 20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

0727Cranial reflex study (both early and late responses) supra occulofacial or corneofacial or flabellofacial: Unilateral

20 8.000 71.50 20 8.000 71.50 30 3.000 168.30

0728Cranial reflex study (both early and late responses) supra occulofacial or corneofacial or flabellofacial: Bilateral

20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

0729 Tendon reflex time 20 7.000 62.60 20 7.000 62.60 30 3.000 168.30

0730 Limb brain somatosensory studies (per limb) 20 49.000 438.10 20 49.000 438.10 - - -

0731 Vision and audio-sensory studies 20 49.000 438.10 20 49.000 438.10 - - -

0733 Motor nerve conduction studies (single nerve) 20 26.000 232.50 20 26.000 232.50 - - -

0735 Examinations of sensory nerve conduction by sweep averages (single nerve) 20 31.000 277.20 20 31.000 277.20 30 3.000 168.30

0737 Biopsy for motor nerve terminals and end plates 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

0739 Combined muscle biopsy with end plates and nerve terminal biopsy 20 34.000 304.00 20 34.000 304.00 30 8.000 448.90

0740 Muscle fatigue studies 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

0741 Muscle biopsy 20 20.000 178.80 20 20.000 178.80 30 8.000 448.90

0742 Global fee for all muscle studies, including histochemical studies 20 262.000 2 342.50 - - - - - -

4701 Biochemical estimations on muscle biopsy specimens: Creatine kinase 20 20.250 181.10 - - - - - -

4703 Biochemical estimations on muscle biopsy specimens: Adenylate kinase 20 33.300 297.70 - - - - - -

4705 Biochemical estimations on muscle biopsy specimens: Pyruvate kinase 20 5.700 51.00 - - - - - -

4707 Biochemical estimations on muscle biopsy specimens: Lactate dehydrogenase 20 1.600 14.30 - - - - - -

4709 Biochemical estimations on muscle biopsy specimens: Adenylate deaminase 20 9.900 88.50 - - - - - -

4711 Biochemical estimations on muscle biopsy specimens: Phosphoglycerate kinase 20 13.700 122.50 - - - - - -

4713 Biochemical estimations on muscle biopsy specimens: Phosphoglycerate mutase 20 25.900 231.60 - - - - - -


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4715 Biochemical estimations on muscle biopsy specimens: Enolase 20 32.700 292.40 - - - - - -

4717 Biochemical estimations on muscle biopsy specimens: Phosphofructokinase 20 37.700 337.10 - - - - - -

4719 Biochemical estimations on muscle biopsy specimens: Aldolase 20 15.750 140.80 - - - - - -

4721Biochemical estimations on muscle biopsy specimens: Glyceraldehyde 3 phosphate dehydrogenase

20 11.060 98.90 - - - - - -

4723 Biochemical estimations on muscle biopsy specimens: Phosphorylase 20 34.700 310.30 - - - - - -

4725 Biochemical estimations on muscle biopsy specimens: Phosphoglucomutase 20 40.300 360.30 - - - - - -

4727Biochemical estimations on muscle biopsy specimens: Phosphohexose Isomerase

20 28.800 257.50 - - - - - -

4729Biochemical estimations on muscle biopsy specimens: Muscle biopsy for muscle tension study

20 43.000 384.50 - - - - - -

4731Biochemical estimations on muscle biopsy specimens: H-response study (per nerve)

20 14.000 125.20 - - - - - -

4733Biochemical estimations on muscle biopsy specimens: Late response study (per nerve)

20 20.000 178.80 - - - - - -

4735 Biochemical estimations on muscle biopsy specimens: Single fibre studies 20 71.000 634.80 - - - - - -

4737Biochemical estimations on muscle biopsy specimens: Somatosensory study (limb-spine)

20 69.000 616.90 - - - - - -

4739 Biochemical estimations on muscle biopsy specimens: Dystrophin estimation 20 82.000 733.20 - - - - - -

4744Biochemical estimations on muscle biopsy specimens: Tension/caffeine/halothane procedure in malignant hyperthermia

20 143.000 1 278.60 - - - - - -

4745 Biochemical estimations on muscle biopsy specimens: Electron microscopy 20 75.000 670.60 - - - - - -

3.4.2 Muscles, tendons and fasciae: Decompression Operations - - - - - -

0743 Major compartmental decompression 20 132.000 1 180.20 20 120.000 1 072.90 30 3.000 168.30

0744 Decompression operation: Fasciotomy only 20 60.000 536.50 20 60.000 536.50 30 3.000 168.30

3.4.3 Muscles, tendons and fasciae: Muscle and tendon repair - - - - - - - - -

0745 Muscle and tendon repair: Biceps humeri 20 109.000 974.60 20 109.000 974.60 30 3.000 168.30

0746 Muscle and tendon repair: Removal of calcification in Rotator cuff 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0747 Muscle and tendon repair: Rotator cuff 20 134.000 1 198.10 20 120.000 1 072.90 30 4.000 224.50

0748 Muscle and tendon repair: Debridement rotator cuff 20 139.700 1 249.10 20 120.000 1 072.90 30 4.000 224.50

0749 Muscle and tendon repair: Scapulopexy - stand alone procedure 20 271.900 2 431.10 20 217.520 1 944.90 30 4.000 224.50


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R

0755 Muscle and tendon repair: Infrapatellar of quadriceps tendon 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

0757 Muscle and tendon repair: Achilles tendon repair 20 197.600 1 766.70 20 158.080 1 413.40 30 4.000 224.50

0759 Muscle and tendon repair: Other single tendon 20 77.000 688.50 20 77.000 688.50 30 3.000 168.30

0763 Muscle and tendon repair: Tendon or ligament injection 20 9.000 80.50 20 9.000 80.50 30 3.000 168.30

0767 Hand: Flexor tendon suture: Primary (per tendon) 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30

0769 Hand: Flexor tendon suture: Secondary (per tendon) 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0771 Extensor tendon suture: Primary (per tendon) 20 129.700 1 159.70 20 120.000 1 072.90 30 3.000 168.30

0773 Extensor tendon suture: Secondary (per tendon) 20 80.000 715.30 20 80.000 715.30 30 3.000 168.30

0774 Repair of Boutonniere deformity or Mallet finger with graft 20 183.700 1 642.50 20 146.960 1 314.00 30 3.000 168.30

3.4.4 Muscles, tendons and fasciae: Tendon graft - - - - - - - - -

0775 Free tendon graft 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0776 Reconstruction of pulley for flexor tendon 20 50.000 447.10 20 50.000 447.10 30 3.000 168.30

0777 Tendon graft: Finger: Flexor 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0779 Tendon graft: Finger: Extensor 20 122.000 1 090.80 20 120.000 1 072.90 30 3.000 168.30

0780 Two stage flexor tendon graft using silastic rod 20 240.000 2 145.80 20 192.000 1 716.70 30 3.000 168.30

3.4.5 Muscles, tendons and fasciae: Tendolysis - - - - - - - - -

0781 Tendon freeing operation, except where specified elsewhere 20 64.000 572.20 20 64.000 572.20 30 3.000 168.30

0782 Carpal tunnel syndrome 20 98.700 882.50 20 98.700 882.50 30 3.000 168.30

0783 Tenolysis: De Quervain 20 38.000 339.80 20 38.000 339.80 30 3.000 168.30

0784 Trigger finger 20 38.000 339.80 20 38.000 339.80 30 3.000 168.30

0785 Flexor tendon freeing operation following free tendon graft or suture 20 186.800 1 670.20 20 149.440 1 336.10 30 3.000 168.30

0787Extensor tendon freeing operation following graft or suture in finger, hand or forearm, each tendon

20 180.900 1 617.40 20 144.720 1 293.90 30 3.000 168.30

0788 Intrinsic tendon release per finger 20 64.000 572.20 20 64.000 572.20 30 3.000 168.30

0789 Central tendon tenotomy for Boutonniere deformity 20 64.000 572.20 20 64.000 572.20 30 3.000 168.30

3.4.6 Muscles, tendons and fasciae: Tenodesis - - - - - - - - -

0790 Tenodesis: Digital joint 20 90.000 804.70 20 90.000 804.70 30 3.000 168.30

3.4.7 Muscles, tendons and fasciae: Muscle tendon and facia transfer - - - - - - - - -

0791 Single tendon transfer 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0792 Multiple tendon transfer 20 128.000 1 144.50 20 120.000 1 072.90 30 3.000 168.30


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R

0793 Hamstring to quadriceps transfer 20 141.000 1 260.70 20 120.000 1 072.90 30 3.000 168.30

0794 Pectoralis major or Latissimus dorsi transfer to biceps tendon 20 320.000 2 861.10 20 256.000 2 288.90 30 5.000 280.60

0795 Tendon transfer at elbow 20 116.000 1 037.20 20 116.000 1 037.20 30 3.000 168.30

0802 Radial club hand repair - stand alone procedure 20 360.300 3 221.40 20 288.240 2 577.20 30 3.000 168.30

0803 Hand tendons: Single tendon transfer (first) 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0809 Hand tendons: Substitution for intrinsic paralysis of hand 20 224.000 2 002.80 20 179.200 1 602.20 30 3.000 168.30

0811 Hand tendons: Opponens tendon transfer (including obtaining of graft) 20 220.600 1 972.40 20 176.480 1 577.90 30 3.000 168.30

3.4.8 Muscles, tendons and fasciae: Muscle slide operations and tendon lengthening - - - - - - - - -

0812 Percutaneous Tenotomy: All sites 20 38.000 339.80 20 38.000 339.80 30 3.000 168.30

0813 Torticollis 20 96.000 858.30 20 96.000 858.30 30 5.000 280.60

0815 Scalenotomy 20 132.000 1 180.20 20 120.000 1 072.90 30 5.000 280.60

0817 Scalenotomy with excision of first rib 20 190.000 1 698.80 20 152.000 1 359.00 30 3.000 168.30

0821 Tennis elbow 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0822 Open release elbow (Mitals) - stand alone procedure 20 278.200 2 487.40 20 222.560 1 989.90 30 3.000 168.30

0823 Excision or slide for Volkmann’s Contracture 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

0825 Hip: Open muscle release 20 116.000 1 037.20 20 116.000 1 037.20 30 7.000 392.80

0829 Knee: Quadriceps plasty 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0831 Knee: Open tenotomy 20 141.000 1 260.70 20 120.000 1 072.90 30 3.000 168.30

0835 Calf 20 96.000 858.30 20 96.000 858.30 30 4.000 224.50

0837 Open elongation tendon Achilles 20 96.000 858.30 20 96.000 858.30 30 4.000 224.50

0838 Percutaneous “Hoke” elongation tendo Achilles 20 79.300 709.00 20 79.300 709.00 30 4.000 224.50

0845 Foot: Plantar fasciotomy 20 70.000 625.90 20 70.000 625.90 30 3.000 168.30

0846 Foot: Postero-medial release for club-foot 20 192.000 1 716.70 20 153.600 1 373.30 30 3.000 168.30

3.5 Bursae and ganglia - - - - - - - - -

0847 Excision: Semimembranosus 20 90.000 804.70 20 90.000 804.70 30 4.000 224.50

0849 Excision: Prepatellar 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

0851 Excision: Olecranon 20 81.800 731.40 20 81.800 731.40 30 3.000 168.30

0853 Excision: Small bursa or ganglion 20 80.900 723.30 20 80.900 723.30 30 3.000 168.30

0855 Excision: Compound palmar ganglion or synovectomy 20 128.000 1 144.50 20 128.000 1 144.50 30 3.000 168.30


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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0857Bursae and ganglia: Aspiration or injection (no after-care) (modifier 0005 not applicable)

20 9.000 80.50 20 9.000 80.50 30 3.000 168.30

3.6 Musculo-skeletal system: Miscellaneous - - - - - - - - -

3.6.1Musculo-skeletal system: Miscellaneous: Leg equalisation and congenital hips and feet

- - - - - - - - -

0859 Leg equalisation and congenital hips and feet: Leg shortening 20 282.000 2 521.40 20 225.600 2 017.10 30 3.000 168.30

0861 Leg equalisation and congenital hips and feet: Leg lengthening 20 416.000 3 719.50 20 332.800 2 975.60 30 3.000 168.30

0863 Leg equalisation and congenital hips and feet: Epiphysiodesis at one level 20 116.000 1 037.20 20 116.000 1 037.20 30 3.000 168.30

0865Congenital dislocation of hip: Initial non-operative reduction and application of plaster cast: One hip

20 109.000 974.60 20 109.000 974.60 30 3.000 168.30

0867Congenital dislocation of hip: Initial non-operative reduction and application of plaster cast: Both hips

20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0868 Open reduction of congenital dislocation of the hip 20 186.000 1 663.00 20 148.800 1 330.40 30 3.000 168.30

0869 Subsequent plasters 20 32.000 286.10 20 32.000 286.10

0873 Congenital club foot: Manipulation and plaster: One foot 20 26.000 232.50 20 26.000 232.50 30 3.000 168.30

0874 Ponseti technique assistant (medical practitioner) 20 13.000 116.20 20 13.000 116.20 - - -

3.6.2Musculo-skeletal system: Miscellaneous: Removal of internal fixatives of prosthesis

- - - - - - - - -

0883 Removal of internal fixatives or prosthesis: Readily accessible 20 36.600 327.20 20 36.600 327.20 30 3.000 168.30

0884 Removal of internal fixatives: Less accessible 20 75.500 675.10 20 75.500 675.10 30 3.000 168.30

0885 Removal of prosthesis for infection soon after operation 20 128.000 1 144.50 20 120.000 1 072.90 30 6.000 336.70

0886Late removal of infected or not infected total joint replacement prosthesis (including six weeks after-care): ADD to the item for total joint replacement of the specific joint

20 64.000 572.20 20 64.000 572.20 30 6.000 336.70

3.7 Plasters (exclusive of after-care) - - - - - - - - -

0887 Limb cast (excluding after-care) (modifier 0005 not applicable) 20 13.000 116.20 20 13.000 116.20 30 3.000 168.30

0889 Spica, plaster jacket or hinged cast brace (excluding after-care) 20 32.000 286.10 20 32.000 286.10 30 4.000 224.50

0891 Turnbuckle cast for scoliosis (excluding after-care) 20 51.000 456.00 20 51.000 456.00 30 5.000 280.60

0893 Adjustment or repair of turnbuckle cast for scoliosis (excluding after-care) 20 19.000 169.90 20 19.000 169.90 30 5.000 280.60

3.8 Musculo-skeletal system: Special areas - - - - - - - - -

3.8.1 Special areas: Foot and Ankle - - - - - - - - -


131 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0895 Club foot: Revision club foot release - stand alone procedure 20 302.700 2 706.40 20 242.160 2 165.20 30 3.000 168.30

0896 Club foot: Posterior release only - stand alone procedure 20 159.300 1 424.30 20 127.440 1 139.40 30 3.000 168.30

0900 Excision tarsal coalition - stand alone procedure 20 141.500 1 265.20 20 120.000 1 072.90 30 3.000 168.30

0901 Tenotomy: Single tendon 20 63.300 566.00 20 63.300 566.00 30 3.000 168.30

0903 Hammer toe: One toe 20 99.500 889.60 20 99.500 889.60 30 3.000 168.30

0905 Filleting of toe or Ruiz-Mora procedure 20 99.500 889.60 20 99.500 889.60 30 3.000 168.30

0906 Arthrodesis Hallux 20 148.000 1 323.30 20 120.000 1 072.90 30 3.000 168.30

0907 Silver bunionectomy or similar for Hallux Valgus 20 126.200 1 128.40 20 120.000 1 072.90 30 3.000 168.30

Not to be charged with item 0911 - - - - - - - - -

0909 Excision arthroplasty 20 145.200 1 298.20 20 120.000 1 072.90 30 3.000 168.30

0910 Cheilectomy or metatarsophangeal implant Hallux 20 183.000 1 636.20 20 146.400 1 309.00 30 3.000 168.30

0911 Metatarsal osteotomy or Lapidus or similar or Chevron - stand alone procedure 20 189.200 1 691.60 20 151.360 1 353.30 30 3.000 168.30

Not to be charged with item 0907 - - - - - - - - -

5730 Hallux Valgus double osteotomy etc. 20 182.600 1 632.60 20 146.080 1 306.10 30 3.000 168.30

5731 Distal soft tissue procedure for Hallux Valgus 20 173.600 1 552.20 20 138.880 1 241.70 30 3.000 168.30

5732 Aitkin procedure or similar 20 166.800 1 491.40 20 133.440 1 193.10 30 3.000 168.30

5734Removal bony prominence foot e.g. bunionette (ò Bunionette not applicable to COID)

20 91.000 813.60 20 91.000 813.60 30 3.000 168.30

5735 Repair angular deformity toe (lesser toes) 20 97.200 869.10 20 97.200 869.10 30 3.000 168.30

5736 Sesamoidectomy 20 97.800 874.40 20 97.800 874.40 30 3.000 168.30

5737 Repair major foot tendons e.g. Tib Post 20 147.300 1 317.00 20 120.000 1 072.90 30 3.000 168.30

5738 Repair of dislocating peroneal tendons 20 173.200 1 548.60 20 138.560 1 238.90 30 3.000 168.30

5739 Forefoot reconstruction for rheumatoid arthritis: Clayton or similar: One foot 20 202.300 1 808.80 20 161.840 1 447.00 30 3.000 168.30

5740 Steindler strip - plantar fascia 20 97.200 869.10 20 97.200 869.10 30 3.000 168.30

5741 Kelikian syndactilly (one web space) 20 97.200 869.10 20 97.200 869.10 30 3.000 168.30

5742 Tendon transfer foot 20 172.000 1 537.90 20 137.600 1 230.30 30 3.000 168.30

5743 Capsulotomy metatarsophalangeal joints: Foot 20 86.800 776.10 20 86.800 776.10 30 3.000 168.30

3.8.2 Big toe (refer to section 3.8.1 for procedures on big toe) - - - - - - - - -

3.8.3 Special areas: Reimplantations - - - - - - - - -

0912 Replantation of amputated upper limb proximal to wrist joint 20 730.000 6 526.90 20 584.000 5 221.50 30 3.000 168.30


132 • Version 4_21




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code CF Units Value

RCF Units

Value R

CF Units Value

R

0913 Replantation of thumb 20 670.000 5 990.50 20 536.000 4 792.40 30 3.000 168.30

0914Replantation of a single digit (to be motivated), for multiple digits (modifier 0005 applicable)

20 580.000 5 185.80 20 464.000 4 148.60 30 3.000 168.30

0915 Replantation operation through the palm 20 1270.000 11 355.10 20 1016.000 9 084.10 30 3.000 168.30

3.8.4 Special areas: Hands: (Note: Skin: See Integumentary System) - - - - - - - - -

0919 Tumours: Epidermoid cysts 20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

0920 Tumours: Ganglion or fibroma 20 77.500 692.90 20 77.500 692.90 30 3.000 168.30

0921 Tumours: Nodular synovitis (Giant cell tumour of tendon sheath) 20 86.000 768.90 20 86.000 768.90 30 3.000 168.30

0922 Removal of foreign bodies requiring incision: Under local anaesthetic 20 19.000 169.90 20 19.000 169.90 30 3.000 168.30

0923Removal of foreign bodies requiring incision: Under general or regional anaesthetic

20 32.000 286.10 20 32.000 286.10 30 3.000 168.30

0924Crushed hand injuries: Initial extensive soft tissue toilet under general anaesthetic (sliding scale) - Minimum

20 37.000 330.80 20 37.000 330.80 30 3.000 168.30

Item 0924: The number of units chargeable under this item ranges from 37.00 to 110.00 for Specialists and General Practitioners.

- - - - - - - - -

0925 Crushed hand injuries: Subsequent dressing changes under general anaesthetic 20 16.000 143.10 20 16.000 143.10 30 3.000 168.30

3.8.5 Special areas: Spine - - - - - - - - -

Please note the following with regard to section 3.8.5: Spine a) Modifier 0005 (multiple procedures/operations under the same anaesthetic) is not applicable if the following procedures are performed together:1. Bone graft procedures and instrumentation are to be charged in addition to arthrodesis. 2. When vertebral procedures are performed by arthrodesis, bone grafts and instrumentation may be charged for in addition. b) Modifier 0005 (multiple procedures/operations under the same anaesthetic) would be applicable when arthrodesis is performed in addition to another procedure, e.g. Osteotomy, laminectomy.

- - - - - - - - -

0927 Excision of one vertebral body, for a lesion within the body (no decompression) 20 207.000 1 850.80 20 165.600 1 480.60 30 3.000 168.30

0928Excision of each additional vertebral segment for a lesion within the body (no decompression)

20 42.000 375.50 20 42.000 375.50 30 3.000 168.30

0929Manipulation of spine under general anaesthetic: (no after-care) (modifier 0005 not applicable)

20 14.000 125.20 20 14.000 125.20 30 5.000 280.60


133 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

0930 Posterior osteotomy of spine: One vertebral segment 20 339.000 3 031.00 20 271.200 2 424.80 30 3.000 168.30

0931 Posterior spinal fusion: One level 20 385.000 3 442.30 20 308.000 2 753.80 30 3.000 168.30

0932 Posterior osteotomy of spine: Each additional vertebral segment 20 103.000 920.90 20 103.000 920.90 30 3.000 168.30

0933 Anterior spinal osteotomy with disc removal: One vertebral segment 20 315.000 2 816.40 20 252.000 2 253.10 30 3.000 168.30

0936 Anterior spinal osteotomy with disc removal: Each additional vertebral segment 20 103.000 920.90 20 103.000 920.90 30 3.000 168.30

0938 Anterior fusion base of skull to C2 20 449.000 4 014.50 20 359.200 3 211.60 30 4.000 224.50

0939Trans-abdominal anterior exposure of the spine for spinal fusion only if done by a second surgeon

20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0940 Trans-thoracic anterior exposure of the spine if done by a second surgeon 20 160.000 1 430.60 20 128.000 1 144.50 30 3.000 168.30

0941 Anterior interbody fusion: One level 20 360.000 3 218.80 20 288.000 2 575.00 30 3.000 168.30

0942 Anterior interbody fusion: Each additional level 20 102.000 912.00 20 102.000 912.00 30 3.000 168.30

0944 Posterior fusion: Occiput to C2 20 390.000 3 487.00 20 312.000 2 789.60 30 4.000 224.50

0946 Posterior spinal fusion: Each additional level 20 111.000 992.50 20 111.000 992.50 30 3.000 168.30

0948 Posterior interbody lumbar fusion: One level 20 364.000 3 254.50 20 291.200 2 603.60 30 3.000 168.30

0950 Posterior interbody lumbar fusion: Each additional interspace 20 95.000 849.40 20 95.000 849.40 30 3.000 168.30

0959 Excision of coccyx 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

0961 Costo-transversectomy 20 198.000 1 770.30 20 158.400 1 416.30 30 3.000 168.30

0963 Antero-lateral decompression of spinal cord or anterior debridement 20 326.000 2 914.80 20 260.800 2 331.80 30 3.000 168.30

MODIFIER - - - - - - - - -

0061Combined procedures on the spine: In cases of combined procedures on the spine, both the orthopaedic surgeon and the neurosurgeon are entitled to the full fee for the relevant part of the operation performed

- - - - - - - - -

3.8.6 Special areas: Spinal deformities - - - - - - - - -

Please note : Posterior fusion for spinal deformity (to be used for scoliosis more than 30 degrees or thoracic kyphosis more than 45 degrees).

- - - - - - - - -

0952 Posterior fusion for spinal deformity: Up to 6 levels 20 359.000 3 209.80 20 287.200 2 567.90 30 3.000 168.30

0954 Posterior fusion for spinal deformity: 7 to 12 levels 20 547.000 4 890.70 20 437.600 3 912.60 30 3.000 168.30

0955 Posterior fusion for spinal deformity: 13 or more levels 20 593.000 5 302.00 20 474.400 4 241.60 30 3.000 168.30

0956 Anterior fusion for spinal deformity: 2 or 3 levels 20 410.000 3 665.80 20 328.000 2 932.70 30 3.000 168.30

0957 Anterior fusion for spinal deformity: 4 to 7 levels 20 444.000 3 969.80 20 355.200 3 175.80 30 3.000 168.30

0958 Anterior fusion for spinal deformity: 8 or more levels 20 539.000 4 819.20 20 431.200 3 855.40 30 3.000 168.30


134 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

MODIFIER - - - - - - - - -

0065Additional operative procedures by same surgeon, under section 3.8.6: Spinal deformities, within a period of 12 months: 75% of scheduled fee for the lesser procedure, except where otherwise specified elsewhere

- - - - - - - - -

3.8.7 Special areas: All spinal problems - - - - - - - - -

0943 Laminectomy with decompression of nerve roots and disc removal: One level 20 240.000 2 145.80 20 192.000 1 716.70 30 3.000 168.30

0960 Posterior non-segmental instrumentation 20 167.000 1 493.20 20 133.600 1 194.50 30 5.000 280.60

0962 Posterior segmental instrumentation: 2 to 6 vertebrae 20 176.000 1 573.60 20 140.800 1 258.90 30 5.000 280.60

0964 Posterior segmental instrumentation: 7 to 12 vertebrae 20 201.000 1 797.10 20 160.800 1 437.70 30 5.000 280.60

0966 Posterior segmental instrumentation:13 or more vertebrae 20 245.000 2 190.60 20 196.000 1 752.40 30 5.000 280.60

0968 Anterior instrumentation: 2 to 3 vertebrae 20 159.000 1 421.60 20 127.200 1 137.30 30 5.000 280.60

0969 Skull or skull-femoral traction including two weeks after-care 20 64.000 572.20 20 64.000 572.20

0970 Anterior instrumentation: 4 to 7 vertebrae 20 185.000 1 654.10 20 148.000 1 323.30 30 5.000 280.60

0971 Halo-splint and POP jacket including two weeks after-care 20 116.000 1 037.20 20 116.000 1 037.20

0972 Anterior instrumentation: 8 or more vertebrae 20 206.000 1 841.90 20 164.800 1 473.50 30 5.000 280.60

0974 Additional pelvic fixation of instrumentation other than sacrum 20 108.000 965.60 20 108.000 965.60 30 5.000 280.60

5750 Reinsertion of instrumentation 20 276.000 2 467.70 20 220.800 1 974.20 30 6.000 336.70

5751 Removal of posterior non-segmental instrumentation 20 173.000 1 546.80 20 138.400 1 237.40 30 6.000 336.70

5752 Removal of posterior segmental instrumentation 20 175.000 1 564.70 20 140.000 1 251.70 30 6.000 336.70

5753 Removal of anterior instrumentation 20 204.000 1 824.00 20 163.200 1 459.20 30 6.000 336.70

5755Laminectomy for spinal stenosis (exclude diskectomy, foraminotomy and spondylolisthesis): One or two levels

20 295.000 2 637.60 20 236.000 2 110.10 30 3.000 168.30

5756 Laminectomy with full decompression for spondylolisthesis (Gill procedure) 20 304.000 2 718.10 20 243.200 2 174.50 30 3.000 168.30

5757Laminectomy for decompression without foraminotomy or diskectory more than two levels

20 321.000 2 870.10 20 256.800 2 296.10 30 3.000 168.30

5758Laminectomy with decompression of nerve roots and disc removal: Each additional level

20 63.000 563.30 20 63.000 563.30 30 3.000 168.30

5759 Laminectomy for decompression diskectomy, etc. revision operation 20 352.000 3 147.20 20 281.600 2 517.80 30 4.000 224.50

5760Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: One level

20 301.000 2 691.20 20 240.800 2 153.00 30 3.000 168.30


135 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

5761Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: Each additional level

20 68.000 608.00 20 68.000 608.00 30 3.000 168.30

5763 Anterior disc removal and spinal decompression cervical: One level 20 344.000 3 075.70 20 275.200 2 460.60 30 3.000 168.30

5764 Anterior disc removal and spinal decompression cervical: Each additional level 20 81.000 724.20 20 81.000 724.20 30 3.000 168.30

5765 Vertebral corpectomy for spinal decompression: One level 20 466.000 4 166.50 20 372.800 3 333.20 30 3.000 168.30

5766 Vertebral corpectomy for spinal decompression: Each additional level 20 88.000 786.80 20 88.000 786.80 30 3.000 168.30

5770Use of microscope in spinal or intracranial procedures (modifier 0005 not applicable)

20 71.000 634.80 20 71.000 634.80 - - -

3.9 Facial bone procedures - - - - - - - - -

Please note: Modifiers 0046 to 0058 are not applicable to section 3.9 - - - - - - - - -

0987 Repair of orbital floor (blowout fracture) 20 184.600 1 650.50 20 147.680 1 320.40 30 4.000 224.50

0988 Genioplasty 20 263.000 2 351.50 20 210.400 1 881.20 30 4.000 224.50

0989Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort I

20 202.200 1 807.90 20 161.760 1 446.30 30 4.000 224.50

0990Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort II

20 302.000 2 700.20 20 241.600 2 160.20 30 4.000 224.50

0991Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort III

20 433.000 3 871.50 20 346.400 3 097.20 30 4.000 224.50

0992Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort I Osteotomy

20 970.000 8 672.80 20 776.000 6 938.20 30 4.000 224.50

0993Open reduction and fixation of central mid-third facial fracture with displacement: Palatal Osteotomy

20 302.000 2 700.20 20 241.600 2 160.20 30 4.000 224.50

0994Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort II Osteotomy (team fee)

20 1103.000 9 861.90 20 882.400 7 889.50 30 4.000 224.50

0995Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort III Osteotomy (team fee)

20 1654.000 14 788.40 20 1323.200 11

830.70 30 4.000 224.50

0996Open reduction and fixation of central mid-third facial fracture with displacement: Fracture of maxilla without displacement

20 - - 20 - - - - -

0997 Mandible: Fractured nose and zygoma: Open reduction and fixation 20 302.000 2 700.20 20 241.600 2 160.20 30 3.000 168.30

0999Mandible: Fractured nose and zygoma: Closed reduction by inter-maxillary fixation

20 184.000 1 645.10 20 147.200 1 316.10 30 3.000 168.30

1001 Temporo-mandibular joint: Reconstruction for dysfunction 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50


136 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1003 Manipulation: Immobilisation and follow-up of fractured nose 20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

1005 Nasal fracture without manipulation 20 - - 20 - - - - -

1007 Mandibulectomy 20 320.000 2 861.10 20 256.000 2 288.90 30 5.000 280.60

1009 Maxillectomy 20 382.500 3 419.90 20 306.000 2 736.00 30 4.000 224.50

1011 Bone graft to mandible 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

1012 Adjustment of occlusion by ramisection 20 227.000 2 029.60 20 181.600 1 623.70 30 4.000 224.50

1013 Fracture of arch of zygoma without displacement 20 - - 20 - - - - -

1015Fracture of arch of zygoma with displacement requiring operative manipulation (not including associated fractures), recent fracture (within four weeks)

20 131.000 1 171.30 20 120.000 1 072.90 30 3.000 168.30

1017Fracture of arch of zygoma with displacement requiring operative manipulation but not including associated fractures (after four weeks)

20 262.000 2 342.50 20 209.600 1 874.00 30 3.000 168.30

4 Respiratory System - - - - - - - - -

4.1 Nose and sinuses - - - - - - - - -

1018 Flexible nasopharyngolaryngoscope examination 20 51.940 464.40 20 51.940 464.40 - - -

1019 ENT endoscopy in rooms with rigid endoscope 20 12.000 107.30 - - - - - -

1020 Repair of perforated septum: Any method 20 141.900 1 268.70 20 120.000 1 072.90 30 4.000 224.50

1022 Functional reconstruction of nasal septum 20 121.200 1 083.70 20 120.000 1 072.90 30 4.000 224.50

1024 Insertion of silastic obturator into nasal septum perforation (excluding material) 20 30.000 268.20 20 30.000 268.20 30 4.000 224.50

1025 Intranasal antrostomy (modifier 0005 to apply to opposite side of nose) 20 64.600 577.60 20 64.600 577.60 30 4.000 224.50

1027 Dacrocystorhinostomy 20 210.000 1 877.60 20 168.000 1 502.10 30 5.000 280.60

1029 Turbinectomy (modifier 0005 to apply to opposite side of nose) 20 62.600 559.70 20 62.600 559.70 30 4.000 224.50

1030 Endoscopic turbinectomy: Laser or microdebrider 20 90.000 804.70 20 90.000 804.70 30 5.000 280.60

1031 Removal of single nasal polyp at rooms (at initial consultation only) 20 25.400 227.10 20 25.400 227.10 - - -

1033 Removal of multiple polyps in hospital under general anaesthetic 20 81.800 731.40 20 81.800 731.40 30 4.000 224.50

1034 Autogenous nasal bone transplant: Bone removal included 20 100.000 894.10 20 100.000 894.10 30 4.000 224.50

1035 Functional endoscopic sinus surgery: Unilateral 20 140.000 1 251.70 20 120.000 1 072.90 30 4.000 224.50

1036 Functional endoscopic sinus surgery: Bilateral 20 245.000 2 190.60 20 196.000 1 752.40 30 4.000 224.50

1037Diathermy to nose or pharynx exclusive of consultation fee, uni- or bilateral: Under local anaesthetic

20 8.000 71.50 20 8.000 71.50 - - -

1039Diathermy to nose or pharynx exclusive of consultation fee, uni- or bilateral: Under general anaesthetic

20 35.000 312.90 20 35.000 312.90 30 4.000 224.50


137 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1041 Control severe epistaxis requiring hospitalisation: Anterior plugging 20 40.000 357.60 20 40.000 357.60 30 6.000 336.70

1043 Control severe epistaxis requiring hospitalisation: Anterior and posterior plugging 20 60.000 536.50 20 60.000 536.50 30 6.000 336.70

1045 Ligation anterior ethmoidal artery 20 135.400 1 210.60 20 120.000 1 072.90 30 6.000 336.70

1047 Caldwell-Luc operation: Unilateral 20 137.300 1 227.60 20 120.000 1 072.90 30 4.000 224.50

1049 Ligation internal maxillary artery 20 196.000 1 752.40 20 156.800 1 402.00 30 6.000 336.70

1050 Vidian neurectomy (transantral or transnasal) 20 113.000 1 010.30 20 113.000 1 010.30 30 4.000 224.50

1051 Removal nasopharyngeal fibroma 20 285.000 2 548.20 20 228.000 2 038.60 30 6.000 336.70

1052Instrumental examination of the nasopharynx including biopsy under general anaesthetic

20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

1053 Frontal sinus drainage, trephine operation 20 93.100 832.40 20 93.100 832.40 30 4.000 224.50

1054Antroscopy through the canine fossa (modifier 0005 to apply to opposite side of nose)

20 37.300 333.50 - - - - - -

1055 External frontal ethmoidectomy 20 190.700 1 705.10 20 152.560 1 364.00 30 4.000 224.50

1057 External ethmoidectomy and/or sphenoidectomy 20 199.400 1 782.80 20 159.520 1 426.30 30 4.000 224.50

1058 Sublabial transseptal sphenoidotomy 20 137.000 1 224.90 20 120.000 1 072.90 30 4.000 224.50

1059 Frontal osteomyelitis 20 194.000 1 734.60 20 155.200 1 387.60 30 4.000 224.50

1060 Obliteration of frontal sinus 20 291.100 2 602.70 20 232.880 2 082.20 30 4.000 224.50

1061 Lateral rhinotomy 20 164.000 1 466.30 20 131.200 1 173.10 30 4.000 224.50

1062 Excision nasolabial cyst 20 186.100 1 663.90 20 148.880 1 331.10 30 4.000 224.50

1063 Removal of foreign bodies from nose: At rooms 20 10.000 89.40 20 10.000 89.40

1065 Removal of foreign body from nose: Under general anaesthetic 20 38.600 345.10 20 38.600 345.10 30 4.000 224.50

1067 Proof puncture at rooms: Unilateral 20 10.000 89.40 20 10.000 89.40 30 4.000 224.50

1069 Proof puncture, uni- or bilateral under general anaesthetic 20 35.000 312.90 20 35.000 312.90 30 4.000 224.50

1071 Proetz treatment (consultation fee only to be charged for first treatment) 20 4.000 35.80 20 4.000 35.80 - - -

1077 Septum abscess: At rooms, including after-care 20 8.000 71.50 20 8.000 71.50 - - -

1079 Septum abscess: Under general anaesthetic 20 35.000 312.90 20 35.000 312.90 30 4.000 224.50

1081 Oro-antral fistula (without Caldwell-Luc) 20 111.800 999.60 20 111.800 999.60 30 4.000 224.50

1083 Choanal atresia: Intranasal approach 20 113.000 1 010.30 20 113.000 1 010.30 30 5.000 280.60

1084 Choanal atresia: Transpalatal approach 20 194.000 1 734.60 20 155.200 1 387.60 30 7.000 392.80

1085Total reconstruction of the nose: Including reconstruction of nasal septum (septum plasty), nasal pyramid (osteotomy) and nasal tip

20 350.000 3 129.40 20 280.000 2 503.50 30 5.000 280.60


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1087Sub-total reconstruction consisting of any two of the following: Septum plasty, osteotomy, nasal tip reconstruction

20 210.000 1 877.60 20 168.000 1 502.10 30 5.000 280.60

1089 Forehead rhinoplasty (all stages): Total 20 552.000 4 935.40 20 441.600 3 948.40 30 5.000 280.60

1091 Forehead rhinoplasty (all stages): Partial 20 414.000 3 701.60 20 331.200 2 961.30 30 5.000 280.60

1093 Forehead rhinoplasty (all stages): Rhinophyma without skin graft 20 138.000 1 233.90 20 120.000 1 072.90 30 5.000 280.60

1095 Full nasal reconstruction for secondary cleft lip deformity 20 357.900 3 200.00 20 286.320 2 560.00 30 5.000 280.60

1097 Partial nasal reconstruction for cleft lip deformity 20 199.700 1 785.50 20 159.760 1 428.40 30 5.000 280.60

1099 Columella reconstruction or lengthening 20 138.000 1 233.90 20 120.000 1 072.90 30 5.000 280.60

MODIFIERS GOVERNING NASAL OPERATIONS - - - - - - - - -

0069When endoscopic instruments are used during intranasal surgery: Add 10% of the fee of the procedure performed. Only applicable to items 1025, 1027, 1030, 1033, 1035, 1036, 1039, 1047, 1054 and 1083

- - - - - - - - -

4.2 Throat - - - - - - - - -

1101 Tonsillectomy (dissection of the tonsils) 20 75.000 670.60 20 75.000 670.60 30 4.000 224.50

1102 Laser tonsillectomy 20 75.000 670.60 20 75.000 670.60 30 6.000 336.70

1105 Removal of adenoids 20 40.000 357.60 20 40.000 357.60 30 4.000 224.50

1106Laser assisted functional reconstruction of palate uvula: In the rooms (+ item 5930 for hire of laser)

20 168.300 1 504.80 20 134.640 1 203.80 30 5.000 280.60

1107 Opening of quinsy: At rooms 20 12.000 107.30 20 12.000 107.30 30 6.000 336.70

1108Laser assisted functional reconstruction of palate uvula: In the rooms (+ item 5930 for hire of laser): Follow-up operation performed by the same surgeon

20 85.000 760.00 20 85.000 760.00 30 5.000 280.60

1109 Opening of quinsy: Under general anaesthetic 20 35.000 312.90 20 35.000 312.90 30 6.000 336.70

1110 Ludwig’s Angina: Drainage 20 42.000 375.50 20 42.000 375.50 30 9.000 505.00

1111 Post tonsillectomy or adenoidectomy haemorrhage 20 46.000 411.30 20 46.000 411.30 30 6.000 336.70

1112 Pharyngeal pouch operation 20 231.800 2 072.50 20 185.440 1 658.00 30 5.000 280.60

1113 Retropharyngeal abscess: Internal approach 20 35.000 312.90 20 35.000 312.90 30 6.000 336.70

1115 Retropharyngeal abscess: External approach 20 85.000 760.00 20 85.000 760.00 30 6.000 336.70

1116 Functional reconstruction of palate and uvula 20 168.300 1 504.80 20 134.640 1 203.80 30 5.000 280.60

4.3 Larynx - - - - - - - - -

1117 Laryngeal intubation 20 10.000 89.40 20 10.000 89.40 - - -

1118 Laryngeal stroboscopy with video capture 20 39.000 348.70 20 39.000 348.70 30 6.000 336.70


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R

1119 Laryngectomy without block dissection of the neck 20 430.000 3 844.60 20 344.000 3 075.70 30 7.000 392.80

1123Botulinus toxin injection for adductor disphonia (+ item 0198 + item 0201 + item 0202)

20 35.000 312.90 - - - - - -

1125Operative laryngoscopy with excision of tumour and/or stripping of vocal cords (excluding after-care)

20 81.100 725.10 20 81.100 725.10 30 6.000 336.70

1126 Post laryngectomy for voice restoration 20 139.500 1 247.30 20 120.000 1 072.90 30 9.000 505.00

1127 Tracheotomy 20 90.000 804.70 20 90.000 804.70 30 9.000 505.00

1128 Endolaryngeal operations 20 75.000 670.60 20 75.000 670.60 30 8.000 448.90

1129External laryngeal operation e.g. laryngeal stenosis, laryngocele, abductor, paralysis, laryngocele-fissure

20 294.400 2 632.20 20 235.520 2 105.80 30 8.000 448.90

1130Direct laryngoscopy: Diagnostic laryngoscopy including biopsy (also to be applied when a flexible fibre-optic laryngoscope was used)

20 41.400 370.20 20 41.400 370.20 30 6.000 336.70

1131 Direct laryngoscopy plus foreign body removal 20 64.600 577.60 20 64.600 577.60 30 6.000 336.70

MODIFIERS - - - - - - - - -

0067

Microsurgery of the larynx: Add 25% to the fee of the operation performed (òFor other operations requiring the use of an operation microscope, the fee include the use of the microscope, except where otherwise specified elsewhare in the Tariff)

- - - - - - - - -

4.4 Bronchial procedures - - - - - - - - -

Note: Please specify on account if a biopsy was performed together with the bronchoscopy

- - - - - - - - -

1132 Bronchoscopy: Diagnostic bronchoscopy 20 65.000 581.20 20 65.000 581.20 30 6.000 336.70

1133 Bronchoscopy: Diagnostic bronchoscopy with removal of foreign body 20 80.000 715.30 20 80.000 715.30 30 8.000 448.90

1134 Bronchoscopy: Bronchoscopy with laser 20 75.000 670.60 30 8.000 448.90

1136 Nebulisation (in rooms) 20 12.000 107.30 20 12.000 107.30 20 12.000 107.30

1137 Bronchial lavage - - - - - - 30 8.000 448.90

1138Thoracotomy: For broncho-pleural fistula (including ruptured bronchus, any cause)

20 350.000 3 129.40 20 280.000 2 503.50 30 12.000 673.40

4.5 Pleura - - - - - - - - -

1139 Pleural needle biopsy (no after-care) (modifier 0005 not applicable) 20 50.000 447.10 20 50.000 447.10 30 3.000 168.30

1141 Insertion of intercostal catheter (under water drainage) 20 50.000 447.10 20 50.000 447.10 30 6.000 336.70


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1142 Intra-pleural block 20 36.000 321.90 20 36.000 321.90 20 36.000 321.90

1143 Paracentesis chest: Diagnostic 20 8.000 71.50 20 8.000 71.50 30 3.000 168.30

1145 Paracentesis chest: Therapeutic 20 13.000 116.20 20 13.000 116.20 30 3.000 168.30

1147 Pneumothorax: Induction (diagnostic) 20 25.000 223.50 20 25.000 223.50 - - -

1149 Pleurectomy 20 250.000 2 235.30 20 200.000 1 788.20 30 11.000 617.20

1151 Decortication of lung 20 350.000 3 129.40 20 280.000 2 503.50 30 11.000 617.20

1153 Chemical pleurodesis (instillation of silver nitrate, tetracycline, talc, etc.) 20 55.000 491.80 20 55.000 491.80 30 3.000 168.30

4.6 Pulmonary procedures - - - - - - - - -

4.6.1 Pulmonary procedures: Surgical - - - - - - - - -

1155 Needle biopsy lung: (no after-care) (modifier 0005 not applicable) 20 32.000 286.10 20 32.000 286.10 30 5.000 280.60

1157 Pneumonectomy 20 350.000 3 129.40 20 280.000 2 503.50 30 11.000 617.20

1159 Pulmonary lobectomy 20 389.500 3 482.50 20 311.600 2 786.00 30 11.000 617.20

1161 Segmental lobectomy 20 365.000 3 263.50 20 292.000 2 610.80 30 11.000 617.20

1163 Excision tracheal stenosis: Cervical 20 375.000 3 352.90 20 300.000 2 682.30 30 8.000 448.90

1164 Excision tracheal stenosis: Intra thoracic 20 350.000 3 129.40 20 280.000 2 503.50 30 12.000 673.40

1167Thoracoplasty associated with lung resection or done by the same surgeon within 6 weeks

20 215.000 1 922.30 20 172.000 1 537.90 30 12.000 673.40

1168 Thoracoplasty: Complete 20 250.000 2 235.30 20 200.000 1 788.20 30 11.000 617.20

1169 Thoracoplasty: Limited (osteoplastic) 20 200.000 1 788.20 20 160.000 1 430.60 30 11.000 617.20

1171 Drainage empyema (including six weeks after treatment) 20 170.000 1 520.00 20 136.000 1 216.00 30 11.000 617.20

1173 Drainage of lung abscess (including six weeks after treatment) 20 170.000 1 520.00 20 136.000 1 216.00 30 11.000 617.20

1175 Thoracotomy (limited): For lung or pleural biopsy 20 115.000 1 028.20 20 115.000 1 028.20 30 11.000 617.20

1177 Major: Diagnostic, as for inoperable carcinoma 20 215.000 1 922.30 20 172.000 1 537.90 30 11.000 617.20

1179 Thoracoscopy 20 89.000 795.80 20 89.000 795.80 30 11.000 617.20

1181 Lung transplant: Unilateral 20 600.000 5 364.60 20 480.000 4 291.70 30 15.000 841.70

1182 Harvesting donor lung: Unilateral 20 120.000 1 072.90 20 120.000 1 072.90 30 5.000 280.60

1183 Excision or plication of emphysematous cyst: Unilateral 20 250.000 2 235.30 20 200.000 1 788.20 30 11.000 617.20

1184Excision or plication of emphysematous cyst: Bilateral synchronous (Median sternotomy)

20 438.000 3 916.20 20 350.400 3 132.90 30 11.000 617.20


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1185Excision or plication of emphysematous cyst: Re-exploration following sternal dehiscence

20 100.000 894.10 20 100.000 894.10 30 11.000 617.20

4.6.2 Pulmonary function tests - - - - - - - - -

When these procedures are performed by an anaesthetist he/she acts as the clinician and not an anaesthetist and the indicated clinical procedure units should be charged and not the anaesthetic tariff or units.

- - - - - - - - -

1186 Flow volume test: Inspiration/expiration 20 30.000 268.20 20 30.000 268.20 20 30.000 268.20

1188Flow volume test: Inspiration/expiration/pre- and post bronchodilator (to be charged for only with first consultation - thereafter item 1186 applies)

20 50.000 447.10 20 50.000 447.10 20 50.000 447.10

1189 Forced expirogram only 20 10.000 89.40 20 10.000 89.40 20 10.000 89.40

1190 Determination of resistance to airflow in paediatric patients, impulse oscilimetry 20 45.310 405.10

1191 N2 single breath distribution 20 10.000 89.40 20 10.000 89.40 20 10.000 89.40

1192 Peak expiratory flow only 20 5.000 44.70 20 5.000 44.70 20 5.000 44.70

1193Functional residual capacity or residual volume: Helium method, nitrogen open circuit method, or other method

20 37.760 337.60 - - - - - -

1195 Thoracic gas volume 20 37.930 339.10 - - - - - -

1196 Determination of resistance to airflow, oscillary or plethysmographic methods 20 45.310 405.10 - - - - - -

1197 Compliance and resistance, using oesophageal balloon 20 24.000 214.60 20 24.000 214.60 20 24.000 214.60

1198Prolonged post exposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine, other chemical agent or after exercise, with subsequent spirometry

20 55.890 499.70 20 55.890 499.70 - - -

1199 Pulmonary stress testing: For determination of VO2 max 20 96.500 862.80 20 96.500 862.80 - - -

1200 Carbon monoxide diffusing capacity, any method 20 38.060 340.30 - - -

1201 Maximum inspiratory/expiratory pressure 20 5.000 44.70 20 5.000 44.70 20 5.000 44.70

4.7 Intensive care - - - - - - - - -

RULES GOVERNING THIS SECTION - - - - - - - - -


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R

Q.

Intensive care/High Care: Units in respect of items 1204 to 1210 (Categories 1 to 3) EXCLUDE the following: (a) Anaesthetic and/or surgical fees for any condition or procedure, as well as a first consultation/visit, which is, regarded as the assessment of the patient, while the daily intensive care/high care fee covers the daily care in the intensive/high care unit. (b) Cost of any drugs and/or materials. (c) Any other cost which may be incurred before, during or after the consultation/visit and/or the therapy. (d) Blood gases and chemistry tests, including the arterial puncture to obtain the specimen. (e) Procedural items 1202 and 1212 to 1221. but INCLUDE the following: (f) Performing and interpretation of a resting ECG. (g) Interpretation of chemistry tests and x-rays. (h) Intravenous treatment (items 0206 and 0207), except intravenous infusion in patients under the age of three years (item 0205) that does not form a part of the daily ICU/High Care fee and may be charged for separately on a daily basis (fee includes the introduction of the cannula as well as the daily management)

- - - - - - - - -

R.Multiple organ failure: Units for items 1208, 1209 and 1210 (Category 3: Cases with multiple organ failure) include resuscitation (i.e. item 1211: Cardio-respiratory resuscitation)

- - - - - - - - -

S.

Ventilation: Units for items 1212, 1213 and 1214 (ventilation) include the following: (a) Measurement of minute volume, vital capacity, time- and vital capacity studies. (b) Testing and connecting the machine. (c) Putting patient on machine: setting machine, synchronising patient with machine. (d) Instruction to nursing staff. (e) All subsequent visits for 24 hours.

- - - - - - - - -

T.Ventilation (items 1212 to 1214) does not form a part of normal post-operative care, but may not be added to item 1204: Catogory 1: Cases requiring intensive monitoring

- - - - - - - - -

4.7.1Intensive care: (in intensive care or high care unit): Respiratory, cardiac, general: Neonatal procedures

- - - - - - - - -

1202 Insertion of central venous catheter via peripheral vein in neonates 20 40.000 357.60 20 40.000 357.60 20 40.000 357.60

4.7.2Intensive care: (in intensive care or high care unit): Respiratory, cardiac, general: Tariff items for intensive care

- - - - - - - - -

1204Intensive care: Category 1 (High Care) : Cases requiring intensive monitoring (to include cases where physiological instability is anticipated e.g. diabetic pre-coma, asthma, gastro-intestinal haemorrhage, etc.): Per day

20 30.000 268.20 20 30.000 268.20 20 30.000 268.20


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(i) Only one practitioner may charge category 1: Intensive monitoring of patient in high care unit. (ii) Item 1204 may not be charged by the surgeon who performed a surgical procedure. Intensive monitoring is regarded as normal postoperative care, which is included in the global fee attached to that surgical procedure. (iii) Practitioners involved in treating a patient in a high care unit must come to an agreement on which practitioner should be regarded as the primary practitioner and to which category the patient is classified. This will ensure that each of the practitioners is remunerated correctly for the actual services they rendered.

- - - - - - - - -

1205

Intensive care: Category 2 (ICU): Cases requiring active system support (where active specialised intervention is required in cases such as acute myocardial infarction, diabetic coma, head injury, severe asthma, acute pancreatitis, eclampsia, flail chest, etc. Ventilation may or may not be part of the active system support): First day

20 100.000 894.10 20 100.000 894.10 20 100.000 894.10

1206

Intensive care: Category 2 (ICU): Cases requiring active system support (where active specialised intervention is required in cases such as acute myocardial infarction, diabetic coma, head injury, severe asthma, acute pancreatitis, eclampsia, flail chest, etc. Ventilation may or may not be part of the active system support): Subsequent days, per day

20 50.000 447.10 20 50.000 447.10 20 50.000 447.10

1207

Intensive care: Category 2(ICU): Cases requiring active system support (where active specialised intervention is required in cases such as acute myocardial infarction, diabetic coma, head injury, severe asthma, acute pancreatitis, eclampsia, flail chest, etc. Ventilation may or may not be part of the active system support): After two weeks, per day

20 30.000 268.20 20 30.000 268.20 20 30.000 268.20


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Please Note: (i) The principal practitioner may charge items 1205 - 1207, other participating practitioners must charge the consultation item, e.g. item 0109 (ii) Only one practitioner may charge category 2: Intensive monitoring of patient in intensive care unit. (ii) Should a patient during the post-operative care period require active system support, the person who is responsible for the active systems support, may use items 1205-1207 (as appropriate). (iii) It would be acceptable for the surgeon who performed a surgical procedure of which the after-care is included, to charge fees according to the appropriate hospital follow-up visit (item 0109) (iv) Practitioners involved in treating a patient in the intensive care unit must come to an agreement on which practitioner should be regarded as the primary practitioner and to which category the patient is classified. This will ensure that each of the practitioners is remunerated correctly for the actual services they rendered.

- - - - - - - - -

1208Intensive care: Category 3 (ICU): Cases with multiple organ failure or Category 2 patients which may require multidisciplinary intervention: First day (primary practitioner)

20 137.000 1 224.90 20 120.000 1 072.90 20 137.000 1 224.90

1209Intensive care: Category 3 (ICU): Cases with multiple organ failure or Category 2 patients which may require multidisciplinary intervention: First day (per involved practitioner)

20 58.000 518.60 20 58.000 518.60 20 58.000 518.60

1210Intensive care: Category 3 (ICU): Cases with multiple organ failure or Category 2 patients which may require multidisciplinary intervention: Subsequent days (per involved practitioner)

20 50.000 447.10 20 50.000 447.10 20 50.000 447.10

Please note: (i) Items 1208-1210 are used if more than one practitioner is involved in active system support on a category 2 patient in the intensive care unit. (ii) Items 1208-1210 are used for category 3 patients with multiple organ failure. (iv) Practitioners involved in treating a patient in the intensive care unit must come to an agreement on which practitioner should be regarded as the primary practitioner and to which category the patient is classified. This will ensure that each of the practitioners is remunerated correctly for the actual services they rendered.

- - - - - - - - -


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4.7.3Intensive care: (in intensive care or high care unit): Respiratory, cardiac, general: Procedures

- - - - - - - - -

When this procedure is performed by an anaesthetist he/she acts as the clinician and not an anaesthetist and the indicated clinical procedure units should be charged and not the anaesthetic tariff or units.

- - - - - - - - -

1211

Cardio-respiratory resuscitation: Prolonged attendance in cases of emergency (not necessarily in ICU) - 50,00 clinical procedure units per half hour or part thereof for the first hour per practitioner, thereafter 25,00 clinical procedure units per half hour up to a maximum of 150,00 clinical procedure units per practitioner. Resuscitation fee includes all necessary additional procedures e.g. infusion, intubation, etc.

- - - - - - - - -

1212 Ventilation: First day 20 75.000 670.60 20 75.000 670.60 20 75.000 670.60

1213 Ventilation: Subsequent days, per day 20 50.000 447.10 20 50.000 447.10 20 50.000 447.10

1214 Ventilation: After two weeks, per day 20 25.000 223.50 20 25.000 223.50 20 25.000 223.50

1215 Insertion of arterial pressure cannula 20 25.000 223.50 20 25.000 223.50 20 25.000 223.50

1216 Insertion of Swan Ganz catheter for haemodynamics monitoring 20 50.000 447.10 20 50.000 447.10 20 50.000 447.10

1217 Insertion of central venous line via peripheral vein 20 10.000 89.40 20 10.000 89.40 20 10.000 89.40

1218 Insertion of central venous line via subclavian or jugular veins 20 25.000 223.50 20 25.000 223.50 20 25.000 223.50

1219 Hyperalimentation (daily tariff) 20 15.000 134.10 20 15.000 134.10 20 15.000 134.10

1220Patient-controlled analgesic pump: Hire fee: Per 24 hours (Cassette to be charged for according to item 0201 per patient)

20 30.000 268.20 20 30.000 268.20 20 30.000 268.20

1221Professional fee for managing a patient-controlled analgesic pump: First 24 hours (for subsequent days charged the appropriate hospital follow-up consultation/visit code)

20 30.000 268.20 20 30.000 268.20 20 30.000 268.20

4.8 Hyperbaric Oxygen Therapy - - - - - - - - -


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Internationally recognized scientific indications for Hyperbaric Oxygen Therapy: a. Arterial gas embolism (traumatic or iatrogenic). b. Decompression sickness (‘the bends’) c. Carbon monoxide poisoning d. Gas gangrene e. Crush injuries, compartment syndromes or acute traumatic ischaemias. f. Problem wounds (selected diabetic wounds, complicated pressure sores, arterial and refractory venous stasis ulcers and non-union) g. Necrotising soft tissue infections (e.g. necrotising fasciitis) h. Refractory osteomyelitis. i. Bone and soft tissue radiation necrosis. j. Compromised skin grafts and flaps. k. Acute thermal burns. l. Acute bloodloss anaemia (transfusion is contraindicated - e.g. Jehovah’s Witnesses or haemolytic anaemia). m. Cerebral abscesses

- - - - - - - - -

4804

Monitoring of a patient at the hyperbaric chamber during hyperbaric treatment (includes pre-hyperbaric assessment, monitoring during treatment, and post treatment evaluation): Low pressure table (1,5-1,8 ATA x 45-60 min): PROFESSIONAL COMPONENT

20 30.000 268.20 20 30.000 268.20 - - -

4820 Low pressure table (1,5-1,8 ATA x 45-60 min): TECHNICAL COMPONENT 20 101.130 904.20 20 101.130 904.20 - - -

4805

Monitoring of a patient at the hyperbaric chamber during hyperbaric treatment (includes pre-hyperbaric assessment, monitoring during treatment, and post treatment evaluation): Routine HBO table (2-2,5 ATA x 90-120 min): PROFESSIONAL COMPONENT

20 60.000 536.50 20 60.000 536.50 - - -

4821 Routine HBO table (2-2,5 ATA x 90-120 min): TECHNICAL COMPONENT 20 131.260 1 173.60 20 131.260 1 173.60 - - -

4806

Monitoring of a patient at the hyperbaric chamber during hyperbaric treatment (includes pre-hyperbaric assessment, monitoring during treatment, and post treatment evaluation): Emergency HBO table (2,5-3 ATA x 90-120 min): PROFESSIONAL COMPONENT

20 80.000 715.30 20 80.000 715.30 - - -

4822 Emergency HBO table (2,5-3 ATA x 90-120 min): TECHNICAL COMPONENT 20 131.260 1 173.60 20 131.260 1 173.60 - - -

4809

Monitoring of a patient at the hyperbaric chamber during hyperbaric treatment (includes pre-hyperbaric assessment, monitoring during treatment, and post treatment evaluation): USN TT5 (2,8 ATA x 135 min): PROFESSIONAL COMPONENT

20 90.000 804.70 20 90.000 804.70 - - -


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4825 USN TT5 (2,8 ATA x 135 min): TECHNICAL COMPONENT 20 214.180 1 915.00 20 214.180 1 915.00 - - -

4810

Monitoring of a patient at the hyperbaric chamber during hyperbaric treatment (includes pre-hyperbaric assessment, monitoring during treatment, and post treatment evaluation): USN TT6 (2,8 ATA x 285 min): PROFESSIONAL COMPONENT

20 190.000 1 698.80 20 190.000 1 698.80 - - -

4826 USN TT6 (2,8 ATA x 285 min): TECHNICAL COMPONENT 20 386.420 3 455.00 20 386.420 3 455.00 - - -

4811

Monitoring of a patient at the hyperbaric chamber during hyperbaric treatment (includes pre-hyperbaric assessment, monitoring during treatment, and post treatment evaluation): USN TT6ext/6A or Cx 30 (2,8-6 ATA x 305-490 min): PROFESSIONAL COMPONENT

20 327.000 2 923.70 20 327.000 2 923.70 - - -

4827 USN TT6ext (2,8-6 ATA x 305-490 min): TECHNICAL COMPONENT 20 680.850 6 087.50 20 680.850 6 087.50 - - -

4828 USN 6A (2,8-6 ATA x 305-490 min): TECHNICAL COMPONENT 20 678.280 6 064.50 20 678.280 6 064.50 - - -

4829 USN Cx 30 (2,8-6 ATA x 305-490 min): TECHNICAL COMPONENT 20 671.850 6 007.00 20 671.850 6 007.00 - - -

4815

Prolonged attendance inside a hyperbaric chamber: 40,00 clinical procedure units per half hour or part thereof for the first hour, thereafter 20,00 clinical procedure units per half hour: Minimum 40,00 clinical procedure units; maximum 320,00 clinical procedure units

- - - - - - - - -


- - - - - - - - -

5 Mediastinal Procedures - - - - - - - - -

1222 Mediastinal tumours 20 285.000 2 548.20 20 228.000 2 038.60 30 11.000 617.20

1223 Mediastinoscopy 20 95.000 849.40 20 95.000 849.40 30 5.000 280.60

1224 Mediastinotomy 20 115.000 1 028.20 20 115.000 1 028.20 30 11.000 617.20

1225 Excision of malignant chest wall tumours involving sternum and multiple ribs 20 350.000 3 129.40 20 280.000 2 503.50 30 11.000 617.20

1226 Removal of single rib with a lesion 20 282.000 2 521.40 20 225.600 2 017.10 30 11.000 617.20

6 Cardiovascular System - - - - - - - - -

MODIFIER GOVERNING FEES FOR AN ANAESTHESIOLOGIST OPERATING INTRA-AORTIC BALLOON PUMP

- - - - - - - - -

6.1 Cardiovascular system: General - - - - - - - - -

1227 Prolonged neonatal resuscitation 20 20.000 178.80 20 20.000 178.80 20 20.000 178.80


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R

Where ECG is done by a general practitioner but interpreted by a physician, the general practitioner is entitled to a consultation fee, plus half of fee determined for ECG

- - - - - - - - -

1228General Practitioner’s fee for the taking of an ECG only: Without effort: ½ (item 1232)

- - - 20 4.500 40.20 - - -

1229General Practitioner’s fee for the taking of an ECG only: Without and with effort: ½ (item 1233)

- - - 20 6.500 58.10 - - -

Note: Items 1228 and 1229 deal only with the fees for taking of the ECG, the consultation fee must still be added

- - - - - - - - -

1230 Physician’s fee for interpreting an ECG: Without effort 20 6.000 53.70 - - - - - -

1231 Physician’s fee for interpreting an ECG: With and without effort 20 10.000 89.40 - - - - - -

A specialist physician is entitled to the fees specified in item 1230 and 1231 for interpretation of an ECG tracing referred for interpretation. This applies also to a paediatrician when an ECG of a child is referred to him for interpretation

- - - - - - - - -

1232 Electrocardiogram: Without effort 20 9.000 80.50 20 9.000 80.50 - - -

1233 Electrocardiogram: With and without effort 20 13.000 116.20 20 13.000 116.20 - - -

1234Effort electrocardiogram with the aid of a special bicycle ergometer, monitoring apparatus and availability of associated apparatus

20 40.000 357.60 20 40.000 357.60 - - -

1235 Multi-stage treadmill test 20 60.000 536.50 20 60.000 536.50 - - -

1236 Electrocardiogram without effort: Under 4 years old 20 18.000 160.90 20 18.000 160.90 - - -

1237 24 Hour ambulatory blood pressure: Hire fee 20 30.000 268.20 20 30.000 268.20 - - -

1238 24 Hour ambulatory ECG monitoring (holter): Hire fee 20 55.000 491.80 20 55.000 491.80 - - -

1239 24 Hour ambulatory ECG monitoring (holter): Interpretation 20 27.000 241.40 20 27.000 241.40 - - -

1240 Signal averaged electrocardiogram 20 80.000 715.30 20 80.000 715.30 - - -

1241 X-ray Screening: Chest 20 4.000 35.80 20 4.000 35.80 - - -

1242 X-ray screening: Prosthetic valves 20 10.000 89.40 20 10.000 89.40 - - -

1243 Two week event triggered ambulatory ECG monitoring: Hire fee 20 55.000 491.80 20 55.000 491.80 - - -

1244 Two week event triggered ambulatory ECG monitoring: Interpretation 20 25.000 223.50 20 25.000 223.50 - - -

1245 Angiography cerebral: First two series 20 34.300 306.70 20 34.300 306.70 30 4.000 224.50

1246 Angiography peripheral: Per limb 20 25.000 223.50 20 25.000 223.50 30 4.000 224.50

1247 Cardioversion for arrhythmias (any method) with doctor in attendance 20 65.000 581.20 20 65.000 581.20 30 6.000 336.70


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code CF Units Value

RCF Units

Value R

CF Units Value

R

1248 Paracentesis of pericardium 20 50.000 447.10 20 50.000 447.10 30 9.000 505.00

1271 Cardiological supervision of Dobutamine magnetic resonance stress testing 20 51.000 456.00 20 51.000 456.00 - - -

MODIFIER GOVERNING PAEDIATRIC CARDIAC CATHETERISATION BY PAEDIATRIC CARDIOLOGISTS WITH A “33” PRACTICE NUMBER

- - - - - - - - -

0073

When item 1288 (Cardiac catheterisation for congenital heart disease: All ages above 1 year old) or item 1289 (Paediatric cardiac catheterisation: Infants below the age of one year) is performed by paediatric cardiologists (‘33’): fee for procedure + 100%

- - - - - - - - -

6.2 Invasive Cardiology - - - - - - - - -

6.2.1 Invasive cardiology: Cardiac catheterisation - - - - - - - - -

1249Right and left cardiac catheterisation without coronary angiography (with or without biopsy)

20 140.000 1 251.70 - - - 30 9.000 505.00

1250 Endomyocardial biopsy 20 70.000 625.90 20 70.000 625.90 30 9.000 505.00

1251 Transeptal puncture 20 70.000 625.90 20 70.000 625.90 30 9.000 505.00

1252 Left heart catheterisation with coronary angiography (with or without biopsy) 20 140.000 1 251.70 - - - 30 9.000 505.00

1253 Right heart catheterisation (with or without biopsy) 20 70.000 625.90 - - - 30 9.000 505.00

1254 Catheterisation of coronary artery bypass grafts and/or internal mammary grafts 20 40.000 357.60 20 40.000 357.60 30 9.000 505.00

1255 Tilt test 20 31.300 279.90 20 31.300 279.90 - - -

6.2.2 Invasive cardiology: Electrophysiological study - - - - - - - - -

1256 Ventricular stimulation study 20 160.000 1 430.60 - - - 30 9.000 505.00

1257 Full electrophysiological study 20 300.000 2 682.30 - - - 30 9.000 505.00

6.2.3 Invasive cardiology: Pacemakers - - - - - - - - -

1258 Pacemaker: Permanent - single chamber 20 155.000 1 385.90 20 124.000 1 108.70 30 9.000 505.00

1259 Pacemaker: Permanent - dual chamber 20 230.000 2 056.40 20 184.000 1 645.10 30 9.000 505.00

1260 AV nodal ablation 20 300.000 2 682.30 20 240.000 2 145.80 30 9.000 505.00

1261 Accessory pathway ablation 20 600.000 5 364.60 20 480.000 4 291.70 30 9.000 505.00

1262 Electrophysiological mapping 20 500.000 4 470.50 20 400.000 3 576.40

1263 Insertion transvenous implantable defibrillator 20 212.000 1 895.50 20 169.600 1 516.40 30 15.000 841.70

1264 Test for implantable transvenous defibrillator 20 120.000 1 072.90 20 120.000 1 072.90 30 15.000 841.70

1265 Renewal of pacemaker unit only, team fee 20 125.000 1 117.60 20 120.000 1 072.90 30 9.000 505.00

1266 Resiting pacemaker generator 20 80.000 715.30 20 80.000 715.30 - - -


150 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1267 Repositioning of catheter electrode 20 50.000 447.10 20 50.000 447.10 30 9.000 505.00

1268 Threshold testing: Own equipment 20 15.000 134.10 - - - - - -

1269 Threshold testing: Hospital equipment 20 11.000 98.40 - - - - - -

1270 Programming of atrio-ventricular sequential pacemaker 20 50.000 447.10 20 50.000 447.10 - - -

1273 Insertion of temporary pacemaker (modifier 0005 not applicable) 20 120.000 1 072.90 20 120.000 1 072.90 30 9.000 505.00

1274Percutaneous transluminal thrombectomy for clot extraction in native coronary arteries and venous and arterial bypass grafts

20 260.000 2 324.70 20 208.000 1 859.70 - - -

1275Termination of arrhythmia - programmed stipulation and lead insertion of temporary pacer

20 200.000 1 788.20 20 160.000 1 430.60 30 9.000 505.00

6.2.4 Invasive cardiology: Percutaneous translumical angioplasty - - - - - - - - -

1276 Percutaneous transluminal angioplasty: First cardiologist: Single lesion 20 260.000 2 324.70 20 208.000 1 859.70 30 13.000 729.50

1277 Percutaneous transluminal angioplasty: Second cardiologist: Single lesion 20 140.000 1 251.70 20 120.000 1 072.90 30 13.000 729.50

1278 Percutaneous transluminal angioplasty: First cardiologist: Second lesion 20 60.000 536.50 20 60.000 536.50 30 13.000 729.50

1279 Percutaneous transluminal angioplasty: Second cardiologist: Second lesion 20 40.000 357.60 20 40.000 357.60 30 13.000 729.50

1280Percutaneous transluminal angioplasty: First cardiologist: Third or subsequent lesions (each)

20 60.000 536.50 20 60.000 536.50 30 13.000 729.50

1281Percutaneous transluminal angioplasty: Second cardiologist: Third or subsequent lesions (each)

20 40.000 357.60 20 40.000 357.60 30 13.000 729.50

1282Use of balloon procedures including: First cardiologist: Atrial septostomy; Pulmonary valve valvuloplasty; Aortic valve valvuloplasty; Coarctation dilation; Mitral valve valvuloplasty

20 260.000 2 324.70 20 208.000 1 859.70 30 15.000 841.70

1283 Use of balloon procedure as in item 1282: Second cardiologist 20 140.000 1 251.70 20 120.000 1 072.90 30 15.000 841.70

1284 Atherectomy: Single lesion: First cardiologist 20 300.000 2 682.30 20 240.000 2 145.80 - - -

1285 Atherectomy: Single lesion: Second cardiologist 20 180.000 1 609.40 20 144.000 1 287.50 - - -

1286 Insertion of intravascular stent: First cardiologist 20 100.000 894.10 20 100.000 894.10 - - -

1287 Insertion of intravascular stent: Second cardiologist 20 50.000 447.10 20 50.000 447.10 - - -

The insertion of a stent(s) (item 1286 & 1267) may only be charged once per vessel regardless of the number of stents inserted in this vessel.

- - - - - - - - -

1290

Use of balloon procedures including: First paediatric cardiologist (33): Atrial septostomy; Pulmonary valve valvuloplasty; Aortic valve valvuloplasty; Coarctation dilation; Mitral valve valvuloplasty; Closure atrial septal defect; Closure of patient ductus arteriosus

20 300.000 2 682.30 - - - 30 15.000 841.70


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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1291 Use of balloon procedure as in item 1290: Second paediatric cardiologist (33) 20 160.000 1 430.60 - - - 30 15.000 841.70

1292 Multi-slice computed tomography coronary angiography: Own equipment 20 655.260 5 858.70 20 524.210 4 687.00 - - -

6.2.5 Invasive cardiology: Paediatric cardiac catheterisation - - - - - - - - -

1288 Cardiac catheterisation for congenital heart disease: All ages above 1 year old 20 210.000 1 877.60 20 168.000 1 502.10 30 12.000 673.40

1289 Paediatric cardiac catheterisation: Infants below the age of one year 20 263.000 2 351.50 20 210.400 1 881.20 30 12.000 673.40

6.3 Cardiac surgery - - - - - - - - -

1294 Patent ductus arteriosus 20 320.000 2 861.10 20 256.000 2 288.90 30 13.000 729.50

1295 Pericardiectomy for constrictive pericarditis 20 400.000 3 576.40 20 320.000 2 861.10 30 15.000 841.70

1297 Coarctation of aorta 20 425.000 3 799.90 20 340.000 3 039.90 30 15.000 841.70

1299 Systemo-pulmonary anastomosis 20 425.000 3 799.90 20 340.000 3 039.90 30 15.000 841.70

1301 Mitral valvotomy: Closed heart technique 20 350.000 3 129.40 20 280.000 2 503.50 30 15.000 841.70

1302 Heart transplant 20 875.000 7 823.40 20 700.000 6 258.70 30 15.000 841.70

1303 Harvesting donor heart 20 75.000 670.60 20 75.000 670.60 30 5.000 280.60

1305 Operative implantation of cardiac pacemaker by thoracotomy 20 220.000 1 967.00 20 176.000 1 573.60 30 15.000 841.70

1307 Re-exploration after cardiac surgery 20 215.000 1 922.30 20 172.000 1 537.90 30 15.000 841.70

1308 Heart and lung transplant 20 1000.000 8 941.00 20 800.000 7 152.80 30 15.000 841.70

1309 Harvesting donor heart and lungs 20 120.000 1 072.90 20 120.000 1 072.90 30 5.000 280.60

1311 Pericardial drainage 20 140.000 1 251.70 20 120.000 1 072.90 30 13.000 729.50

6.3.1 Cardiac surgery: Open heart surgery - - - - - - - - -

1312 Evaluation of coronary angiogram by cardiothoracic surgeon 20 25.000 223.50 - - - - - -

1320 Repeat open heart surgery (additional fee above procedure fee) 20 250.000 2 235.30 20 200.000 1 788.20 30 15.000 841.70

1321 Stand-by fee for coronary angioplasty 20 30.000 268.20 20 30.000 268.20 20 30.000 268.20

1322Attendance at other operations or monitoring at bedside, by physician e.g. heart block etc.: Per hour

20 20.000 178.80 - - - - - -

6.3.1.1 Cardiac surgery: Open heart surgery: Congenital conditions - - - - - - - - -

1323 Atrial septal defect: Osteum secundum 20 500.000 4 470.50 20 400.000 3 576.40 30 15.000 841.70

1325 Atrial septal defect: Sinus venosus or osteum primum 20 563.000 5 033.80 20 450.400 4 027.00 30 15.000 841.70

1327 Atrial septal defect: Ventricular septal defect 20 603.800 5 398.60 20 483.040 4 318.90 30 15.000 841.70

1329 Atrial septal defect: Fallot’s tetralogy 20 563.000 5 033.80 20 450.400 4 027.00 30 15.000 841.70

1330 Atrial septal defect: Pulmonary stenosis 20 500.000 4 470.50 20 400.000 3 576.40 30 15.000 841.70


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Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1331 Transposition of large vessels (venous repair) 20 563.000 5 033.80 20 450.400 4 027.00 30 15.000 841.70

1332 Transposition of great arteries (arterial repair) 20 750.000 6 705.80 20 600.000 5 364.60 30 15.000 841.70

1333 Ebstein’s Anomaly 20 563.000 5 033.80 20 450.400 4 027.00 30 15.000 841.70

1334Aorto-coronary bypass operation as a MidCab procedure (thoracotomy with coronary grafting without bypass or hypothermal)

20 548.800 4 906.80 20 439.040 3 925.50 30 20.000 1

122.30

1335 Total anomalous venous drainage 20 563.000 5 033.80 20 450.400 4 027.00 30 15.000 841.70

1336Aorto-coronary bypass operation as a OpCab procedure (sternotomy with coronary grafting without bypass or hypothermia)

20 658.900 5 891.20 20 527.120 4 713.00 30 20.000 1

122.30

1337 Creation of atrial septal defect by thoracotomy with or without cardiac bypass 20 500.000 4 470.50 20 400.000 3 576.40 30 15.000 841.70

1338 Fontan type repair 20 750.000 6 705.80 20 600.000 5 364.60 30 15.000 841.70

6.3.1.2 Cardiac surgery: Open heart surgery: Acquired conditions

1339 Mitral valve replacement 20 657.000 5 874.20 20 525.600 4 699.40 30 15.000 841.70

1340 Mitral valvuloplasty 20 688.000 6 151.40 20 550.400 4 921.10 30 15.000 841.70

1341 Aortic valve replacement 20 623.800 5 577.40 20 499.040 4 461.90 30 15.000 841.70

1342 Tricuspid annulo plasty 20 188.000 1 680.90 20 150.400 1 344.70 30 15.000 841.70

1343 Double valve replacement 20 968.900 8 662.90 20 775.120 6 930.40 30 15.000 841.70

1344 Acute dissecting aneurysm repair 20 750.000 6 705.80 20 600.000 5 364.60 30 15.000 841.70

1345 Aortic arch aneurysm repair utilising deep hypothermal and circulatory arrest 20 1000.000 8 941.00 20 800.000 7 152.80 30 15.000 841.70

1346Aorta-coronary bypass operation (including interpretation of angiogram): Harvesting of saphenous veins: Unilateral (modifier 0005 not applicable)

20 100.000 894.10 20 100.000 894.10 - - -

1347Aorta-coronary bypass operation (including interpretation of angiogram): Harvesting of saphenous veins: Bilateral (modifier 0005 not applicable)

20 175.000 1 564.70 20 140.000 1 251.70 - - -

1348Aorta-coronary bypass operation (including interpretation of angiogram): Utilizing saphenous veins

20 750.000 6 705.80 20 600.000 5 364.60 30 15.000 841.70

1349Aorta-coronary bypass operation (including interpretation of angiogram): Additional arterial implant: Any artery

20 781.000 6 982.90 20 624.800 5 586.30 30 15.000 841.70

1350Aorta-coronary bypass operation (including interpretation of angiogram): Additional double arterial implant: Any artery

20 813.000 7 269.00 20 650.400 5 815.20 30 15.000 841.70

1351Aorta-coronary bypass operation with valve replacement or excision of cardiac aneurysm

20 875.000 7 823.40 20 700.000 6 258.70 30 15.000 841.70


153 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1352 Cardiac aneurysm 20 563.000 5 033.80 20 450.400 4 027.00 30 15.000 841.70

1353 Ascending/descending thoracic aortic aneurysm repair 20 625.000 5 588.10 20 500.000 4 470.50 30 15.000 841.70

1354 Arrhythmia surgery 20 688.000 6 151.40 20 550.400 4 921.10 30 15.000 841.70

1355 Cardiac tumour 20 625.000 5 588.10 20 500.000 4 470.50 30 15.000 841.70

1356 Insertion and removal of intra-aortic balloon pump (modifier 0005 not applicable) 20 188.000 1 680.90 20 150.400 1 344.70 30 15.000 841.70

1358 Harvesting of radial artery 20 175.000 1 564.70 20 140.000 1 251.70 - - -

6.4 Peripheral vascular system - - - - - - - - -

MODIFIER GOVERNING THIS SECTION - - - - - - - - -

0072Non invasive peripheral vascular tests: The number of tests in a single case is restricted to two (2) per diagnosis. Tests are not justified in cases of uncomplicated varicose veins

- - - - - - - - -

6.4.1 Peripheral vascular system: Investigations - - - - - - - - -

1357 Skin temperature test: Response to reflex heating 20 15.000 134.10 20 15.000 134.10 - - -

1359 Skin temperature test: Response to reflex cooling 20 15.000 134.10 20 15.000 134.10 - - -

1361 Cold sensitivity test 20 17.000 152.00 20 17.000 152.00 - - -

1363 Oscillometry test 20 5.000 44.70 20 5.000 44.70 - - -

1365 Sweating test 20 17.000 152.00 20 17.000 152.00 - - -

1366 Transcutaneous oximetry: Transcutaneous oximetry - single site 20 26.300 235.20 20 26.300 235.20 - - -

1367 Doppler blood tests 20 6.000 53.70 20 6.000 53.70 - - -

5369 Doppler arterial pressures 20 6.000 53.70 20 6.000 53.70 - - -

5371 Doppler arterial pressures with exercise 20 10.000 89.40 20 10.000 89.40 - - -

5373 Doppler segmental pressures and wave forms 20 12.000 107.30 20 12.000 107.30 - - -

5375 Venous doppler examination (both limbs) 20 9.000 80.50 20 9.000 80.50 - - -

5377 Venous plethysmography 20 16.000 143.10 20 16.000 143.10 - - -

5379 Supra-orbital doppler test 20 5.000 44.70 20 5.000 44.70 - - -

5381 Carotid non-invasive complex tests 20 39.000 348.70 20 39.000 348.70 - - -

6.4.2 Peripheral vascular system: Arterio-venous abnormalities - - - - - - - - -

1369 Fistula or aneurysm (as for grafting of various arteries) - - - - - - - - -

6.4.3 Arteries - - - - - - - - -

6.4.3.1 Peripheral vascular system: Arteries: Aorta-iliac and major branches - - - - - - - - -


154 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1372 Abdominal aorta and iliac artery: Unruptured 20 540.000 4 828.10 20 432.000 3 862.50 30 15.000 841.70

1373 Abdominal aorta and iliac artery: Ruptured 20 600.000 5 364.60 20 480.000 4 291.70 30 15.000 841.70

1375 Grafting and/or thrombo-endarterectomy for thrombosis 20 444.000 3 969.80 20 355.200 3 175.80 30 15.000 841.70

1376Aorta bi-femoral graft, including proximal and distal endarterectomy and preparation for anastomosis

20 594.000 5 311.00 20 475.200 4 248.80 30 15.000 841.70

6.4.3.2 Peripheral vascular system: Arteries: Iliac artery - - - - - - - - -

1379 Prosthetic grafting and/or thrombo-endarterectomy 20 300.000 2 682.30 20 240.000 2 145.80 30 13.000 729.50

6.4.3.3 Peripheral vascular system: Arteries: Peripheral - - - - - - - - -

1385 Prosthetic grafting 20 255.000 2 280.00 20 204.000 1 824.00 30 5.000 280.60

1387 Grafting vein: Vein grafting proximal to knee joint 20 300.000 2 682.30 20 240.000 2 145.80 30 5.000 280.60

1388 Grafting vein: Distal to knee joint 20 444.000 3 969.80 20 355.200 3 175.80 30 5.000 280.60

1389 Grafting vein: Endarterectomy when not part of another specified procedure 20 264.000 2 360.40 20 211.200 1 888.30 30 5.000 280.60

1390 Grafting vein: Carotid endarterectomy 20 321.000 2 870.10 20 256.800 2 296.10 30 15.000 841.70

1393 Embolectomy: Peripheral embolectomy transfemoral 20 168.000 1 502.10 20 134.400 1 201.70 30 5.000 280.60

1395 Miscellaneous arterial procedures: Arterial suture: Trauma 20 125.000 1 117.60 20 100.000 894.10 30 5.000 280.60

1396

Suture major blood vessel (artery or vein) - trauma (major blood vessels are defined as aorta, innominate artery, carotid artery and vertebral artery, subclavian artery, axillary artery, iliac artery, common femoral and popliteal arteries are included because of popliteal artery. The vertebral and popliteal arteries are included because of the relevant inaccessibility of the arteries and difficult surgical exposure

20 264.000 2 360.40 20 211.200 1 888.30 30 15.000 841.70

1397 Profundoplasty 20 210.000 1 877.60 20 168.000 1 502.10 30 5.000 280.60

1399 Distal tibial (ankle region) 20 456.000 4 077.10 20 364.800 3 261.70 30 5.000 280.60

1401 Femoro-femoral 20 254.000 2 271.00 20 203.200 1 816.80 30 5.000 280.60

1402 Carotid-subclavian 20 288.000 2 575.00 20 230.400 2 060.00 30 8.000 448.90

1403 Axillo-femoral: (Bifemoral + 50%) 20 288.000 2 575.00 20 230.400 2 060.00 30 8.000 448.90

6.4.4 Peripheral vascular system: Veins - - - - - - - - -

1407 Ligation of saphenous vein 20 50.000 447.10 20 50.000 447.10 30 3.000 168.30

1408 Placement of Hickman catheter or similar 20 91.000 813.60 20 91.000 813.60 30 4.000 224.50

1410 Litigation of inferior vena cava: Abdominal 20 180.000 1 609.40 20 144.000 1 287.50 30 8.000 448.90


155 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1412 Umbrella operation on inferior vena cava: Abdominal 20 100.000 894.10 20 100.000 894.10 30 8.000 448.90

1413Combined procedure for varicose veins: Ligation of saphenous vein stripping, multiple ligation including of perforating veins as indicated: Unilateral

20 141.000 1 260.70 20 120.000 1 072.90 30 3.000 168.30

1415Combined procedure for varicose veins: Ligation of saphenous vein stripping, multiple ligation including of perforating veins as indicated: Bilateral

20 247.000 2 208.40 20 197.600 1 766.70 30 3.000 168.30

1417 Extensive sub-fascial ligation of perforating veins 20 125.000 1 117.60 20 120.000 1 072.90 30 3.000 168.30

1419 Lesser varicose vein procedures 20 31.000 277.20 20 31.000 277.20 30 3.000 168.30

1421Compression sclerotherapy of varicose veins: Per injection to a maximum of nine (9) injections per leg (excluding cost of material)

20 9.000 80.50 20 9.000 80.50 - - -

1425 Thrombectomy: Inferior vena cava (Trans-abdominal) 20 240.000 2 145.80 20 192.000 1 716.70 30 11.000 617.20

1427 Thrombectomy: IIlio-femoral 20 175.000 1 564.70 20 140.000 1 251.70 30 6.000 336.70

6.4.5 Peripheral vascular system: Portal hypertension - - - - - - - - -

1429 Porto-caval shunt 20 500.000 4 470.50 20 400.000 3 576.40 30 11.000 617.20

6.5 Cardiac rehabilitation - - - - - - - - -

1431Cardiac rehabilitation: Phase II: Exercise rehabilitation: Per patient per 60 minute session with a maximum of 5 patients per group

20 12.000 107.30 20 12.000 107.30 - - -

1432Cardiac rehabilitation: Phase III: Exercise rehabilitation: Per patient per 60 minute session with a maximum of 10 patients per group

20 6.000 53.70 20 6.000 53.70 - - -

Please note : a. A practitioner is only allowed to instruct one group at a time. b. Benefits are limited to 3 times per week for a period of 60 minutes with a maximum of 3 months.

- - - - - - - - -

7 Lympho Reticular System - - - - - - - - -

7.1 Spleen - - - - - - - - -

1435 Splenectomy (in all cases) 20 221.300 1 978.60 20 177.040 1 582.90 30 9.000 505.00

1436 Splenorrhaphy 20 231.800 2 072.50 20 185.440 1 658.00 30 9.000 505.00

7.2 Lymph nodes and lymphatic channels - - - - - - - - -

1439 Excision of lymph node for biopsy: Neck or axilla 20 65.000 581.20 20 65.000 581.20 30 4.000 224.50

1441 Excision of lymph node for biopsy: Groin 20 65.000 581.20 20 65.000 581.20 30 3.000 168.30


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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1443 Simple excision of lymph nodes for tuberculosis 20 91.000 813.60 20 91.000 813.60 30 3.000 168.30

1445 Radical excision of lymph nodes of neck: Total: Unilateral 20 315.000 2 816.40 20 252.000 2 253.10 30 5.000 280.60

1447 Radical excision of lymph nodes of neck: Total: Suprahyoid unilateral 20 235.000 2 101.10 20 188.000 1 680.90 30 5.000 280.60

1449 Radical excision of lymph nodes of axilla 20 160.000 1 430.60 20 128.000 1 144.50 30 4.000 224.50

1450Bone marrow transplantation: Cryopreservation of bone marrow or peripheral blood stem cells

20 58.000 518.60 20 58.000 518.60 30 5.000 280.60

1451 Radical excision of lymph nodes of groin: Ilio-inguinal 20 175.000 1 564.70 20 140.000 1 251.70 30 4.000 224.50

1453 Radical excision of lymph nodes of groin: Inguinal 20 150.000 1 341.20 20 120.000 1 072.90 30 4.000 224.50

1454Bone marrow transplantation: Plasma/cell separation using designated cell separator equipment (per hour) (specify time used)

20 39.000 348.70 20 39.000 348.70 30 5.000 280.60

1455 Retroperitoneal lymph adenectomy including pelvic, aortic and renal nodes 20 275.000 2 458.80 20 220.000 1 967.00 30 6.000 336.70

1456Bone marrow transplantation: Preparation for extra-corporeal equipment by the medical practitioner for plasma, platelet and leucocyte phaeresis

20 42.000 375.50 20 42.000 375.50 30 5.000 280.60

1457 Bone marrow biopsy: By trephine 20 13.000 116.20 20 13.000 116.20 30 3.000 168.30

1458 Bone marrow biopsy: Simple aspiration of marrow by means of trocar or cannula 20 8.000 71.50 20 8.000 71.50

1459 Staging laparotomy for lymphoma (including splenectomy 20 245.000 2 190.60 20 196.000 1 752.40 30 7.000 392.80

8 Digestive System - - - - - - - - -

MODIFIERS GOVERNING THIS SECTION - - - - - - - - -

0074Endoscopic procedures performed with own equipment: The basic procedure fee plus 33.33% (1/3) of that fee (“+” codes excluded) will apply where endoscopic procedures are performed with own equipment.

- - - - - - - - -

0075

Endoscopic procedures performed in own procedure room: The fee plus 21,00 clinical procedure units will apply where endoscopic procedures are performed in rooms with own equipment. This fee is chargeable by medical practitioners who own or rent the facility. Please note: Modifier 0075 is not applicable to any of the items for diagnostic procedures in the otorhinolaryngology sections of the tariff.

20 21.000 187.80 20 21.000 187.80 - - -

8.1 Oral cavity - - - - - - - - -

1461 All dental procedures - - - - - - 30 4.000 224.50

1463 Surgical biopsy of tongue or palate: Under general anaesthetic 20 35.000 312.90 20 35.000 312.90 30 4.000 224.50

1465 Surgical biopsy of tongue or palate: Under local anaesthetic 20 15.000 134.10 20 15.000 134.10 30 4.000 224.50

1467 Drainage of intra-oral abscess 20 31.000 277.20 20 31.000 277.20 30 4.000 224.50


157 • Version 4_21




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code CF Units Value

RCF Units

Value R

CF Units Value

R

1469 Local excision of mucosal lesion of oral cavity 20 23.000 205.60 20 23.000 205.60 30 4.000 224.50

1471Resection of malignant lesion of buccal mucosa including radical neck dissection (Commando operation), but not including reconstructive plastic procedure

20 549.000 4 908.60 20 439.200 3 926.90 30 7.000 392.80

1473Complicated reconstruction following major ablative procedure for head and neck cancer

20 - - 20 - - 30 7.000 392.80

1475 Cleft palate: Repair primary deformity with or without pharyngoplasty 20 215.000 1 922.30 20 172.000 1 537.90 30 6.000 336.70

1477 Cleft palate: Secondary repair 20 174.200 1 557.50 20 139.360 1 246.00 30 6.000 336.70

1478 Velopharyngeal reconstruction with myoneuro-vascular transfer (dynamic repair) 20 240.000 2 145.80 20 192.000 1 716.70 30 6.000 336.70

1479 Velopharyngeal reconstruction with or without pharyngeal flap (static repair) 20 227.000 2 029.60 20 181.600 1 623.70 30 6.000 336.70

1480 Repair of oronasal fistula (large) e.g. distant flap 20 227.000 2 029.60 20 181.600 1 623.70 30 6.000 336.70

1481 Repair of oronasal fistula (small) e.g. trapdoor: One stage or first stage 20 138.000 1 233.90 20 120.000 1 072.90 30 5.000 280.60

1482 Repair of oronasal fistula (large): Second stage 20 138.000 1 233.90 20 120.000 1 072.90 30 5.000 280.60

1483 Alveolar periosteal or other flaps for arch closure 20 138.000 1 233.90 20 120.000 1 072.90 30 4.000 224.50

1486 Closure of anterior nasal floor 20 138.000 1 233.90 20 120.000 1 072.90 30 5.000 280.60

8.2 Lips - - - - - - - - -

1484 Cleft lip repair: Lip adhesion (cleft lip) 20 95.000 849.40 20 95.000 849.40 30 5.000 280.60

1485 Local excision of benign lesion of lip 20 27.000 241.40 20 27.000 241.40 30 4.000 224.50

1487 Resection for lip malignancy 20 91.000 813.60 20 91.000 813.60 30 4.000 224.50

1489 Cleft lip repair: Repair unilateral cleft lip (with muscle reconstruction) 20 227.000 2 029.60 20 181.600 1 623.70 30 5.000 280.60

1490Cleft lip repair: Bilateral cleft lip repair (with muscle reconstruction): One of two stages

20 251.600 2 249.60 20 201.280 1 799.60 30 5.000 280.60

1491 Cleft lip repair: Repair bilateral cleft lip (with muscle reconstruction): One stage 20 329.900 2 949.60 20 263.920 2 359.70 30 5.000 280.60

1492 Cleft lip repair: Bilateral cleft lip repair: Second stage 20 227.000 2 029.60 20 181.600 1 623.70 30 5.000 280.60

1493 Cleft lip repair: Total revision of secondary cleft lip deformities 20 251.600 2 249.60 20 201.280 1 799.60 30 5.000 280.60

1494 Cleft lip repair: Partial revision of secondary cleft lip deformity 20 91.000 813.60 20 91.000 813.60 30 5.000 280.60

1495 Abbé or Estlander type flap (all stages included) 20 273.100 2 441.80 20 218.480 1 953.40 30 5.000 280.60

1497 Vermilionectomy 20 94.900 848.50 20 94.900 848.50 30 4.000 224.50

1499 Lip reconstruction following an injury: Direct repair 20 105.600 944.20 20 105.600 944.20 30 4.000 224.50

1501 Lip reconstruction following an injury or tumour removal: Flap repair 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

1503Lip reconstruction following an injury or tumour removal: Total reconstruction (first stage)

20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50


158 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1504Lip reconstruction following an injury or tumour removal: Subsequent stages (see item 0297)

20 104.000 929.90 20 104.000 929.90 30 4.000 224.50

8.3 Tongue - - - - - - - - -

1505 Partial glossectomy 20 225.000 2 011.70 20 180.000 1 609.40 30 6.000 336.70

1507 Local excision of lesion of tongue 20 27.000 241.40 20 27.000 241.40 30 4.000 224.50

8.4 Palate, uvula and salivary glands - - - - - - - - -

1509 Wide excision of lesion of palate 20 100.000 894.10 20 100.000 894.10 30 5.000 280.60

1511 Radical resection of palate (including skin graft) 20 250.000 2 235.30 20 200.000 1 788.20 30 7.000 392.80

1513 Excision of ranula 20 85.600 765.40 20 85.600 765.40 30 5.000 280.60

1515 Excision of sublingual salivary gland 20 120.000 1 072.90 20 120.000 1 072.90 30 4.000 224.50

1517 Excision of submandibular salivary gland 20 146.000 1 305.40 20 120.000 1 072.90 30 4.000 224.50

1519 Excision of submandibular salivary gland with suprahyoid dissection 20 150.000 1 341.20 20 120.000 1 072.90 30 5.000 280.60

1521 Excision of submandibular salivary gland: With radical neck dissection 20 352.000 3 147.20 20 281.600 2 517.80 30 6.000 336.70

1523 Local resection of parotid tumour 20 169.600 1 516.40 20 135.680 1 213.10 30 5.000 280.60

1525 Partial parotidectomy 20 310.000 2 771.70 20 248.000 2 217.40 30 5.000 280.60

1526 Total parotidectomy with preservation of facial nerve 20 358.500 3 205.40 20 286.800 2 564.30 30 5.000 280.60

1527 Total parotidectomy 20 358.500 3 205.40 20 286.800 2 564.30 30 5.000 280.60

1529 Parotidectomy: Extracapsular 20 300.000 2 682.30 20 240.000 2 145.80 30 5.000 280.60

1531 Drainage of parotid abscess 20 25.000 223.50 20 25.000 223.50 30 4.000 224.50

1533 Closure of salivary fistula 20 91.000 813.60 20 91.000 813.60 30 4.000 224.50

1535 Dilatation of salivary duct 20 10.000 89.40 20 10.000 89.40 30 4.000 224.50

1537 Operative removal of salivary calculus 20 55.000 491.80 20 55.000 491.80 30 4.000 224.50

1539 Salivary duct: Meatotomy 20 20.000 178.80 20 20.000 178.80 30 4.000 224.50

1541 Branchial cyst and/or fistula: Excision 20 140.000 1 251.70 20 120.000 1 072.90 30 5.000 280.60

1543 Excision of cystic hygroma 20 140.000 1 251.70 20 120.000 1 072.90 30 5.000 280.60

1544 Ludwig’s Angina: Drainage 20 42.000 375.50 20 42.000 375.50 30 9.000 505.00

8.5 Oesophagus - - - - - - - - -

1545 Oesophagoscopy with rigid instrument: First and subsequent 20 47.000 420.20 20 47.000 420.20 30 4.000 224.50

1549 Oesophagoscopy with dilatation of stricture 20 70.000 625.90 20 70.000 625.90 30 4.000 224.50

1550 Oesophagoscopy with removal of foreign body 20 70.000 625.90 20 70.000 625.90 30 4.000 224.50


159 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1551 Oesophagoscopy with insertion of indwelling oesophageal tube 20 80.000 715.30 20 80.000 715.30 30 4.000 224.50

1552 Injection and/or ligation of oesophageal varices (endoscopy inclusive) 20 80.000 715.30 20 80.000 715.30 30 4.000 224.50

1553Subsequent injection and/or ligation of oesophageal varices (endoscopy inclusive)

20 65.000 581.20 20 65.000 581.20 30 4.000 224.50

1554 Per-oral small bowel biopsy 20 25.000 223.50 20 25.000 223.50 30 4.000 224.50

1555 Repair of tracheal oesophageal fistula and oesophageal atresia 20 400.000 3 576.40 20 320.000 2 861.10 30 15.000 841.70

1557 Oesophageal dilatation 20 40.000 357.60 20 40.000 357.60 30 4.000 224.50

1559 Oesophagectomy: Two stage 20 500.000 4 470.50 20 400.000 3 576.40 30 11.000 617.20

1560 Oesophagectomy: Three stage 20 550.000 4 917.60 20 440.000 3 934.00 30 11.000 617.20

1561 Thoraco-abdominal oesophagogastrectomy 20 500.000 4 470.50 20 400.000 3 576.40 30 11.000 617.20

1563 Hiatus hernia and diaphragmatic hernia repair: With anti-reflux procedure 20 300.000 2 682.30 20 240.000 2 145.80 30 11.000 617.20

1565Hiatus hernia and diaphragmatic hernia repair: With Collis Nissen oesophageal lengthening procedure

20 350.000 3 129.40 20 280.000 2 503.50 30 11.000 617.20

1566 Private fee: Gastroplasty 20 325.000 2 905.80 20 260.000 2 324.70 30 8.000 448.90

1567 Bochdalek hernia repair in newborn 20 250.000 2 235.30 20 200.000 1 788.20 30 14.000 785.60

1568 Hiatus hernia and diaphragmatic repair: Revision after previous repair 20 375.000 3 352.90 20 300.000 2 682.30 30 11.000 617.20

1569 Heller’s operation 20 250.000 2 235.30 20 200.000 1 788.20 30 14.000 785.60

1575 Insertion of indwelling oesophageal tube by laparotomy 20 142.000 1 269.60 20 120.000 1 072.90 30 6.000 336.70

1578 Oesophageal motility (4 channel + pneumograph) 20 100.000 894.10 20 100.000 894.10 30 4.000 224.50

1579Oesophageal substitution (without oesophagectomy) using colon, small bowel or stomach

20 400.000 3 576.40 20 320.000 2 861.10 30 11.000 617.20

1580 Oesophageal motility (6 Channel + pneumograph + pH pull-through) 20 110.000 983.50 20 110.000 983.50 30 4.000 224.50

1581 Removal of benign oesophageal tumours 20 285.000 2 548.20 20 228.000 2 038.60 30 11.000 617.20

1582Oesophageal motility (4 or 6 channel + pneumograph - ECG + provocative tests for oesophageal spasm vs. myocardial ischaemia)

20 150.000 1 341.20 20 120.000 1 072.90 30 4.000 224.50

1583 Excision of intrathoracic oesophageal diverticulum 20 250.000 2 235.30 20 200.000 1 788.20 30 11.000 617.20

158424 Hour oesophageal pH studies: Hire fee (Item 0201 applicable for pro-rata of probe: 50 examinations per glass electrode pH probe and 10 examinations per antimone pH probe)

20 55.000 491.80 20 55.000 491.80 - - -

1585 24 Hour oesophageal pH studies: Interpretation 20 27.000 241.40 20 27.000 241.40 - - -

8.6 Stomach - - - - - - - - -


160 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1587 Upper gastro-intestinal endoscopy: Hospital equipment 20 48.750 435.90 20 48.750 435.90 30 4.000 224.50

1588 Plus polypectomy: ADD to gastro-intestinal endoscopy (Item 1587) 20 25.000 223.50 20 25.000 223.50 30 4.000 224.50

1589

Endoscopic control of gastrointestinal haemorrhage from upper gastrointestinal tract, intestines or large bowel by injection, ligation or application of energy device (endoscopic haemostasis) to be added to gastroscopy (item 1587) or colonoscopy (item 1653)

20 34.000 304.00 20 34.000 304.00 30 6.000 336.70

1591Plus removal of foreign bodies (stomach): ADD to gastro-intestinal endoscopy (Item 1587)

20 25.000 223.50 20 25.000 223.50 30 4.000 224.50

1593 Augmented histamine test: Gastric intubation with x-ray screening 20 5.000 44.70 20 5.000 44.70

1597 Gastrostomy or Gastrotomy 20 147.500 1 318.80 20 120.000 1 072.90 30 6.000 336.70

1598 Gastrotomy with suture repair of bleeding ulcer 20 251.200 2 246.00 20 200.960 1 796.80 30 6.000 336.70

1599 Pyloromyotomy (Rammstedt) 20 116.000 1 037.20 20 116.000 1 037.20 30 6.000 336.70

1601 Local excision of ulcer or benign neoplasm 20 195.600 1 748.90 20 156.480 1 399.10 30 6.000 336.70

1603 Vagotomy: Abdominal 20 150.000 1 341.20 20 120.000 1 072.90 30 6.000 336.70

1604 Vagotomy: Thoracic 20 150.000 1 341.20 20 120.000 1 072.90 30 11.000 617.20

1605 Truncal or selective with drainage procedures 20 250.000 2 235.30 20 200.000 1 788.20 30 6.000 336.70

1607 Vagotomy and antrectomy 20 320.000 2 861.10 20 256.000 2 288.90 30 6.000 336.70

1609 Highly selective vagotomy 20 250.000 2 235.30 20 200.000 1 788.20 30 6.000 336.70

1611 Pyloroplasty 20 180.200 1 611.20 20 144.160 1 288.90 30 6.000 336.70

1613 Gastroenterostomy 20 203.600 1 820.40 20 162.880 1 456.30 30 6.000 336.70

1615 Suture of perforated gastric or duodenal ulcer or wound or injury 20 200.000 1 788.20 20 160.000 1 430.60 30 7.000 392.80

1617 Partial gastrectomy 20 328.300 2 935.30 20 262.640 2 348.30 30 7.000 392.80

1619 Total gastrectomy 20 384.430 3 437.20 20 307.540 2 749.70 30 7.000 392.80

1621 Revision of gastrectomy or gastro-enterostomy 20 375.000 3 352.90 20 300.000 2 682.30 30 7.000 392.80

1625 Gastro-esophageal operation for portal hypertension (Tanner) 20 375.000 3 352.90 20 300.000 2 682.30 30 11.000 617.20

8.7 Duodenum - - - - - - - - -

1626Endoscopic examination of the small bowel beyond the duodenojenunal flexure with biopsy with or without polypectomy with or without arrest of haemorrhage (enteroscopy)

20 120.000 1 072.90 20 120.000 1 072.90 30 6.000 336.70

1627 Duodenal intubation (under X-ray screening) 20 8.000 71.50 - - - - - -

1629 Duodenal intubation with biliary drainage after gall bladder stimulation 20 21.000 187.80 - - - - - -


161 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1631 Duodenal intubation: Under 3 years of age 20 15.000 134.10 - - - - - -

8.8 Intestines - - - - - - - - -

1632 H2 breath test (intestines) 20 9.000 80.50 20 9.000 80.50 - - -

1633 Complete test using lactose or lactulose 20 27.000 241.40 20 27.000 241.40 - - -

1634 Enterotomy or Enterostomy 20 202.600 1 811.50 20 162.080 1 449.20 30 6.000 336.70

1635 Intestinal obstruction of the newborn 20 240.000 2 145.80 20 192.000 1 716.70 30 7.000 392.80

1637 Operation for relief of intestinal obstruction 20 240.000 2 145.80 20 192.000 1 716.70 30 7.000 392.80

1639 Resection of small bowel with enterostomy or anastomosis 20 244.900 2 189.70 20 195.920 1 751.70 30 6.000 336.70

1641 Entero-enterostomy or entero-colostomy for bypass 20 213.100 1 905.30 20 170.480 1 524.30 30 6.000 336.70

1642

Gastrointestinal tract imaging, intraluminal (e.g. video capsule endoscopy): Hire fee (item 0201 applicable for video capsule - disposable single patient use) (Please note: All patients should have had a normal gastroscopy and colonoscopy)

20 150.000 1 341.20 20 120.000 1 072.90 - - -

1643Gastrointestinal tract imaging, intraluminal (e.g. video capsule endoscopy), oesophagus through ileum: Doctor interpretation and report

20 90.000 804.70 20 90.000 804.70 - - -

1645 Suture of intestine (small or large): Perforated ulcer, wound or injury 20 185.200 1 655.90 20 148.160 1 324.70 30 6.000 336.70

1647 Closure of intestinal fistula 20 258.000 2 306.80 20 206.400 1 845.40 30 6.000 336.70

1649 Excision of Meckel’s diverticulum 20 179.800 1 607.60 20 143.840 1 286.10 30 6.000 336.70

1651 Excision of lesion of mesentery 20 171.600 1 534.30 20 137.280 1 227.40 30 4.000 224.50

1652 Laparotomy for mesenteric thrombosis 20 300.000 2 682.30 20 240.000 2 145.80 30 8.000 448.90

1653 Total colonoscopy: With hospital equipment (including biopsy) 20 90.000 804.70 20 90.000 804.70 30 4.000 224.50

1654 Plus removal of polyps: ADD to colonoscopy (Item 1653) 20 30.000 268.20 20 30.000 268.20 30 4.000 224.50

1656 Left-sided colonoscopy 20 60.000 536.50 20 60.000 536.50 30 4.000 224.50

1657 Right or left hemicolectomy or segmental colectomy 20 325.000 2 905.80 20 260.000 2 324.70 30 6.000 336.70

1658 Reconstruction of colon after Hartman’s procedure 20 359.400 3 213.40 20 287.520 2 570.70 30 6.000 336.70

1661 Colotomy: Including removal of tumour or foreign body 20 205.700 1 839.20 20 164.560 1 471.30 30 6.000 336.70

1663 Total colectomy 20 390.000 3 487.00 20 312.000 2 789.60 30 6.000 336.70

1665 Colostomy or ileostomy isolated procedure 20 233.800 2 090.40 20 187.040 1 672.30 30 6.000 336.70

1666 Continent ileostomy pouch (all types) 20 300.000 2 682.30 20 240.000 2 145.80 30 6.000 336.70

1667 Colostomy: Closure 20 179.100 1 601.30 20 143.280 1 281.10 30 5.000 280.60


162 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1668 Revision of ileostomy pouch 20 375.000 3 352.90 20 300.000 2 682.30 30 6.000 336.70

1669 Total proctocolectomy and ileostomy 20 480.000 4 291.70 20 384.000 3 433.30 30 7.000 392.80

1670 Proctocolectomy, ileostomy and ileostomy pouch 20 540.000 4 828.10 20 432.000 3 862.50 30 7.000 392.80

1671 Colomyotomy (Reilly operation) 20 185.000 1 654.10 20 148.000 1 323.30 30 6.000 336.70

8.9 Appendix - - - - - - - - -

1673 Drainage of appendix abscess 20 150.000 1 341.20 20 120.000 1 072.90 30 5.000 280.60

1675 Appendicectomy 20 160.000 1 430.60 20 128.000 1 144.50 30 4.000 224.50

8.10 Rectum and anus - - - - - - - - -

1676 Flexible sigmoidoscopy (including rectum and anus): Hospital equipment. 20 48.750 435.90 20 48.750 435.90 30 3.000 168.30

1677 Sigmoidoscopy: First and subsequent, with or without biopsy 20 13.000 116.20 20 13.000 116.20 30 3.000 168.30

1678 Plus polypectomy: ADD to sigmoidoscopy (Item 1676) 20 25.000 223.50 20 25.000 223.50 30 3.000 168.30

1679 Sigmoidoscopy with removal of polyps, first and subsequent 20 30.000 268.20 20 30.000 268.20 30 3.000 168.30

1681 Proctoscopy with removal of polyps: First time 20 21.000 187.80 20 21.000 187.80 30 3.000 168.30

1683 Proctoscopy with removal of polyps: Subsequent times 20 15.000 134.10 20 15.000 134.10 30 3.000 168.30

1685 Endoscopic fulguration of tumour 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

1687Anterior resection of rectum performed for carcinoma of rectum including excision of any part of proximal colon necessary

20 381.300 3 409.20 20 305.040 2 727.40 30 6.000 336.70

1688Total mesorectal excision with colo-anal anastomosis and defunctioning enterostomy or colostomy

20 445.000 3 978.80 20 356.000 3 183.00 30 8.000 448.90

1689 Perineal resection of rectum 20 141.000 1 260.70 20 120.000 1 072.90 30 5.000 280.60

Please note: Items 1691 and 1692: Abdominal and/or perineal assistant’s fee to be charged additionally.

- - - - - - - - -

1691 Abdomino-perineal resection of rectum: Abdominal surgeon 20 409.300 3 659.60 20 327.440 2 927.60 30 7.000 392.80

1692 Abdomino-perineal resection of rectum: Perineal surgeon 20 158.500 1 417.20 20 126.800 1 133.70 - - -

1693Abdomino-perineal resection of rectum: Local excision of rectal tumour (posterior approach)

20 200.000 1 788.20 20 160.000 1 430.60 30 4.000 224.50

1695Abdomino-perineal resection of rectum: Combined abdomino-anal pull-through procedure for Hirschsprung’s disease, rectal agenesis or tumour

20 400.000 3 576.40 20 320.000 2 861.10 30 7.000 392.80

1697 Repair of prolapsed rectum: Abdominal: Roscoe Graham Moskovitz 20 300.000 2 682.30 20 240.000 2 145.80 30 6.000 336.70

1699 Repair of prolapsed rectum: Abdominal: Ivalon sponge 20 200.000 1 788.20 20 160.000 1 430.60 30 6.000 336.70

1701 Repair of prolapsed rectum: Abdominal: Perineal 20 150.000 1 341.20 20 120.000 1 072.90 30 4.000 224.50


163 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1703 Repair of prolapsed rectum: Abdominal: Thierisch suture 20 35.000 312.90 20 35.000 312.90 30 4.000 224.50

1705 Incision and drainage of peri-anal abscess 20 40.000 357.60 20 40.000 357.60 30 3.000 168.30

1707 Drainage of submucous abscess 20 40.000 357.60 20 40.000 357.60 30 3.000 168.30

1709 Drainage of ischio-rectal abscess 20 87.000 777.90 20 87.000 777.90 30 3.000 168.30

1711 Excision of pelvi-rectal fistula 20 200.000 1 788.20 20 160.000 1 430.60 30 5.000 280.60

1713 Excision of fistula-in-ano 20 105.000 938.80 20 105.000 938.80 30 3.000 168.30

1715 Operation for fissure-in-ano 20 66.800 597.30 20 66.800 597.30 30 3.000 168.30

1719 Rubber band ligation of haemorrhoids: Per haemorrhoid 20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

1721 Sclerosing injection for haemorrhoids: Per injection 20 5.000 44.70 20 5.000 44.70

1723 Haemorrhoidectomy 20 120.000 1 072.90 20 120.000 1 072.90 30 3.000 168.30

1725 Drainage of external thrombosed pile 20 12.500 111.80 20 12.500 111.80 30 3.000 168.30

1727 Multiple procedures (haemorrhoids, fissure, etc.) 20 90.000 804.70 20 90.000 804.70 30 3.000 168.30

1728 Biopsy of ano-rectal wall, for congenital megacolon 20 60.600 541.80 20 60.600 541.80 30 5.000 280.60

1729 Excision of anal skin tags 20 25.000 223.50 20 25.000 223.50 30 3.000 168.30

1731 Operation for low imperforate anus 20 105.000 938.80 20 105.000 938.80 30 6.000 336.70

1733 Anoplasty: Y-V-plasty 20 41.000 366.60 20 41.000 366.60 30 3.000 168.30

1735 Anal sphincteroplasty for incontinence 20 120.000 1 072.90 20 120.000 1 072.90 30 3.000 168.30

1737 Dilation of ano-rectal stricture 20 12.500 111.80 20 12.500 111.80 30 3.000 168.30

1739 Closure of recto-vesical fistula 20 241.000 2 154.80 20 192.800 1 723.80 30 5.000 280.60

1741 Closure of recto-urethral fistula 20 241.000 2 154.80 20 192.800 1 723.80 30 5.000 280.60

1742Bio-feedback training for faecal incontinence during anorectal manometry performed by doctor

20 27.000 241.40 20 27.000 241.40 - - -

8.11 Liver - - - - - - - - -

1743 Needle biopsy of liver 20 30.300 270.90 20 30.300 270.90 30 3.000 168.30

1745 Biopsy of liver by laparotomy 20 125.000 1 117.60 20 120.000 1 072.90 30 4.000 224.50

1747 Drainage of liver abscess or cyst 20 179.100 1 601.30 20 143.280 1 281.10 30 7.000 392.80

1748 Body composition measured by bio-electrical impedance 20 3.000 26.80 20 3.000 26.80 - - -

1749 Hemi-hepatectomy: Right 20 564.000 5 042.70 20 451.200 4 034.20 30 9.000 505.00

1751 Hemi-hepatectomy: Left 20 521.100 4 659.20 20 416.880 3 727.30 30 9.000 505.00

1752 Extended right or left hepatectomy 20 570.900 5 104.40 20 456.720 4 083.50 30 9.000 505.00


164 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1753 Partial or segmental hepatectomy 20 378.000 3 379.70 20 302.400 2 703.80 30 9.000 505.00

1754 Hepatico-jejunostomy 20 369.200 3 301.00 20 295.360 2 640.80 30 9.000 505.00

1755Liver transplant

20 1400.800 12 524.60 20 1120.640 10

019.60 30 15.000 841.70

1756 Harvesting donor hepatectomy 20 616.200 5 509.40 20 492.960 4 407.60 30 5.000 280.60

1757 Suture of liver wound or injury 20 214.200 1 915.20 20 171.360 1 532.10 30 9.000 505.00

8.12 Biliary tract - - - - - - - - -

1759 Cholecystostomy 20 171.600 1 534.30 20 137.280 1 227.40 30 6.000 336.70

1761 Cholecystectomy 20 225.000 2 011.70 20 180.000 1 609.40 30 6.000 336.70

1762 Cholecystectomy and operative cholangiogram 20 255.000 2 280.00 20 204.000 1 824.00 30 6.000 336.70

1763 With exploration of common bile duct 20 264.500 2 364.90 20 211.600 1 891.90 30 6.000 336.70

1765 Exploration of common bile duct: Secondary operation 20 327.700 2 930.00 20 262.160 2 344.00 30 6.000 336.70

1767 Reconstruction of common bile duct 20 371.700 3 323.40 20 297.360 2 658.70 30 6.000 336.70

1768 Resection bile duct tumour with reconstruction 20 327.700 2 930.00 20 262.160 2 344.00 30 6.000 336.70

1769 Cholecysto-enterostomy or gastrostomy 20 236.300 2 112.80 20 189.040 1 690.20 30 6.000 336.70

1772 Endoscopic placement of a nasobiliary drainage tube: ADD to ERCP (item 1778) 20 25.600 228.90 20 25.600 228.90 30 6.000 336.70

1773 Transduodenal sphincteroplasty 20 225.000 2 011.70 20 180.000 1 609.40 30 6.000 336.70

1774 Balloon dilatation of common bile duct strictures 20 125.000 1 117.60 20 100.000 894.10 30 6.000 336.70

1775 Excision choledochal cyst with reconstruction 20 327.700 2 930.00 20 262.160 2 344.00 30 6.000 336.70

1777 Porto-enterostomy for biliary atresia 20 400.000 3 576.40 20 320.000 2 861.10 30 11.000 617.20

8.13 Pancreas - - - - - - - - -

1778Endoscopic Retrograde Cholangiopancreatography (ERCP): Endoscopy + catheterisation of pancreas duct or choledochus

20 105.900 946.90 20 105.900 946.90 30 4.000 224.50

1779Endoscopic retrograde removal of stone(s) as for biliary and/or pancreatic duct. ADD to ERCP (item 1778)

20 15.820 141.50 20 15.820 141.50 30 4.000 224.50

1780 Gastric and duodenal intubation 20 8.000 71.50 20 8.000 71.50 - - -

1781 Procedure (excluding laboratory tests) 20 21.000 187.80 20 21.000 187.80 - - -

1782 Endoscopic Sphincterotomy: ADD to ERCP (item 1778) 20 30.000 268.20 20 30.000 268.20 30 4.000 224.50

1783 Drainage of pancreatic abscess 20 239.300 2 139.60 20 191.440 1 711.70 30 6.000 336.70

1784 Debridement pancreatic necrosis 20 348.400 3 115.00 20 278.720 2 492.00 30 6.000 336.70


165 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

1785 Internal drainage of pancreatic cyst 20 250.600 2 240.60 20 200.480 1 792.50 30 6.000 336.70

1770 Endoscopic placement of biliduodenal endoprosthesis: ADD to ERCP (item 1778) 20 30.000 268.20 20 30.000 268.20 30 6.000 336.70

1786 Internal drainage of pancreatic cyst with Roux-Y 20 306.800 2 743.10 20 245.440 2 194.50 30 6.000 336.70

1787 Operative pancreatogram: ADD 20 10.000 89.40 20 10.000 89.40 - - -

1788 Biopsy of pancreas 20 177.700 1 588.80 20 142.160 1 271.10 30 6.000 336.70

1789 Pancreatico-duodenectomy 20 704.800 6 301.60 20 563.840 5 041.30 30 8.000 448.90

1791 Local, partial or subtotal pancreatectomy 20 351.300 3 141.00 20 281.040 2 512.80 30 8.000 448.90

1793 Distal pancreatectomy with internal drainage 20 377.400 3 374.30 20 301.920 2 699.50 30 8.000 448.90

8.14 Peritoneal cavity - - - - - - - - -

1797 Pneumo-peritoneum: First 20 13.000 116.20 20 13.000 116.20 30 4.000 224.50

1799 Pneumo-peritoneum: Repeat 20 6.000 53.70 20 6.000 53.70 30 4.000 224.50

1800 Peritoneal lavage 20 20.000 178.80 20 20.000 178.80 - - -

1801 Diagnostic paracentesis: Abdomen 20 8.000 71.50 20 8.000 71.50 - - -

1803 Therapeutic paracentesis: Abdomen 20 13.000 116.20 20 13.000 116.20 - - -

1807ADD to open procedure where procedure was performed through a laparoscope (for anaesthetic refer to modifier 0027)

20 45.000 402.40 20 45.000 402.40 30 5.000 280.60

1809 Laparotomy 20 196.000 1 752.40 20 156.800 1 402.00 30 4.000 224.50

1810Radical removal of retro-peritoneal malignant tumours (including sacro-coccygeal and pre-sacral)

20 350.000 3 129.40 20 280.000 2 503.50 30 7.000 392.80

1811 Suture of burst abdomen 20 188.300 1 683.60 20 150.640 1 346.90 30 7.000 392.80

1812 Laparotomy for control of surgical haemorrhage 20 105.000 938.80 20 105.000 938.80 30 9.000 505.00

1813 Drainage of sub-phrenic abscess 20 180.000 1 609.40 20 144.000 1 287.50 30 7.000 392.80

1815Drainage of other intraperitoneal abscess (excluding appendix abscess): Transabdominal

20 248.400 2 220.90 20 198.720 1 776.80 30 5.000 280.60

1817Drainage of other intraperitoneal abscess (excluding appendix abscess): Transrectal drainage of pelvic abscess

20 75.000 670.60 20 75.000 670.60 30 4.000 224.50

9 Herniae - - - - - - - - -

1819 Inguinal or femoral hernia: Adult 20 125.000 1 117.60 20 120.000 1 072.90 30 4.000 224.50

1821 Inguinal or femoral hernia: Child under 14 years 20 90.000 804.70 20 90.000 804.70 30 4.000 224.50

1823 Inguinal hernia: Infant under one year 20 100.000 894.10 20 100.000 894.10 30 4.000 224.50

1825 Recurrent inguinal or femoral hernia 20 155.000 1 385.90 20 124.000 1 108.70 30 4.000 224.50


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code CF Units Value

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CF Units Value

R

1827 Strangulated hernia or femoral hernia 20 238.000 2 128.00 20 190.400 1 702.40 30 7.000 392.80

1829 Epigastric hernia 20 93.300 834.20 20 93.300 834.20 30 4.000 224.50

1831 Umbilical hernia: Adult 20 140.000 1 251.70 20 120.000 1 072.90 30 4.000 224.50

1833 Umbilical hernia: Child under 14 years 20 60.000 536.50 20 60.000 536.50 30 4.000 224.50

1835 Incisional hernia 20 166.800 1 491.40 20 133.440 1 193.10 30 4.000 224.50

1836Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in addition to item for the incisional or ventral hernia repair)

20 77.000 688.50 20 77.000 688.50 30 4.000 224.50

1837 Repair of omphalocele in new-born (one or more procedures) 20 275.000 2 458.80 20 220.000 1 967.00 30 7.000 392.80

10 Urinary System - - - - - - - - -

RULES GOVERNING THE SECTION URINARY SYSTEM - - - - - - - - -

FF.

(a) When a cystoscopy precedes a related operation, Modifier 0013: Endoscopic examination done at an operation, applies, e.g. cystoscopy followed by transurethral (TUR) prostatectomy. (b) When a cystoscopy precedes an unrelated operation, Modifier 0005: Multiple procedures/operations under the same anaesthetic, applies, e.g. cystoscopy for urinary tract infection followed by inguinal hernia repair. (c) No modifier applies to item 1949: Cystoscopy, when performed together with any of items 1951 to 1973.

- - - - - - - - -

10.1 Kidney - - - - - - - - -

1839 Renal biopsy: Per kidney: Open 20 71.000 634.80 20 71.000 634.80 30 5.000 280.60

1841 Renal biopsy: Needle 20 30.000 268.20 20 30.000 268.20 30 3.000 168.30

1843 Peritoneal dialysis: First day 20 33.000 295.10 20 33.000 295.10 - - -

1845 Peritoneal dialysis: Every subsequent day 20 33.000 295.10 20 33.000 295.10 - - -

1847 Haemodialysis: Per hour or part thereof 20 21.000 187.80 20 21.000 187.80 - - -

1849 Haemodialysis: Maximum: Eight hours 20 168.000 1 502.10 20 134.400 1 201.70 - - -

1851 Haemodialysis: Thereafter per week 20 55.000 491.80 20 55.000 491.80 - - -

1852 Continuous haemodiafiltration per day in intensive or high care unit 20 33.000 295.10 20 33.000 295.10 - - -

1853 Nephrectomy: Primary nephrectomy 20 225.000 2 011.70 20 180.000 1 609.40 30 5.000 280.60

1855 Nephrectomy: Secondary nephrectomy 20 267.000 2 387.30 20 213.600 1 909.80 30 5.000 280.60

1857 Radical with regional lymph adenectomy for tumour 20 280.000 2 503.50 20 224.000 2 002.80 30 6.000 336.70

1859 Nephrectomy: Partial 20 267.000 2 387.30 20 213.600 1 909.80 30 5.000 280.60

1861 Symphysiotomy for horse-shoe kidney 20 287.000 2 566.10 20 229.600 2 052.90 30 6.000 336.70


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code CF Units Value

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R

1863 Nephro-ureterectomy 20 305.000 2 727.00 20 244.000 2 181.60 30 5.000 280.60

1865 Nephrotomy with drainage nephrostomy 20 189.000 1 689.90 20 151.200 1 351.90 30 6.000 336.70

1869 Nephrolithotomy 20 227.000 2 029.60 20 181.600 1 623.70 30 5.000 280.60

1870 Nephrolithotomy: Multiple calculi: Repeat open operation + 25% 20 284.000 2 539.20 20 227.200 2 031.40 30 5.000 280.60

1871 Staghorn stone: Surgical 20 341.000 3 048.90 20 272.800 2 439.10 30 6.000 336.70

1873 Suture renal laceration (renorraphy) 20 193.000 1 725.60 20 154.400 1 380.50 30 6.000 336.70

1875 Percutaneous aspiration cyst: Nephrostomy, pyelostomy 20 34.000 304.00 20 34.000 304.00 30 3.000 168.30

1877 Operation for renal cyst: Marsupialisation or excision 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

1879 Closure renal fistula 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

1881 Pyeloplasty 20 252.000 2 253.10 20 201.600 1 802.50 30 5.000 280.60

1883 Pyelostomy 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

1885 Pyelolithotomy 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

1887Complicated pyelo-lithotomy (e.g. solitary, ectopic, horse-shoe kidney or secondary operation)

20 223.000 1 993.80 20 178.400 1 595.10 30 5.000 280.60

1889 Nephrectomy for Allograft: Living or dead 20 255.000 2 280.00 20 204.000 1 824.00 30 5.000 280.60

1891 Perinephric abscess or renal abscess: Drainage 20 200.000 1 788.20 20 160.000 1 430.60 30 7.000 392.80

1893 Aberrant renal vessels: Repositioning with pyeloplasty 20 210.000 1 877.60 20 168.000 1 502.10 30 5.000 280.60

1894 Auto transplantation of kidney 20 420.000 3 755.20 20 336.000 3 004.20 30 10.000 561.10

1895 Allo transplantation of kidney 20 420.000 3 755.20 20 336.000 3 004.20 30 10.000 561.10

10.2 Ureter - - - - - - - - -

1897 Ureterorraphy: Suture of ureter 20 147.000 1 314.30 20 120.000 1 072.90 30 5.000 280.60

1898 Ureterorraphy: Lumbar approach 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

1899 Ureteroplasty 20 181.000 1 618.30 20 144.800 1 294.70 30 5.000 280.60

1901 Ureterolysis 20 118.000 1 055.00 20 118.000 1 055.00 30 5.000 280.60

1902 Ureterolysis: Lumbar approach 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

1903 Ureterectomy only 20 137.000 1 224.90 20 120.000 1 072.90 30 5.000 280.60

1905 Ureterolithotomy 20 265.800 2 376.50 20 212.640 1 901.20 30 5.000 280.60

1907 Cutaneous ureterostomy: Unilateral 20 108.000 965.60 20 108.000 965.60 30 5.000 280.60

1909 Cutaneous ureterostomy: Bilateral 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

1911 Uretero-enterostomy: Unilateral 20 137.000 1 224.90 20 120.000 1 072.90 30 5.000 280.60


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R

1913 Uretero-enterostomy: Bilateral 20 240.000 2 145.80 20 192.000 1 716.70 30 5.000 280.60

1915 Uretero-ureterostomy 20 137.000 1 224.90 20 120.000 1 072.90 30 5.000 280.60

1917 Transuretero-ureterostomy 20 155.000 1 385.90 20 124.000 1 108.70 30 5.000 280.60

1919 Closure of ureteric fistula 20 147.000 1 314.30 20 120.000 1 072.90 30 5.000 280.60

1921 Immediate deligation of ureter 20 147.000 1 314.30 20 120.000 1 072.90 30 5.000 280.60

1923 Ureterolysis for retrocaval ureter with anastomosis 20 168.000 1 502.10 20 134.400 1 201.70 30 5.000 280.60

1925 Uretero-pyelostomy 20 252.000 2 253.10 20 201.600 1 802.50 30 5.000 280.60

1927 Uretero-neo-cystostomy: Unilateral 20 316.100 2 826.30 20 252.880 2 261.00 30 5.000 280.60

1929 Uretero-neo-cystostomy: Bilateral 20 474.150 4 239.40 20 379.320 3 391.50 30 5.000 280.60

1931 Uretero-neo-cystostomy: With Boariplasty 20 351.800 3 145.40 20 281.440 2 516.40 30 5.000 280.60

1933 Uretero-sigmoidostomy with rectal bladder and colostomy 20 252.000 2 253.10 20 201.600 1 802.50 30 5.000 280.60

1935 Uretero-ileal conduit 20 388.000 3 469.10 20 310.400 2 775.30 30 5.000 280.60

1937 Replacement of ureter by bowel segment: Unilateral 20 277.000 2 476.70 20 221.600 1 981.30 30 5.000 280.60

1939 Replacement of ureter by bowel segment: Bilateral 20 485.000 4 336.40 20 388.000 3 469.10 30 5.000 280.60

1941 Ureterostomy-in-situ: Unilateral 20 100.000 894.10 20 100.000 894.10 30 5.000 280.60

1943 Ureterostomy-in-situ: Bilateral 20 175.000 1 564.70 20 140.000 1 251.70 30 5.000 280.60

10.3 Bladder - - - - - - - - -

1952 J J Stent catheter 20 44.000 393.40 20 44.000 393.40 30 3.000 168.30

1953 With hydrodilatation of the bladder for interstitial cystitis 20 5.000 44.70 20 5.000 44.70 30 3.000 168.30

1954 Uretroscopy 20 35.000 312.90 - - - 30 3.000 168.30

1955And bilateral ureteric catheterisation with differential function studies requiring additional attention time

20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

1957 With dilatation of the ureter or ureters 20 25.000 223.50 20 25.000 223.50 30 3.000 168.30

1959 With manipulation of ureteral calculus 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

1961 With removal of foreign body or calculus from urethra or bladder 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

1963 With fulguration or treatment of minor lesions, with or without biopsy 20 15.000 134.10 20 15.000 134.10 30 3.000 168.30

1964 And control of haemorrhage and blood clot evacuation 20 15.000 134.10 20 15.000 134.10 30 3.000 168.30

1965 And catheterisation of the ejaculatory duct 20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

1967 With ureteric meatotomy: Unilateral or bilateral 20 15.000 134.10 20 15.000 134.10 30 3.000 168.30

1969 And cold biopsy 20 15.000 134.10 20 15.000 134.10 30 3.000 168.30


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R

1971 With cryosurgery for bladder or prostatic disease 20 55.000 491.80 20 55.000 491.80 30 3.000 168.30

1973With incision fulguration, or resection of bladder neck and/or posterior urethra for congenital valves or obstructive hypertrophic bladder neck in a child

20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

1975 Ultraviolet cystoscopy for bladder tumour 20 60.000 536.50 20 60.000 536.50 30 3.000 168.30

1976 Optic urethrotomy 20 80.000 715.30 20 80.000 715.30 30 3.000 168.30

1977 Transurethral resection of ejaculatory duct 20 60.700 542.70 20 60.700 542.70 30 3.000 168.30

1979 Internal urethrotomy: Female 20 50.000 447.10 20 50.000 447.10 30 3.000 168.30

1981 Internal urethrotomy: Male 20 76.200 681.30 20 76.200 681.30 30 3.000 168.30

1983 Transurethral resection of bladder tumour 20 100.000 894.10 20 100.000 894.10 30 5.000 280.60

1984 Transurethral resection of bladder tumours: Large multiple tumours 20 115.000 1 028.20 20 115.000 1 028.20 30 5.000 280.60

1985 Transurethral resection of bladder neck: Female or child 20 105.000 938.80 20 105.000 938.80 30 5.000 280.60

1986 Transurethral resection of bladder neck: Male 20 125.000 1 117.60 20 120.000 1 072.90 30 5.000 280.60

1987 Litholapaxy 20 80.000 715.30 20 80.000 715.30 30 5.000 280.60

1989 Cystometrogram 20 25.000 223.50 20 25.000 223.50 30 3.000 168.30

1991 Flometric bladder, studies with videocystograph 20 40.000 357.60 20 40.000 357.60 30 3.000 168.30

1992 Without videocystograph 20 25.000 223.50 20 25.000 223.50 30 3.000 168.30

1993 Voiding cysto-urethrogram 20 21.000 187.80 20 21.000 187.80 30 3.000 168.30

1994 Rigiscan examination 20 66.000 590.10 20 66.000 590.10 - - -

1995 Percutaneous aspiration of bladder 20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

1996 Bladder catheterisation: Male (not at operation) 20 6.000 53.70 20 6.000 53.70 30 3.000 168.30

1997 Bladder catheterisation: Female (not at operation) 20 3.000 26.80 20 3.000 26.80 - - -

1999 Percutaneous cystostomy 20 24.000 214.60 20 24.000 214.60 30 3.000 168.30

1945 Instillation of radio-opaque material for cystography or urethrocystography 20 5.000 44.70 20 5.000 44.70 30 3.000 168.30

1947Instillation of anti-carcinogenic agent including retention time, but not cost of material or hydro-dilatation of bladder

20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

1949 Cystoscopy: Hospital equipment 20 44.000 393.40 20 44.000 393.40 30 3.000 168.30

1951And retrograde pyelography or retrograde ureteral catheterisation: Unilateral or bilateral

20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

2001 Total cystectomy: After previous urinary diversion 20 294.000 2 628.70 20 235.200 2 102.90 30 8.000 448.90

2003 Total cystectomy: With conduit construction and ureteric anastomosis 20 554.700 4 959.60 20 443.760 3 967.70 30 8.000 448.90


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code CF Units Value

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R

2005Cystectomy with substitute bowel bladder construction with anastomosis to urethra or trigone

20 650.000 5 811.70 20 520.000 4 649.30 30 8.000 448.90

2006 Cystectomy with continent urinary diversion (e.g. Kocks Pouch) 20 700.000 6 258.70 20 560.000 5 007.00 30 8.000 448.90

2007 Partial cystectomy 20 147.000 1 314.30 20 120.000 1 072.90 30 6.000 336.70

2008 Continent urinary diversion without cystectomy (e.g. Kocks Pouch) 20 600.000 5 364.60 20 480.000 4 291.70 30 8.000 448.90

2009Radical total cystectomy with block dissection, ileal conduit and transplantation of ureters

20 462.000 4 130.70 20 369.600 3 304.60 30 8.000 448.90

2010 Reversion of temporary conduit 20 360.000 3 218.80 20 288.000 2 575.00 30 8.000 448.90

2011 Partial cystectomy with uretero-neo-cystostomy 20 202.000 1 806.10 20 161.600 1 444.90 30 6.000 336.70

2012 Reversion of conduit with major urinary tract reconstruction 20 600.000 5 364.60 20 480.000 4 291.70 30 8.000 448.90

2013 Diverticulectomy (independent procedure): Multiple or single 20 137.000 1 224.90 20 120.000 1 072.90 30 5.000 280.60

2015 Suprapubic cystostomy 20 67.000 599.10 20 67.000 599.10 30 5.000 280.60

2016 Abdomino-neo-urethrostomy 20 252.000 2 253.10 20 201.600 1 802.50 30 5.000 280.60

2017 Open loop fulguration or excision of bladder tumour 20 101.000 903.00 20 101.000 903.00 30 5.000 280.60

2019 Operation for vesico-vaginal or urethra-vaginal fistula 20 155.000 1 385.90 20 124.000 1 108.70 30 5.000 280.60

2020 Repair of vesico vaginal fistula: Abdominal approach 20 255.000 2 280.00 20 204.000 1 824.00 30 5.000 280.60

2021 Vesico-plication (Hamilton Stewart) 20 118.000 1 055.00 20 118.000 1 055.00 30 5.000 280.60

2023 Vesico-urethropexy for correction or urinary incontinence: Abdominal approach 20 195.000 1 743.50 20 156.000 1 394.80 30 5.000 280.60

2025 Vesico-urethropexy with rectus sling 20 229.400 2 051.10 20 183.520 1 640.90 30 5.000 280.60

2027 Open operation for ureterocele: Unilateral 20 118.000 1 055.00 20 118.000 1 055.00 30 5.000 280.60

2029 Open operation for ureterocele: Bilateral 20 207.000 1 850.80 20 165.600 1 480.60 30 5.000 280.60

2031Reconstruction of ectopic bladder exclusive of orthopaedic operation (if required): Initial

20 264.000 2 360.40 20 211.200 1 888.30 30 8.000 448.90

2033Reconstruction of ectopic bladder exclusive of orthopaedic operation (if required): Subsequent

20 53.000 473.90 20 53.000 473.90 30 8.000 448.90

2035 Cutaneous vesicostomy 20 118.000 1 055.00 20 118.000 1 055.00 30 5.000 280.60

2037 Cystoplasty, cysto-urethraplasty, vesicolysis 20 126.000 1 126.60 20 120.000 1 072.90 30 5.000 280.60

2039 Operation for ruptured bladder 20 137.000 1 224.90 20 120.000 1 072.90 30 6.000 336.70

2042 Enterocystoplasty plus bowel anastomosis 20 419.900 3 754.30 20 335.920 3 003.50 30 5.000 280.60

2043 Cysto-lithotomy 20 132.000 1 180.20 20 120.000 1 072.90 30 5.000 280.60


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code CF Units Value

RCF Units

Value R

CF Units Value

R

2045 Excision of patent-urachus or urachal cyst 20 112.000 1 001.40 20 112.000 1 001.40 30 5.000 280.60

2047 Drainage of perivesical or prevesical abscess 20 105.000 938.80 20 105.000 938.80 30 5.000 280.60

2049 Evacuation of clots from bladder: Other than post-operative 20 132.100 1 181.10 20 120.000 1 072.90 30 3.000 168.30

2050 Evacuation of clots from bladder: Post-operative - - - - - - 30 4.000 224.50

2051 Simple bladder lavage: Including catheterisation 20 12.000 107.30 20 12.000 107.30 30 3.000 168.30

2053 Bladder neck plasty: Male 20 137.000 1 224.90 20 120.000 1 072.90 30 5.000 280.60

2057 Bladder neck plasty: Female 20 137.000 1 224.90 20 120.000 1 072.90 30 5.000 280.60

10.4 Urethra - - - - - - - - -

2059 Open biopsy of urethra: Male 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

2061 Open biopsy of urethra: Female 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

2063 Dilatation of urethra stricture: By passage sound: Initial (male) 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

2065 Dilatation of urethra stricture: By passage sound: Subsequent (male) 20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

2067Dilatation of urethra stricture: By passage sound: By passage of filiform and follower (male)

20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

2069 Dilatation of female urethra 20 5.000 44.70 20 5.000 44.70 30 3.000 168.30

2071 Urethrorraphy: Suture of urethral wound or injury 20 139.000 1 242.80 20 120.000 1 072.90 30 4.000 224.50

2073 External urethrotomy: Pendulous urethra (anterior) 20 67.000 599.10 20 67.000 599.10 30 3.000 168.30

2075 Urethraplasty: Pendulous urethra: First stage 20 71.000 634.80 20 71.000 634.80 30 4.000 224.50

2077 Urethraplasty: Pendulous urethra: Second stage 20 145.000 1 296.50 20 120.000 1 072.90 30 4.000 224.50

2079 Reconstruction of female urethra 20 147.000 1 314.30 20 120.000 1 072.90 30 4.000 224.50

2081 Reconstruction or repair of male anterior urethra (one stage) 20 261.600 2 339.00 20 209.280 1 871.20 30 4.000 224.50

2083 Reconstruction or repair of prostatic or membranous urethra: First stage 20 168.000 1 502.10 20 134.400 1 201.70 30 6.000 336.70

2085 Reconstruction or repair of prostatic or membranous urethra: Second stage 20 168.000 1 502.10 20 134.400 1 201.70 30 6.000 336.70

2086 Reconstruction or repair of prostatic or membranous urethra: If done in one stage 20 294.000 2 628.70 20 235.200 2 102.90 30 6.000 336.70

2087 Urethral diverticulectomy: Male or female 20 147.000 1 314.30 20 120.000 1 072.90 30 4.000 224.50

2088Peri-urethral teflon injection: Male or female - fee as for cystoscopy (item 1949) plus 42,00 clinical procedure units

20 86.000 768.90 20 86.000 768.90 - - -

2089 Marsupialisation of urethral diverticula: Male or female 20 115.100 1 029.10 20 115.100 1 029.10 30 4.000 224.50

2091 Total urethrectomy: Female 20 147.000 1 314.30 20 120.000 1 072.90 30 5.000 280.60

2093 Total urethrectomy: Male 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60


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code CF Units Value

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Value R

CF Units Value

R

2095 Drainage of simple localised perineal urinary extravasation 20 128.800 1 151.60 20 120.000 1 072.90 30 5.000 280.60

2097 Drainage of extensive perineal and/or abdominal urinary extravasation 20 137.000 1 224.90 20 120.000 1 072.90 30 5.000 280.60

2099 Fulguration for urethral caruncle or polyp 20 53.600 479.20 20 53.600 479.20 30 3.000 168.30

2101 Excision of urethral caruncle 20 53.600 479.20 20 53.600 479.20 30 3.000 168.30

2103 Simple urethral meatotomy 20 26.300 235.20 20 26.300 235.20 30 3.000 168.30

2105 Incision of deep peri-urethral abscess: Female 20 123.100 1 100.60 20 120.000 1 072.90 30 3.000 168.30

2107 Incision of deep peri-urethral abscess: Male 20 123.100 1 100.60 20 120.000 1 072.90 30 3.000 168.30

2109 Badenoch pull-through for intractable stricture or incontinence 20 181.000 1 618.30 20 144.800 1 294.70 30 5.000 280.60

2111 External sphincterotomy 20 108.000 965.60 20 108.000 965.60 30 5.000 280.60

2113 Drainage of Skene gland abscess or cyst 20 42.300 378.20 20 42.300 378.20 30 3.000 168.30

2115Operation for correction of male urinary incontinence with or without introduction of prostheses (excluding cost of prostheses)

20 168.000 1 502.10 20 134.400 1 201.70 30 5.000 280.60

2116 Urethral meatoplasty 20 101.500 907.50 20 101.500 907.50 30 3.000 168.30

2117 Closure of urethrostomy or urethro-cutaneous fistula (independent procedure) 20 150.300 1 343.80 20 120.240 1 075.10 30 3.000 168.30

2121 Closure of urethrovaginal fistula: Including diversionary procedures 20 189.000 1 689.90 20 151.200 1 351.90 30 5.000 280.60

11 Male Genital System - - - - - - - - -

11.1 Penis - - - - - - - - -

2123 Biopsy of penis (independent procedure) 20 52.100 465.80 20 52.100 465.80 30 3.000 168.30

2125Destruction of condylomata/chemo- or cryotherapy: Limited number (see item 2317)

20 16.600 148.40 20 16.600 148.40 30 3.000 168.30

2127 Destruction of condylomata/chemo-or cryotherapy: Multiple extensive 20 41.600 372.00 20 41.600 372.00 30 3.000 168.30

2129 Electrodesiccation: Limited number 20 20.800 186.00 20 20.800 186.00 30 3.000 168.30

2131 Electrodesiccation: Multiple extensive 20 41.600 372.00 20 41.600 372.00 30 3.000 168.30

2132 Ligation of abnormal venous drainage 20 106.100 948.60 20 106.100 948.60 30 3.000 168.30

2133 Circumcision: Clamp procedure 20 42.300 378.20 20 42.300 378.20 30 3.000 168.30

2137 Circumcision: Surgical excision other than by clamp or dorsal slit, any age 20 60.000 536.50 20 60.000 536.50 30 3.000 168.30

2139 Circumcision: Dorsal slit of prepuce (independent procedure) 20 36.800 329.00 20 36.800 329.00 30 3.000 168.30

2141Reconstructive operation of penis: Reconstructive operation for insertion of prostheses

20 101.000 903.00 20 101.000 903.00 30 3.000 168.30

2143Reconstructive operation of penis: For straightening of chordee e.g. hypospadias with or without mobilisation of urethra

20 188.600 1 686.30 20 150.880 1 349.00 30 3.000 168.30


173 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2145Reconstructive operation of penis: For straightening of chordee with transplantation of prepuce

20 224.600 2 008.20 20 179.680 1 606.50 30 3.000 168.30

2147Reconstructive operation of penis: For injury: Including fracture of penis and skin graft, if required

20 168.000 1 502.10 20 134.400 1 201.70 30 3.000 168.30

2149 Reconstructive operation of penis: For epispadias distal to the external sphincter 20 168.000 1 502.10 20 134.400 1 201.70 30 3.000 168.30

2153 Reconstructive operation for epispadias with incontinence 20 168.000 1 502.10 20 134.400 1 201.70 30 3.000 168.30

2154 Induction of artificial erection 20 16.000 143.10 20 16.000 143.10 30 3.000 168.30

2155 Hypospadias: Urethral reconstruction 20 187.000 1 672.00 20 149.600 1 337.60 30 3.000 168.30

2157 Hypospadias: Subsequent procedures for repair of urethra: Total 20 84.000 751.00 20 84.000 751.00 30 3.000 168.30

2159 Hypospadias: Urethraplasty: Complete, one stage for hypospadias 20 300.000 2 682.30 20 240.000 2 145.80 30 3.000 168.30

2161 Total amputation of penis: Without gland dissection 20 210.000 1 877.60 20 168.000 1 502.10 30 4.000 224.50

2163 Total amputation of penis: With gland-dissection 20 336.000 3 004.20 20 268.800 2 403.30 30 6.000 336.70

2165 Partial amputation of penis: With gland-dissection 20 210.000 1 877.60 20 168.000 1 502.10 30 6.000 336.70

2167 Partial amputation of penis: Without gland-dissection 20 84.000 751.00 20 84.000 751.00 30 4.000 224.50

2169 Injection procedure for Peyronie’s disease 20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

2171 Priapism operation: Irrigation of corpora cavernosa for priapism 20 42.000 375.50 20 42.000 375.50 30 3.000 168.30

2173 Priapism operation: Shunt procedure: Any type 20 252.000 2 253.10 20 201.600 1 802.50 30 4.000 224.50

2174 Priapism operation: Stab shunt 20 114.400 1 022.90 20 114.400 1 022.90 30 4.000 224.50

11.2 Testis and epididymis - - - - - - - - -

0078When a testis biopsy is done combined with vasogram or seminal vesiculogram or epididymogram, add 50% of the units for the appropriate procedure

- - - - - - - - -

2175 Testis biopsy: Needle (independent procedure) 20 18.500 165.40 20 18.500 165.40 30 3.000 168.30

2177 Testis biopsy: Incisional: Independent procedure: Unilateral 20 58.900 526.60 20 58.900 526.60 30 3.000 168.30

2179 Testis biopsy: Incisional: Independent procedure: Bilateral 20 58.900 526.60 20 58.900 526.60 30 3.000 168.30

2181 Epididymis biopsy: Needle 20 86.100 769.80 20 86.100 769.80 30 3.000 168.30

2183 Puncture aspiration hydrocele with or without injection of medication 20 10.000 89.40 20 10.000 89.40 30 3.000 168.30

2185 Operation for maldescended testicle: Including herniotomy 20 135.000 1 207.00 20 120.000 1 072.90 30 4.000 224.50

2187 Operation for torsion appendix testis 20 119.200 1 065.80 20 119.200 1 065.80 30 4.000 224.50

2189 Operation for torsion testis with fixation of contralateral testis 20 119.200 1 065.80 20 119.200 1 065.80 30 4.000 224.50

2191 Orchidectomy (total or subcapsular): Unilateral 20 98.000 876.20 20 98.000 876.20 30 3.000 168.30


174 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2193 Orchidectomy (total or subcapsular): Bilateral 20 147.000 1 314.30 20 120.000 1 072.90 30 3.000 168.30

2195 Radical operation for malignant testis: Excluding gland dissection 20 155.300 1 388.50 20 124.240 1 110.80 30 6.000 336.70

2197 Operation for hydrocele or spermatocele 20 99.800 892.30 20 99.800 892.30 30 4.000 224.50

2199 Varicocelectomy 20 106.100 948.60 20 106.100 948.60 30 4.000 224.50

2201 Abdominal ligation of spermatic vein for varicocele 20 112.800 1 008.50 20 112.800 1 008.50 30 4.000 224.50

2203 Epididymectomy: Unilateral 20 114.400 1 022.90 20 114.400 1 022.90 30 3.000 168.30

2205 Epididymectomy: Bilateral 20 158.200 1 414.50 20 126.560 1 131.60 30 3.000 168.30

2207Vasectomy: Unilateral or bilateral (no extra fee to be charged if done in combination with prostatectomy)

20 55.900 499.80 20 55.900 499.80 30 3.000 168.30

2209 Vasotomy: Unilateral or bilateral 20 70.400 629.50 20 70.400 629.50 30 3.000 168.30

2210 Vasogram, seminal vesiculogram: Unilateral 20 58.100 519.50 20 58.100 519.50 30 3.000 168.30

2211 Vasogram, seminal vesiculogram: Bilateral 20 58.100 519.50 20 58.100 519.50 30 3.000 168.30

2212Insertion of testicular prosthesis: Independent procedure (exclusive of cost of material)

20 91.200 815.40 20 91.200 815.40 30 4.000 224.50

2213 Suture or repair of testicular injury 20 110.300 986.20 20 110.300 986.20 30 4.000 224.50

2215 Incision and drainage of testis or epididymis e.g. abscess or haematoma 20 90.000 804.70 20 90.000 804.70 30 4.000 224.50

2217 Excision of local lesion of testis or epididymis 20 90.800 811.80 20 90.800 811.80 30 4.000 224.50

2219 Vaso-vasostomy: Unilateral 20 67.000 599.10 20 67.000 599.10 30 3.000 168.30

2221 Vaso-vasostomy: Bilateral 20 117.000 1 046.10 20 117.000 1 046.10 30 3.000 168.30

2223 Epididymo-vasostomy: Unilateral 20 67.000 599.10 20 67.000 599.10 30 3.000 168.30

2225 Epididymo-vasostomy: Bilateral 20 117.000 1 046.10 20 117.000 1 046.10 30 3.000 168.30

2227 Incision and drainage of scrotal wall abscess 20 42.700 381.80 20 42.700 381.80 30 3.000 168.30

2229 Excision of Mullerian duct cyst 20 189.000 1 689.90 20 151.200 1 351.90 30 4.000 224.50

2231 Excision of lesion of spermatic cord 20 84.000 751.00 20 84.000 751.00 30 3.000 168.30

2233 Seminal Vesiculectomy 20 220.000 1 967.00 20 176.000 1 573.60 30 5.000 280.60

11.3 Prostate - - - - - - - - -

2235 Biopsy prostate: Needle or punch, single or multiple, any approach 20 23.300 208.30 20 23.300 208.30 30 3.000 168.30

2237 Biopsy prostate: Incisional, any approach 20 105.000 938.80 20 105.000 938.80 30 4.000 224.50

2239 Transurethral drainage of prostatic abscess 20 117.400 1 049.70 20 117.400 1 049.70 30 4.000 224.50

2241 Perineal drainage of prostatic abscess 20 77.000 688.50 20 77.000 688.50 30 4.000 224.50


175 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2243 Trans-urethral cryo-surgical removal of prostate 20 126.000 1 126.60 20 120.000 1 072.90 30 6.000 336.70

2245 Trans-urethral resection of prostate 20 252.000 2 253.10 20 201.600 1 802.50 30 6.000 336.70

2247Trans-urethral resection of residual prostatic tissue 90 days post-operative or longer

20 126.000 1 126.60 20 120.000 1 072.90 30 6.000 336.70

2249 Trans-urethral resection of post-operative bladder neck contracture 20 126.000 1 126.60 20 120.000 1 072.90 30 5.000 280.60

2251 Prostatectomy: Perineal: Sub-total 20 252.000 2 253.10 20 201.600 1 802.50 30 6.000 336.70

2253 Prostatectomy: Perineal: Radical 20 336.000 3 004.20 20 268.800 2 403.30 30 8.000 448.90

2254 Pelvic lymph adenectomy 20 175.000 1 564.70 20 140.000 1 251.70 30 8.000 448.90

2255 Supra-pelvic, transversical 20 252.000 2 253.10 20 201.600 1 802.50 30 6.000 336.70

2257 Retropubic: Sub-total 20 252.000 2 253.10 20 201.600 1 802.50 30 6.000 336.70

2259 Retropubic: Radical 20 336.000 3 004.20 20 268.800 2 403.30 30 8.000 448.90

2260 Prostate brachytherapy 20 230.000 2 056.40 20 184.000 1 645.10 30 8.000 448.90

12 Female Genital System - - - - - - - - -

12.1 Vulva and introitus - - - - - - - - -

2271 Removal of tag or polyp 20 6.000 53.70 20 6.000 53.70 30 3.000 168.30

2272 Removal of small superficial benign lesions 20 23.000 205.60 20 23.000 205.60 30 3.000 168.30

2273 Biopsy with suture in theatre (excluding after-care) 20 27.000 241.40 20 27.000 241.40 30 3.000 168.30

2274 Laser therapy of vulva and/or vagina (colposcopically directed) 20 71.000 634.80 20 71.000 634.80 30 3.000 168.30

2275 Reduction labial hypertrophy 20 67.000 599.10 20 67.000 599.10 30 4.000 224.50

2277 Removal of extensive benign vulva tumour 20 67.000 599.10 20 67.000 599.10 30 4.000 224.50

2279 Secondary perineal repair: Repair second degree tear 20 45.000 402.40 20 45.000 402.40 30 6.000 336.70

2280 Secondary perineal repair: Repair third degree tear 20 96.000 858.30 20 96.000 858.30 30 6.000 336.70

2281 Excision of inclusion cyst 20 43.000 384.50 20 43.000 384.50 30 4.000 224.50

2283 Hymenectomy 20 43.000 384.50 20 43.000 384.50 30 4.000 224.50

2285 Drainage haematocolpos 20 54.000 482.80 20 54.000 482.80 30 4.000 224.50

2287 Clitoris repair for injury: Including skin graft, if required 20 67.000 599.10 20 67.000 599.10 30 4.000 224.50

2288 Clitoral reduction 20 160.000 1 430.60 20 128.000 1 144.50 30 4.000 224.50

2289 Denervation or alcohol infiltration vulva (Woodruff) 20 54.000 482.80 20 54.000 482.80 30 4.000 224.50

2291 Vulva: Undercutting skin (ball) 20 58.000 518.60 20 58.000 518.60 30 4.000 224.50

2293 Vulva and introitus: Drainage of abscess 20 27.000 241.40 20 27.000 241.40 30 3.000 168.30


176 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2295 Bartholin gland: Bartholin abscess marsupialisation 20 36.000 321.90 20 36.000 321.90 30 3.000 168.30

2297 Bartholin gland: Bartholin gland excision 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

2299 Bartholin gland: Bartholin radical excision for malignant lesion 20 357.000 3 191.90 20 285.600 2 553.60 30 6.000 336.70

2301 Operation for enlarging introitus: Fenton plasty 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

2303 Operation for enlarging introitus: Bilateral Z-plastic 20 88.000 786.80 20 88.000 786.80 30 4.000 224.50

2305 Vulvectomy: Partial 20 161.000 1 439.50 20 128.800 1 151.60 30 4.000 224.50

2307 Vulvectomy 20 225.000 2 011.70 20 180.000 1 609.40 30 6.000 336.70

2309 Radical vulvectomy with bilateral lymphdenectomy 20 357.000 3 191.90 20 285.600 2 553.60 30 6.000 336.70

2311Radical vulvectomy with bilateral lymphadenectomy, plus deep lymph gland dissection

20 402.000 3 594.30 20 321.600 2 875.40 30 6.000 336.70

12.2 Vaginal procedures and operations - - - - - - - - -

2312 Artificial insemination 20 13.000 116.20 20 13.000 116.20 - - -

2313Examination under anaesthetic when no other procedures are performed (not limited to female patients only) - Stand alone procedure

20 25.500 228.00 20 25.500 228.00 30 3.000 168.30

2314 Intra uterine insemination 20 18.000 160.90 20 18.000 160.90 - - -

2315 Simms Hühner test plus wet smear 20 5.000 44.70 20 5.000 44.70 - - -

2316Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: First lesion

20 14.000 125.20 20 14.000 125.20 30 3.000 168.30

2317Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: Repeat - Limited

20 7.000 62.60 20 7.000 62.60 30 3.000 168.30

2318Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: Widespread

20 56.000 500.70 20 56.000 500.70 30 3.000 168.30

2319 Excision of cysts or tumours 20 54.000 482.80 20 54.000 482.80 30 3.000 168.30

2321 Drainage of vaginal abscess 20 54.000 482.80 20 54.000 482.80 30 3.000 168.30

2322 Pudendal nerve block 20 15.000 134.10 20 15.000 134.10 - - -

2323 Reconstruction of vagina after atresia 20 107.000 956.70 20 107.000 956.70 30 5.000 280.60

2325 Construction of artificial vagina: Labial fusion 20 179.000 1 600.40 20 143.200 1 280.40 30 4.000 224.50

2327 Construction of artificial vagina: Macindoe type 20 196.000 1 752.40 20 156.800 1 402.00 30 5.000 280.60

2329 Construction of vagina: Bowel pull-through operation: Two surgeons: Each 20 241.000 2 154.80 20 192.800 1 723.80 30 6.000 336.70

2331 Vaginal septum removal 20 107.000 956.70 20 107.000 956.70 30 4.000 224.50

2333 Vaginal prolapse: Abdominal approach: Sacrocolpopexy with use of mesh 20 243.300 2 175.40 20 194.640 1 740.30 30 6.000 336.70


177 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2334 Vaginal prolapse: Abdominal approach: Use of rectus sheath or tape 20 243.300 2 175.40 20 194.640 1 740.30 30 6.000 336.70

2335 Vaginal prolapse: Vaginal approach: Sacrospinous fixations 20 166.900 1 492.30 20 133.520 1 193.80 30 6.000 336.70

2336 Vaginal prolapse: Vaginal approach: Use of mesh or tape 20 166.900 1 492.30 20 133.520 1 193.80 30 6.000 336.70

2339 Colpotomy: Diagnostic (excluding after-care) 20 20.000 178.80 20 20.000 178.80 30 4.000 224.50

2341 Colpotomy: Therapeutic, with or without sterilisation 20 103.000 920.90 20 103.000 920.90 30 4.000 224.50

2343 Vaginal hysterectomy: Without repair 20 210.500 1 882.10 20 168.400 1 505.70 30 6.000 336.70

2345 Vaginal hysterectomy: With repair 20 231.700 2 071.60 20 185.360 1 657.30 30 6.000 336.70

2357Vaginal hysterectomy and repair with unilateral or bilateral salpingo-oophorectomy

20 320.000 2 861.10 20 256.000 2 288.90 30 6.000 336.70

2361 Vaginal hysterectomy and repair for total prolapse 20 320.000 2 861.10 20 256.000 2 288.90 30 6.000 336.70

2363 Fothergill or Manchester repair operation 20 196.000 1 752.40 20 156.800 1 402.00 30 5.000 280.60

2365Repair of recurrent enterocele or vault prolapse (except at the time of hysterectomy)

20 232.000 2 074.30 20 185.600 1 659.50 30 5.000 280.60

2366 Posterior repair alone 20 107.000 956.70 20 107.000 956.70 30 5.000 280.60

2367 Other operations for prolapse: Anterior repair - with or without posterior repair 20 161.000 1 439.50 20 128.800 1 151.60 30 5.000 280.60

2368 Uterovesical fistula 20 210.000 1 877.60 20 168.000 1 502.10 30 5.000 280.60

2369 Repair of Vesico- or urethro-vaginal fistula 20 179.000 1 600.40 20 143.200 1 280.40 30 5.000 280.60

2370 Repair of VVF - Obstetric or radiation 20 232.000 2 074.30 20 185.600 1 659.50 30 5.000 280.60

2371 Closure of uretero-vaginal fistula 20 250.000 2 235.30 20 200.000 1 788.20 30 5.000 280.60

2372 Closure of uretero-vaginal fistula: Obstetric or radiation 20 250.000 2 235.30 20 200.000 1 788.20 30 5.000 280.60

2373 Closure of recto-vaginal fistula 20 134.000 1 198.10 20 120.000 1 072.90 30 5.000 280.60

2374 Closure of recto-vaginal fistula: Obstetric or radiation 20 151.000 1 350.10 20 120.800 1 080.10 30 5.000 280.60

2375 Colpocleisis 20 129.000 1 153.40 20 120.000 1 072.90 30 4.000 224.50

2377 Le Fort operation 20 129.000 1 153.40 20 120.000 1 072.90 30 4.000 224.50

2379 Schauta operation 20 357.000 3 191.90 20 285.600 2 553.60 30 8.000 448.90

2381 Vaginectomy 20 268.000 2 396.20 20 214.400 1 917.00 30 8.000 448.90

2383 Synchronous combined hysterocolpectomy: One or two surgeons - total fee 20 429.000 3 835.70 20 343.200 3 068.60 30 8.000 448.90

2385 Vaginal laceration or trauma: Repair 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

12.3 Cervix - - - - - - - - -


178 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2389 Paracervical (pelvis) nerve block (for neck refer to item 3294) 20 20.000 178.80 20 20.000 178.80 - - -

2391 Cervix: Canal reconstruction 20 147.000 1 314.30 20 120.000 1 072.90 30 3.000 168.30

2392Cryo- or electro-cauterisation, or Lletz of cervix (excluding cost of disposable loop electrode): In consulting room

20 14.000 125.20 20 14.000 125.20 - - -

2395Cryo- or electro-cauterisation, or Lletz of cervix (excluding cost of disposable loop electrode): Under anaesthetic

20 22.000 196.70 20 22.000 196.70 30 3.000 168.30

2396 Laser or harmonic scalpel treatment of the cervix 20 80.000 715.30 20 80.000 715.30 30 3.000 168.30

2397 Dilation of cervix for stenosis and insertion of prosthesis and Budge suture 20 31.000 277.20 20 31.000 277.20 30 3.000 168.30

2399 Punch biopsy (excluding after-care) 20 9.000 80.50 20 9.000 80.50 30 3.000 168.30

2400 Biopsy during pregnancy (excluding after-care) 20 13.000 116.20 20 13.000 116.20 30 3.000 168.30

2403 Wedge biopsy: Cervix (excluding after-care) 20 18.000 160.90 20 18.000 160.90 30 3.000 168.30

2404 Biopsy: Wedge during pregnancy: Cervix (excluding after-care) 20 24.000 214.60 20 24.000 214.60 30 3.000 168.30

2405 Cone biopsy: Cervix (excluding after-care) 20 54.000 482.80 20 54.000 482.80 30 3.000 168.30

2407 Amputation: Cervix 20 67.000 599.10 20 67.000 599.10 30 3.000 168.30

2409 Cervix encirclage: McDonald stitch 20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

2411 Cervix encirclage: Shirodkar suture 20 60.000 536.50 20 60.000 536.50 30 3.000 168.30

2413 Cervix encirclage: Lash 20 49.000 438.10 20 49.000 438.10 30 3.000 168.30

2415 Cervix encirclage: Removal items 2409 and 2411: Without anaesthetic 20 5.000 44.70 20 5.000 44.70 - - -

2416 Cervix: Removal items 2409 and 2411: With anaesthetic in theatre 20 30.000 268.20 20 30.000 268.20 30 3.000 168.30

2417 Repair of tears: Emmet repair of tears 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

2418 Repair of tears: Sturmdorff repair of tears 20 54.000 482.80 20 54.000 482.80 30 3.000 168.30

2421 Extirpation of cervical stump: Vaginal 20 134.000 1 198.10 20 120.000 1 072.90 30 5.000 280.60

2423 Extirpation of cervical stump: Abdominal 20 134.000 1 198.10 20 120.000 1 072.90 30 5.000 280.60

2425 Removal of cervical polyps (excluding after-care) 20 13.000 116.20 20 13.000 116.20 30 3.000 168.30

2427 Removal of cervical myomata 20 54.000 482.80 20 54.000 482.80 30 3.000 168.30

2429 Colposcopy (excluding after-care) 20 27.000 241.40 20 27.000 241.40 30 3.000 168.30

12.4 Uterus - - - - - - - - -

2433 Embryo transfer 20 45.000 402.40 20 45.000 402.40 30 4.000 224.50

2434 Endometrial biopsy (excluding after-care) 20 18.000 160.90 20 18.000 160.90 30 3.000 168.30

2435 Hysterosalpingogram (excluding after-care) 20 22.000 196.70 20 22.000 196.70 30 3.000 168.30


179 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2436 Hysteroscopy (excluding after-care) 20 40.000 357.60 20 40.000 357.60 30 3.000 168.30

2437 Hysteroscopy and D&C (excluding after-care) 20 58.000 518.60 20 58.000 518.60 30 3.000 168.30

2438 Hysteroscopy and removal of uterine septum (excluding after-care) 20 80.000 715.30 20 80.000 715.30 30 3.000 168.30

2439Hysteroscopy and division of endometrial and endocervical bands (excluding after-care)

20 63.000 563.30 20 63.000 563.30 30 3.000 168.30

2440 Hysteroscopy and polypectomy (excluding after-care) 20 75.000 670.60 20 75.000 670.60 30 3.000 168.30

2441 Hysteroscopy and myomectomy (excluding after-care) 20 130.000 1 162.30 20 120.000 1 072.90 30 3.000 168.30

2442 Insertion of intra uterine contraceptive device (IUCD) (excluding after-care) 20 18.000 160.90 20 18.000 160.90 30 3.000 168.30

2443 Dilatation and curettage (D&C) (excluding after-care) 20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

2444 Fractional dilatation and curettage (D&C) (excluding after-care) 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

2445 Evacuation of uterus: Incomplete abortion: Before 12 weeks gestation 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

2447 Evacuation of uterus, incomplete abortion: After 12 weeks gestation 20 71.000 634.80 20 71.000 634.80 30 4.000 224.50

2448 Termination of pregnancy before 12 weeks 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

2449 Evacuation: Missed abortion: Before 12 weeks gestation 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

2451 Evacuation: Missed abortion: After 12 weeks gestation 20 80.000 715.30 20 80.000 715.30 30 4.000 224.50

2452Termination of pregnancy after 12 weeks - administration of intra/extra amniotic prostaglandin

20 54.000 482.80 20 54.000 482.80 30 4.000 224.50

2453 Evacuation hydatidiform mole 20 80.000 715.30 20 80.000 715.30 30 5.000 280.60

2455 Evacuation uterus post-partum 20 54.000 482.80 20 54.000 482.80 30 6.000 336.70

2461 Ventrosuspension 20 80.000 715.30 20 80.000 715.30 30 4.000 224.50

2463 Uteroplasty: Strassman 20 143.000 1 278.60 20 120.000 1 072.90 30 6.000 336.70

2465 Uteroplasty: Tompkins 20 143.000 1 278.60 20 120.000 1 072.90 30 6.000 336.70

2467 Myomectomy 20 143.000 1 278.60 20 120.000 1 072.90 30 6.000 336.70

2469Subtotal hysterectomy with or without unilateral or bilateral salpingo-oophorectomy

20 254.100 2 271.90 20 203.280 1 817.50 30 6.000 336.70

2471Total abdominal hysterectomy: With or without unilateral or bilateral salpingo-oophorectomy - uncomplicated

20 252.200 2 254.90 20 201.760 1 803.90 30 6.000 336.70

2473Total abdominal hysterectomy plus vaginal cuff with or without unilateral or bilateral salpingo-oophorectomy

20 355.000 3 174.10 20 284.000 2 539.20 30 6.000 336.70

2475 Radical abdominal hysterectomy with bilateral lymphadenectomy (Wertheim) 20 472.800 4 227.30 20 378.240 3 381.80 30 8.000 448.90


180 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2477 Abdominal hysterotomy with or without sterilisation 20 188.000 1 680.90 20 150.400 1 344.70 30 6.000 336.70

2478Non-surgical endometrial destruction, any method, not utilising hysteroscopic instrumentation or assistance

20 200.000 1 788.20 20 160.000 1 430.60 30 6.000 336.70

2479Surgical endometrial destruction: Any method, utilising hysteroscopic instrumentation or assistance

20 225.000 2 011.70 20 180.000 1 609.40 30 6.000 336.70

2480 Laparoscopy by second gynaecologist during endometrial ablation (item 2479) 20 120.000 1 072.90 - - - - - -

12.5 Fallopian tubes - - - - - - - - -

0066Microsurgery of the fallopian-tubes and ovaries: Where micro-surgical techniques are used, with the aid of a microscope, 25% may be added to the fee

- - - - - - - - -

2481 Insufflation Fallopian tubes (excluding after-care) 20 16.000 143.10 20 16.000 143.10 30 3.000 168.30

2483 Salpingolysis 20 125.000 1 117.60 20 120.000 1 072.90 30 4.000 224.50

2485 Salpingostomy 20 161.000 1 439.50 20 128.800 1 151.60 30 4.000 224.50

2487 Tuboplasty tubal anastomosis or re-implantation 20 196.000 1 752.40 20 156.800 1 402.00 30 4.000 224.50

2489 Ectopic pregnancy under 12 weeks (salpingectomy) 20 125.000 1 117.60 20 120.000 1 072.90 30 6.000 336.70

2490 Ectopic pregnancy under 12 weeks (salpingostomy) 20 161.000 1 439.50 20 128.800 1 151.60 30 6.000 336.70

2491 Ectopic pregnancy - after 12 weeks 20 225.000 2 011.70 20 180.000 1 609.40 30 6.000 336.70

2492 Salpingectomy: Uni- or bilateral or sterilisation for accepted medical reasons 20 94.000 840.50 20 94.000 840.50 30 5.000 280.60

Note: Use item 1807 for open procedures performed with a laparoscope instead of item 2493. Item 1807 may only be added once, and may not be charged together with item 2493 for more than one procedure performed laparoscopically

- - - - - - - - -

2493 Diagnostic laparoscopy (excluding after-care) 20 94.400 844.00 20 94.400 844.00 30 5.000 280.60

2496 Laparoscopy: Plus aspiration of a cyst (excluding after-care) 20 18.000 160.90 20 18.000 160.90 30 5.000 280.60

2497 Laparoscopy: Plus sterilisation 20 40.000 357.60 20 40.000 357.60 30 5.000 280.60

2499 Laparoscopy: Plus biopsy (excluding after-care) 20 18.000 160.90 20 18.000 160.90 30 5.000 280.60

2500 Laparoscopy: Plus ablation of endometriosis by laser, harmonic scalpel or cautery 20 51.000 456.00 20 51.000 456.00 30 5.000 280.60

2501 Laparoscopy: Plus cauterisation and/or lysis of adhesions 20 18.000 160.90 20 18.000 160.90 30 5.000 280.60

2502 Laparoscopy: Plus aspiration of follicles (IVF) (excluding after-care) 20 52.000 464.90 20 52.000 464.90 30 5.000 280.60

2503 Laparoscopy: Plus ovarian drilling 20 40.000 357.60 20 40.000 357.60 30 5.000 280.60

2504Laparoscopy: Plus Gamete intra fallopian tube transfer (includes follicle aspiration) (GIFT)

20 107.000 956.70 20 107.000 956.70 30 5.000 280.60

2505 Laparoscopy: Plus laparoscopic uterosacral nerve ablation 20 52.000 464.90 20 52.000 464.90 30 5.000 280.60


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code CF Units Value

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CF Units Value

R

2506 Transcervical gamete/embryo intra-fallopian tube transfer (TET/TEST) 20 58.000 518.60 20 58.000 518.60 - - -

12.6 Ovaries - - - - - - - - -

2525 Wedge resection of ovaries, unilateral or bilateral 20 105.000 938.80 20 105.000 938.80 30 4.000 224.50

2527 Removal of ovarian tumour or cyst 20 187.000 1 672.00 20 149.600 1 337.60 30 4.000 224.50

2529 Oophorectomy: Uni- or bilateral 20 134.500 1 202.60 20 120.000 1 072.90 30 4.000 224.50

2531 Ovarian carcinoma debulking and omentectomy 20 357.000 3 191.90 20 285.600 2 553.60 30 6.000 336.70

2532Ovarian carcinoma: Abdominal hysterectomy, bilateral salpingo-oophorectomy, debulking and omentectomy

20 469.000 4 193.30 20 375.200 3 354.70 30 6.000 336.70

12.7 Miscellaneous procedures - - - - - - - - -

2535 Exenteration: Anterior Exenteration 20 402.000 3 594.30 20 321.600 2 875.40 30 8.000 448.90

2537 Exenteration: Posterior Exenteration 20 402.000 3 594.30 20 321.600 2 875.40 30 8.000 448.90

2539 Exenteration: Total 20 625.000 5 588.10 20 500.000 4 470.50 30 8.000 448.90

2541 Presacral neurectomy 20 98.000 876.20 20 98.000 876.20 30 5.000 280.60

2543 Moschowitz operation 20 120.000 1 072.90 20 120.000 1 072.90 30 5.000 280.60

2544Laparoscopic vaginal suspension for stress incontinence (item 1807 may not be used together with this item)

20 193.100 1 726.50 20 154.480 1 381.20 30 5.000 280.60

2545 Operations for stress incontinence: Marshall-Marchetti-Kranz operation 20 195.000 1 743.50 20 156.000 1 394.80 30 5.000 280.60

2546 Operations for stress incontinence: Urethro-vesicopexy: Abdominal approach 20 149.000 1 332.20 20 120.000 1 072.90 30 6.000 336.70

2547 Operations for stress incontinence: Burch colposuspension 20 161.000 1 439.50 20 128.800 1 151.60 30 5.000 280.60

2548 Operation for stress incontinence: Use of tape 20 229.400 2 051.10 20 183.520 1 640.90 30 5.000 280.60

2550Operations for stress incontinence: Urethro-vesicopexy: Combined abdominal and vaginal approach

20 196.000 1 752.40 20 156.800 1 402.00 30 5.000 280.60

2551 Laparotomy 20 196.000 1 752.40 20 156.800 1 402.00 30 4.000 224.50

2552 Removal benign retroperitoneal tumour 20 223.000 1 993.80 20 178.400 1 595.10 30 6.000 336.70

2553 Radical removal of malignant retroperitoneal tumour 20 350.000 3 129.40 20 280.000 2 503.50 30 8.000 448.90

2554 Drainage of pelvic abscess per abdomen 20 180.000 1 609.40 20 144.000 1 287.50 30 6.000 336.70

2556 Drainage of pelvic abscess per vagina (refer to item 2341) 20 75.000 670.60 20 75.000 670.60 30 5.000 280.60

2558 Drainage intra-abdominal abscess: Delayed closure 20 268.000 2 396.20 20 214.400 1 917.00 30 6.000 336.70

2560 Surgery for moderate endometriosis (AFS stages 2 + 3): Any method 20 150.000 1 341.20 20 120.000 1 072.90 30 6.000 336.70


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R

2561Surgery for severe endometriosis (AFS stage 4 - retrovaginal septum): Any method (may not be used with another procedure or as a modifier)

20 210.000 1 877.60 20 168.000 1 502.10 30 6.000 336.70

2562Treatment of endometriosis (any method) found as an incidental finding during surgery for unrelated condition (histology required)

20 51.000 456.00 20 51.000 456.00 30 6.000 336.70

2565 Implantation hormone pellets (excluding after-care) 20 3.000 26.80 20 3.000 26.80 - - -

2570 Ligation of internal iliac vessels (when not part of another procedure) 20 225.000 2 011.70 20 180.000 1 609.40 30 8.000 448.90

13 Obstetric Procedures - - - - - - - - -

RULES GOVERNING THIS SECTION - - - - - - - - -

U.

Obstetric procedures: (a) When a general practitioner treats a patient in the ante-natal period and, after starting the confinement, requests an obstetrician to take over the case, the general practitioner shall be entitled to charge for all the ante-natal consultations he/she has performed. (i) If the patient has been in labour for less than 6 hours, the general practitioner shall charge 50,00 clinical procedure units according to item 2614: Global obstetric care. (ii) If the patient has been in labour for more than 6 hours, the general practitioner shall charge 80,00 clinical procedure units according to item 2614: Global obstetric care. (b) When a general practitioner calls an obstetrician to help with a confinement, take over the management of a confinement, and treats the patient until after the post-partum visit, the obstetrician shall charge according to item 2614: Global obstetric care. (c) When a general practitioner calls an obstetrician (specialist or general practitioner) to help with a confinement, or take over the management of a confinement, but the general practitioner treats the patient until after the post-partum visit, the obstetrician shall charge according to item 2616: Intrapartum obstetric care by obstetrician in consultation, and the general practitioner according to item 2614: Global obstetric care.

- - - - - - - - -

13.1 Pre-natal care and procedures - - - - - - - - -

2603 External cephalic version (excluding after-care) 20 22.000 196.70 20 22.000 196.70 - - -

2605 Amniocentesis (excluding after-care) 20 36.000 321.90 20 36.000 321.90 - - -

2607 Amnioscopy (excluding after-care) 20 18.000 160.90 20 18.000 160.90 - - -

2609 Intra-uterine transfusion of foetus or cordocentesis 20 134.000 1 198.10 20 120.000 1 072.90 - - -

2610Tococardiography - pre-natal and intrapartum (including stress and non-stress test: Own machine) (excluding after-care)

20 16.000 143.10 20 16.000 143.10 - - -

2611 Chorion villus sampling (excluding after-care) 20 54.000 482.80 20 54.000 482.80 - - -


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R

13.2 Confinements - - - - - - - - -

2614Global obstetric care: All inclusive fee that includes all modes of vaginal delivery (excluding Caesarean section) and obstetric care from the commencement of labour until after the post-partum visit (6 weeks visit)

20 282.000 2 521.40 20 225.600 2 017.10 30 6.000 336.70

2615Global obstetric care: All inclusive fee for caesarean section and obstetric care from the commencement of labour until after the post-partum visit (6 weeks visit). See modifier 0011 for emergency caesarean section (all hours)

20 267.000 2 387.30 20 213.600 1 909.80 30 6.000 336.70

2616 Intrapartum obstetric care by obstetrician in consultation (excluding after-care) 20 190.000 1 698.80 20 152.000 1 359.00 - - -

Global obstetric care includes o All modes of delivery (including Caesarean) o All inductions of labour (medical or surgical) o Intrapartum paracervical and pudential blocks o Intrapartum amnioscopy o Foetal blood sampling o Application of scalp leads o Symphysiotomy o Manual removal of placenta o Repair cervical tears o Correction of uterine inversion o Drainage of vulval haematoma o Repair third degree tear o Repair second degree tear o Repair episiotomy o Resuscitation of newborn by obstetrician o Tracheal intubation o Missed confinement

- - - - - - - - -

Global obstetric care excludes o Prenatal consultations o Prenatal procedures (Items 2603 - 2611) o Emergency hysterectomy for obstetrical reasons o Abdominal operation for repair of ruptured gravid uterus o Intensive care for obstetrical emergencies o Tubal ligation performed as a post-partum procedure o Post-partum complications occurring after discharge from the hospital

- - - - - - - - -


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R

13.3 Operative procedures (excluding antenatal care) - - - - - - - - -

2653 Caesarean-hysterectomy 20 335.000 2 995.20 20 268.000 2 396.20 30 9.000 505.00

2657 Post-partum hysterectomy 20 300.000 2 682.30 20 240.000 2 145.80 30 8.000 448.90

2669 Abdominal operation for ruptured gravid uterus: Repair 20 250.000 2 235.30 20 200.000 1 788.20 30 9.000 505.00

14 Nervous System - - - - - - - - -

14.1 Diagnostic procedures - - - - - - - - -

2681 Visual evoked potentials (VEP): Unilateral 20 50.000 447.10 - - - - - -

2682 Visual evoked potentials (VEP): Bilateral 20 88.000 786.80 - - - - - -

2683 Electro-retinography (Ganzfeld method): Unilateral 20 60.000 536.50 - - - - - -

2684 Electro-retinography (Ganzfeld method): Bilateral 20 105.000 938.80 - - - - - -

2685 Electro-oculography: Unilateral 20 30.000 268.20 - - - - - -

2686 Electro-oculography: Bilateral 20 53.000 473.90 - - - - - -

2687 VEP stable condition (photic drive): Unilateral 20 50.000 447.10 - - - - - -

2689 VEP stable condition (photic drive): Bilateral 20 88.000 786.80 - - - - - -

2690Total fee for full evaluation of visual tracts including bilateral electroretinography and VEP

20 150.000 1 341.20 - - - - - -

Note: See items 2691 to 2702 under section 17.5.1: Audiometry - - - - - - - - -

2703Somatosensory evoked potentials (SEP) single nerve examination to brachial or lumbosacral plexus, spinal cord and cortex

20 48.000 429.20 - - - - - -

2705Transcutaneous nerve stimulation in the treatment of post-operative and chronic intractable pain, per treatment

20 6.000 53.70 20 6.000 53.70 - - -

2707Full fee for complete neurological evoked potential evaluation including neurological AEP, bilateral VEP, and bilateral median and/or posterior tibial stimulation

20 220.000 1 967.00 - - - - - -

2708 Evaluation of cognitive evoked potential with visual or audiology stimulus 20 80.000 715.30 - - - - - -

2709 Full spinogram including bilateral median and posterior-tibial studies 20 140.000 1 251.70 - - - - - -

2710Morphia saturation testing in rooms (consultation x2 plus item 0206: Intravenous infusion) (excluding injection material)

- - - - - - - - -

2711 Electro-encephalography: Taking of record 20 36.100 322.80 20 36.100 322.80 - - -

2712 Electro-encephalography: Interpretation 20 24.000 214.60 20 24.000 214.60 - - -


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R

2713Spinal (lumbar) puncture. For diagnosis, for drainage of spinal fluid or for therapeutic indications

20 18.400 164.50 20 18.400 164.50 - - -


- - - - - - - - -

2714 Cisternal puncture and/or intrathecal injections 20 15.000 134.10 20 15.000 134.10 - - -

2715 8 Hour ambulatory EEG monitoring (Holter): Hire 20 136.000 1 216.00 - - - - - -

2716 8 Hour ambulatory EEG monitoring (Holter): Interpretation 20 30.000 268.20 - - - - - -

2717 Electromyography: First 20 75.000 670.60 20 75.000 670.60 - - -

2718 Electromyography: Subsequent 20 75.000 670.60 20 75.000 670.60 - - -

2719 Overnight polysomnogram and sleep staging: Hire 20 125.000 1 117.60 - - - - - -

2720 Overnight polysomnogram and sleep staging: Interpretation 20 23.000 205.60 - - - - - -

2721 Daytime polysomnogram: Hire 20 125.000 1 117.60 - - - - - -

2722 Daytime polysomnogram: Interpretation 20 17.000 152.00 - - - - - -

2723 Multiple sleep latency test: Interpretation 20 125.000 1 117.60 - - - - - -

2724 Overnight continuous positive airways pressure (CPAP) titration 20 155.000 1 385.90 20 124.000 1 108.70 - - -

2725 Angiography carotis: Unilateral 20 25.000 223.50 20 25.000 223.50 30 4.000 224.50

2726 Angiography carotis: Bilateral 20 44.000 393.40 20 44.000 393.40 30 4.000 224.50

2727 Vertebral artery: Direct needling 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

2729 Vertebral catheterisation 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

2730Neostigmine Test, the diagnostic test for Myasthenia Gravis under the supervision of a neurologist (‘20’) (not to be used with item 0714)

20 60.000 536.50 - - - - - -

2731Air encephalography and posterior fossa tomography: Injection of air (independent procedure)

20 14.500 129.60 - - - 30 4.000 224.50

2733 Cortical Stimulation 20 58.900 526.60 20 58.900 526.60

2734 Sodium Amytal Testing (WADA test) 20 88.700 793.10 20 88.700 793.10 30 13.000 729.50

2735Air encephalography and posterior fossa tomography: Posterior fossa tomography attendance by clinician

20 31.500 281.60 20 - - - - -

2737Air encephalography and posterior fossa tomography: Visual field charting on Bjerrum Screen

20 7.000 62.60 20 7.000 62.60 - - -

2739 Ventricular needling without burring: Tapping only 20 16.000 143.10 20 16.000 143.10 30 4.000 224.50


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R

2741Ventricular needling without burring: Plus introduction of air and/or contrast dye for ventriculography

20 43.000 384.50 20 43.000 384.50 30 4.000 224.50

2743 Subdural tapping: First sitting 20 15.000 134.10 20 15.000 134.10 30 4.000 224.50

2745 Subdural tapping: Subsequent 20 10.000 89.40 20 10.000 89.40 30 4.000 224.50

6001Sleep electro-encephalography: Infants that fit into a perambulator: Taking of record

20 36.100 322.80 20 36.100 322.80 - - -

6002 Sleep electro-encephalography: Infants that fit into a perambulator: Interpretation 20 24.500 219.10 20 24.500 219.10 - - -

6003Sleep electro-encephalography: Adults and children over infant age: Taking of record

20 36.100 322.80 20 36.100 322.80 - - -

6004Sleep electro-encephalography: Adults and children over infant age: Interpretation

20 24.500 219.10 20 24.500 219.10 - - -

6010Electroenchephalogram monitoring: Monitoring for localisation of cerebral seizure focus using computerised sixteen or more channel EEG, which may include video recording (e.g. for pre-operative localisation): Each full 24 hour period

20 294.600 2 634.00 20 235.680 2 107.20 - - -

6011Interpretation of item 6010: Electro-encephalogram monitoring: To be charged once only for each full 24 hour period of monitoring

20 128.600 1 149.80 20 120.000 1 072.90 - - -

14.2 Introduction of burr holes for - - - - - - - - -

2747 Ventriculography 20 150.000 1 341.20 20 120.000 1 072.90 30 8.000 448.90

2749 Catheterisation for ventriculography and/or drainage 20 150.000 1 341.20 20 120.000 1 072.90 30 8.000 448.90

2751 Biopsy of brain tumour 20 150.000 1 341.20 20 120.000 1 072.90 30 8.000 448.90

2753 Subdural haematoma or hygroma 20 150.000 1 341.20 20 120.000 1 072.90 30 8.000 448.90

2755 Subdural empyema 20 150.000 1 341.20 20 120.000 1 072.90 30 8.000 448.90

2757 Brain abscess 20 150.000 1 341.20 20 120.000 1 072.90 30 8.000 448.90

14.3 Nerve procedures - - - - - - - - -

2759 Nerve biopsy: Peripheral 20 37.000 330.80 20 37.000 330.80 30 4.000 224.50

2763 Nerve biopsy: Cranial nerves: Extra-cranial 20 20.000 178.80 20 20.000 178.80 30 4.000 224.50

2765 Nerve biopsy: Nerve conduction studies (see items 0733 and 3285) 20 26.000 232.50 20 26.000 232.50 30 4.000 224.50

6005 Botulinus toxin injections: For blepharospasm (+ 0198 + item 0201 + item 0202) 20 25.000 223.50 - - - - - -

6006Botulinus toxin injections: For hemifacial spasm or for hyperhidrosis per region (+ item 0198 + item 0201 + item 0202)

20 30.000 268.20 - - - - - -


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R

6007Botulinus toxin injections: For adductor disphonia (+ item 0198 + 0201 + item 0202)

20 35.000 312.90 - - - - - -

6008Botulinus toxin injections: In extra-ocular muscles (+ item 0198 + item 0201 + item 0202)

20 35.000 312.90 - - - - - -

6009Botulinus toxin injections: For spasmodic torticollis and/or cranial dystonia or for spasticity or for focal dystonia (+ item 0198 + item 0201 + item 0202)

20 50.000 447.10 - - - - - -

14.3.1 Nerve procedures: Nerve repair or suture - - - - - - - - -

2767 Suture brachial plexus (see also items 2837 and 2839) 20 300.000 2 682.30 20 240.000 2 145.80 30 6.000 336.70

2769 Suture: Large nerve: Primary 20 134.000 1 198.10 20 120.000 1 072.90 30 5.000 280.60

2771 Suture: Large nerve: Secondary 20 202.000 1 806.10 20 161.600 1 444.90 30 5.000 280.60

2773 Digital nerve: Primary 20 65.000 581.20 20 65.000 581.20 30 3.000 168.30

2775 Digital nerve: Secondary 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

2777 Nerve graft: Simple 20 202.000 1 806.10 20 161.600 1 444.90 30 4.000 224.50

2779 Fascicular: First fasciculus 20 202.000 1 806.10 20 161.600 1 444.90 30 4.000 224.50

2781 Fascicular: Each additional fasciculus 20 50.000 447.10 20 50.000 447.10 30 4.000 224.50

2783 Fascicular: Nerve flap: To include all stages 20 224.000 2 002.80 20 179.200 1 602.20 30 4.000 224.50

2785 Fascicular: Facio-accessory or facio-hypoglossal anastomosis 20 124.000 1 108.70 20 120.000 1 072.90 30 6.000 336.70

2787 Fascicular: Grafting of facial nerve 20 215.000 1 922.30 20 172.000 1 537.90 30 5.000 280.60

14.3.2 Nerve procedures: Neurectomy

2789 Trigeminal ganglion: Injection of alcohol 20 150.000 1 341.20 20 120.000 1 072.90 30 4.000 224.50

2791 Trigeminal ganglion: Injection of cortisone 20 65.000 581.20 20 65.000 581.20 30 3.000 168.30

2793 Trigeminal ganglion: Coagulation through high frequency 20 170.000 1 520.00 20 136.000 1 216.00 30 3.000 168.30

2799 Procedures for pain relief: Intrathecal injections for pain 20 36.000 321.90 20 36.000 321.90 30 4.000 224.50

2800 Procedures for pain relief: Plexus nerve block 20 36.000 321.90 20 36.000 321.90 20 36.000 321.90

2801Procedures for pain relief: Epidural injection for pain (refer to modifier 0045 for post-operative pain relief) (refer to modifier 0021 for epidural anaesthetic)

20 36.000 321.90 20 36.000 321.90 - - -


- - - - - - - - -

2802 Procedures for pain relief: Peripheral nerve block 20 25.000 223.50 20 25.000 223.50 20 25.000 223.50

2803 Alcohol injection in peripheral nerves for pain: Unilateral 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30


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code CF Units Value

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R

2804Inserting an indwelling nerve catheter (includes removal of catheter) (not for bolus technique)

20 10.000 89.40 20 10.000 89.40 20 10.000 89.40

2805 Alcohol injection in peripheral nerves for pain: Bilateral 20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

2809 Peripheral nerve section for pain 20 45.000 402.40 20 45.000 402.40 30 3.000 168.30

2811 Pudendal neurectomy: Bilateral 20 116.000 1 037.20 20 116.000 1 037.20 30 3.000 168.30

2813 Obturator or Stoffels 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

2815 Interdigital 20 82.300 735.80 20 82.300 735.80 30 3.000 168.30

2825 Excision: Neuroma: Peripheral 20 109.500 979.00 20 109.500 979.00 30 3.000 168.30

14.3.3 Nerve procedures: Other nerve procedures - - - - - - - - -

2827 Transposition of ulnar nerve 20 100.000 894.10 20 100.000 894.10 30 3.000 168.30

2829 Neurolysis: Minor 20 51.000 456.00 20 51.000 456.00 30 3.000 168.30

2831 Neurolysis: Major 20 132.000 1 180.20 20 120.000 1 072.90 30 3.000 168.30

2833 Neurolysis: Digital 20 96.000 858.30 20 96.000 858.30 30 3.000 168.30

2835 Scalenotomy 20 132.000 1 180.20 20 120.000 1 072.90 30 6.000 336.70

2837 Brachial plexus, suture or neurolysis (item 2767) 20 300.000 2 682.30 20 240.000 2 145.80 30 6.000 336.70

2839 Total brachial plexus exposure with graft, neurolysis and transplantation 20 895.200 8 004.00 20 716.160 6 403.20 30 6.000 336.70

2841 Carpal Tunnel 20 64.000 572.20 20 64.000 572.20 30 3.000 168.30

2843 Lumbar sympathectomy: Unilateral 20 153.000 1 368.00 20 122.400 1 094.40 30 4.000 224.50

2845 Lumbar sympathectomy: Bilateral 20 268.000 2 396.20 20 214.400 1 917.00 30 6.000 336.70

2846Cervical sympathectomy: Trans-thoracic approach (use item 2847 or item 2848 as appropriate)

- - - - - - 30 11.000 617.20

2847 Cervical sympathectomy: Unilateral 20 153.000 1 368.00 20 122.400 1 094.40 30 4.000 224.50

2848 Cervical sympathectomy: Bilateral 20 268.000 2 396.20 20 214.400 1 917.00 30 6.000 336.70

2849 Sympathetic block: Other levels: Unilateral 20 20.000 178.80 20 20.000 178.80 30 3.000 168.30

2851 Sympathetic block: Other levels: Bilateral 20 35.000 312.90 20 35.000 312.90 30 3.000 168.30

2853Sympathetic block: Other levels: Diagnostic/Therapeutic nerve block (unassociated with surgery) - either intercostal, or brachial, or peripheral, or stellate ganglion

20 20.000 178.80 20 20.000 178.80 30 4.000 224.50

14.4 Skull procedures - - - - - - - - -

2855 Removal of skull tumour: With or without plastic repair: Small 20 170.000 1 520.00 20 136.000 1 216.00 30 5.000 280.60


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R

2857 Removal of skull tumour: With or without plastic repair: Major 20 200.000 1 788.20 20 160.000 1 430.60 30 8.000 448.90

2859 Repair of depressed fracture of skull: Without brain laceration: Major 20 200.000 1 788.20 20 160.000 1 430.60 30 8.000 448.90

2860 Repair of depressed fracture of skull: Without brain laceration: Small 20 170.000 1 520.00 20 136.000 1 216.00 30 8.000 448.90

2861 Repair of depressed fracture of skull: With brain lacerations: Small 20 200.000 1 788.20 20 160.000 1 430.60 30 8.000 448.90

2862 Repair of depressed fracture of skull: With brain lacerations: Major 20 375.000 3 352.90 20 300.000 2 682.30 30 8.000 448.90

2863 Cranioplasty 20 280.000 2 503.50 20 224.000 2 002.80 30 8.000 448.90

2864 Encephalocele (excluding frontal) 20 200.000 1 788.20 20 160.000 1 430.60 30 8.000 448.90

2865 Craniostenosis: Few suturae 20 213.000 1 904.40 20 170.400 1 523.60 30 9.000 505.00

2867 Craniostenosis: Multiple suturae 20 280.000 2 503.50 20 224.000 2 002.80 30 9.000 505.00

14.5 Shunt procedures - - - - - - - - -

2869 Ventriculo-cisternostomy 20 280.000 2 503.50 20 224.000 2 002.80 30 8.000 448.90

2871 Ventriculo-caval shunt 20 280.000 2 503.50 20 224.000 2 002.80 30 11.000 617.20

2873 Ventriculo-peritoneal shunt 20 280.000 2 503.50 20 224.000 2 002.80 30 8.000 448.90

2875 Theco-peritoneal C.S.F. shunt 20 280.000 2 503.50 20 224.000 2 002.80 30 8.000 448.90

14.6 Aneurysm repair - - - - - - - - -

2876 Repair of aneurysms or arteriovenous anomalies (Intracranial) 20 700.000 6 258.70 20 560.000 5 007.00 30 15.000 841.70

2877 Extracranial to intracranial vascular 20 700.000 6 258.70 20 560.000 5 007.00 30 15.000 841.70

2878 Posterior fossa arteriovenous anomalies 20 700.000 6 258.70 20 560.000 5 007.00 30 15.000 841.70

14.7 Posterior fossa surgery - - - - - - - - -

2879 Glosso pharyngeal nerve 20 480.000 4 291.70 20 384.000 3 433.30 30 6.000 336.70

2881 Eighth nerve: Intracranial 20 480.000 4 291.70 20 384.000 3 433.30 30 8.000 448.90

2883 Eighth nerve: Extracranial 20 480.000 4 291.70 20 384.000 3 433.30 30 4.000 224.50

2884 Sub-temporal section of the trigeminal nerve 20 375.000 3 352.90 20 300.000 2 682.30 30 9.000 505.00

2885 Trigeminal tractotomy 20 480.000 4 291.70 20 384.000 3 433.30 30 9.000 505.00

2886Posterior fossa decompression with or without laminectomy with or without dural insertion for Arnold Chiarri malformation or obstructive cysts e.g. Dandy Walker or parasites

20 450.000 4 023.50 20 360.000 3 218.80 30 9.000 505.00

2887 Vestibular nerve 20 480.000 4 291.70 20 384.000 3 433.30 30 9.000 505.00


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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

2889Posterior fossa tumour removal: Acoustic neuroma, benign cerebello-pontine tumours, meningioma, clivus meningioma, chordoma, clivus chordoma or cholesteatoma

20 700.000 6 258.70 20 560.000 5 007.00 30 11.000 617.20

2891 Posterior fossa tumour removal: Glioma, secondary deposits 20 450.000 4 023.50 20 360.000 3 218.80 30 11.000 617.20

2893 Posterior fossa tumour removal: Abscess 20 450.000 4 023.50 20 360.000 3 218.80 30 11.000 617.20

2895 Excision of tumour of glomus jugulare: Intracranial 20 420.000 3 755.20 20 336.000 3 004.20 30 11.000 617.20

2897 Excision of tumour of glomus jugulare: Extracranial 20 420.000 3 755.20 20 336.000 3 004.20 30 9.000 505.00

2898 Excision of tumour of glomus jugulare: Hemispherectomy 20 500.000 4 470.50 20 400.000 3 576.40 30 15.000 841.70

14.7.1 Posterior fossa surgery: Supratentorial procedures - - - - - - - - -

2899 Craniectomy for extra-dural haematoma or empyema 20 375.000 3 352.90 20 300.000 2 682.30 30 11.000 617.20

14.8 Craniotomy for - - - - - - - - -

2900 Craniotomy for Extra-dural orbital decompression or excision of orbital tumour 20 700.000 6 258.70 20 560.000 5 007.00 30 11.000 617.20

2901Craniotomy for Osteoplastic Flap for removal of: Meningioma, basal extracerebral mass, intra ventricular tumours, pineal tumours, pituitary adenoma, total excision cranio-pharyngioma/pharyngioma

20 700.000 6 258.70 20 560.000 5 007.00 30 11.000 617.20

2903 Craniotomy for Abscess, Glioma 20 450.000 4 023.50 20 360.000 3 218.80 30 11.000 617.20

2904 Craniotomy for Haematoma, foreign body: Cerebral or cerebellar 20 450.000 4 023.50 20 360.000 3 218.80 30 11.000 617.20

2905 Craniotomy for Focal epilepsy: Excision of cortical scar 20 450.000 4 023.50 20 360.000 3 218.80 30 11.000 617.20

2906 Craniotomy with anterior fossa meningocele and repair of bony skull defect 20 375.000 3 352.90 20 300.000 2 682.30 30 11.000 617.20

2907 Craniotomy for Temporal lobectomy 20 450.000 4 023.50 20 360.000 3 218.80 30 11.000 617.20

2908 Craniotomy for Torkildsen anastomosis 20 375.000 3 352.90 20 300.000 2 682.30 30 11.000 617.20

2909 Craniotomy for CSF-leaks 20 450.000 4 023.50 20 360.000 3 218.80 30 11.000 617.20

2910 Craniotomy for removal of arteriovenous malformation 20 700.000 6 258.70 20 560.000 5 007.00 30 11.000 617.20

14.8.1 Craniotomy for Stereo-tactic cerebral and spinal cord procedures - - - - - - - - -

2911 Stereo-tactic cerebral and spinal cord procedure: First sitting 20 280.000 2 503.50 20 224.000 2 002.80 30 4.000 224.50

2913 Stereo-tactic cerebral and spinal cord procedure: Repeat 20 196.000 1 752.40 20 156.800 1 402.00 30 4.000 224.50

2915 Transnasal hypophysectomy 20 300.000 2 682.30 20 240.000 2 145.80 30 11.000 617.20

2916 Transfrontal hypophysectomy 20 480.000 4 291.70 20 384.000 3 433.30 30 11.000 617.20

2917 Transnasal hypophyseal implants 20 172.000 1 537.90 20 137.600 1 230.30 30 11.000 617.20

2918Non-operative supervision of paraplegics for all disciplines except urologists. Per service (specified)

20 - - 20 - - - - -


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R

14.9 Spinal operations - - - - - - - - -

See section 3.8.7 for laminectomy procedures - - - - - - - - -

2923 Chordotomy: Unilateral 20 178.000 1 591.50 20 142.400 1 273.20 30 3.000 168.30

2925 Chordotomy: Open 20 350.000 3 129.40 20 280.000 2 503.50 30 3.000 168.30

2927 Rhizotomy: Extradural, but intraspinal 20 320.000 2 861.10 20 256.000 2 288.90 30 3.000 168.30

2928 Rhizotomy: Intradural 20 350.000 3 129.40 20 280.000 2 503.50 30 3.000 168.30

2929 Removal of spinal cord tumour: Intramedullar: Posterior approach 20 700.000 6 258.70 20 560.000 5 007.00 30 8.000 448.90

2930 Removal of spinal cord tumour: Intramedullar: Anterio-lateral approach 20 700.000 6 258.70 20 560.000 5 007.00 30 8.000 448.90

2931 Removal of spinal cord tumour: Extramedullary, but intradural: Posterior approach 20 350.000 3 129.40 20 280.000 2 503.50 30 3.000 168.30

2932Removal of spinal cord tumour: Extramedullary, but intradural: Anterio-lateral approach

20 350.000 3 129.40 20 280.000 2 503.50 30 8.000 448.90

2933Removal of spinal cord tumour: Extramedullary, but intradural: Intraspinal, but extradural: Posterior approach

20 320.000 2 861.10 20 256.000 2 288.90 30 7.000 392.80

2935Removal of spinal cord tumour: Extramedullary, but intradural: Transcutaneous chordotomy

20 225.000 2 011.70 20 180.000 1 609.40 30 3.000 168.30

2937 Repair of meningocele, involving nerve tissue 20 250.000 2 235.30 20 200.000 1 788.20 30 9.000 505.00

2938 Simple 20 150.000 1 341.20 20 120.000 1 072.90 30 9.000 505.00

2939 Excision of arterial vascular malformations and cysts of the spinal cord 20 700.000 6 258.70 20 560.000 5 007.00 30 9.000 505.00

2940 Lumbar osteophyte removal 20 187.000 1 672.00 20 149.600 1 337.60 30 3.000 168.30

2941 Cervical or thoracic osteophyte removal 20 285.000 2 548.20 20 228.000 2 038.60 30 3.000 168.30

14.10 Arterial ligations

2951 Carotis: Trauma 20 120.000 1 072.90 20 120.000 1 072.90 30 8.000 448.90

2953 Carotis: For aneurysm (AV anomaly) 20 150.000 1 341.20 20 120.000 1 072.90 30 8.000 448.90

2955 Removal of carotid body tumour (without vascular reconstruction) 20 335.600 3 000.60 20 268.480 2 400.50 30 8.000 448.90

14.11 Medical psychotherapy - - - - - - - - -

2957Individual psychotherapy (specify type): Including play therapy for children: Per short session (20 minutes)

- - - 20 16.000 143.10 - - -

2958 Psychoanalytic therapy: Per 60-minute session - - - 20 48.000 429.20 - - -

2962 Directive therapy to family, parent(s), spouse: Per 20-minute session - - - 20 16.000 143.10 - - -

2963 Pairs, marriage or sex therapy: Per 20-minute session - - - 20 16.000 143.10 - - -


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Value R

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R

2968Group therapy: Adults (specify number): Tariff per person per 80-minute session; Children (specify number): Tariff per person per 80-minute session

- - - 20 8.000 71.50 - - -

2974Individual psychotherapy (specify type): Including play therapy for children: Per intermediate session (40 minutes)

- - - 20 32.000 286.10 - - -

2975Individual psychotherapy (specify type): Including play therapy for children: Per extended session (60 minutes or longer)

- - - 20 48.000 429.20 - - -

2976Intermediate treatment where either items 2962 or 2963 are used: Per 40-minute session

- - - 20 32.000 286.10 - - -

2977Extended treatment where either items 2962 or 2963 are used: Per 60-minute session

- - - 20 48.000 429.20 - - -

RULES GOVERNING THE SECTION MEDICAL PSYCHOTHERAPY - - - - - - - - -

V.


- - - - - - - - -

0079

When a first consultation/visit proceeds into, or is immediately followed by a medical psychotherapeutic procedure, fees for the procedure are calculated according to the appropriate individual psychotherapy code (items 2957, 2974 or 2975)

- - - - - - - - -

0099

Stat basis tests: For tests performed on a stat basis, an additional premium of 50% of the fee for the particular pathology service shall apply, with the following provisos: o Stat test requesting may only be done by the referring practitioner and not by the pathologist. o Specimens must be collected on a stat basis where applicable. o Test must be performed on a stat basis. o Documentation (or a copy thereof) relating to the request of the referring practitioner must be retained. o This modifier will only apply during normal working hours and will never be used in combination with item 4547: After-hours service.

- - - - - - - - -

14.12 Physical treatment methods - - - - - - - - -


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Code: 11000

code CF Units Value

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Value R

CF Units Value

R

2970 Electro-convulsive treatment (ECT): Each time (See rule Va) - - - 20 17.000 152.00 30 3.000 168.30

14.13 Psychiatric examination methods - - - - - -

2972 Narco-analysis (Maximum of 3 sessions per treatment): Per 60 min session - - - 20 16.000 143.10 - - -

2973Psychometry (specify examination): Per session (Maximum of 3 sessions per examination)

- - - 20 16.000 143.10 - - -

15 Endocrine System - - - - - - - - -

15.1 Thyroid - - - - - - - - -

2983 Lobectomy: Partial 20 198.100 1 771.20 20 158.480 1 417.00 30 5.000 280.60

2985 Lobectomy: Total 20 200.000 1 788.20 20 160.000 1 430.60 30 5.000 280.60

2987 Thyroidectomy: Subtotal 20 266.000 2 378.30 20 212.800 1 902.60 30 5.000 280.60

2989 Thyroidectomy: Total 20 279.000 2 494.50 20 223.200 1 995.60 30 5.000 280.60

2991 Thyroglossal cyst or fistula excision 20 126.200 1 128.40 20 120.000 1 072.90 30 5.000 280.60

15.2 Parathyroid - - - - - - - - -

2993 Exploration of parathyroid glands for hyperparathyroidism including removal 20 275.000 2 458.80 20 220.000 1 967.00 30 5.000 280.60

15.3 Adrenals - - - - - - - - -

2995 Adrenalectomy: Unilateral 20 225.000 2 011.70 20 180.000 1 609.40 30 9.000 505.00

2997 Bilateral exploration of adrenal glands: Including removal 20 394.000 3 522.80 20 315.200 2 818.20 30 11.000 617.20

15.4 Hypophysis - - - - - - - - -

2999 Transethmoidal hypophysectomy 20 300.000 2 682.30 20 240.000 2 145.80 30 11.000 617.20

3000 Transnasal hypophysectomy (see also item 2915) 20 300.000 2 682.30 20 240.000 2 145.80 30 11.000 617.20

15.5 Endocrine system: General - - - - - - - - -

3001 Implantation of pellets (excluding cost of material) (excluding after-care) 20 3.000 26.80 20 3.000 26.80 - - -

16 Eye - - - - - - - - -

16.1 Eye: Procedures performed in rooms - - - - - - - - -

(a) Eye investigations and photography refer to both eyes except where otherwise indicated. No extra fee may be charged where each eye is examined separately on two different occasions (b) Material used is excluded (c) The fee for photography is not related to the number of photographs taken

- - - - - - - - -

16.1.1 Eye investigations - - - - - - - - -

3002 Gonioscopy 20 7.000 62.60 20 7.000 62.60 - - -


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code CF Units Value

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Value R

CF Units Value

R

3003Fundus contact lens or 90 D lens examination (not to be charged with item 3004 or item 3012)

20 7.000 62.60 20 7.000 62.60 - - -

3004Peripheral fundus examination with indirect ophthalmoscope (not to be charged with item 3003 and/or item 3012)

20 7.000 62.60 20 7.000 62.60 - - -

3006 Keratometry 20 7.000 62.60 20 7.000 62.60 - - -

3009Basic capital equipment used in own rooms by ophthalmologists. Only to be charged at first and follow-up consultations. Not to be charged for post-operative follow-up consultations

20 11.680 104.40 - - - - - -

3012 Pre-surgical retinal examination before retinal surgery 20 32.000 286.10 20 32.000 286.10 - - -

3013 Ocular motility assessment: Comprehensive examination 20 12.000 107.30 20 12.000 107.30 - - -

3014Tonometry per test with maximum of 2 tests for provocative tonometry (one or both eyes)

20 7.000 62.60 20 7.000 62.60 - - -

3021Special eye investigations: Retinal function assessment including refraction after ocular surgery (within four months), maximum two examinations

20 9.000 80.50 20 9.000 80.50 - - -

16.1.2 Special eye investigations - - - - - - - - -

3005 Endothelial cell count 20 7.000 62.60 20 7.000 62.60 - - -

3007 Potential acuity measurement 20 7.000 62.60 20 7.000 62.60 - - -

3008 Contrast sensitivity test 20 7.000 62.60 20 7.000 62.60 - - -

3010 Orthoptics consultation 20 10.000 89.40 20 10.000 89.40 - - -

3011 Orthoptic subsequent sessions 20 5.000 44.70 20 5.000 44.70 - - -

3015 Charting of visual field with manual perimeter 20 28.000 250.40 20 28.000 250.40 - - -

3016 Retinal threshold test without storage facilities 20 30.000 268.20 20 30.000 268.20 - - -

3017Retinal threshold test inclusive of computer disc storage for Delta of Statpak programs

20 74.000 661.60 20 74.000 661.60 - - -

3018 Retinal threshold trend evaluation (additional to item 3017) 20 16.000 143.10 20 16.000 143.10 - - -

3019 Ocular muscle function with Hess screen or perimeter 20 16.000 143.10 20 16.000 143.10 - - -

3020Special eye investigations: Pachymetry: Only when own instrument is used, per eye. Only in addition to corneal surgery

20 46.000 411.30 20 46.000 411.30 - - -

3022 Digital fluorescein video angiography 20 68.000 608.00 20 68.000 608.00 30 9.000 505.00

3023 Digital indocyanine video angiography 20 110.000 983.50 20 110.000 983.50 30 9.000 505.00


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Code: 11000

code CF Units Value

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Value R

CF Units Value

R

3024Infusion of dye used during Fluorescein Angiography, Indocyanine Green Video Angiography and Photodynamic therapy. Linked to items 3022, 3023, 3031, 3039

20 12.000 107.30 20 12.000 107.30 - - -

3025 Electronic tonography 20 19.000 169.90 20 19.000 169.90 - - -

3026Digital Tomography of optic nerve with Scanning Laser Ophthalmoscope (SLO). Limited to two exams per annum

20 19.300 172.60 20 19.300 172.60 - - -

3027 Fundus photography 20 21.000 187.80 20 21.000 187.80 - - -

3028 Optical Coherent Tomography (OCT) of Optic nerve or macula: Per eye 20 40.000 357.60 20 40.000 357.60 - - -

3029 Anterior segment microphotography 20 21.000 187.80 20 21.000 187.80 - - -

3031 Fluorescein Angiography: One or both eyes (not to be used with item 3022) 20 45.000 402.40 20 45.000 402.40 - - -

3032 Eyelid and orbit photography 20 9.000 80.50 20 9.000 80.50 - - -

3033 Interpretation of items 3022, 3023 and 3031 referred by other clinicians 20 16.000 143.10 20 16.000 143.10 - - -

3034 Determination of lens implant power per eye 20 15.000 134.10 20 15.000 134.10 - - -

3035Where a minor procedure usually done in the consulting rooms requires a general anaesthetic or use of an operating theatre, an additional fee may be charged

20 22.000 196.70 20 22.000 196.70 - - -

3036Corneal topography: For pathological corneas only on special motivation. For refractive surgery - may be charged once pre-operative and once post-operative per sitting (for one or both eyes)

20 36.000 321.90 20 36.000 321.90 - - -

16.2 Retina - - - - - - - - -

3037Surgical treatment of retinal detachment including vitreous replacement but excluding vitrectomy

20 306.900 2 744.00 20 245.520 2 195.20 30 6.000 336.70

3039Prophylaxis and treatment of retina and choroid by cryotherapy and/or diathermy and/or photocoagulation and/or laser per eye

20 105.000 938.80 20 105.000 938.80 30 6.000 336.70

3041 Pan retinal photocoagulation (per eye): Done in one sitting 20 150.000 1 341.20 20 120.000 1 072.90 30 6.000 336.70

3044 Removal of encircling band and/or buckling material 20 105.000 938.80 20 105.000 938.80 30 6.000 336.70

16.3 Cataract - - - - - - - - -

3045 Cataract: Intra-capsular 20 210.000 1 877.60 20 168.000 1 502.10 30 7.000 392.80

3047 Cataract: Extra-capsular (including capsulotomy) 20 210.000 1 877.60 20 168.000 1 502.10 30 7.000 392.80

3049Insertion of lenticulus in addition to item 3045 or item 3047 (cost of lens excluded) (modifier 0005 not applicable)

20 57.000 509.60 20 57.000 509.60 30 7.000 392.80

3050 Repositioning of intra ocular lens 20 171.100 1 529.80 20 136.880 1 223.80 30 7.000 392.80


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Value R

CF Units Value

R

3051 Needling or capsulotomy 20 130.000 1 162.30 20 120.000 1 072.90 30 4.000 224.50

3052 Laser capsulotomy 20 105.000 938.80 20 105.000 938.80 30 4.000 224.50

3057 Removal of lenticulus 20 210.000 1 877.60 20 168.000 1 502.10 30 7.000 392.80

3058 Exchange of intra ocular lens 20 236.000 2 110.10 20 188.800 1 688.10 30 7.000 392.80

3059Insertion of lenticulus when item 3045 or item 3047 was not executed (cost of lens excluded)

20 210.000 1 877.60 20 168.000 1 502.10 30 7.000 392.80

3060Use of own surgical microscope for surgery or examination (not for slit lamp microscope) (for use by ophthalmologists only)

20 4.000 35.80 - - - - - -

16.4 Glaucoma - - - - - - - - -

3061 Drainage operation 20 247.600 2 213.80 20 198.080 1 771.00 30 6.000 336.70

3062 Implantation of aqueous shunt device/seton in glaucoma (additional to item 3061) 20 60.000 536.50 20 60.000 536.50 30 6.000 336.70

3063 Cyclocryotherapy or cyclodiathermy 20 105.000 938.80 20 105.000 938.80 30 6.000 336.70

3064 Laser trabeculoplasty 20 105.000 938.80 20 105.000 938.80 30 6.000 336.70

3065 Removal of blood from anterior chamber 20 105.000 938.80 20 105.000 938.80 30 4.000 224.50

3067 Goniotomy 20 210.000 1 877.60 20 168.000 1 502.10 30 7.000 392.80

16.5 Intra-ocular foreign body

3071 Intra-ocular foreign body: Anterior to Iris 20 127.000 1 135.50 20 120.000 1 072.90 30 4.000 224.50

3073Intra-ocular foreign body: Posterior to Iris (including prophylactic thermal treatment to retina)

20 210.000 1 877.60 20 168.000 1 502.10 30 6.000 336.70

16.6 Strabismus - - - - - - - - -

3074Strabismus (whether operation performed on one eye or both): Adjustment of sutures if not done at the time of the operation. Additional fee for sterile tray (refer to item 0202)

20 20.000 178.80 20 20.000 178.80 - - -

3075Strabismus (whether operation performed on one eye or both): Operation on one or two muscles

20 175.600 1 570.00 20 140.480 1 256.00 30 5.000 280.60

3076Strabismus (whether operation performed on one eye or both): Operation on three or four muscles

20 200.000 1 788.20 20 160.000 1 430.60 30 5.000 280.60

3077Strabismus (whether operation performed on one eye or both): Subsequent operation one or two muscles

20 120.000 1 072.90 20 120.000 1 072.90 30 5.000 280.60

3078Strabismus (whether operation performed on one eye or both): Subsequent operation on three or four muscles

20 150.000 1 341.20 20 120.000 1 072.90 30 5.000 280.60


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Code: 11000

code CF Units Value

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Value R

CF Units Value

R

16.7 Globe - - - - - - - - -

3079 Transcleral biopsy 20 132.000 1 180.20 20 120.000 1 072.90 30 4.000 224.50

3080 Examination of eyes under general anaesthetic where no surgery is done 20 80.000 715.30 20 80.000 715.30 30 4.000 224.50

3081 Treatment of minor perforating injury 20 161.600 1 444.90 20 129.280 1 155.90 30 6.000 336.70

3083 Treatment of major perforating injury 20 267.500 2 391.70 20 214.000 1 913.40 30 6.000 336.70

3085 Enucleation or Evisceration 20 105.000 938.80 20 105.000 938.80 30 5.000 280.60

3087Enucleation or Evisceration with mobile implant: Excluding cost of implant and prosthesis

20 160.000 1 430.60 20 128.000 1 144.50 30 5.000 280.60

3088 Hydroxyapetite insertion (additional to item 3087) 20 40.000 357.60 20 40.000 357.60 30 5.000 280.60

3089 Subconjunctival injection if not done at time of operation 20 10.000 89.40 20 10.000 89.40 30 5.000 280.60

3090 Intra vitreal injection drug 20 47.600 425.60 20 47.600 425.60 30 4.000 224.50

3091 Retrobulbar injection (if not done at time of operation) 20 16.000 143.10 20 16.000 143.10 30 4.000 224.50

3092 External laser treatment for superficial lesions 20 53.000 473.90 20 53.000 473.90 - - -

3093Treatment of tumours of retina or choriod by radioactive plaque and/or diathermy and/or cryotherapy and/or laser therapy and/or photocoagulation

20 209.000 1 868.70 20 167.200 1 494.90 30 6.000 336.70

3094 Implantation of intra vitreal drug delivery system 20 247.600 2 213.80 20 198.080 1 771.00 30 4.000 224.50

3095 Biopsy of vitreous body or anterior chamber contents 20 105.000 938.80 20 105.000 938.80 30 6.000 336.70

3096Adding of air or gas in vitreous as a post-operative procedure or pneumo-retinopexy

20 130.000 1 162.30 20 120.000 1 072.90 30 7.000 392.80

3097 Anterior vitrectomy 20 280.000 2 503.50 20 224.000 2 002.80 30 6.000 336.70

3098 Removal of silicon from globe 20 280.000 2 503.50 20 224.000 2 002.80 30 6.000 336.70

3099Posterior vitrectomy including anterior vitrectomy, encircling of globe and vitreous replacement

20 419.000 3 746.30 20 335.200 2 997.00 30 6.000 336.70

3100 Lensectomy done at time of posterior vitrectomy 20 30.000 268.20 20 30.000 268.20 30 7.000 392.80

16.8 Orbit - - - - - - - - -

3101 Drainage of orbital abscess 20 105.000 938.80 20 105.000 938.80 30 5.000 280.60

3103 Orbit: Removal of tumour 20 240.000 2 145.80 20 192.000 1 716.70 30 5.000 280.60

3104 Removal orbital prosthesis 20 212.700 1 901.80 20 170.160 1 521.40 30 5.000 280.60

3105 Orbit: Exenteration 20 275.000 2 458.80 20 220.000 1 967.00 30 5.000 280.60

3107 Orbitotomy requiring bone flap 20 393.000 3 513.80 20 314.400 2 811.10 30 5.000 280.60

3108 Eye socket reconstruction 20 206.000 1 841.90 20 164.800 1 473.50 30 5.000 280.60


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code CF Units Value

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Value R

CF Units Value

R

3109Hydroxyapetite implantation in eye cavity when evisceration or enucleation was done previously

20 300.000 2 682.30 20 240.000 2 145.80 30 5.000 280.60

3110 Second stage hydroxyapetite implantation 20 110.000 983.50 20 110.000 983.50 30 5.000 280.60

16.9 Cornea - - - - - - - - -

3111Contact lenses: Assessment involving preliminary fittings and tolerance visits (costs of lenses borne by patient)

20 - - 20 - - - - -

3112Fitting of contact lens for treatment of disease including supply of lens. Bandage contact lens as for corneal erosion, ulcer, abrasion or corneal wound.

20 12.200 109.10 20 12.200 109.10 - - -

3113Fitting of contact lenses and instructions to patient: Includes eye examination, first fitting of the contact lenses and further post-fitting visits for one (1) year

20 200.000 1 788.20 20 160.000 1 430.60 - - -

3114Wavefront analysis (Aberometry) for customized ablation of pathological corneas prior to LASIK surgery - EQUIPMENT component only

20 78.850 705.00 - - - - - -

3115Fitting of only one contact lens and instructions to the patient: Eye examination, first fitting of the contact lens and further post-fitting visits for one year included

20 166.000 1 484.20 20 132.800 1 187.40 - - -

3116Astigmatic correction with T-cuts or wedge resection in pathological corneal astigmatism following trauma, intra ocular surgery or penetrating keratoplasty

20 135.200 1 208.80 20 120.000 1 072.90 30 6.000 336.70

3117 Removal of foreign body: On the basis of fee per consultation 20 - - 20 - - 30 4.000 224.50

3118 Curettage of cornea after removal of foreign body (after-care excluded) 20 10.000 89.40 20 10.000 89.40

3119 Tattooing 20 26.000 232.50 20 26.000 232.50 30 4.000 224.50

3120Excimer laser (per eye) for refractive keratectomy or Holmium laser thermo keratoplasty (LTK) (For machine hire fee for LTK: Use item 3201)

20 150.000 1 341.20 20 120.000 1 072.90 30 6.000 336.70

3121 Corneal graft (Lamellar or full thickness) 20 289.000 2 584.00 20 231.200 2 067.20 30 6.000 336.70

3122 Epikeratophakia 20 289.000 2 584.00 20 231.200 2 067.20 - - -

3123 Insertion of intra-corneal or intrascleral prosthesis for refractive surgery 20 254.000 2 271.00 20 203.200 1 816.80 30 6.000 336.70

3124Removal of corneal stitches under microscope (maximum of 2 procedures). Additional fee for sterile tray (see item 0202)

20 9.000 80.50 20 9.000 80.50 - - -

3125 Keratectomy 20 127.000 1 135.50 20 120.000 1 072.90 30 6.000 336.70

3126Additional to item 3120 for the use of own microkeratome used with a excimer laser

20 52.180 466.50 20 52.180 466.50 - - -

3127 Cauterisation of cornea (by chemical, thermal or cryotherapy methods) 20 10.000 89.40 20 10.000 89.40 30 4.000 224.50

3128Radial keratotomy or keratoplasty for astigmatism (cosmetic unless medical reasons can be proved)

20 150.000 1 341.20 20 120.000 1 072.90 30 6.000 336.70


199 • Version 4_21




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Code: 11000

code CF Units Value

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Value R

CF Units Value

R

3129 Additional to item 3128 for the use of own diamond knives 20 40.000 357.60 20 40.000 357.60 - - -

3130Pterygium or conjunctival cyst or conjunctival tumour. No conjunctival flap or graft used

20 96.900 866.40 20 96.900 866.40 30 4.000 224.50

3131 Cornea: Paracentesis 20 53.000 473.90 20 53.000 473.90 30 4.000 224.50

3132 Lamellar keratectomy for refractive surgery (LK, ALK, MLK) 20 150.000 1 341.20 20 120.000 1 072.90 30 6.000 336.70

3134Pterygium or conjunctival cyst or conjunctival tumour. Conjunctival flap or graft used - stand alone procedure

20 116.300 1 039.80 20 116.300 1 039.80 30 4.000 224.50

3136 Conjunctival flap or graft (not for use with pterigium surgery) 20 95.700 855.70 20 95.700 855.70 30 6.000 336.70

3138 Removal corneal epithelium and chelating agent for band keratopathy 20 69.500 621.40 20 69.500 621.40 30 4.000 224.50

16.10 Ducts - - - - - - - - -

3133 Probing and/or syringing, per duct 20 10.000 89.40 20 10.000 89.40 30 4.000 224.50

3135 Insert polythene tubes 20 51.800 463.10 20 51.800 463.10 30 4.000 224.50

3137 Excision of lacrimal sac: Unilateral 20 132.000 1 180.20 20 120.000 1 072.90 30 4.000 224.50

3139 Dacrocystorhinostomy (Single) with or without polythene tube 20 210.000 1 877.60 20 168.000 1 502.10 30 5.000 280.60

3141 Sealing Punctum surgical or by cautery: Per eye 20 24.900 222.60 20 24.900 222.60 30 4.000 224.50

3142 Sealing Punctum with plugs: Per eye 20 20.000 178.80 20 20.000 178.80 30 4.000 224.50

3143 Three-snip operation 20 10.000 89.40 20 10.000 89.40 30 4.000 224.50

3145 Repair of caniculus: Primary procedure 20 132.000 1 180.20 20 120.000 1 072.90 30 4.000 224.50

3147 Repair of caniculus: Secondary procedure 20 175.000 1 564.70 20 140.000 1 251.70 30 4.000 224.50

16.11 Iris - - - - - - - - -

3149 Iridectomy or iridotomy by open operation as isolated procedure 20 132.000 1 180.20 20 120.000 1 072.90 30 4.000 224.50

3151 Excision of iris tumour 20 185.000 1 654.10 20 148.000 1 323.30 30 6.000 336.70

3153Iridectomy or iridotomy by laser or photocoagulation as isolated procedure (maximum one procedure)

20 105.000 938.80 20 105.000 938.80 30 4.000 224.50

3155 Iridocyclectomy for tumour 20 266.000 2 378.30 20 212.800 1 902.60 30 6.000 336.70

3157 Division of anterior synechiae as isolated procedure 20 132.000 1 180.20 20 120.000 1 072.90 30 4.000 224.50

3158 Repair iris as in dialysis: Anterior chamber reconstruction 20 142.400 1 273.20 20 120.000 1 072.90 30 4.000 224.50

16.12 Lids - - - - - - - - -

3161 Tarsorrhaphy 20 47.000 420.20 20 47.000 420.20 30 4.000 224.50

3163 Excision of superficial lid tumour 20 47.000 420.20 20 47.000 420.20 30 4.000 224.50


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CF Units Value

R

3165 Repair of skin laceration lid: Simple 20 27.300 244.10 20 27.300 244.10 30 4.000 224.50

3167 Diathermy to wart on lid margin 20 12.000 107.30 20 12.000 107.30 30 4.000 224.50

3169 Electrolysis of any number of eyelashes: Per eye 20 15.000 134.10 20 15.000 134.10

3171 Excision of Meibomian cyst. Additional fee for sterile tray (see item 0202) 20 20.400 182.40 20 20.400 182.40 30 4.000 224.50

3173 Epicanthal folds 20 128.700 1 150.70 20 120.000 1 072.90 30 4.000 224.50

3174Botulinus toxin injection for blepharospasm (+ item 0198 + item 0201 + item 0202)

20 25.000 223.50 - - - - - -

3175Botulinus toxin injection in extra-ocular muscles (+ item 0198 + item 0201+ item 0202)

20 35.000 312.90 - - - - - -

3176Lid operation for facial nerve paralysis including tarsorrhaphy but excluding cost of material

20 187.000 1 672.00 20 149.600 1 337.60 30 4.000 224.50

16.12.1 Lids: Entropion or ectropion by - - - - - - - - -

3177 Entropion or ectropion by Cautery 20 10.000 89.40 20 10.000 89.40 30 4.000 224.50

3179 Entropion or ectropion by Suture 20 49.400 441.70 20 49.400 441.70 30 4.000 224.50

3181 Entropion or ectropion by Open operation 20 111.500 996.90 20 111.500 996.90 30 4.000 224.50

3183 Entropion or ectropion by Free skin, mucosal grafting or flap 20 122.600 1 096.20 20 122.600 1 096.20 30 4.000 224.50

16.12.2 Lids: Reconstruction of eyelid - - - - - - - - -

3185 Staged procedure for partial or total loss of eyelid: First stage 20 259.000 2 315.70 20 207.200 1 852.60 30 4.000 224.50

3187 Staged procedure for partial or total loss of eyelid: Subsequent stage 20 206.000 1 841.90 20 164.800 1 473.50 30 4.000 224.50

3189 Full thickness eyelid laceration for tumour or injury: Direct repair 20 136.500 1 220.50 20 120.000 1 072.90 30 4.000 224.50

3191 Blepharoplasty: Upper lid for improvement in function (unilateral) 20 150.200 1 342.90 20 120.160 1 074.40 30 4.000 224.50

3172 Blepharoplasty lower eyelid plus fat pad 20 125.800 1 124.80 20 120.000 1 072.90 30 4.000 224.50

16.12.3 Lids: Ptosis - - - - - - - - -

3193 Repair by superior rectus, levator or frontalis muscle operation 20 190.000 1 698.80 20 152.000 1 359.00 30 4.000 224.50

3195 Ptosis: By lesser procedure e.g. sling operation: Unilateral 20 137.600 1 230.30 20 120.000 1 072.90 30 4.000 224.50

3197 Ptosis: By lesser procedure e.g. sling operation: Bilateral 20 166.000 1 484.20 20 132.800 1 187.40 30 4.000 224.50

16.13 Conjunctiva - - - - - - - - -

3199 Repair of conjunctiva by grafting 20 132.000 1 180.20 20 120.000 1 072.90 30 4.000 224.50

3200 Repair of lacerated conjunctiva 20 47.000 420.20 20 47.000 420.20 30 4.000 224.50

16.14 Eye: General - - - - - - - - -


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R

OWN EQUIPMENT USED IN TREATMENT: Only the owner of the equipment may charge hire fees for equipment used and not the person using the equipment.

- - - - - - - - -

3190Holmium laser apparatus (ophthalmic): Hire fee for one or both eyes done in one sitting

20 109.000 974.60 - - - - - -

3192Applicable to Medical Scheme Benefits only: Item 3192: If a practitioner performs the procedure in his own facility an excimer laser theatre fee of the indicated amount per minute may be charged

20 2.250 20.10 20 2.250 20.10 - - -

3196 Diamond knife: Use of own diamond knife during intraocular surgery 20 12.000 107.30 - - - - - -

3198 Excimer laser: Hire fee (per eye) 20 284.130 2 540.40 - - - - - -

3201Laser apparatus (ophthalmic): Hire fee for one or both eyes done in one sitting (Not to be used with IOL Master)

20 109.000 974.60 - - - - - -

3202 Phako emulsification apparatus: Hire fee 20 109.000 974.60 - - - - - -

3203 Vitrectomy apparatus: Hire fee 20 120.000 1 072.90 - - - - - -

17 Ear - - - - - - - - -

Fitting / orientation / checking of a hearing aid: report this service using the appropriate consultation code

- - - - - - - - -

Repair / modification of hearing aid: report this service using item 0201 and supply invoice

- - - - - - - - -

17.1 External ear (Pinna) - - - - - - - - -

Fitting / orientation / checking of a hearing aid: report this service using the appropriate consultation code

- - - - - - - - -

Repair / modification of hearing aid: report this service using 0201 and supply invoice

- - - - - - - - -

3267 Major congenital deformity reconstruction of external ear: Unilateral 20 138.000 1 233.90 20 120.000 1 072.90 30 5.000 280.60

3269 Major congenital deformity reconstruction of external ear: Bilateral 20 242.000 2 163.70 20 193.600 1 731.00 30 5.000 280.60

3270 Excision of superficial pre-auricular fistula 20 55.000 491.80 20 55.000 491.80 30 4.000 224.50

3271Partial or total reconstruction for congenital or traumatic absence or following tumour excision of external ear

20 - - - - - - - -

3272 Excision of complicated pre-auricular fistula 20 140.000 1 251.70 20 120.000 1 072.90 30 4.000 224.50

17.2 External ear canal - - - - - - - - -


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R

3204 External ear canal: Removal of foreign body: At rooms 20 - - 20 - - - - -

3205 External ear canal: Removal of foreign body: Under general anaesthetic 20 21.000 187.80 20 21.000 187.80 30 4.000 224.50

3215 Meatus atresia: Repair of stenosis of cartilaginous portion 20 164.000 1 466.30 20 131.200 1 173.10 30 4.000 224.50

3217 Meatus atresia: Congenital 20 277.000 2 476.70 20 221.600 1 981.30 30 4.000 224.50

3218Remove impacted wax (one or both ears) with the use of a microscope (excludes loupe) - not to be used combined with item 3206

20 17.420 155.80 20 17.420 155.80 - - -

3219 Meatus atresia: Removal of osteoma from meatus: Solitary 20 77.000 688.50 20 77.000 688.50 30 4.000 224.50

3221 Meatus atresia: Removal of osteoma from meatus: Multiple 20 215.000 1 922.30 20 172.000 1 537.90 30 4.000 224.50

17.3 Middle ear - - - - - - - - -

3206 Microscopic examination of tympanic membrane including microsuction 20 8.000 71.50 20 8.000 71.50 - - -

3207 Myringotomy: Unilateral 20 28.000 250.40 20 28.000 250.40 30 4.000 224.50

3209 Myringotomy: Bilateral 20 46.000 411.30 20 46.000 411.30 30 4.000 224.50

3211 Unilateral myringotomy with insertion of ventilation tube 20 38.000 339.80 20 38.000 339.80 30 4.000 224.50

3212 Bilateral myringotomy with insertion of unilateral ventilation tube 20 57.000 509.60 20 57.000 509.60 30 4.000 224.50

3213Bilateral myringotomy with insertion of bilateral ventilation tube (modifier 0005 not applicable)

20 65.000 581.20 20 65.000 581.20 30 4.000 224.50

3214 Reconstruction of middle ear ossicles (ossiculoplasty) 20 255.000 2 280.00 20 204.000 1 824.00 30 5.000 280.60

3237 Exploratory tympanotomy 20 158.900 1 420.70 20 127.120 1 136.60 30 5.000 280.60

3243 Myringoplasty 20 138.000 1 233.90 20 120.000 1 072.90 30 5.000 280.60

3245 Functional reconstruction of tympanic membrane 20 277.000 2 476.70 20 221.600 1 981.30 30 5.000 280.60

3249 Stapedotomy and stapedectomy 20 277.000 2 476.70 20 221.600 1 981.30 30 5.000 280.60

3257 Cortical mastoidectomy 20 188.500 1 685.40 20 150.800 1 348.30 30 5.000 280.60

3259 Radical mastoidectomy (excluding minor procedures) 20 277.400 2 480.20 20 221.920 1 984.20 30 5.000 280.60

3261 Muscle grafting to mastoid cavity without tympanoplasty 20 180.000 1 609.40 20 144.000 1 287.50 30 5.000 280.60

3263 Autogenous bone graft to mastoid cavity 20 180.000 1 609.40 20 144.000 1 287.50 30 5.000 280.60

3264 Tympanomastoidectomy 20 375.000 3 352.90 20 300.000 2 682.30 30 5.000 280.60

3265 Reconstruction of posterior canal wall, following radical mastoid 20 320.000 2 861.10 20 256.000 2 288.90 30 5.000 280.60

3266Gentamycin steroids instillation into the middle ear for Ménière’s disease (myringotomy and cost of material excluded)

20 30.000 268.20 20 30.000 268.20 30 5.000 280.60

17.4 Facial nerve - - - - - - - - -


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R

17.4.1 Facial nerve: Facial nerve tests - - - - - - - - -

3223 Percutaneous stimulation of the facial nerve 20 9.000 80.50 20 9.000 80.50 30 4.000 224.50

3224 Electroneurography (ENOG) 20 75.000 670.60 20 75.000 670.60 30 4.000 224.50

17.4.2 Facial nerve: Facial nerve surgery

3227 Exploration of facial nerve: Exploration of tympanomastiod segment 20 297.000 2 655.50 20 237.600 2 124.40 30 5.000 280.60

3228Exploration of facial nerve: Grafting of the tympanomastoid section (including item 3227)

20 436.000 3 898.30 20 348.800 3 118.60 30 5.000 280.60

3230 Exploration of facial nerve: Extratemporal grafting of the facial nerve 20 436.000 3 898.30 20 348.800 3 118.60 30 5.000 280.60

3232 Exploration of facial nerve: Facio-assessory or facio-hypoglossal anastomosis 20 124.000 1 108.70 20 120.000 1 072.90 30 6.000 336.70

17.5 Inner ear - - - - - - - - -

17.5.1 Inner ear: Audiometry - - - - - - - - -

2691Short latency brainstem evoked potentials (AEP) neurological examination, single decibel: Unilateral

20 50.000 447.10 - - - - - -

2692Short latency brainstem evoked potentials (AEP) neurological examination, single decibel: Bilateral

20 88.000 786.80 - - - - - -

2693 AEP: Audiological examination: Unilateral at a minimum of 4 decibels 20 60.000 536.50 - - - - - -

2694 AEP: Audiological examination: Bilateral at a minimum of 4 decibels 20 105.000 938.80 - - - - - -

2695 Audiology 40Hz response: Unilateral 20 30.000 268.20 - - - - - -

2696 Audiology 40Hz response: Bilateral 20 53.000 473.90 - - - - - -

2697 Mid- and long latency auditory evoked potentials: Unilateral 20 30.000 268.20 - - - - - -

2698 Mid- and long latency auditory evoked potentials: Bilateral 20 53.000 473.90 - - - - - -

2699 Electro-cochleography: Unilateral 20 50.000 447.10 - - - - - -

2700 Electro-cochleography: Bilateral 20 88.000 786.80 - - - - - -

2702Total fee for audiological evaluation including bilateral AEP and bilateral electro-cochleography

20 140.000 1 251.70 - - - 30 4.000 224.50

3248 Otoacoustic emission performed as a screening test 20 33.240 297.20 20 33.240 297.20 - - -

3250 Otoacoustic emission (high risk patients only) 20 66.480 594.40 20 66.480 594.40 - - -

3273 Pure tone audiometry (air conduction) 20 6.500 58.10 20 6.500 58.10 - - -

3274 Pure tone audiometry (bone conduction with masking) 20 6.500 58.10 20 6.500 58.10 - - -

3275 Impedance audiometry (tympanometry) 20 6.500 58.10 20 6.500 58.10 - - -


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R

3276 Impedance audiometry (stapedial reflex) - no charge for volume, compliance etc. 20 6.500 58.10 20 6.500 58.10 - - -

3277Speech audiometry: Fee includes speech audiogram, speech reception threshold, discrimination score

20 10.000 89.40 20 10.000 89.40 - - -

3278 Recruitment tests: Inclusive fee (Bekesy, Fowler, etc.) 20 6.500 58.10 20 6.500 58.10 - - -

17.5.2 Inner ear: Balance tests - - - - - - - - -

3251 Minimal caloric test (excluding consultation fee) 20 10.000 89.40 20 10.000 89.40 - - -

3252 Bithermal Halpike caloric test (excluding consultation fee) 20 20.000 178.80 20 20.000 178.80 - - -

3253 Electro-nystagmography for spontaneous and positional nystagmus 20 25.000 223.50 20 25.000 223.50 - - -

3254 Video nystagmoscopy (monocular) 20 25.000 223.50 20 25.000 223.50 - - -

3255 Caloric test done with electronystamography 20 70.000 625.90 20 70.000 625.90 - - -

3256 Video nystagmoscopy (binocular) 20 50.000 447.10 20 50.000 447.10 - - -

3258 Otolith repositioning manoeuvre 20 14.000 125.20 20 14.000 125.20 30 4.000 224.50

3260Computerised static posturography consists of standing a patient on a Piezo-electric platform which tests the vestibular and proprioceptive systems

20 71.480 639.10 20 71.480 639.10 - - -

17.5.3 Inner ear surgery - - - - - - - - -

3233 Labyrinthectomy via the middle ear or mastoid 20 277.000 2 476.70 20 221.600 1 981.30 30 5.000 280.60

3240 Endolymphatic sac surgery 20 277.000 2 476.70 20 221.600 1 981.30 30 4.000 224.50

3244Fenestration and occulasion of the posterior semicircular canal (FOS) for benign paroxysmal positioning vertigo (BPPV)

20 310.000 2 771.70 20 248.000 2 217.40 30 5.000 280.60

3246 Cochlear implant surgery 20 340.500 3 044.40 20 272.400 2 435.50 30 5.000 280.60

17.6 Microsurgery of the skull base - - - - - - - - -

17.6.1Microsurgery of the skull base: Middel fossa approach (i.e transtemporal or supralabyrinthine)

- - - - - - - - -

3229 Facial nerve: Exploration of the labyrinthine segment 20 420.000 3 755.20 20 336.000 3 004.20 30 5.000 280.60

5221Facial nerve: Grafting of labyrinthine segment (graft removal and exploration of labyrinthine segment are included)

20 510.000 4 559.90 20 408.000 3 647.90 30 11.000 617.20

5222Facial nerve surgery inside the internal auditory canal (if grafting is required, the grafting and harvesting of graft are included)

20 620.000 5 543.40 20 496.000 4 434.70 30 11.000 617.20

5223Vestibular neurectomy, removal of supra-labyrinthine tumours, or similar procedures

20 530.000 4 738.70 20 424.000 3 791.00 30 11.000 617.20

5224 Removal of acoustic neuroma via the middle fossa approach 20 660.000 5 901.10 20 528.000 4 720.90 30 11.000 617.20


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R

17.6.2 Microsurgery of the skull base: Translabyrinthe approach - - - - - - - - -

3239 Acoustic neuroma removal translabyrinthine 20 660.000 5 901.10 20 528.000 4 720.90 30 5.000 280.60

5227 Cochleo-vestibular neurectomy 20 530.000 4 738.70 20 424.000 3 791.00 30 11.000 617.20

5229Facial nerve surgery in the internal auditory canal, translabyrinthine (if grafting is required, the grafting and harvesting of graft are included)

20 660.000 5 901.10 20 528.000 4 720.90 30 11.000 617.20

17.6.3 Microsurgery of the skull base: Transotic approach to the cerebellopontime angle - - - - - - - - -

5232 Removal of acoustic neuroma or cyst of the internal auditory canal 20 660.000 5 901.10 20 528.000 4 720.90 30 11.000 617.20

17.6.4 Microsurgery of the skull base: Intratemporal fossa approach type A - - - - - - - - -

5235Removal of tumour for the jugular foramen, internal carotid artery, petrous apex and large intratemporal tumours

20 710.000 6 348.10 20 568.000 5 078.50 30 11.000 617.20

17.6.5 Microsurgery of the skull base: Intratemporal fossa approach type B - - - - - - - - -

5238 Removal of tumour of the petrous apex 20 620.000 5 543.40 20 496.000 4 434.70 30 11.000 617.20

5239 Removal of tumour of the clivus 20 620.000 5 543.40 20 496.000 4 434.70 30 11.000 617.20

17.6.6 Microsurgery of the skull base: Intrafemoral approach type C - - - - - - - - -

5242 Removal of nasopharyngeal angiofibroma or carcinoma 20 520.000 4 649.30 20 416.000 3 719.50 30 8.000 448.90

5243Removal of tumour from the intratemporal fossa, pterygopalatine fossa, parasellar region or nasopharynx

20 520.000 4 649.30 20 416.000 3 719.50 30 11.000 617.20

17.6.7 Microsurgery of the skull base: Subtotal petrosectomy - - - - - - - - -

5246 Subtotal petrosectomy for removal of temporal bone tumour 20 600.000 5 364.60 20 480.000 4 291.70 30 11.000 617.20

5247Subtotal petrosectomy for CSF leak and/or for total obliteration of the mastoid cavity

20 480.000 4 291.70 20 384.000 3 433.30 30 11.000 617.20

17.6.8Microsurgery of the skull base: Petrosectomy and radical dissection of petromandibular fossa

- - - - - - - - -

5250Partial mastoido-tympanectomy for malignancy of the deep lobe of the parotid gland

20 520.000 4 649.30 20 416.000 3 719.50 30 11.000 617.20

5251Total mastoido-tympanectomy for more extensive malignancy of the deep lobe of the parotid gland

20 600.000 5 364.60 20 480.000 4 291.70 30 8.000 448.90

5252Extended petrosectomy for extensive malignancy of the deep lobe of the parotid gland

20 660.000 5 901.10 20 528.000 4 720.90 30 8.000 448.90

18 Physical Treatment - - - - - - - - -


206 • Version 4_21




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R

3279Domiciliary or nursing home treatment (only applicable where a patient is physically incapable of attending the rooms, and the equipment has to be transported to the patient)

20 0.750 6.70 - - - - - -

3280Consultation units for specialists in physical medicine when treatment is given (per treatment)

20 13.500 120.70 - - - - - -

3281 Ultrasonic therapy 20 10.000 89.40 - - - - - -

3282 Shortwave diathermy 20 10.000 89.40 - - - - - -

3284 Sensory nerve conduction studies 20 31.000 277.20 - - - - - -

3285 Motor nerve conduction studies 20 26.000 232.50 - - - - - -

3287 Spinal joint and ligament injection 20 20.000 178.80 20 20.000 178.80 - - -

3288 Epidural injection 20 36.000 321.90 - - - - - -

3289 Multiple injections: First joint 20 7.500 67.10 - - - - - -

3290 Multiple injections: Each additional joint 20 4.500 40.20 - - - - - -

3291 Tendon or ligament injection 20 9.000 80.50 - - - - - -

3292 Aspiration of joint or inter-articular injection 20 9.000 80.50 - - - - - -

3293 Aspiration or injection of bursa or ganglion 20 9.000 80.50 - - - - - -

3294 Paracervical (neck) nerve block (for pelvis refer to item 2389) 20 20.000 178.80 - - - - - -

3295 Paravertebral root block: Unilateral 20 20.000 178.80 - - - - - -

3296 Paravertebral root block: Bilateral 20 30.000 268.20 - - - - - -

3297 Manipulation of spine performed by a specialist in Physical Medicine 20 14.000 125.20 - - - - - -

3298 Spinal traction 20 6.000 53.70 - - - - - -

3299 Manipulation of large joints: Under general anaesthesia 20 14.000 125.20 - - - 30 3.000 168.30

3299a Manipulation of large joints: Under general anaesthesia 20 14.000 125.20 - - - 30 4.000 224.50

3300 Manipulation of large joints: Without anaesthetic 20 - - 20 - - - - -

3301 Muscle fatigue studies 20 20.000 178.80 - - - - - -

3302 Strength duration curve per session 20 10.500 93.90 - - - - - -

3303 Electromyography 20 75.000 670.60 - - - - - -

3304

All other physical treatments carried out: Complete physical treatment: Specify treatment (For subsequent treatments by a general practitioner, for the same condition within 4 months after initial treatment: A fee for the treatment only, is applicable: See general rules L and M)

20 10.000 89.40 20 10.000 89.40 - - -


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SPECIAL MODIFIER: SECTION ON PHYSICAL TREATMENT - - - - - - - - -

0077

Physical treatment: When two separate areas are treated simultaneously for totally different conditions, such treatment shall be regarded as two treatments for which separate fees may be charged. (Only applicable if services are provided by a specialist in physical medicine)

- - - - - - - - -

5431Physical status modifier: Normal health patient, ASA 1: Add 0.00 anaesthetic units

- - - - - - - - -

5432Physical status modifier: A patient with mild systemic disease, ASA 2: Add 0,00 anaesthetic units

- - - - - - - - -

5436Physical status modifier: A declared brain-dead patient whose organs are being removed for donor purposes ASA 6: Add 0,00 anaesthetic units

- - - - - - - - -

19 Radiology - - - - - - - - -

Please note: The calculated amounts in this section (except for sections 19.9 and 19.11) are calculated according to the radiology unit values

- - - - - - - - -

RULES GOVERNING THE SECTION RADIOLOGY - - - - - - - - -

Y.Except where otherwise indicated, radiologists are entitled to charge for contrast material used

- - - - - - - - -

Z. No fee is subject to more than one reduction - - - - - - - - -

GG.

Capturing and recording of examinations: Images from all radiological, ultrasound and magnetic resonance imaging procedures must be captured during every examination and a permanent record generated by means of film, paper, or magnetic media. A report of the examination, including the findings and diagnostic comment, must be written and stored for five years

- - - - - - - - -

RR.

The radiology section in this price list is not for use by registered specialist radiology practices (Pr No “038”) or nuclear medicine practices (Pr No “025”), but only for use by other specialist practices or general practitioners. A separate radiology schedule is for the exclusive use of registered specialist radiology practices (Pr No “038”) and nuclear medicine practices (Pr No “025”).

- - - - - - - - -

MODIFIERS GOVERNING THE SECTION - - - - - - - - -


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0002

Written report on X-rays: The lowest level code for a new patient office (consulting rooms) visit, is applicable only where a radiologist is requested to give a written report on X-rays taken elsewhere and submitted to him. The above mentioned item and the lowest level initial hospital visit code, as appropriate are not to be used for routine reporting of X-rays taken elsewhere

- - - - - - - - -

0080 Multiple examinations: Full Fee - - - - - - - - -

0081 Repeat examinations: No reduction - - - - - - - - -

0082“+” Means that this item is complementary to a preceding item and is therefore not subject to reduction

- - - - - - - - -

0083A reduction of 33,33% (1/3) in the fee will apply to radiological examinations as indicated in section 19: Radiology where hospital equipment is used

- - - - - - - - -

0084

Film costs: In the case of radiological items where films are used, practitioners should adjust the fee upwards or downwards in accordance with changes in the price of films in comparison with November 1979; the calculation must be done on the basis that film costs comprise 10% of the monetary value of the unit (This information is obtainable from the Radiological Society of SA)

- - - - - - - - -

19.1 Skeleton - - - - - - - - -

19.1.1 Skeleton: Limbs - - - - - - - - -

3305 Finger, toe - - - 40 6.300 79.80 - - -

3309 Smith-Petersen or equivalent control, in theatre - - - 40 38.700 490.10 - - -

3311 Stress studies, e.g, joint - - - 40 7.700 97.50 - - -

3313 Full length study, both legs - - - 40 15.500 196.30 - - -

3315 Skeletal survey under 5 years - - - 40 19.900 252.00 - - -

3317 Skeletal survey over 5 years - - - 40 28.000 354.60 - - -

3319 Arthrography per joint - - - 40 15.400 195.00 - - -

3320 Introduction of contrast medium or air: ADD - - - 40 13.800 174.80 - - -

6500 Hand - - - 40 7.700 97.50 - - -

6501 Wrist (specify region) - - - 40 7.700 97.50 - - -

6503 Scaphoid - - - 40 7.700 97.50 - - -

6504 Radius and ulna - - - 40 7.700 97.50 - - -

6505 Elbow - - - 40 7.700 97.50 - - -

6506 Humerus - - - 40 7.700 97.50 - - -


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6507 Shoulder - - - 40 7.700 97.50 - - -

6508 Acromio-Clavicula joint - - - 40 7.700 97.50 - - -

6509 Clavicle - - - 40 7.700 97.50 - - -

6510 Scapula - - - 40 7.700 97.50 - - -

6511 Foot - - - 40 7.700 97.50 - - -

6512 Ankle - - - 40 7.700 97.50 - - -

6513 Calcaneus - - - 40 7.700 97.50 - - -

6514 Tibia and fibula - - - 40 7.700 97.50 - - -

6515 Knee - - - 40 7.700 97.50 - - -

6516 Patella - - - 40 7.700 97.50 - - -

6517 Femur - - - 40 7.700 97.50 - - -

6518 Hip - - - 40 7.700 97.50 - - -

6519 Sesamoid Bone - - - 40 7.700 97.50 - - -

19.1.2 Skeleton: Spinal column - - - - - - - - -

3321 Per region, e.g. cervical, sacral, lumbar coccygeal, one region thoracic - - - 40 11.000 139.30 - - -

3325 Stress studies - - - 40 11.000 139.30 - - -

3329 Scoliosis studies - - - 40 21.000 266.00 - - -

3331Pelvis (Sacro-iliac or hip joints only to be added where an extra set of view is required)

- - - 40 11.000 139.30 - - -

3333 Myelography: Lumbar - - - 40 28.900 366.00 30 4.000 224.50

3334 Myelography: Thoracic - - - 40 22.200 281.20 30 4.000 224.50

3335 Myelography: Cervical - - - 40 35.500 449.60 30 4.000 224.50

3336Multiple (lumbar, thoracic, cervical): Same fee as for first segment (no additional introduction of contrast medium)

- - - - - - 30 4.000 224.50

3344 Introduction of contrast medium - - - 40 18.700 236.80 - - -

3345 Discography - - - 40 34.600 438.20 30 4.000 224.50

3347 Introduction of contrast medium per disc level: ADD - - - 40 28.200 357.20 - - -

19.1.3 Skeleton: Skull - - - - - -

3349 Skull studies - - - 40 15.700 198.80 - - -

3351 Paranasal sinuses - - - 40 11.000 139.30 - - -


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3353 Facial bones and/or orbits - - - 40 12.600 159.60 - - -

3355 Mandible - - - 40 9.400 119.10 - - -

3357 Nasal bone - - - 40 7.800 98.80 - - -

3359 Mastoid: Bilateral - - - 40 18.000 228.00 - - -

3361 Teeth: One quadrant - - - 40 3.700 46.90 - - -

3363 Teeth: Two quadrants - - - 40 6.300 79.80 - - -

3365 Teeth: Full mouth - - - 40 11.000 139.30 - - -

3366 Teeth: Rotation tomography of the teeth and jaws - - - 40 13.300 168.40 - - -

3367 Teeth: Tempero-mandibular joints: Per side - - - 40 11.000 139.30 - - -

3369 Teeth: Tomography: Per side - - - 40 11.000 139.30 - - -

3371 Localisation of foreign body in the eye - - - 40 15.700 198.80 - - -

3381 Ventriculography - - - 40 27.300 345.80 30 4.000 224.50

3385 Post-nasal studies: Lateral neck - - - 40 6.300 79.80 - - -

3387 Maxillo-facial cephalometry - - - 40 8.800 111.50 - - -

3389 Dacrocystography - - - 40 11.000 139.30 30 4.000 224.50

3391 For introduction of contrast medium: ADD - - - 40 11.000 139.30 - - -

19.2 Alimentary tract - - - - - - - - -

3393 Bowel washout: ADD - - - 40 4.800 60.80 - - -

3395 Sialography (plus 80% for each additional gland) - - - 40 12.700 160.90 30 4.000 224.50

3397 Introduction of contrast medium (plus 80% for each additional gland: ADD) - - - 40 11.000 139.30 - - -

3399 Pharynx and oesophagus - - - 40 12.700 160.90 - - -

3403Oesophagus, stomach and duodenum (control film of abdomen included) and limited follow through

- - - 40 20.000 253.30 - - -

3405 Double contrast: ADD - - - 40 7.300 92.50 - - -

3406Small bowel meal (control film of abdomen included except when part of item 3408)

- - - 40 20.000 253.30 - - -

3408Barium meal and dedicated gastro-intestinal tract follow through (including control film of the abdomen, oesophagus, duodenum, small bowel and colon)

- - - 40 28.900 366.00 - - -

3409 Barium enema (control film of abdomen included) - - - 40 18.300 231.80 - - -

3411 Air contrast study: ADD - - - 40 19.300 244.40 - - -


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3415Biliary Tract: ERCP own equipment: Choledogram and/or pancreatography screening included

- - - 40 23.300 295.10 30 4.000 224.50

3416Pancreas: ERCP hospital equipment: Choledogram and/or pancreatography screening included

- - - 40 15.500 196.30 30 4.000 224.50

Note: For items 3415 and 3416: Endoscopy (see item 1778) - - - - - - - - -

3417 Gastric/oesophageal/duodenal intubation control - - - 40 5.900 74.70 - - -

3419 Gastric/oesophageal intubation insertion of tube: ADD - - - 40 5.600 70.90 - - -

3421 Duodenal intubation: Insertion of tube: ADD - - - 40 11.000 139.30 - - -

3423 Hypotonic duodenography (item 3403 and item 3405 included) - - - 40 29.300 371.10 - - -

19.3 Biliary tract - - - - - - - - -

3425 Oral cholecystography - - - 40 15.700 198.80 - - -

3427 Cholangiography: Intravenous - - - 40 22.000 278.60 - - -

3431Operative cholangiography: First series: ADD item 3607 only when the Radiologist attends personally in theatre

- - - 40 21.000 266.00 - - -

3433 Post operative: T-tube - - - 40 16.700 211.50 - - -

3435 Introduction of contrast medium: ADD - - - 40 5.600 70.90 - - -

3437 Trans hepatic, percutaneous - - - 40 18.300 231.80 - - -


3441 Tomography of biliary tract: ADD - - - 40 9.400 119.10 - - -

19.4 Chest - - - - - - - - -

3443 Larynx (Tomography included) - - - 40 12.500 158.30 - - -

3445 Chest (item 3601 included) - - - 40 9.400 119.10 - - -

3447 Chest and cardiac studies (item 3601) - - - 40 12.600 159.60 - - -

3449 Ribs - - - 40 12.300 155.80 - - -

3451 Sternum or sterno-clavicular joints - - - 40 12.600 159.60 - - -

3453 Bronchography: Unilateral - - - 40 12.600 159.60 30 8.000 448.90

3455 Bronchography: Bilateral - - - 40 22.100 279.90 30 8.000 448.90

3457 Introduction of contrast medium included - - - 40 35.700 452.10

3461 Pleurography - - - 40 12.600 159.60 30 3.000 168.30



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3465 Laryngography - - - 40 11.000 139.30 - - -


3468 Thoracic inlet - - - 40 6.300 79.80 - - -

19.5 Abdomen - - - - - - - - -

3477Control films of the Abdomen (not being part of examination for barium meal, barium enema, pyelogram, cholecystogram, cholangiogram etc.)

- - - 40 9.400 119.10 - - -

3479 Acute abdomen or equivalent studies - - - 40 15.700 198.80 - - -

19.6 Urinary tract - - - - - - - - -

3487Excretory urogram: Control film included and bladder views before and after micturition (intravenous pyelogram) (item 0206 not applicable)

- - - 40 25.100 317.90 - - -

3493 Waterload test: ADD - - - 40 12.200 154.50 - - -

3497 Cystography only or urethrography only (retrograde) - - - 40 19.300 244.40 - - -

3499 Cysto-urethrography: Retrograde - - - 40 31.900 404.00 - - -

3503 Cysto-urethrography: Introduction of contrast medium - - - 40 3.700 46.90 - - -

3505 Retrograde-prograde pyelography - - - 40 18.300 231.80 30 3.000 168.30

3511 Aspiration renal cyst - - - 40 18.400 233.00 - - -

3513 Tomography of renal tract: ADD - - - 40 9.400 119.10 - - -

19.7 Gynaecology and obstetrics - - - - - - - - -

3515 Pregnancy - - - 40 9.400 119.10 - - -

3517 Pelvimetry - - - 40 17.400 220.40 - - -

3519 Hystero-salpingography - - - 40 12.500 158.30 30 3.000 168.30


19.8 Vascular studies - - - - - - - - -


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The following rules are applicable to Section 19.8 (Vascular studies) and Section 19.14 (Interventional Radiological Procedures): a. The machine fee (items 3536 to 3550 includes the cost of the following: i. All runs (runs may not be billed for separately). ii. All film costs (modifier 0084 is not applicable). iii All fluoroscopy (item 3601 does not apply). iv All minor consumables (defined as any item other than catheters,

guidewires, introducer sets, specialised catheters, balloon catheters, stents, embolic agents, drugs and contrast media).

b. The machine fee (items 3536 to 3550) may only be billed for as a once off fee per case per day by the owner of the equipment and is only applicable to radiology practices.

c. If a procedure is performed by a non-radiologist together with a radiologist as a team, in a facility owned by the radiologist, each member of the team will fee at their respective full rates as per modifiers and the applicable items.

d. If a procedure is performed by a non-radiologists and a radiologist as a team, in a facility not owned by the radiologist, modifiers 6301 and 6302 applies.

Please note : Modifier 0083 is not applicable to section 19.8 (Vascular Studies) and section 19.14 (Interventional Radiological Procedures)

- - - - - - - - -

MODIFIER GOVERNING VASCULAR STUDIES - - - - - - - - -

0086Vascular groups: “Film series” and “Introduction of Contrast Media” are complementary and together constitute a single examination: neither fee is therefore subject to increase in terms of Modifier 0080: Multiple examinations

- - - - - - - - -

6300If a procedure lasts less than 30 minutes, only 50% of the machine fees for items 3536-3550 will be allowed (specify time of procedure on account)

- - - - - - - - -

6301If a procedure is performed by a radiologist in a facility not owned by himself, the fee will be reduced by 40% (i.e. 60% of the fee will be charged)

- - - - - - - - -

6302When the procedure is performed by a non-radiologist, the fee will be reduced by 40% (i.e. 60% of the fee will be charged)

- - - - - - - - -

6303When a procedure is performed entirely by a non-radiologist in a facility owned by a radiologist, the radiologist owning the facility may charge 55% of the procedure units used. Modifier 6302 applies to the non radiologist performing the procedure

- - - - - - - - -


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6305

When multiple catheterisation procedures are used (items 3557, 3559, 3560, 3562) and an angiogram investigation is performed at each level, the unit value of each such multiple procedure will be reduced by 20,00 radiological units for each procedure after the initial catheterisation. The first catheterisation is charged at 100% of the unit value

- - - - - - - - -

19.8.1 Vascular studies: Film Series - - - - - - - - -

Note: In the case of selective catheterisation of a branch of the aorta, the fee for catheterisation of the aorta is not added.

- - - - - - - - -

3536Dedicated angiography suite: Analogue monoplane unit. Once off charge per patient by owner of equipment

- - - - - - - - -

3537Dedicated angiography suite: Digital monoplane unit. Once off charge per patient by owner of equipment

- - - - - - - - -

3538 Analogue monoplane table with DSA attachment - - - - - - - - -

3539Dedicated angiography suite: Digital bi-plane unit. Once off charge per patient by owner of equipment

- - - - - - - - -

3540Radiography fee for coronary catheterisation laboratory, per radiographer, per half hour or part thereof

- - - 40 15.500 196.30 - - -

3545 Venography: Per limb - - - 40 16.500 209.00 - - -

3548 Analogue monoplane screening table - - - - - - - - -

3550 Digital monoplane screening table - - - - - - - - -

3551Lymphangiogram per limb (global fee) including lymphatic catheterisation (no machine fee applicable)

- - - 40 166.800 2 112.50 - - -

3557Catheterisation aorta or vena cava, any level, any route, with aortogram/cavogram

- - - 40 48.600 615.50 30 4.000 224.50

3558 Translumbar aortic puncture, with full study - - - 40 69.600 881.50 30 5.000 280.60

3559 Selective first order catheterisation, arterial or venous, with angiogram/venogram - - - 40 57.000 721.90 30 4.000 224.50

3560Selective second order catheterisation, arterial or venous, with angiogram/ venogram

- - - 40 65.400 828.30 30 4.000 224.50

3562 Selective third order catheterisation, arterial or venous, with angiogram/venogram - - - 40 73.200 927.10 30 4.000 224.50

3564 Direct femoral arterial or venous or jugular venous puncture - - - 40 37.200 471.10

3566Guiding catheter placement, any site arterial or venous, for any intracranial procedure or anteriovenous malformation (AVM)

- - - 40 85.800 1 086.70 30 5.000 280.60


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3569 Intravascular pressure studies, arterial or venous, once off per case - - - 40 19.800 250.80

3570Microcatheter insertion, any cranial vessel and/or pulmonary vessel, arterial or venous (including guiding catheter placement)

- - - 40 130.800 1 656.60 30 5.000 280.60

3572 Transcatheter selective blood sampling, arterial or venous - - - 40 32.400 410.40

3574 Spinal angiogram (global fee) including all selective catheterisations - - - 40 480.000 6 079.20 30 5.000 280.60

19.8.2 Vascular studies: Introduction of contrast medium - - - - - -

3563 Direct intravenous for limb - - - 40 7.400 93.70 - - -

3575 Cut-downs for venography: ADD - - - 40 11.000 139.30 - - -

19.9 Tomography and cinematography - - - - - - - - -

Please note: The calculated amounts in this section are calculated according to the computed tomography unit values

- - - - - - - - -

3577

Tomography (conventional except where otherwise specified): ADD 100% provided that if it is more than one dimension fee shall be charged for the additional investigation at 50% of the tariff with a maximum of two additional investigations

- - - - - - - - -

3579 Tomography (multi-dimensional in motion): ADD 150% - - - - - - - - -

3581 Cinematography: For first series: ADD 100% - - - - - - - - -

3583 Cinematography: For each series after the first: ADD 80% of the primary fee - - - - - - - - -

19.9.1 Tomography and cinematography: Computed Tomography - - - - - - - - -

3592Where a fully digital C-arm portable x-ray unit, with angiography/interventional capability is used in hospital or theatre, per half hour

- - - - - - - - -

3597Contrast media: General Rule Y applies (Please note: Item 0201 is not applicable for contrast media)

- - - - - - - - -

3598Electron beam computed tomography (EBCT) for assessment of coronary artery calcification (complete fee - no additions)

- - - 70 - - - - -

3599Electron beam computed tomography (EBCT) of the heart. Total fee for contract examination excluding cost of contrast medium (not to be used for coronary artery calcium assessment or scoring - see item 3598)

- - - 70 - - - - -

6400 Plus spiral CT - - - - - - - - -

6401 Plus 3D reconstruction - - - - - - - - -

6402 Plus high resolution study - - - - - - - - -

6403 CT limb uncontrasted - - - - - - 30 5.000 280.60


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6404 CT limb with contrast only - - - - - - 30 5.000 280.60

6405 CT limb pre- AND post contrast - - - - - - 30 5.000 280.60

6406 CT joint uncontrasted - - - - - - 30 5.000 280.60

6407 CT joint with contrast only - - - - - - 30 5.000 280.60

6408 CT joint pre AND post contrast - - - - - - 30 5.000 280.60

6409 CT brain uncontrasted (including posterior fossa) - - - - - - 30 5.000 280.60

6410 CT brain with contrast only (including posterior fossa) - - - - - - 30 5.000 280.60

6411 CT brain pre AND post contrast (including posterior fossa) - - - - - - 30 5.000 280.60

6412 CT orbits complete study, axial OR coronal, uncontrasted - - - - - - 30 5.000 280.60

6413 CT orbits complete study, axial AND coronal, uncontrasted - - - - - - 30 5.000 280.60

6414 CT orbits complete study, axial OR coronal pre AND post contrast - - - - - - 30 5.000 280.60

6415 CT orbits complete study, axial AND coronal pre AND post contrast - - - - - - 30 5.000 280.60

6416 CT paranasal sinuses limited study axial OR coronal - - - - - - 30 5.000 280.60

6417 CT paranasal sinuses limited study axial AND coronal - - - - - - 30 5.000 280.60

6418 CT paranasal sinuses complete study, axial or coronal, uncontrasted - - - - - - 30 5.000 280.60

6419 CT paranasal sinuses complete study, axial AND coronal, uncontrasted - - - - - - 30 5.000 280.60

6420 CT paranasal sinuses complete study, axial OR coronal, pre AND post contrast - - - - - - 30 5.000 280.60

6421 CT paranasal sinuses complete study, axial AND coronal, pre AND post contrast - - - - - - 30 5.000 280.60

6422 CT pituitary fossa, uncontrasted - - - - - - 30 5.000 280.60

6423 CT pituitary fossa, pre AND post contrast - - - - - - 30 5.000 280.60

6424 CT internal auditory meati, uncontrasted - - - - - - 30 5.000 280.60

6425 CT internal audiory meati, pre AND post contrast - - - - - - 30 5.000 280.60

6426 CT mastoids - - - - - - 30 5.000 280.60

6427 CT ear structures, limited study - - - - - - 30 5.000 280.60

6428 CT middle AND inner ear, complete study including reconstructions - - - - - - 30 5.000 280.60

6429 CT facial bones - - - - - - 30 5.000 280.60

6430 CT neck soft tissue, uncontrasted - - - - - - 30 5.000 280.60

6431 CT neck soft tissue with contrast only - - - - - - 30 5.000 280.60

6432 CT neck pre AND post contrast - - - - - - 30 5.000 280.60

6433 CT cervical spine uncontrasted - - - - - - 30 5.000 280.60


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6434 CT cervical spine pre AND post contrast - - - - - - 30 5.000 280.60

6435 CT cervical spine post myelogram - - - - - - 30 5.000 280.60

6436 CT dorsal spine uncontrasted - - - - - - 30 5.000 280.60

6437 CT dorsal spine pre AND post contrast - - - - - - 30 5.000 280.60

6438 CT dorsal spine post myelogram - - - - - - 30 5.000 280.60

6439 CT lumbar spine uncontrasted - - - - - - 30 5.000 280.60

6440 CT lumbar spine pre AND post contrast - - - - - - 30 5.000 280.60

6441 CT lumbar spine post myelogram - - - - - - 30 5.000 280.60

6442 CT pelvimetry (topogram only) - - - - - - 30 5.000 280.60

6443 CT chest uncontrasted - - - - - - 30 5.000 280.60

6444 CT chest with contrast - - - - - - 30 5.000 280.60

6445 CT chest pre AND post contrast - - - - - - 30 5.000 280.60

6446 CT chest high resolution lungs, limited study - - - - - - 30 5.000 280.60

6447 CT high resolution lungs, complete study - - - - - - 30 5.000 280.60

6448 CT abdomen uncontrasted - - - - - - 30 5.000 280.60

6449 CT abdomen with contrast - - - - - - 30 5.000 280.60

6450 CT abdomen pre AND post contrast - - - - - - 30 5.000 280.60

6451 CT abdomen triphasic study - - - - - - 30 5.000 280.60

6452 CT pelvis uncontrasted - - - - - - 30 5.000 280.60

6453 CT pelvis with contrast - - - - - - 30 5.000 280.60

6454 CT pelvis pre AND post contrast - - - - - - 30 5.000 280.60

6455 CT abdomen AND pelvis uncontrasted - - - - - - 30 5.000 280.60

6456 CT abdomen AND pelvis with contrast - - - - - - 30 5.000 280.60

6457 CT abdomen AND pelvis pre AND post contrast - - - - - - 30 5.000 280.60

6458 CT chest, abdomen AND pelvis with contrast - - - - - - 30 5.000 280.60

6459 CT base of skull to symphysis pubis with contrast - - - - - - 30 5.000 280.60

6460 CT for dental implants maxilla OR mandible - - - - - - - - -

6461 CT for dental implants maxilla AND mandible - - - - - - - - -

6462CT angiography per limited region (including spiral, high resolution, AND all reconstructions)

- - - - - - 30 5.000 280.60


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6463CT angiography per extensive region (including spiral, high resolution, 3D AND all other reconstructions)

- - - - - - 30 5.000 280.60

6464 CT limited study, any region. Region to be identified on the account - - - - - - 30 5.000 280.60

6465 CT guidance for aspiration, biopsy or drainage - - - - - - 30 11.000 617.20

6466 CT guidance for aspiration at time of CT diagnostic study - - - - - -

6467 CT stereotactic localisation for biopsy - - - - - - 30 11.000 617.20

6468 CT for radiotherapy planning (not to be used as an add-on) - - - - - - - - -

6469 Quantitative CT for bone mineral density - - - - - - - - -

6470 Triphasic study of the liver with CT Abdomen and Pelvis pre and post contrast - - - - - - 30 5.000 280.60

6471 CT of the chest, triphasic study of the liver, abdomen and pelvis with contrast - - - - - - 30 5.000 280.60

6472 Computer Aided Diagnosis for Mammography - - - - - - - - -

19.10 Radiology: Miscellaneous - - - - - - - - -

3594 Mammogram of surgically removed breast biopsy specimen - - - - - - - - -

3600 Peripheral bone densitometry utilizing ionizing radiation 40 13.000 164.70 40 13.000 164.70 - - -

3601 Fluoroscopy: Per half hour: ADD (not applicable for items 3445 and 3447) - - - 40 7.700 97.50 - - -

3602Where a C-arm portable X-ray unit is used in hospital or theatre: Per half hour: ADD

- - - 40 10.700 135.50 - - -

3603 Sinography - - - 40 18.400 233.00 - - -

3604Bone densitometry (to be charged once only for one or more levels done at the same session)

40 77.000 975.20 40 77.000 975.20 - - -

3605

Mammography: Unilateral or bilateral, including ultrasound and doppler ultrasound examination, where necessary. This item may not be used together with an item from the ultrasound section. Note that when an ultrasound of the breast is requested without mammography, item 3629 is used

- - - 40 33.000 418.00 - - -

3606 Repeat mammography, unilateral or bilateral, for localisation of tumour - - - 40 21.000 266.00 - - -

3607Attendance at operation in theatre or at radiological procedure performed by a surgeon or physician in X-ray department (except item 3309): Per half hour: Plus fee or examination performed (Only to be used by radiological technical staff)

- - - 40 5.600 70.90 - - -

3608Repeat mammography procedure with minimally invasive breast biopsy, core biopsy or fine needle aspiration biopsy utilising dedicated stereotactic equipment with patient in erect or prone position

- - - 40 40.000 506.60 30 3.000 168.30


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3609Foreign body localisation: Fee for part examined plus two-thirds for every additional series plus fluoroscopy fee if this is done

- - - 40 - - - - -

3611 Foreign body localisation: Introduction of sterile needle markers: ADD - - - 40 11.000 139.30 - - -

3613 Setting of sterile trays - - - 40 3.300 41.80 - - -

5029 Mammotome - stereotaxis: Hand held - - - - - -

5034 Fine needle aspiration or biopsy or core biopsy of mamma - - - 40 25.000 316.60 30 6.000 336.70

19.10.2 Radiology: Miscellaneous: Mammography - - - - - - - - -

19.11 Ultrasound investigations - - - - - - - - -

Please note: The calculated amounts in this section are calculated according to the ultrasound unit values

- - - - - - - - -

Note: See rule GG for requirements for reports and the keeping of records which are also applicable to ultrasonic investigations.

- - - - - - - - -

3596 Intravascular ultrasound per case, arterial or venous, for intervention 60 30.000 255.70 60 30.000 255.70 - - -

3610Transrectal ultrasonographic prostate volume study for prostate brachytherapy (own equipment)

60 110.000 937.40 60 110.000 937.40 30 5.000 280.60

3612 Ultrasonic bone densitometry 60 19.000 161.90 60 19.000 161.90 - - -

3614 Transvaginal aspiration of ova 60 110.000 937.40 60 110.000 937.40 - - -

3615Routine obstetric ultrasound at 10 to 20 weeks gestational age preferable at 10 to 14 weeks gestational age to include nuchal translucency assessment

60 50.000 426.10 60 50.000 426.10 - - -

3616 Contrast media: General Rule Y applies - - -

3617Routine obstetric ultrasound at 20 to 24 weeks to include detailed anatomical assessment

60 50.000 426.10 60 50.000 426.10 - - -

3618Pelvic organs ultrasound transabdominal probe (this is a gynaecological ultrasound examination and may not be used in pregnancy)

60 40.000 340.90 60 40.000 340.90 - - -

3619

Intravascular ultrasound imaging assesses the atheroschlerotic process to guide the placement of an intracoronary stent. This item may be applied once per vessel (left anterior descending territory, circumflex territory and/or right coronary territory) in which a stent or multiple stents are deployed

60 30.000 255.70 60 30.000 255.70 30 9.000 505.00

3620 Cardiac examination plus Doppler colour mapping 60 50.000 426.10 60 50.000 426.10 - - -

3621 Cardiac examination (MMode) 60 25.000 213.10 60 25.000 213.10 - - -

3622 Cardiac examination: 2 Dimensional 60 50.000 426.10 60 50.000 426.10 - - -

3623 Cardiac examination + effort 60 10.000 85.20 60 10.000 85.20 - - -


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RCF Units

Value R

CF Units Value

R

3624 Cardiac examinations + contrast 60 10.000 85.20 60 10.000 85.20 - - -

3625 Cardiac examinations + doppler 60 50.000 426.10 60 50.000 426.10 - - -

3626 Cardiac examination + phonocardiography 60 10.000 85.20 60 10.000 85.20 - - -

3627Ultrasound examination includes whole abdomen and pelvic organs, where pelvic organs are clinically indicated (including liver, gall bladder, spleen, pancreas, abdominal vascular anatomy, para-aortic area, renal tract, pelvic organs)

60 60.000 511.30 60 60.000 511.30 - - -

3628 Renal tract 60 50.000 426.10 60 50.000 426.10 - - -

3629 High definition (small parts) scan: Thyroid, breast lump, scrotum, etc. 60 50.000 426.10 60 50.000 426.10 - - -

3631 Ophthalmic examination 60 50.000 426.10 60 50.000 426.10 - - -

3632Axial length measurement and calculation of intra ocular lens power. Per eye. Not to be used with item 3034

60 50.000 426.10 60 50.000 426.10 - - -

3633 Neonatal head scan 60 50.000 426.10 60 50.000 426.10 - - -

3634 Peripheral vascular study, B mode only 60 39.000 332.40 60 39.000 332.40 - - -

3635 + Doppler 60 39.000 332.40 60 39.000 332.40 - - -

3636 Trans-oesophageal echocardiography including passing the device 60 100.000 852.20 60 100.000 852.20 - - -

3637+ Colour Doppler (may be added onto any other regional exam, but not to be added to items 3605, 5110, 5111, 5112, 5113 or 5114)

60 78.000 664.70 60 78.000 664.70 - - -

5026 Ultrasound guided amniocentesis 60 39.000 332.40 - - - 30 6.000 336.70

5100 Pelvic organs ultrasound: Transvaginal or trans rectal probe 60 50.000 426.10 60 50.000 426.10 - - -

5101 Pleural space ultrasound 60 50.000 426.10 60 50.000 426.10 - - -

5102 Ultrasound of joints (e.g. shoulder, hip, knee), per joint 60 50.000 426.10 60 50.000 426.10 - - -

5103 Ultrasound soft tissue, any region 60 50.000 426.10 60 50.000 426.10 - - -

5106Obstetric ultrasound before 10 weeks gestational age for complicated pregnancy i.e. suspected ectopic pregnancy abortion or discrepancy between gestational age and dates. Not to be used for routine diagnosis of pregnancy

60 25.000 213.10 60 25.000 213.10 - - -

5107 Ultrasound after 24 weeks - motivation required 60 25.000 213.10 60 25.000 213.10 - - -

5108Second opinion obstetric ultrasound may be charged by practitioners accepted by SASOG or RSSA (list of names available from SASOG or RSSA)

60 50.000 426.10 60 50.000 426.10 - - -

5110Carotid ultrasound vascular study: B mode, pulsed and colour Doppler; bilateral study, internal, external and common carotid flow and anatomy

60 128.000 1 090.80 60 120.000 1 022.60 - - -


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5111Full ultrasonic and colour Doppler evaluation of entire extracranial vascular tree: Carotids, vertebral and subclavian vessels (not to be used together with items 5110, 5112, 5113 or 5114)

60 206.000 1 755.50 60 164.800 1 404.40 - - -

5112Peripheral arterial ultrasound vascular study: B mode, pulsed and colour Doppler; per limb; to include waveforms at minimum of three levels, pressure studies at two levels and full interpretation of results

60 117.000 997.10 60 117.000 997.10 - - -

5113Peripheral venous ultrasound vascular study; B mode, pulsed and colour Doppler; to evaluate deep vein thrombosis

60 117.000 997.10 60 117.000 997.10 - - -

5114Peripheral venous ultrasound vascular study; B mode, pulsed and colour Doppler; in erect and supine position including compression manoeuvres and reflux in superficial and deep systems, bilaterally

60 178.000 1 516.90 60 142.400 1 213.50 - - -

5115 Intra-operative ultrasound study 60 50.000 426.10 60 50.000 426.10 30 3.000 168.30

5117Diagnostic intravascular ultrasound (IVUS) imaging or wave wire mapping (without accompanying angioplasty). May be used only once per angiographic procedure

60 88.000 749.90 60 88.000 749.90 - - -

5118

Diagnostic intravascular ultrasound imaging or wave wire imaging (with accompanying angioplasty or accompanying intravascular ultrasound imaging or wave wire mapping in a different coronary artery [LAD (left anterior desending), Circumflex or Right coronary artery]). May be used a maximum of twice per angiographic procedure

60 44.000 375.00 60 44.000 375.00 - - -

MODIFIERS GOVERNING ULTRASONIC INVESTIGATIONS - - - - - - - - -

0160Aspiration of biopsy procedure performed under direct ultrasound control by an ultrasound aspiration biopsy transducer (Static Realtime): Fee for part examined plus 30% of the units

- - - - - - - - -

0165 Use of contrast during ultrasound study: add 6.00 ultrasound units 60 6.000 51.10 60 6.000 51.10 - - -

5104 Ultrasound in pregnancy, multiple gestation, after twenty weeks: plus 30% - - - - - - - - -

GENERAL RULE GOVERNING ULTRASONIC EXAMINATIONS DURING PREGNANCY

- - - - - - - - -


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EE.

Ultrasound examinations: The international norm approved for use in South Africa for NORMAL PREGNANCY is two ultrasound exams: (a) The first scan should preferably include a nuchal thickness estimation and be performed between 10 and 14 weeks gestation. The second scan should be performed between 20 and 24 weeks and should include a full anatomical report. All subsequent ultrasound scans are excluded from the benefits of medical schemes unless accompanied by proper motivation. An ultrasound scan to assess an abnormal early pregnancy may be formed before 10 weeks but this scan may not be used to diagnose a normal uncomplicated pregnancy. Item 3618 is a gynaecological scan and its use is not approved for use in pregnancy. (b) In cases where the scan is performed by the attending practitioner, a clear indication for such a scan must be entered on the account rendered, or a letter of motivation must be attached to the account (the practitioner must elect one of the two options). (c) In case of a referral, the referring doctor must submit a letter of motivation to the radiologist or other practitioner doing the scan. A copy of the letter of motivation must be attached to the first account rendered to the patient (by the radiologist or the other practitioner doing the scan) and must be attached to the first account submitted to the medical scheme by the patient or the doctor, as the case may be. (d) In case of a referral to a radiologist, no motivation should be required from the radiologist

- - - - - - - - -

19.12 Portable unit examinations - - - - - - - - -

3639 Where portable X-ray unit is used in the hospital or theatre: ADD - - - 40 7.000 88.70 - - -

3640 Theatre investigations with fixed installation - - - 40 3.000 38.00 - - -

19.13 Diagnostic procedures requiring the use of radio-isotopes - - - - - - - - -

AA. Procedures to exclude cost of isotope - - - - - - - - -

3641 Tracer test 40 33.200 420.50 40 22.100 279.90 - - -

3642 Repeat of further tracer tests for same investigation: Half of above fee 40 16.600 210.20 40 11.100 140.60 - - -

3643If both tracer and therapeutic procedures are done, half fee of tracer test to be charged plus therapeutic fee

- - - - - - - - -

3644 Tracer test of complete body or brain tumour location 40 82.200 1 041.10 40 54.800 694.00 - - -

3645 Other organ scanning with use of relevant radio isotopes 40 82.200 1 041.10 40 54.800 694.00 - - -

3646 Thyroid scanning 40 28.800 364.80 40 19.200 243.20 - - -

6474Positron Emission Tomography (PET) imaging of the whole body using a Coincidence Camera

- - - - - - - - -


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6475Positron Emission Tomography (PET) imaging of a limited body region using a Coincidence Camera

- - - - - - - - -

19.14 Interventional radiological procedures - - - - - - - - -

The following rules are applicable to Section 19.8 (Vascular studies) and Section 19.14 (Interventional Radiological Procedures): a. The machine fee (items 3536 to 3550 includes the cost of the following: i. All runs (runs may not be billed for separately). ii. All film costs (modifier 0084 is not applicable). iii All fluoroscopy (item 3601 does not apply). iv All minor consumables (defined as any item other than catheters,

guidewires, introducer sets, specialised catheters, balloon catheters, stents, embolic agents, drugs and contrast media).

b. The machine fee (items 3536 to 3550) may only be billed for as a once off fee per case per day by the owner of the equipment and is only applicable to radiology practices.

c. If a procedure is performed by a non-radiologist together with a radiologist as a team, in a facility owned by the radiologist, each member of the team will fee at their respective full rates as per modifiers and the applicable items.

d. If a procedure is performed by a non-radiologists and a radiologist as a team, in a facility not owned by the radiologist, modifiers 6301 and 6302 applies.

Please note : Modifier 0083 is not applicable to section 19.8 (Vascular Studies) and section 19.14 (Interventional Radiological Procedures)

- - - - - - - - -

Note: In regard to multiple examinations see modifier 0080 - - - - - - - - -

5002 Percutaneous transluminal angioplasty: Aortic/IVC - - - 40 102.600 1 299.40 30 13.000 729.50

5004Percutaneous transluminal angioplasty, arterial or venous, iliac vessel/subclavian vessel

- - - 40 102.600 1 299.40 30 13.000 729.50

5006Percutaneous transluminal angioplasty: Femoral to popliteal bifurcation, axillary and brachial

- - - 40 102.600 1 299.40 30 13.000 729.50

5008 Percutaneous transluminal angioplasty: Sub-popliteal sub-brachial - - - 40 139.200 1 763.00 30 13.000 729.50

5010 Percutaneous transluminal angioplasty: Renal/Visceral/Brachiocephalic - - - 40 139.200 1 763.00 30 13.000 729.50

5012Percutaneous transluminal angioplasty: Extracranial Carotid/Vertebral - stand alone procedure

- - - 40 172.200 2 180.90 30 13.000 729.50

5014 Atherectomy (per vessel) - - - 40 204.600 2 591.30 - - -


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5016 Aspiration thrombectomy (per vessel) - - - 40 131.400 1 664.20 - - -

5018 On-table thrombolysis/transcatheter infusion performed in angiography suite - - - 40 106.800 1 352.60 30 5.000 280.60

5022 Embolisation non-intracranial, per vessel - - - 40 106.800 1 352.60 30 9.000 505.00

5030 Percutaneous nephrostomy for further procedure or drainage - - - 40 73.800 934.70 30 6.000 336.70

5031 Antegrade ureteric stent insertion - - - 40 69.600 881.50 30 6.000 336.70

5033 Percutaneous cystostomy in radiology suite - - - 40 30.000 380.00 - - -

5035 Urethral balloon dilatation in radiology suite - - - 40 22.800 288.80 - - -

5036 Percutaneous abdominal/pelvic/other drain insertion, any modality - - - 40 34.200 433.10 - - -

5037 Urethral stenting in radiology suite - - - 40 102.600 1 299.40 - - -

5038 Intracranial/spinal AVM embolisation (per session) - - - 40 335.400 4 247.80 30 13.000 729.50

5039 Intracranial thrombolysis (on-table) per session - - - 40 139.200 1 763.00 30 13.000 729.50

5040 Intracranial aneurysm occlusion - - - 40 286.800 3 632.30 30 13.000 729.50

5041 Balloon occlusion/Wada test - - - 40 106.800 1 352.60 30 9.000 505.00

5042 Carotico/cavernous fistula/head and neck AV fistula embolisation - - - 40 286.800 3 632.30 30 13.000 729.50

5043 Intracranial angioplasty - - - 40 204.600 2 591.30 30 13.000 729.50

5044 Transhepatic portogram - - - 40 139.200 1 763.00 30 9.000 505.00

5045 Hepatic arterial infusion catheter insertion - - - 40 156.000 1 975.70 30 6.000 336.70

5046 Percutaneous biliary drainage (external) - - - 40 102.600 1 299.40 30 9.000 505.00

5047 Combined internal/external biliary drainage - - - 40 102.600 1 299.40 30 9.000 505.00

5048 Biliary stent insertion - - - 40 139.200 1 763.00 30 9.000 505.00

5049 Percutaneous gall bladder drainage - - - 40 69.600 881.50 30 9.000 505.00

5050 Percutaneous or renal gall bladder stone removal - - - 40 172.200 2 180.90 30 5.000 280.60

5058Stent insertion: Aortic/IVC - including percutaneous transluminal angioplasty (PTA)

- - - 40 139.200 1 763.00 30 13.000 729.50

5060Stent insertion: Iliac/subclavian/AV fistula - including percutaneous transluminal angioplasty (PTA)

- - - 40 139.200 1 763.00 30 13.000 729.50

5062Stent insertion: Femoral popliteal bifurcation, axillary and brachial - including percutaneous transluminal angioplasty (PTA)

- - - 40 139.200 1 763.00 30 13.000 729.50

5064Stent insertion: Sub-popliteal - including percutaneous transluminal angioplasty (PTA)

- - - 40 172.200 2 180.90 30 13.000 729.50


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5066Stent insertion: Renal/visceral/brachiocephalic - including percutaneous transluminal angioplasty (PTA)

- - - 40 204.600 2 591.30 30 13.000 729.50

5068Stent insertion: Extracranial carotid/vertebral - including percutaneous transluminal angioplasty (PTA) - stand alone procedure

- - - 40 204.600 2 591.30 30 13.000 729.50

5070Stent insertion: Aorto-iliac stent graft - including percutaneous transluminal angioplasty (PTA)

- - - 40 311.400 3 943.90 30 13.000 729.50

5072 Tunnelled/subcutaneous arterial/venous line performed in radiology suite - - - 40 82.200 1 041.10 30 5.000 280.60

5074 IVC filter insertion jugular or femoral route - - - 40 156.000 1 975.70 30 9.000 505.00

5076 Intravascular foreign body removal, arterial or venous, any route - - - 40 204.600 2 591.30 30 9.000 505.00

5078 Percutaneous sclerotherapy of an arteriovenous malformation (AVM) - - - 40 70.200 889.10 30 5.000 280.60

5080 Transjugular intrahepatic porto-systemic shunt - - - 40 335.400 4 247.80 30 13.000 729.50

5082 Transjugular liver biopsy - - - 40 69.600 881.50 30 9.000 505.00

5084 Endoluminal fallopian tube recanalisation - - - 40 172.200 2 180.90 30 6.000 336.70

5086 Renal cyst aspiration/ablation - - - 40 22.800 288.80

5088 Oesophageal stent insertion in radiology suite - - - 40 102.600 1 299.40 30 6.000 336.70

5090 Tracheal stent insertion - - - 40 102.600 1 299.40 30 6.000 336.70

5091 GIT balloon dilatation under fluoroscopy - - - 40 66.600 843.50 30 6.000 336.70

5092 Other GIT stent insertion - - - 40 102.600 1 299.40 30 6.000 336.70

5093 Percutaneous gastrostomy in radiology suite - - - 40 85.800 1 086.70 - - -

5094 Cutting needle biopsy with image guidance - - - 40 22.800 288.80 - - -

5095 Chest drain insertion in radiology suite - - - 40 32.400 410.40 - - -

5096 Percutaneous cyst or tumour ablation (non aspiration) - - - 40 54.600 691.50 - - -

5097Vertebroplasty - Introduction of stabilising material under screening or CT control - per level

- - - - - - 30 13.000 729.50

MODIFIER GOVERNING INTERVENTIONAL RADIOLOGICAL PROCEDURES - - - - - - - - -

0090

Radiologist’s fee for participation in a team: 30,00 radiology units per ½ hour or part thereof for all interventional radiological procedures, excluding any pre- or post-operative angiography, catheterisation, CT-scanning, ultrasound-scanning or x-ray procedures. (Only to be charged if radiologist is hands-on, and not for interpretation of images only)

- - - - - - - - -

19.15 Magnetic Resonance Imaging (MRI) - - - - - - - - -


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6100

In order to charge the full fee (600,00 magnetic resonance units) for an examination of a specific single anatomical region, it should be performed with the applicable radio frequency coil including T1 and T2 weighted images on at least two planes

- - - - - - - - -

6101

Where a limited series of a specific anatomical region is performed (except bone tumour), e.g a T2 weighted image of a bone for an occult stress fracture, not more than two-thirds (2/3) of the fee may be charged. Also applicable to all radiotherapy planning studies, per region

- - - - - - - - -

6102All post-contrast studies (except bone tumour), including perfusion studies, to be charges at 50% of the fee

- - - - - - - - -

6103 Post-contrast study: Bone tumour: 100% of the fee - - - - - - - - -

6104Limited examination of the hypophysis e.g. where a coronal T1 and sagittal T1 series are performed, two-thirds (2/3) of the fee is applicable

- - - - - - - - -

6105Where, in a limited hypophysis examination, Gadolinium is administered and coronal T1 and sagittal T1 series are repeated, a single full fee for the entire examination is applicable + cost of Gadolinium + disposable items

- - - - - - - - -

6106

Where a magnetic resonance angiography (MRA) of large vessels is performed as primary examination, 100% of the fee is applicable. This modifier is only applicable if the series is performed by use of a recognised angiographic software package with reconstruction capability

- - - - - - - - -

6107

Where a magnetic resonance angiography (MRA) of the vessels is performed additional to an examination of a particular region, 50% of the fee is applicable for the angiography. This modifier is only applicable if the series is performed by use of a recognised angiographic software package with reconstruction capability

- - - - - - - - -

6108Where only a gradient echo series is performed with a machine without a recognised angiographic software package with reconstruction ability, 20% of the full fee is applicable specifying that it is a “flow sensitive series”

- - - - - - - - -

6109Very limited studies to be charged at 33,33% of the full fee e.g. MR urography for renal colic, diffusion studies of the brain additional to routine brain

- - - - - - - - -

6110 MRI spectroscopy: 50% of fee - - - - - - - - -

Please note: The calculated amounts in this section are calculated according to the magnetic resonance imaging unit value.

- - - - - - - - -

Items 6200 to 6255 reflect the anatomical region examined. The modifiers above reflect what was done and how the fee was arrived at.

- - - - - - - - -


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6200 Magnetic Resonance Imaging: Per anatomical region: Brain - - - 75 400.000 3 855.60 30 5.000 280.60

6201 Magnetic Resonance Imaging: Per anatomical region: Orbitae - - - 75 400.000 3 855.60 30 5.000 280.60

6202 Magnetic Resonance Imaging: Per anatomical region: Paranasal sinuses - - - 75 400.000 3 855.60 30 5.000 280.60

6203 Magnetic Resonance Imaging: Per anatomical region: Soft tissue: Face/skull - - - 75 400.000 3 855.60 30 5.000 280.60

6204Magnetic Resonance Imaging: Per anatomical region: Skull basis/cranio-cervical joint

- - - 75 400.000 3 855.60 30 5.000 280.60

6205 Magnetic Resonance Imaging: Per anatomical region: Middle and internal ears - - - 75 400.000 3 855.60 30 5.000 280.60

6206 Magnetic Resonance Imaging: Per anatomical region: Soft tissue: Neck - - - 75 400.000 3 855.60 30 5.000 280.60

6207 Magnetic Resonance Imaging: Per anatomical region: Thyroid/para-thyroid - - - 75 400.000 3 855.60 30 5.000 280.60

6208Magnetic Resonance Imaging: Per anatomical region: Hypophysis (see modifiers 6104 and 6105 for limited examinations)

- - - 75 400.000 3 855.60 30 5.000 280.60

6209Magnetic Resonance Imaging: Per anatomical region: Bone tumour (see modifier 6103)

- - - 75 400.000 3 855.60 30 5.000 280.60

6210 Magnetic Resonance Imaging: Per anatomical region: Cervical vertebrae - - - 75 400.000 3 855.60 30 5.000 280.60

6211 Magnetic Resonance Imaging: Per anatomical region: Thoracic vertebrae - - - 75 400.000 3 855.60 30 5.000 280.60

6212 Magnetic Resonance Imaging: Per anatomical region: Lumbar vertebrae - - - 75 400.000 3 855.60 30 5.000 280.60

6213 Magnetic Resonance Imaging: Per anatomical region: Sacrum - - - 75 400.000 3 855.60 30 5.000 280.60

6214 Magnetic Resonance Imaging: Per anatomical region: Pelvis - - - 75 400.000 3 855.60 30 5.000 280.60

6215 Magnetic Resonance Imaging: Per anatomical region: Pelvic organs - - - 75 400.000 3 855.60 30 5.000 280.60

6216 Magnetic Resonance Imaging: Per anatomical region: Abdomen - - - 75 400.000 3 855.60 30 5.000 280.60

6217 Magnetic Resonance Imaging: Per anatomical region: Thorax wall - - - 75 400.000 3 855.60 30 5.000 280.60

6218 Magnetic Resonance Imaging: Per anatomical region: Mediastinum - - - 75 400.000 3 855.60 30 5.000 280.60

6219 Magnetic Resonance Imaging: Per anatomical region: Soft tissue: Back - - - 75 400.000 3 855.60 30 5.000 280.60

6220 Magnetic Resonance Imaging: Per anatomical region: Left shoulder - - - 75 400.000 3 855.60 30 5.000 280.60

6221 Magnetic Resonance Imaging: Per anatomical region: Right shoulder - - - 75 400.000 3 855.60 30 5.000 280.60

6222 Magnetic Resonance Imaging: Per anatomical region: Both hips - - - 75 400.000 3 855.60 30 5.000 280.60

6223 Magnetic Resonance Imaging: Per anatomical region: Left hip - - - 75 400.000 3 855.60 30 5.000 280.60

6224 Magnetic Resonance Imaging: Per anatomical region: Right hip - - - 75 400.000 3 855.60 30 5.000 280.60

6225 Magnetic Resonance Imaging: Per anatomical region: Left upper-arm - - - 75 400.000 3 855.60 30 5.000 280.60

6226 Magnetic Resonance Imaging: Per anatomical region: Right upper-arm - - - 75 400.000 3 855.60 30 5.000 280.60


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6227 Magnetic Resonance Imaging: Per anatomical region: Left elbow - - - 75 400.000 3 855.60 30 5.000 280.60

6228 Magnetic Resonance Imaging: Per anatomical region: Right elbow - - - 75 400.000 3 855.60 30 5.000 280.60

6229 Magnetic Resonance Imaging: Per anatomical region: Left fore-arm - - - 75 400.000 3 855.60 30 5.000 280.60

6230 Magnetic Resonance Imaging: Per anatomical region: Right fore-arm - - - 75 400.000 3 855.60 30 5.000 280.60

6231 Magnetic Resonance Imaging: Per anatomical region: Left wrist and hand - - - 75 400.000 3 855.60 30 5.000 280.60

6232 Magnetic Resonance Imaging: Per anatomical region: Right wrist and hand - - - 75 400.000 3 855.60 30 5.000 280.60

6233 Magnetic Resonance Imaging: Per anatomical region: Left upper-leg - - - 75 400.000 3 855.60 30 5.000 280.60

6234 Magnetic Resonance Imaging: Per anatomical region: Right upper-leg - - - 75 400.000 3 855.60 30 5.000 280.60

6235 Magnetic Resonance Imaging: Per anatomical region: Left knee - - - 75 400.000 3 855.60 30 5.000 280.60

6236 Magnetic Resonance Imaging: Per anatomical region: Right knee - - - 75 400.000 3 855.60 30 5.000 280.60

6237 Magnetic Resonance Imaging: Per anatomical region: Left lower-leg - - - 75 400.000 3 855.60 30 5.000 280.60

6238 Magnetic Resonance Imaging: Per anatomical region: Right lower-leg - - - 75 400.000 3 855.60 30 5.000 280.60

6239 Magnetic Resonance Imaging: Per anatomical region: Left ankle - - - 75 400.000 3 855.60 30 5.000 280.60

6240 Magnetic Resonance Imaging: Per anatomical region: Right ankle - - - 75 400.000 3 855.60 30 5.000 280.60

6241 Magnetic Resonance Imaging: Per anatomical region: Left foot - - - 75 400.000 3 855.60 30 5.000 280.60

6242 Magnetic Resonance Imaging: Per anatomical region: Right foot - - - 75 400.000 3 855.60 30 5.000 280.60

6250 Magnetic Resonance angiography (See modifiers 6106 to 6108): Brain - - - 75 400.000 3 855.60 30 5.000 280.60

6251Magnetic Resonance angiography (See modifiers 6106 to 6108): Large vessels: Neck

- - - 75 400.000 3 855.60 30 5.000 280.60

6252Magnetic Resonance angiography (See modifiers 6106 to 6108): Large vessels: Chest

- - - 75 400.000 3 855.60 30 5.000 280.60

6253Magnetic Resonance angiography (See modifiers 6106 to 6108): Large vessels: Abdomen

- - - 75 400.000 3 855.60 30 5.000 280.60

6254Magnetic Resonance angiography (See modifiers 6106 to 6108): Large vessels: Legs

- - - 75 400.000 3 855.60 30 5.000 280.60

6255 Magnetic Resonance angiography (See modifiers 6106 to 6108): Heart - - - 75 400.000 3 855.60 30 5.000 280.60

6260Contrast medium: Current price according the regular price list published by the Radiology Society of SA

- - - - - - - - -

6270Low field strength peripheral joint magnetic resonance imaging: Low field strength peripheral joint examination (feet, knees, hands, and elbows), in dedicated limb units not able to perform body, spine or head examinations

- - - 75 70.000 674.70 30 5.000 280.60


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20 Radiation Oncology - - - - - - - - -

GENERAL RULES REGARDING THIS SECTION OF THE NATIONAL REFERENCE PRICE LIST (a) Unless specifically stated in this section of the NRPL-HS, the general descriptors between the professional and technical component apply to both components of the services. (b) The items reflecting the technical component in this section of the NRPL-HS may only be charged by the owner of the equipment.

- - - - - - - - -

BB.The fees in this section (radiation oncology) do NOT include the cost of radium or isotopes

- - - - - - - - -

Please note: The calculated amounts in this section are calculated according to the radiotherapy unit values

- - - - - - - - -

20.1 Kilovolt therapy - - - - - - - - -

20.2 Radium therapy - - - - - - - - -

20.3 Isotope therapy - - - - - - - - -

0096Radio-isotope therapy patients who fail to keep their appointments: Fee will include cost of isotope

- - - - - - - - -

20.4 Megavolt therapy - - - - - - - - -

20.5 Beta-ray therapy with strontium-90-applicator - - - - - - - - -

20.6 Planning of therapy - - - - - - - - -

20.7 Technical aids - - - - - - - - -

5141 Radiation materials (see modifier 0095) - - - - - - - - -

20.8 Oncological surgical procedures - - - - - - - - -

20.9 Special procedures - - - - - - - - -

20.10 Chemotherapy - - - - - - - - -

Where patients are not treated in chemotherapy facilities, items 0213, 0214 and 0215 are used instead of items 5790, 5793 and 5795. Codes 0213, 0214 and 0215 are applicable to providers who only administer the drugs i.e. don’t own or rent a facility and do not manage the patient.

- - - - - - - - -

Codes 5790 to 5795 are for exclusive use by oncology trained doctors working within chemotherapy facilities

- - - - - - - - -


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5790

Non Infusional Chemotherapy: Global Fee for the management of and for related services delivered in the treatment of cancer with oral chemotherapy (per cycle), intramuscular (IMI), subcutaneous, intrathecal or bolus chemotherapy or oncology specific drug administration per treatment day - for exclusive use by doctors with appropriate oncology training (consultations to be charged separately) - (not applicable to oral hormonal therapy)

20 42.950 384.00 20 42.950 384.00 - - -

5791

Non Infusional Chemotherapy Facility Fee: A facility where oncology medicines are procured or scripted for oral chemotherapy, intramuscular (IMI), subcutaneous, intrathecal or bolus chemotherapy or oncology specific drug administration per treatment day. This fee is chargeable by doctors with appropriate oncology training who owns or rents the facility, and by others e.g. hospitals or clinics that provide the services as per the appropriate billing structure. Said facilities are to be accredited under the auspices of SASMO and/or SASCRO (to be used in conjunction with item 5790) - (not applicable to oral hormonal therapy) - only one of the parties are to charge this fee

20 24.490 219.00 20 24.490 219.00 - - -

5792

Non Infusional Chemotherapy Facility Fee: A facility where oncology medicines are purchased, stored and dispensed during oral chemotherapy (per cycle), intramuscular (IMI), subcutaneous, intrathecal or bolus chemotherapy or oncology specific drug administration per treatment day. This fee is chargeable by doctors with appropriate oncology training who owns or rents the facility, and by others e.g. hospitals or clinics that provide the services as per the appropriate billing structure. Said facilities are to be accredited under the auspices of SASMO and/or SASCRO (to be used in conjunction with item 5790) - (not applicable to oral hormonal therapy) - only one of the parties are to charge this fee

20 30.610 273.70 20 30.610 273.70 - - -

Non-infusional chemotherapy: Consultations are charged separately. - - - - - - - - -

Non-infusional chemotherapy: In the case of intramuscular (IMI), subcutaneous, intrathecal or bolus chemotherapy administration the management fee can only be charged once per treatment day. Consultations are charged separately.

- - - - - - - - -

5793

Infusional Chemotherapy: Global fee for the management of and for services delivered during infusional chemotherapy per treatment day - for exclusive use by doctors with appropriate oncology training using recognised chemotherapy facilities(consultations to be charged separately)

20 159.470 1 425.80 20 127.580 1 140.70 - - -


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R

5794

Infusional Chemotherapy Facility Fee: A facility where oncology medicines are procured, stored, admixed and administered, and in which appropriately-trained medical, nursing and support staff are in attendance. This fee is chargeable by doctors with appropriate oncology training who owns or rents the facility, and by others e.g. hospitals or clinics that provide the services as per the appropriate billing structure. Said facilities are to be accredited under the auspices of SASMO and/or SASCRO (to be used in conjunction with item 5793) - only one of the parties are to charge this fee

20 90.030 805.00 20 90.030 805.00 - - -

5795

Infusional Chemotherapy Facility Fee: A facility where oncology medicines are purchased, stored, dispensed, admixed and administered and in which appropriately-trained medical, nursing and support staff are in attendance. This fee is chargeable by doctors with appropriate oncology training who owns or rents the facility, and by others e.g. hospitals or clinics that provide the services as per the appropriate billing structure. Said facilities are to be accredited under the auspices of SASMO and/or SASCRO (to be used in conjunction with item 5793) - only one of the parties are to charge this fee

20 112.540 1 006.20 20 112.540 1 006.20 - - -

Item 5795 is chargeable in addition to item 5793 by the Oncologist who owns or rents the chemotherapy facility, and by others e.g. hospitals or clinics that provide the services as per the appropriate billing structure. Said facilities are to be accredited under the auspices of SASMO and/or SASCRO (only to be added to item 5793 if own or rented facility is used).

- - - - - - - - -

20.11 Radiation Therapy Planning - - - - - - - - -

20.11.1 Manual Radiotherapy Planning Procedures - - - - - - - - -

5801Manual Radiotherapy Planning Procedures: No Simulation, Limited Graphic Planning, Single Volume of Interest - PROFESSIONAL COMPONENT

50 42.560 462.50 - - - - - -

5601Manual Radiotherapy Planning Procedures: No Simulation, Limited Graphic Planning, Single Volume of Interest -TECHNICAL COMPONENT

50 99.320 1 079.20 - - - - - -

5802Manual Radiotherapy Planning Procedures: No Simulation, Limited Graphic Planning, Multiple Volumes of Interest - PROFESSIONAL COMPONENT

50 56.180 610.50 - - - - - -

5602Manual Radiotherapy Planning Procedures: No Simulation, Limited Graphic Planning, Multiple Volumes of Interest - TECHNICAL COMPONENT

50 131.100 1 424.50 - - - - - -

5803Manual Radiotherapy Planning Procedures: No Simulation, Limited Graphic Planning, Special Technique - PROFESSIONAL COMPONENT

50 76.620 832.60 - - - - - -


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R

5603Manual Radiotherapy Planning Procedures: No Simulation, Limited Graphic Planning, Special Technique - TECHNICAL COMPONENT

50 178.770 1 942.50 - - - - - -

20.11.2 Conventional Radiotherapy Planning Procedures - - - - - - - - -

5808Conventional Radiotherapy Planning: Simulation, Limited Graphic Planning, Single Volume of Interest - PROFESSIONAL COMPONENT

50 170.260 1 850.10 - - - - - -

5608Conventional Radiotherapy Planning: Simulation, Limited Graphic Planning, Single Volume of Interest - TECHNICAL COMPONENT

50 397.270 4 316.70 - - - - - -

5809Conventional Radiotherapy Planning: Simulation, Limited Graphic Planning, Multiple Volumes of Interest - PROFESSIONAL COMPONENT

50 238.360 2 590.00 - - - - - -

5609Conventional Radiotherapy Planning: Simulation, Limited Graphic Planning, Multiple Volumes of Interest - TECHNICAL COMPONENT

50 556.180 6 043.50 - - - - - -

5810Conventional Radiotherapy Planning: Simulation, Limited Graphic Planning, Special Technique - PROFESSIONAL COMPONENT

50 297.950 3 237.50 - - - - - -

5610Conventional Radiotherapy Planning: Simulation, Limited Graphic Planning, Special Technique - TECHNICAL COMPONENT

50 695.220 7 554.30 - - - - - -

20.11.3 Three Dimensional Radiotherapy Planning Procedures - - - - - -

5820Three Dimensional Radiotherapy Planning Procedures: 3-Dimensional Simulation and Graphic Planning, Single Volume of Interest - PROFESSIONAL COMPONENT (excludes imaging costs for CT and MRI)

50 240.230 2 610.30 - - - - - -

5620Three Dimensional Radiotherapy Planning Procedures: 3-Dimensional Simulation and Graphic Planning, Single Volume of Interest - TECHNICAL COMPONENT (excludes imaging costs for CT and MRI)

50 977.200 10 618.30 - - - - - -

5821Three Dimensional Radiotherapy Planning Procedures: 3-Dimensional Simulation and Graphic Planning, Multiple Volumes of Interest - PROFESSIONAL COMPONENT (excludes imaging costs for CT and MRI)

50 407.750 4 430.60 - - - - - -

5621Three Dimensional Radiotherapy Planning Procedures: 3-Dimensional Simulation and Graphic Planning, Multiple Volumes of Interest - TECHNICAL COMPONENT (excludes imaging costs for CT and MRI)

50 1368.070 14 865.50 - - - - - -

5822Three Dimensional Radiotherapy Planning Procedures: 3-Dimensional Simulation and Graphic Planning, Special Technique - PROFESSIONAL COMPONENT (excludes imaging costs for CT and MRI)

50 554.330 6 023.40 - - - - - -


233 • Version 4_21




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Value R

CF Units Value

R

5622Three Dimensional Radiotherapy Planning Procedures: 3-Dimensional Simulation and Graphic Planning, Special Technique - TECHNICAL COMPONENT (excludes imaging costs for CT and MRI)

50 1710.090 18 581.80 - - - - - -

20.11.4 Intensity Modulated Radiotherapy Planning Procedures - - - - - - - - -

5823Intensity Modulated Radiotherapy Planning Procedures: Intensity Modulated Radiotherapy Simulation, Inverse Planning, Radical Course - PROFESSIONAL COMPONENT (excludes imaging costs for CT and MRI)

50 642.920 6 986.00 - - - - - -

5623Intensity Modulated Radiotherapy Planning Procedures: Intensity Modulated Radiotherapy Simulation, Inverse Planning, Radical Course - TECHNICAL COMPONENT (excludes imaging costs for CT and MRI)

50 1916.810 20 828.10 - - - - - -

5825

Intensity Modulated Radiotherapy Planning Procedures: Intensity Modulated Radiotherapy Simulation, Inverse Planning, Booster Volumes (not for use with other IMRT planning codes) - PROFESSIONAL COMPONENT (excludes imaging costs for CT and MRI)

50 232.180 2 522.90 - - - - - -

5625

Intensity Modulated Radiotherapy Planning Procedures: Intensity Modulated Radiotherapy Simulation, Inverse Planning, Booster Volumes (not for use with other IMRT planning codes) - TECHNICAL COMPONENT (excludes imaging costs for CT and MRI)

50 958.400 10 414.00 - - - - - -

5826

Intensity Modulated Radiotherapy Planning Procedures: Intensity Modulated Radiotherapy Simulation, Inverse Planning, CT Scan with Magnetic Resonance Imaging or other Similar Imaging Fusion Techniques - PROFESSIONAL COMPONENT (excludes imaging costs for CT and MRI)

50 753.350 8 185.90 - - - - - -

5626

Intensity Modulated Radiotherapy Planning Procedures: Intensity Modulated Radiotherapy Simulation, Inverse Planning, CT Scan with Magnetic Resonance Imaging or other Similar Imaging Fusion Techniques - TECHNICAL COMPONENT (excludes imaging costs for CT and MRI)

50 2174.480 23 627.90 - - - - - -

20.11.5 Kilovolt Radiation Treatment - - - - - - - - -

5834Kilovolt Radiation Treatment: Weekly Treatment, Kilovolt or Similar, per week or part thereof - PROFESSIONAL COMPONENT

50 49.080 533.30 - - - - - -

5634Kilovolt Radiation Treatment: Weekly Treatment, Kilovolt or Similar, per week or part thereof - TECHNICAL COMPONENT

50 114.520 1 244.40 - - - - - -

20.11.6 Short Course Radiation Treatment - - - - - - - - -

5835Short Course Radiation Treatment: Short course treatment, Single Volume of Interest - PROFESSIONAL COMPONENT

50 105.740 1 149.00 - - - - - -


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Value R

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R

5635Short Course Radiation Treatment: Short course treatment, Single Volume of Interest - TECHNICAL COMPONENT

50 246.730 2 681.00 - - - - - -

5836Short Course Radiation Treatment: Short course treatment, Multiple Volumes of Interest - PROFESSIONAL COMPONENT

50 148.040 1 608.60 - - - - - -

5636Short Course Radiation Treatment: Short course treatment, Multiple Volumes of Interest - TECHNICAL COMPONENT

50 345.410 3 753.20 - - - - - -

5837Short Course Radiation Treatment: Short course Treatment, Special Technique - PROFESSIONAL COMPONENT

50 190.330 2 068.10 - - - - - -

5637Short Course Radiation Treatment: Short course Treatment, Special Technique - TECHNICAL COMPONENT

50 444.110 4 825.70 - - - - - -

20.11.7 Weekly Radiation Treatment Sessions - - - - - - - - -

20.11.7.1 Weekly Radiation Treatment Sessions - Conventional Techniques - - - - - - - - -

5839Weekly Radiation Treatment Sessions - Conventional Techniques: Weekly Treatment, Single Volume of Interest - PROFESSIONAL COMPONENT

50 193.860 2 106.50 - - - - - -

5639Weekly Radiation Treatment Sessions - Conventional Techniques: Weekly Treatment, Single Volume of Interest - TECHNICAL COMPONENT

50 452.330 4 915.00 - - - - - -

5840Weekly Radiation Treatment Sessions - Conventional Techniques: Weekly Treatment, Multiple Volumes of Interest - PROFESSIONAL COMPONENT

50 246.730 2 681.00 - - - - - -

5640Weekly Radiation Treatment Sessions - Conventional Techniques: Weekly Treatment, Multiple Volumes of Interest - TECHNICAL COMPONENT

50 575.690 6 255.50 - - - - - -

5841Weekly Radiation Treatment Sessions - Conventional Techniques: Weekly Treatment, Special Technique - PROFESSIONAL COMPONENT

50 317.220 3 446.90 - - - - - -

5641Weekly Radiation Treatment Sessions - Conventional Techniques: Weekly Treatment, Special Technique - TECHNICAL COMPONENT

50 740.180 8 042.80 - - - - - -

20.11.7.2 Weekly Radiation Treatment Sessions - Advanced Techniques - - - - - - - - -

5849Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Multi Leaf Collimators, Single Volume of Interest - PROFESSIONAL COMPONENT

50 236.240 2 567.00 - - - - - -

5649Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Multi Leaf Collimators, Single Volume of Interest - TECHNICAL COMPONENT

50 551.210 5 989.50 - - - - - -


235 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

5850Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Multi Leaf Collimators, Multiple Volumes of Interest - PROFESSIONAL COMPONENT

50 330.730 3 593.70 - - - - - -

5650Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Multi Leaf Collimators, Multiple Volumes of Interest - TECHNICAL COMPONENT

50 771.710 8 385.40 - - - - - -

5851Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Multi Leaf Collimators, Special Technique - PROFESSIONAL COMPONENT

50 425.230 4 620.60 - - - - - -

5651Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Multi Leaf Collimators, Special Technique - TECHNICAL COMPONENT

50 992.190 10 781.10 - - - - - -

5854Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Intensity Modulated Radiotherapy - PROFESSIONAL COMPONENT

50 348.870 3 790.80 - - - - - -

5654Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Intensity Modulated Radiotherapy - TECHNICAL COMPONENT

50 814.030 8 845.30 - - - - - -

5855Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Total Body Radiotherapy or Similar - PROFESSIONAL COMPONENT

50 826.830 8 984.30 - - - - - -

5655Weekly Radiation Treatment Sessions - Advanced Techniques: Weekly Treatment, Total Body Radiotherapy or Similar - TECHNICAL COMPONENT

50 1929.260 20 963.30 - - - - - -

20.11.8 Stereotactic Radiation - - - - - - - - -

5860Stereotactic Radiation: Stereotactic Radiation, Single or up to 4 (four) Fractions, Global Fee - PROFESSIONAL COMPONENT

50 3719.340 40 414.40 - - - - - -

5660Stereotactic Radiation: Stereotactic Radiation, Single Fraction, Global Fee - TECHNICAL COMPONENT

50 8678.460 94 300.20 - - - - - -

5861Stereotactic Radiation: Stereotactic Radiation, 5 (five) or more Fractions, Full course, Global Fee - PROFESSIONAL COMPONENT

50 4277.240 46 476.50 - - - - - -

5661Stereotactic Radiation: Stereotactic Radiation, Fractionated, Full course, Global Fee - TECHNICAL COMPONENT

50 9980.230 108 445.20 - - - - - -

20.12 Brachytherapy - - - - - - - - -

20.12.1 Isotope/Applicator Therapy - - - - - - - - -

5870Isotope/Applicator Therapy: Isotopes - Low Complexity, administration of low dose oral isotopes or use of surface applicators, up to five applications. Typically an out patient procedure. The cost of any isotopes and materials are not included

50 108.400 1 177.90 - - - - - -


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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

5872

Isotope/Applicator Therapy: Isotopes - Intermediate Complexity, administration of isotopes requiring invasive techniques such as intravenous, intracavitary or intra-articular radioactive isotopes. Typical out patient procedure or admission and monitoring less than 48 hours. The cost of any isotopes and materials are not included

50 216.800 2 355.80 - - - - - -

5873

Isotope/Applicator Therapy: Isotopes - High Complexity, surface application of seed arrays requiring dosimetric assessment and/or high dose radio-active isotopes requiring admission and monitoring. Typically requires in patient admission and monitoring for more than 48 hours. The cost of any isotopes and materials are not included

50 601.160 6 532.20 - - - - - -

20.12.2 Brachytherapy Implants - - - - - - - - -

5882Brachytherapy Implants: Implants - Low Complexity, placement of a single guide tube for the administration of brachytherapy requiring <8 dwell points. The cost of materials are not included

50 216.800 2 355.80 - - - - - -

5883

Brachytherapy Implants: Implants - Intermediate Complexity, planar implants requiring >1 guide tube for the administration of brachytherapy, or the use of >8 dwell points in a single guide tube, or any procedure requiring <8 dwell points but which requires general anaesthesia for insertion. The cost of materials are not included

50 786.800 8 549.40 - - - - - -

5885Brachytherapy Implants: Implants - High Complexity requiring complex volumetric studies. Inclusive fee for implant under local or general anaesthetic. The cost of materials are not included

50 1049.070 11 399.20 - - - - - -

20.12.3 Brachytherapy Treatment - - - - - - - - -

5890

Brachytherapy Treatment: Global fee for manual afterloading - includes storage, handling, calibration, planning (manual or computerized), manual loading, daily treatment, monitoring, removal and disposal of the isotopes. The cost of any isotopes and materials are not included

50 613.040 6 661.30 - - - - - -

5892

Brachytherapy Treatment: Global fee for remote afterloading - includes input in calibration, graphic planning, daily treatment, monitoring, removal and disposal of implant materials on completion. The cost of materials are not included - PROFESSIONAL COMPONENT

50 415.960 4 519.80 - - - - - -


237 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

5893

Global Fee for remote afterloading - includes input in calibration, graphic planning, daily treatment, monitoring, removal and disposal of implant materials on completion. The cost of materials are not included - TECHNICAL COMPONENT

50 970.560 10 546.10 - - - - - -

20.12.4 Brachytherapy Imaging - - - - - - - - -

5895Brachytherapy Imaging: Brachytherapy: Special imaging where needed and if used, unusual to be added to any code other than items 5883 or 5885

50 156.770 1 703.50 - - - - - -

21 Clinical Pathology - - - - - - - - -

0097

Pathology tests performed by non-pathologists: Where items under Clinical Pathology (section 21) and Anatomical Pathology (section 22) fall within the province of other specialists or general practitioners, the fee is to be charged at two-thirds of the pathologists fee

- - - - - - - - -

Please note: The calculated amounts in this section are calculated according to the clinical pathology unit values. Note: For fees for Histology and Cytology refer to items 4561-4593 under Section 22: Anatomical Pathology.

- - - - - - - - -

21.1 Haematology - - - - - - - - -

3705 Alkali resistant haemoglobin 80 4.500 46.50 80 3.000 31.00 - - -

3709 Antiglobulin test (Coombs’ or trypsinzied red cells) 80 3.650 37.70 80 2.450 25.30 - - -

3710 Antibody titration 80 7.200 74.40 80 4.800 49.60 - - -

3712 Antibody identification 80 8.450 87.30 80 5.650 58.40 - - -

3713 Bleeding time (does not include the cost of the simplate device) 80 6.940 71.70 80 4.630 47.90 - - -

3714 Blood volume, dye method 80 7.200 74.40 80 4.800 49.60 - - -

3715 Buffy layer examination 80 19.900 205.70 80 13.270 137.20 - - -

3716 Mean Cell Volume 80 2.250 23.30 80 1.500 15.50 - - -

3717 Bone marrow cytological examination only 80 19.900 205.70 80 13.270 137.20 - - -

3719 Bone marrow: Aspiration 80 8.400 86.80 80 5.600 57.90 - - -

3720 Bone marrow trephine biopsy 80 32.600 337.00 80 21.700 224.30 - - -

3721 Bone marrow aspiration and trephine biopsy (excluding histology) 80 36.800 380.40 80 24.500 253.20 - - -

3722 Capillary fragility: Hess 80 2.020 20.90 80 1.350 14.00 - - -

3723 Circulating anticoagulants 80 5.850 60.50 80 3.900 40.30 - - -

3724 Coagulation factor inhibitor assay 80 57.560 594.90 80 38.370 396.60 - - -


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Value R

CF Units Value

R

3726 Activated protein C resistance 80 26.000 268.70 80 17.300 178.80 - - -

3727 Coagulation time 80 3.160 32.70 80 2.110 21.80 - - -

3728 Anti-factor Xa Activity 80 53.600 554.00 80 35.730 369.30 - - -

3729 Cold agglutinins 80 3.600 37.20 80 2.400 24.80 - - -

3730 Protein S: Functional 80 37.500 387.60 80 25.000 258.40 - - -

3731 Compatibility for blood transfusion 80 3.600 37.20 80 2.400 24.80 - - -

3732 Cryoglobulin 80 3.600 37.20 80 2.400 24.80 - - -

3734 Protein C (chromogenic) 80 30.290 313.10 80 20.190 208.70 - - -

3735 Anti-thrombin III (chromogenic) 80 22.000 227.40 80 14.700 151.90 - - -

3736 Plasminogen (chromogenic) 80 61.650 637.20 80 41.100 424.80 - - -

3737 Lupus Russel Viper method 80 17.000 175.70 80 11.300 116.80 - - -

3738 Lupus Kaolin Exner method 80 25.000 258.40 80 16.700 172.60 - - -

3739 Erythrocyte count 80 2.250 23.30 80 1.500 15.50 - - -

3740 Factors V and VII: Qualitative 80 7.200 74.40 80 4.800 49.60 - - -

3741 Coagulation factor assay: Functional 80 9.450 97.70 80 6.300 65.10 - - -

3743 Erythrocyte sedimentation rate 80 3.000 31.00 80 2.000 20.70 - - -

3744 Fibrin stabilizing factor (urea test) 80 4.500 46.50 80 3.000 31.00 - - -

3746 Fibrin monomers 80 2.700 27.90 80 1.800 18.60 - - -

3748 Plasminogen activator inhibitor (PAI-I) 80 65.950 681.70 80 43.970 454.50 - - -

3750 Tissue plasminogen Activator (tPA) 80 67.790 700.70 80 45.190 467.10 - - -

3753 Osmotic fragility (before and after incubation) 80 18.000 186.10 80 12.000 124.00 - - -

3754 ABO Reverse Group 80 3.600 37.20 80 2.400 24.80 - - -

3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) 80 10.500 108.50 80 7.000 72.40 - - -

3756 Full cross match 80 7.200 74.40 80 4.800 49.60 - - -

3757 Coagulation factors: Quantitative 80 32.200 332.80 80 21.470 221.90 - - -

3758 Factor VIII related antigen 80 60.460 624.90 80 40.310 416.60 - - -

3759 Coagulation factor correction study 80 11.720 121.10 80 7.810 80.70 - - -

3761 Factor XIII related antigen 80 61.110 631.60 80 40.740 421.10 - - -

3762 Haemoglobin estimation 80 1.800 18.60 80 1.200 12.40 - - -

3763 Contact activated product assay 80 16.200 167.40 80 10.800 111.60 - - -


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Value R

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R

3764 Grouping: A B and O antigens 80 3.600 37.20 80 2.400 24.80 - - -

3765 Grouping: Rh antigen 80 3.600 37.20 80 2.400 24.80 - - -

3766 PIVKA 80 43.490 449.50 80 28.990 299.60 - - -

3767 Euglobulin Lysis time 80 25.580 264.40 80 17.050 176.20 - - -

3768 Haemoglobin A2 (column chromatography) 80 15.000 155.00 80 10.000 103.40 - - -

3769 Haemoglobin electrophoresis 80 26.820 277.20 80 17.880 184.80 - - -

3770 Haemoglobin-S (solubility test) 80 3.600 37.20 80 2.400 24.80 - - -

3772 Haptoglobin: Quantitative 80 9.450 97.70 80 6.300 65.10 - - -

3773 Ham’s acidified serum test 80 8.000 82.70 80 5.330 55.10 - - -

3775 Heinz bodies 80 2.250 23.30 80 1.500 15.50 - - -

3776 Haemosiderin in urinary sediment 80 2.250 23.30 80 1.500 15.50 - - -

3783 Leucocyte differential count 80 6.200 64.10 80 4.150 42.90 - - -

3785 Leucocytes: Total count 80 1.800 18.60 80 1.200 12.40 - - -

3786 QBC malaria concentration and fluorescent staining 80 25.000 258.40 80 16.700 172.60 - - -

3787 LE-cells 80 8.300 85.80 80 5.550 57.40 - - -

3789 Neutrophil alkaline phosphatase 80 28.000 289.40 80 18.700 193.30 - - -

3791 Packed cell volume: Haematocrit 80 1.800 18.60 80 1.200 12.40 - - -

3792 Plasmodium falciparum: Monoclonal immunological identification 80 9.000 93.00 80 6.000 62.00 - - -

3793 Plasma haemoglobin 80 6.750 69.80 80 4.500 46.50 - - -

3794 Platelet sensitivities 80 18.640 192.70 80 12.430 128.50 - - -

3795 Platelet aggregation per aggregant 80 12.140 125.50 80 8.090 83.60 - - -

3797 Platelet count 80 2.250 23.30 80 1.500 15.50 - - -

3799 Platelet adhesiveness 80 4.500 46.50 80 3.000 31.00 - - -

3801 Prothrombin consumption 80 5.850 60.50 80 3.900 40.30 - - -

3803 Prothrombin determination (two stages) 80 5.850 60.50 80 3.900 40.30 - - -

3805 Prothrombin index 80 6.000 62.00 80 4.000 41.30 - - -

3806 Therapeutic drug level: Dosage 80 4.500 46.50 80 3.000 31.00 - - -

3809 Reticulocyte count 80 3.000 31.00 80 2.000 20.70 - - -

3810 Schumm’s test 80 3.600 37.20 80 2.400 24.80 - - -

3811 Sickling test 80 2.250 23.30 80 1.500 15.50 - - -


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R

3814 Sucrose lysis test for PNH 80 3.600 37.20 80 2.400 24.80 - - -

3816 T and B-cells EAC markers (limited to ONE marker only for CD4/8 counts) 80 21.100 218.10 80 14.070 145.40 - - -

3820 Thrombo - Elastogram 80 26.000 268.70 80 17.330 179.10 - - -

3825 Fibrinogen titre 80 3.600 37.20 80 2.400 24.80 - - -

3829 Glucose 6-phosphate-dehydrogenase: Qualitative 80 8.000 82.70 80 5.330 55.10 - - -

3830 Glucose 6-phosphate-dehydrogenase: Quantitative 80 16.000 165.40 80 10.700 110.60 - - -

3832 Red cell pyruvate kinase: Quantitative 80 16.000 165.40 80 10.700 110.60 - - -

3834 Red cell Rhesus phenotype 80 9.900 102.30 80 6.600 68.20 - - -

3835 Haemoglobin F in blood smear 80 5.850 60.50 80 3.900 40.30 - - -

3837 Partial thromboplastin time 80 5.850 60.50 80 3.900 40.30 - - -

3841 Thrombin time (screen) 80 7.160 74.00 80 4.770 49.30 - - -

3843 Thrombin time (serial) 80 7.650 79.10 80 5.100 52.70 - - -

3847 Haemoglobin H 80 2.250 23.30 80 1.500 15.50 - - -

3851 Fibrin degeneration products (diffusion plate) 80 10.350 107.00 80 6.900 71.30 - - -

3853 Fibrin degeneration products (latex slide) 80 4.500 46.50 80 3.000 31.00 - - -

3854 XDP (Dimer test or equivalent latex slide test) 80 8.500 87.90 80 5.670 58.60 - - -

3855 Haemagglutination inhibition 80 9.900 102.30 80 6.600 68.20 - - -

3856 D-Dimer (quantitative) 80 27.520 284.50 80 18.350 189.70 - - -

3857 Ristocetin Cofactor 80 35.530 367.20 80 23.690 244.90 - - -

3858 Heparin removal 80 28.880 298.50 80 19.250 199.00 - - -

21.2 Microscopic and miscellaneous tests - - - - - - - - -

3863 Autogenous vaccine 80 12.600 130.20 80 8.400 86.80 - - -

3864 Entomological examination 80 20.700 214.00 80 13.800 142.60 - - -

3865 Parasites in blood smear 80 5.600 57.90 80 3.730 38.60 - - -

3867 Miscellaneous (body fluids, urine, exudate, fungi, puss, scrapings, etc.) 80 4.900 50.70 80 3.300 34.10 - - -

3868 Fungus identification 80 8.300 85.80 80 5.500 56.90 - - -

3869 Faeces (including parasites) 80 4.900 50.70 80 3.270 33.80 - - -

3873 Transmission electron microscopy 80 85.000 878.60 80 57.000 589.20 - - -

3874 Scanning electron microscopy 80 100.000 1 033.60 80 67.000 692.50 - - -

3875 Inclusion bodies 80 4.500 46.50 80 3.000 31.00 - - -


241 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

3878 Crystal identification polarized light microscopy 80 4.500 46.50 80 3.000 31.00 - - -

3879 Campylobacter in stool: Fastidious culture 80 9.900 102.30 80 6.600 68.20 - - -

3880 Antigen detection with polyclonal antibodies 80 4.500 46.50 80 3.000 31.00 - - -

3881 Mycobacteria 80 3.000 31.00 80 2.000 20.70 - - -

3882 Antigen detection with monoclonal antibodies 80 10.800 111.60 80 7.200 74.40 - - -

3883 Concentration techniques for parasites 80 3.000 31.00 80 2.000 20.70 - - -

3884 Dark field, phase or interference contrast microscopy, Nomarski or Fontana 80 6.300 65.10 80 4.200 43.40 - - -

3885 Cytochemical stain 80 5.450 56.30 80 3.650 37.70 - - -

21.3 Bacteriology - - - - - - - - -

3887 Antibiotic susceptibility test: Per organism 80 8.000 82.70 80 5.330 55.10 - - -

3888 Adhesive tape preparation 80 2.700 27.90 80 1.800 18.60 - - -

3889 Clostridium difficile toxin: Monoclonal immunological 80 12.400 128.20 80 8.270 85.50 - - -

3890 Antibiotic assay of tissues and fluids 80 13.900 143.70 80 9.270 95.80 - - -

3891 Blood culture: Aerobic 80 5.850 60.50 80 3.900 40.30 - - -

3892 Blood culture: Anaerobic 80 5.850 60.50 80 3.900 40.30 - - -

3893 Bacteriological culture: Miscellaneous 80 6.300 65.10 80 4.200 43.40 - - -

3894 Radiometric blood culture 80 10.800 111.60 80 7.200 74.40 - - -

3895 Bacteriological culture: Fastidious organisms 80 9.900 102.30 80 6.600 68.20 - - -

3896 In vivo culture: Bacteria 80 16.000 165.40 80 10.650 110.10 - - -

3897 In vivo culture: Virus 80 16.000 165.40 80 10.650 110.10 - - -

3899 Bacterial exotoxin production (in vivo assay) 80 20.700 214.00 80 13.800 142.60 - - -

3901 Fungal culture 80 4.500 46.50 80 3.000 31.00 - - -

3902 Clostridium difficile (cytotoxicity neutralisation) 80 30.000 310.10 80 20.000 206.70 - - -

3903 Antibiotic level: Biological fluids 80 11.700 120.90 80 7.800 80.60 - - -

3904 Rotavirus latex slide test 80 5.620 58.10 80 3.750 38.80 - - -

3905 Identification of virus or rickettsia 80 20.700 214.00 80 13.800 142.60 - - -

3906 Identification: Chlamydia 80 16.000 165.40 80 10.650 110.10 - - -

3907 Culture for staphylococcus aureus 80 2.250 23.30 80 1.500 15.50 - - -

3908 Anaerobe culture: Comprehensive 80 9.900 102.30 80 6.600 68.20 - - -

3909 Anaerobe culture: Limited procedure 80 4.500 46.50 80 3.000 31.00 - - -


242 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

3911 Beta-lactamase assay 80 4.500 46.50 80 3.000 31.00 - - -

3914 Sterility control test: Biological method 80 4.500 46.50 80 3.000 31.00 - - -

3915 Mycobacterium culture 80 4.500 46.50 80 3.000 31.00 - - -

3916 Radiometric tuberculosis culture 80 10.800 111.60 80 7.200 74.40 - - -

3918 Mycoplasma culture: Comprehensive 80 9.900 102.30 80 6.600 68.20 - - -

3919 Identification of mycobacterium 80 9.900 102.30 80 6.600 68.20 - - -

3920 Mycobacterium: Antibiotic sensitivity 80 9.900 102.30 80 6.600 68.20 - - -

3921 Antibiotic synergistic study 80 20.700 214.00 80 13.800 142.60 - - -

3922 Viable cell count 80 1.350 14.00 80 0.900 9.30 - - -

3923 Biochemical identification of bacterium: Abridged 80 3.150 32.60 80 2.100 21.70 - - -

3924 Biochemical identification of bacterium: Extended 80 12.500 129.20 80 8.330 86.10 - - -

3925 Serological identification of bacterium: Abridged 80 3.150 32.60 80 2.100 21.70 - - -

3926 Serological identification of bacterium: Extended 80 10.200 105.40 80 6.800 70.30 - - -

3927 Grouping for streptococci 80 7.300 75.50 80 4.850 50.10 - - -

3928 Antimicrobic substances 80 3.800 39.30 80 2.500 25.80 - - -

3929 Radiometric mycobacterium identification 80 14.000 144.70 80 9.300 96.10 - - -

3930 Radiometric mycobacterium antibiotic sensitivity 80 25.000 258.40 80 16.700 172.60 - - -

3931 Helicobacter: Monoclonal immunological 80 12.400 128.20 80 8.270 85.50 - - -

4650 Antibiotic MIC per organism per antibiotic 80 8.000 82.70 80 5.330 55.10 - - -

4651 Non-radiometric automated blood cultures 80 13.900 143.70 80 9.270 95.80 - - -

4652 Rapid automated bacterial identification per organism 80 15.000 155.00 80 10.000 103.40 - - -

4653 Rapid automated antibiotic susceptibility per organism 80 17.000 175.70 80 11.330 117.10 - - -

4654 Rapid automated MIC per organism per antibiotic 80 17.000 175.70 80 11.330 117.10 - - -

4655 Mycobacteria: MIC determination - E Test 80 16.500 170.50 80 11.000 113.70 - - -

4656 Mycobacteria: Identification HPLC 80 35.000 361.80 80 23.330 241.10 - - -

4657 Mycobacteria: Liquefied, consentrated, fluorochrome stain 80 9.900 102.30 80 6.600 68.20 - - -

21.4 Serology - - -

3958 Anti Gad/Ia2 Ab 80 67.950 702.30 80 45.300 468.20 - - -

3959 Rose Waaler agglutination test 80 4.500 46.50 80 3.000 31.00 - - -

3960 Gonococcal, listeria or echinococcus agglutination 80 9.500 98.20 80 6.300 65.10 - - -


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code CF Units Value

RCF Units

Value R

CF Units Value

R

3961 Slide agglutination test 80 2.630 27.20 80 1.750 18.10 - - -

3963 Serum complement level: Each component 80 3.150 32.60 80 2.100 21.70 - - -

3965 Anti Ia2 Antibodies 80 36.000 372.10 80 24.000 248.10 - - -

3966 Anti Gad Antibodies 80 36.000 372.10 80 24.000 248.10 - - -

3967 Auto-antibody: Sensitized erythrocytes 80 4.500 46.50 80 3.000 31.00 - - -

3968 Herpes virus typing: Monoclonal immunological 80 20.690 213.90 80 13.790 142.50 - - -

3969 Western blot technique 80 74.000 764.90 80 49.000 506.50 - - -

3970 Epstein-Barr virus antibody titer 80 6.750 69.80 80 4.500 46.50 - - -

3932 Antibodies to human immunodeficiency virus (HIV): ELISA 80 14.100 145.70 80 9.400 97.20 - - -

3933 IgE: Total: EMIT or ELISA 80 11.700 120.90 80 7.800 80.60 - - -

3934 Auto antibodies by labelled antibodies 80 16.000 165.40 80 10.650 110.10 - - -

3935 Sperm antibodies 80 16.000 165.40 80 10.650 110.10 - - -

3936 Virus neutralisation test: First antibody 80 75.000 775.20 80 50.000 516.80 - - -

3937 Virus neutralisation test: Each additional antibody 80 15.000 155.00 80 10.000 103.40 - - -

3938 Precipitation test per antigen 80 4.500 46.50 80 3.000 31.00 - - -

3939 Agglutination test per antigen 80 5.500 56.90 80 3.670 37.90 - - -

3940 Haemagglutination test: Per antigen 80 9.900 102.30 80 6.600 68.20 - - -

3941 Modified Coombs’ test for brucellosis 80 4.500 46.50 80 3.000 31.00 - - -

3942 Hepatitis Rapid Viral Ab 80 12.240 126.50 80 8.160 84.30 - - -

3943 Antibody titer to bacterial exotoxin 80 3.600 37.20 80 2.400 24.80 - - -

3944 IgE: Specific antibody titer: ELISA/EMIT: Per Ag 80 12.400 128.20 80 8.270 85.50 - - -

3945 Complement fixation test 80 5.850 60.50 80 3.900 40.30 - - -

3946 IgM: Specific antibody titer:ELISA/EMIT: Per Ag 80 14.050 145.20 80 9.370 96.90 - - -

3947 C-reactive protein 80 10.840 112.00 80 7.227 74.70 - - -

3948 IgG: Specific antibody titer: ELISA/EMIT: Per Ag 80 12.950 133.90 80 8.630 89.20 - - -

3949 Qualitative Kahn, VDRL or other flocculation 80 2.250 23.30 80 1.500 15.50 - - -

3950 Neutrophil phagocytosis 80 25.200 260.50 80 16.800 173.60 - - -

3951 Quantitative Kahn, VDRL or other flocculation 80 3.600 37.20 80 2.400 24.80 - - -

3952 Neutrophil chemotaxis 80 67.950 702.30 80 45.300 468.20 - - -

3953 Tube agglutination test 80 4.150 42.90 80 2.760 28.50 - - -


244 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

3955 Paul Bunnell: Presumptive 80 2.250 23.30 80 1.500 15.50 - - -

3956 Infectious mononucleosis latex slide test (Monospot or equivalent) 80 8.500 87.90 80 5.670 58.60 - - -

3971 Immuno-diffusion test: Per antigen 80 3.150 32.60 80 2.100 21.70 - - -

3972 Respiratory syncytial virus (ELISA technique) 80 35.000 361.80 80 23.000 237.70 - - -

3973 Immuno electrophoresis: Per immune serum 80 9.450 97.70 80 6.300 65.10 - - -

3974 Polymerase chain reaction 80 75.000 775.20 80 50.000 516.80 - - -

3975 Indirect immuno-fluorescence test (bacterial, viral, parasitic) 80 12.000 124.00 80 8.000 82.70 - - -

3978 Lymphocyte transformation 80 51.700 534.40 80 34.500 356.60 - - -

3980 Bilharzia Ag Serum/Urine 80 14.500 149.90 80 9.670 100.00 - - -

3982 Histone Ab 80 16.000 165.40 80 10.670 110.30 - - -

4600 Anti-CCP 80 17.460 180.50 80 11.640 120.30 - - -

4601 Panel typing: Antibody detection: Class I 80 36.000 372.10 80 24.000 248.10 - - -

4602 Panel typing: Antibody detection: Class II 80 44.000 454.80 80 29.300 302.80 - - -

4603 HLA test for specific locus/antigen - serology 80 27.000 279.10 80 18.000 186.10 - - -

4604 HLA typing: Class I - serology 80 52.000 537.50 80 34.700 358.70 - - -

4605 HLA typing: Class II - serology 80 52.000 537.50 80 34.700 358.70 - - -

4606 HLA typing: Class I & II - serology 80 90.000 930.20 80 60.000 620.20 - - -

4607 Cross matching T-cells (per tray) 80 18.000 186.10 80 12.000 124.00 - - -

4608 Cross matching B-cells 80 38.000 392.80 80 25.300 261.50 - - -

4609 Cross matching T- & B-cells 80 48.000 496.10 80 32.000 330.80 - - -

4610 Helicobacter: Pylori antigen test 80 34.600 357.60 80 23.070 238.50 - - -

4611 Erythropoietin 80 20.000 206.70 80 13.330 137.80 - - -

4612 HTLV I/II 80 20.000 206.70 80 13.330 137.80 - - -

4613 Anti-Gm1 Antibody Assay 80 75.000 775.20 80 50.000 516.80 - - -

4614 HIV Ab - Rapid Test 80 12.000 124.00 80 8.000 82.70 - - -

21.5 Skin tests - - - - - - - - -

For skin-prick allergy tests, please refer to items 0218, 0220 and 0221 in Section 2: Integumentary Section

- - - - - - - - -

21.6 Biochemical tests: Blood - - - - - - - - -

3991 Abnormal pigments: Qualitative 80 4.500 46.50 80 3.000 31.00 - - -


245 • Version 4_21




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code CF Units Value

RCF Units

Value R

CF Units Value

R

3993 Abnormal pigments: Quantitative 80 9.000 93.00 80 6.000 62.00 - - -

3995 Acid phosphate 80 5.180 53.50 80 3.450 35.70 - - -

3998 Amino acids Quantitative (Post derivatisation HPLC) 80 78.120 807.50 80 52.080 538.30 - - -

3999 Albumin 80 4.800 49.60 80 3.200 33.10 - - -

4000 Alcohol 80 12.400 128.20 80 8.270 85.50 - - -

4001 Alkaline phosphatase 80 5.180 53.50 80 3.450 35.70 - - -

4002 Alkaline phosphatase-iso-enzymes 80 11.700 120.90 80 7.800 80.60 - - -

4003 Ammonia: Enzymatic 80 7.710 79.70 80 5.140 53.10 - - -

4004 Ammonia: Monitor 80 4.500 46.50 80 3.000 31.00 - - -

4005 Alpha-1-antitrypsin: Total 80 7.200 74.40 80 4.800 49.60 - - -

4006 Amylase 80 5.180 53.50 80 3.450 35.70 - - -

4007 Arsenic in blood, hair or nails 80 36.250 374.70 80 24.170 249.80 - - -

4008 Bilirubin - Reflectance 80 4.770 49.30 80 3.180 32.90 - - -

4009 Bilirubin: Total 80 4.770 49.30 80 3.180 32.90 - - -

4010 Bilirubin: Conjugated 80 3.620 37.40 80 2.410 24.90 - - -

4011 Breath Hydrogen Test 80 21.560 222.80 80 14.370 148.50 - - -

4012 CSF Nicotinic Acid 80 12.420 128.40 80 8.280 85.60 - - -

4013 CSF Glutamine 80 11.250 116.30 80 7.500 77.50 - - -

4014 Cadmium: Atomic absorption 80 18.120 187.30 80 12.080 124.90 - - -

4016 Calcium: Ionized 80 6.750 69.80 80 4.500 46.50 - - -

4017 Calcium: Spectrophotometric 80 3.620 37.40 80 2.410 24.90 - - -

4018 Calcium: Atomic absorption 80 7.250 74.90 80 4.830 49.90 - - -

4019 Carotene 80 2.250 23.30 80 1.500 15.50 - - -

4020 Carnitine (Total or free) in biological fluid: Each 80 11.690 120.80 80 7.790 80.50 - - -

4021 Carnitine (Total or free) in muscle: Each 80 23.380 241.70 80 15.590 161.10 - - -

4022 Acyl Carnitine 80 23.380 241.70 80 15.590 161.10 - - -

4023 Chloride 80 2.590 26.80 80 1.730 17.90 - - -

4025 Chol/HDL/LDL/Trig 80 27.070 279.80 80 18.050 186.60 - - -

4026 LDL cholesterol (chemical determination) 80 6.900 71.30 80 4.600 47.60 - - -

4027 Cholesterol total 80 5.340 55.20 80 3.560 36.80 - - -


246 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

4028 HDL cholesterol 80 6.900 71.30 80 4.600 47.60 - - -

4029 Cholinesterase: Serum or erythrocyte: Each 80 7.480 77.30 80 4.990 51.60 - - -

4030 Cholinesterase phenotype (Dibucaine or fluoride each) 80 9.000 93.00 80 6.000 62.00 - - -

4031 Total CO2 80 5.180 53.50 80 3.450 35.70 - - -

4032 Creatinine 80 3.620 37.40 80 2.410 24.90 - - -

4033 CSF-Immunoglobulin G 80 9.450 97.70 80 6.300 65.10 - - -

4034 C1-Esterase Inhibitor 80 9.450 97.70 80 6.300 65.10 - - -

4035 CSF-Albumin 80 9.450 97.70 80 6.300 65.10 - - -

4036 CSF-IgG Index 80 22.050 227.90 80 14.700 151.90 - - -

4038 Glutamic acid 80 29.060 300.40 80 19.370 200.20 - - -

4040 Homocysteine (random) 80 15.300 158.10 80 10.200 105.40 - - -

4041 Homocysteine (after Methionine load) 80 18.100 187.10 80 12.060 124.70 - - -

4042 D-Xylose absorption test: Two hours 80 13.150 135.90 80 8.750 90.40 - - -

4045 Fibrinogen: Quantitative 80 3.600 37.20 80 2.400 24.80 - - -

4049 Glucose tolerance test (2 specimens) 80 8.970 92.70 80 5.980 61.80 - - -

4050 Glucose strip-test with photometric reading 80 1.800 18.60 80 1.200 12.40 - - -

4051 Galactose 80 11.250 116.30 80 7.500 77.50 - - -



4057 Glucose: Quantitative 80 3.620 37.40 80 2.410 24.90 - - -


4062 Galactose-1-phosphate uridyl transferase 80 16.000 165.40 80 10.700 110.60 - - -

4063 Fructosamine 80 7.200 74.40 80 4.800 49.60 - - -

4064 HbA1C 80 14.250 147.30 80 9.500 98.20 - - -

4066 Immunofixation: Total protein, IgG, IgA, IgM, Kappa, Lambda 80 46.880 484.60 80 31.250 323.00 - - -

4067 Lithium: Flame ionisation 80 5.180 53.50 80 3.450 35.70 - - -

4068 Lithium: Atomic absorption 80 7.480 77.30 80 4.990 51.60 - - -

4071 Iron 80 6.750 69.80 80 4.500 46.50 - - -

4073 Iron-binding capacity 80 7.650 79.10 80 5.100 52.70 - - -


247 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

4076Blood gases: Astrup/pO2 and ancillary tests - can only be charged to a maximum of 6 times per patient per day

80 19.100 197.40 80 12.730 131.60 - - -

4078 Oximetry analysis: MetHb, COHb, O2Hb, RHb, SulfHb 80 6.750 69.80 80 4.500 46.50 - - -

4079 Ketones in plasma: Qualitative 80 2.250 23.30 80 1.500 15.50 - - -

4081 Drug level-biological fluid: Quantitative 80 10.800 111.60 80 7.200 74.40 - - -

4082 Tacrolimus assay 80 20.100 207.80 80 13.400 138.50 - - -

4083 Lysosomal enzyme assay 80 36.560 377.90 80 24.370 251.90 - - -

4084 Thymidine kinase 80 20.000 206.70 80 13.330 137.80 - - -

4085 Lipase 80 5.180 53.50 80 3.450 35.70 - - -

4086 Lactate 80 16.000 165.40 80 10.670 110.30 - - -

4091 Lipoprotein electrophoresis 80 9.000 93.00 80 6.000 62.00 - - -

4092 Orosmucoid 80 9.450 97.70 80 6.300 65.10 - - -

4093 Osmolality: Serum or urine 80 6.750 69.80 80 4.500 46.50 - - -

4094 Magnesium: Spectrophotometric 80 3.620 37.40 80 2.410 24.90 - - -

4095 Magnesium: Atomic absorption 80 7.250 74.90 80 4.830 49.90 - - -

4096 Mercury: Atomic absorption 80 18.120 187.30 80 12.080 124.90 - - -

4098 Copper: Atomic absorption 80 18.120 187.30 80 12.080 124.90 - - -

4105 Protein electrophoresis 80 9.000 93.00 80 6.000 62.00 - - -

4106 IgG sub-class 1, 2, 3 or 4: Per sub-class 80 20.000 206.70 80 13.200 136.40 - - -

4109 Phosphate 80 3.620 37.40 80 2.410 24.90 - - -

4113 Potassium 80 3.620 37.40 80 2.410 24.90 - - -

4114 Sodium 80 3.620 37.40 80 2.410 24.90 - - -

4117 Protein: Total 80 3.110 32.10 80 2.070 21.40 - - -

4121 pH, pCO2 or pO2: Each 80 6.750 69.80 80 4.500 46.50 - - -

4123 Pyruvic acid 80 4.500 46.50 80 3.000 31.00 - - -

4125 Salicylates 80 4.500 46.50 80 3.000 31.00 - - -

4127 Caeruloplasmin 80 4.500 46.50 80 3.000 31.00 - - -

4128 Phenylalanine: Quantitative 80 11.250 116.30 80 7.500 77.50 - - -

4130 Aspartate aminotransferase (AST) 80 5.400 55.80 80 3.600 37.20 - - -

4131 Alanine aminotransferase (ALT) 80 5.400 55.80 80 3.600 37.20 - - -


248 • Version 4_21




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code CF Units Value

RCF Units

Value R

CF Units Value

R

4132 Creatine kinase (CK) 80 5.400 55.80 80 3.600 37.20 - - -

4133 Lactate dehidrogenase (LD) 80 5.400 55.80 80 3.600 37.20 - - -

4134 Gamma glutamyl transferase (GGT) 80 5.400 55.80 80 3.600 37.20 - - -

4135 Aldolase 80 5.400 55.80 80 3.600 37.20 - - -

4136 Angiotensin converting enzyme (ACE) 80 9.000 93.00 80 6.000 62.00 - - -

4137 Lactate dehydrogenase isoenzyme 80 10.800 111.60 80 7.200 74.40 - - -

4138 CK-MB: Immunoinhibition/precipitation 80 10.800 111.60 80 7.200 74.40 - - -

4139 Adenosine deaminase 80 5.400 55.80 80 3.600 37.20 - - -

4143 Serum/plasma enzymes 80 5.400 55.80 80 3.600 37.20 - - -

4144 Transferrin 80 11.700 120.90 80 7.800 80.60 - - -

4146 Lead: Atomic absorption 80 15.000 155.00 80 10.000 103.40 - - -

4147 Triglyceride 80 7.930 82.00 80 5.290 54.70 - - -

4148 Tay - Sachs Study 80 36.560 377.90 80 24.370 251.90 - - -

4149 Red cell magnesium 80 11.700 120.90 80 7.800 80.60 - - -

4151 Urea 80 3.620 37.40 80 2.410 24.90 - - -

4152 CK-MB: Mass determination: Quantitative (Automated) 80 12.400 128.20 80 8.270 85.50 - - -

4153 CK-MB: Mass determination: Quantitative (Not automated) 80 17.470 180.60 80 11.650 120.40 - - -

4154 Myoglobin quantitative: Monoclonal immunological 80 12.400 128.20 80 8.270 85.50 - - -

4155 Uric acid 80 3.780 39.10 80 2.520 26.10 - - -

4156 Vitamin D3 80 12.420 128.40 80 8.280 85.60 - - -

4157 Vitamin A-saturation test 80 15.300 158.10 80 10.200 105.40 - - -

4158 Vitamin E (tocopherol) 80 3.600 37.20 80 2.400 24.80 - - -

4159 Vitamin A 80 6.300 65.10 80 4.200 43.40 - - -

4161 Troponin isoforms: Each 80 20.000 206.70 80 13.330 137.80 - - -

4163 Apoprotein AI: Turbidometric method 80 8.280 85.60 80 5.520 57.10 - - -

4165 Apoprotein AII: Turbidometric method 80 8.280 85.60 80 5.520 57.10 - - -

4167 Apoprotein B: Turbidometric method 80 8.280 85.60 80 5.520 57.10 - - -

4170 Lipoprotein (a)(Lp(a)) assay 80 12.420 128.40 80 8.280 85.60 - - -

4171 Sodium + potassium + chloride + CO2 + urea 80 15.840 163.70 80 10.560 109.20 - - -

4172 ELISA/EMIT technique 80 12.420 128.40 80 8.280 85.60 - - -


249 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

4173 Sirolimus Assay 80 78.000 806.20 80 52.000 537.50 - - -

4181 Quantitative protein estimation: Mancini method 80 7.760 80.20 80 5.170 53.40 - - -

4182 Quantitative protein estimation: Nephelometer or Turbidometeric method 80 8.280 85.60 80 5.520 57.10 - - -

4183 Quantitative protein estimation: Labelled antibody 80 12.420 128.40 80 8.280 85.60 - - -

4184 C-reactive protein (Ultra sensitive) 80 11.680 120.70 80 7.790 80.50 - - -

4185 Lactose 80 10.800 111.60 80 7.200 74.40 - - -

4186 Vitamin B6 80 15.300 158.10 80 10.200 105.40 - - -

4187 Zinc: Atomic absorption 80 18.120 187.30 80 12.080 124.90 - - -

21.7 Biochemical tests: Urine - - - - - - - - -

4188 Urine dipstick, per stick (irrespective of the number of tests on stick) 80 1.500 15.50 80 1.000 10.30 - - -

4189 Abnormal pigments 80 4.500 46.50 80 3.000 31.00 - - -

4193 Alkapton test: Homogentisic acid 80 4.500 46.50 80 3.000 31.00 - - -

4194 Amino acids: Quantitative (Post derivatisation HPLC) 80 78.120 807.50 80 52.080 538.30 - - -

4195 Amino laevulinic acid 80 18.000 186.10 80 12.000 124.00 - - -

4197 Amylase 80 5.180 53.50 80 3.450 35.70 - - -

4198 Arsenic 80 18.120 187.30 80 12.080 124.90 - - -

4199 Ascorbic acid 80 2.250 23.30 80 1.500 15.50 - - -

4201 Bence-Jones protein 80 2.700 27.90 80 1.800 18.60 - - -

4204 Calcium: Atomic absorption 80 7.250 74.90 80 4.830 49.90 - - -

4205 Calcium: Spectrophotometric 80 3.620 37.40 80 2.410 24.90 - - -

4209 Lead: Atomic absorption 80 15.000 155.00 80 10.000 103.40 - - -

4210 Urine collagen telopeptides 80 36.500 377.30 80 24.330 251.50 - - -

4211 Bile pigments: Qualitative 80 2.250 23.30 80 1.500 15.50 - - -

4213 Protein: Quantitative 80 2.250 23.30 80 1.500 15.50 - - -

4216 Mucopolysaccharides: Qualitative 80 3.600 37.20 80 2.400 24.80 - - -

4217 Oxalate 80 9.380 97.00 80 6.250 64.60 - - -

4218 Glucose: Quantitative 80 2.250 23.30 80 1.500 15.50 - - -

4219 Steroids: Chromatography (each) 80 7.200 74.40 80 4.800 49.60 - - -

4221 Creatinine 80 3.620 37.40 80 2.410 24.90 - - -

4223 Creatinine clearance 80 7.650 79.10 80 5.100 52.70 - - -


250 • Version 4_21




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Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

4227 Electrophoresis: Qualitative 80 4.500 46.50 80 3.000 31.00 - - -

4228 Fetal Lung Maturity 80 36.560 377.90 80 24.370 251.90 - - -

4230 Urine/Fluid - Specific Gravity 80 0.900 9.30 80 0.600 6.20 - - -

4231 Metabolites HPLC (High Pressure Liquid Chromatography) 80 37.500 387.60 80 25.000 258.40 - - -

4232 Metabolites (Gaschromatography/Mass spectrophotometry) 80 46.800 483.70 80 31.200 322.50 - - -

4233Pharmacological/Drugs of abuse: Metabolites HPLC (High Pressure Liquid Chromatography)

80 37.500 387.60 80 25.000 258.40 - - -

4234Pharmacological/Drugs of abuse: Metabolites (Gaschromatography/Mass spectrophotometry)

80 46.800 483.70 80 31.200 322.50 - - -

4237 5-Hydroxy-indole-acetic acid: Screen test 80 2.700 27.90 80 1.800 18.60 - - -

4238 5HIAA (Hplc) 80 78.120 807.50 80 52.080 538.30 - - -

4247 Ketones: Excluding dip-stick method 80 2.250 23.30 80 1.500 15.50 - - -

4248 Reducing substances 80 1.800 18.60 80 1.200 12.40 - - -

4251 Metanephrines: Column chromatography 80 22.050 227.90 80 14.700 151.90 - - -

4252 Metanephrine (Hplc) 80 78.120 807.50 80 52.080 538.30 - - -

4253 Aromatic amines (gas chromatography/mass spectrophotometry) 80 27.000 279.10 80 18.000 186.10 - - -

4254 Nitrosonaphtol test for tyrosine 80 2.250 23.30 80 1.500 15.50 - - -

4255 Orotic Acid - Urine 80 9.450 97.70 80 6.300 65.10 - - -

4256 Very long Chain Fatty Acids 80 129.380 1 337.30 80 86.250 891.50 - - -

4261 Micro Albumin: Quantitative 80 12.420 128.40 80 8.280 85.60 - - -

4262 Micro Albumin: Qualitative 80 4.500 46.50 80 3.000 31.00 - - -

4263 pH: Excluding dip-stick method 80 0.900 9.30 80 0.600 6.20 - - -

4265 Thin layer chromatography: One way 80 6.750 69.80 80 4.500 46.50 - - -

4266 Thin layer chromatography: Two way 80 11.250 116.30 80 7.500 77.50 - - -

4268 Organic acids: Quantitative: GCMS 80 109.380 1 130.60 80 72.920 753.70 - - -

4269 Phenylpyruvic acid: Ferric chloride 80 2.250 23.30 80 1.500 15.50 - - -

4270 Chromium Total Urine 80 18.120 187.30 80 12.080 124.90 - - -

4271 Phosphate excretion index 80 22.050 227.90 80 14.700 151.90 - - -

4272 Porphobilinogen qualitative screen: Urine 80 5.000 51.70 80 3.330 34.40 - - -

4273 Porphobilinogen/ALA: Quantitative each 80 15.000 155.00 80 10.000 103.40 - - -


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code CF Units Value

RCF Units

Value R

CF Units Value

R

4283 Magnesium: Spectrophotometric 80 3.620 37.40 80 2.410 24.90 - - -

4284 Magnesium: Atomic absorption 80 7.250 74.90 80 4.830 49.90 - - -

4285 Identification of carbohydrate 80 7.650 79.10 80 5.100 52.70 - - -

4287 Identification of drug: Qualitative 80 4.500 46.50 80 3.000 31.00 - - -

4288 Identification of drug: Quantitative 80 10.800 111.60 80 7.200 74.40 - - -

4293 Urea clearance 80 5.400 55.80 80 3.600 37.20 - - -

4297 Copper: Spectrophotometric 80 3.620 37.40 80 2.410 24.90 - - -

4298 Copper: Atomic absorption 80 18.120 187.30 80 12.080 124.90 - - -

4301 Chloride 80 2.590 26.80 80 1.730 17.90 - - -

4309 Urobilinogen: Quantitative 80 6.750 69.80 80 4.500 46.50 - - -

4313 Phosphates 80 3.620 37.40 80 2.410 24.90 - - -

4315 Potassium 80 3.620 37.40 80 2.410 24.90 - - -

4316 Sodium 80 3.620 37.40 80 2.410 24.90 - - -

4319 Urea 80 3.620 37.40 80 2.410 24.90 - - -

4321 Uric acid 80 3.620 37.40 80 2.410 24.90 - - -

4323 Total protein and protein electrophoresis 80 11.250 116.30 80 7.500 77.50 - - -

4325 VMA: Quantitative 80 11.250 116.30 80 7.500 77.50 - - -

4326 Catecholamines (HPLC) 80 78.120 807.50 80 52.080 538.30 - - -

4327 Immunofixation: Total protein, IgG, IgA, IgM, Kappa, Lambda 80 46.880 484.60 80 31.250 323.00 - - -

4328 Immunoglobulin D 80 9.450 97.70 80 6.300 65.10 - - -

4335 Cystine: Quantitative 80 12.600 130.20 80 8.400 86.80 - - -

4336 Dinitrophenol hydrazine test: Ketoacids 80 2.250 23.30 80 1.500 15.50 - - -

21.8 Biochemical tests: Faeces - - - - - - - - -

4339 Chloride 80 2.590 26.80 80 1.730 17.90 - - -

4343 Fat: Qualitative 80 3.150 32.60 80 2.100 21.70 - - -

4345 Fat: Quantitative 80 22.050 227.90 80 14.700 151.90 - - -

4347 Ph 80 0.900 9.30 80 0.600 6.20 - - -

4351 Occult blood: Chemical test 80 2.250 23.30 80 1.500 15.50 - - -

4352 Occult blood: Monoclonal antibodies 80 10.000 103.40 80 6.670 68.90 - - -

4357 Potassium 80 3.620 37.40 80 2.410 24.90 - - -


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Value R

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R

4358 Sodium 80 3.620 37.40 80 2.410 24.90 - - -

4359 Secretory IgA 80 9.450 97.70 80 6.300 65.10 - - -

4362 Elastase quantitative ELISA 80 47.000 485.80 80 31.330 323.80 - - -

4363 Stercobilinogen: Quantitative 80 6.750 69.80 80 4.500 46.50 - - -

21.9 Biochemical tests: Miscellaneous - - - - - - - - -

4366 Porphyrin screen qualitative: Urine, stool, red blood cells: Each 80 5.000 51.70 80 3.330 34.40 - - -

4367 Porphyrin qualitative analysis by TLC: Urine, stool, red blood cells: Each 80 20.000 206.70 80 13.330 137.80 - - -

4368 Porphyrin: Total quantisation: Urine, stool, red blood cells: Each 80 20.000 206.70 80 13.330 137.80 - - -

4369 Porphyrin quantitative analysis by TLC/HPLC: Urine, stool, red blood cells: Each 80 30.000 310.10 80 20.000 206.70 - - -

4370 Drug level in biological fluid: Monoclonal immunological 80 12.400 128.20 80 8.270 85.50 - - -

4371 Amylase in exudate 80 5.180 53.50 80 3.450 35.70 - - -

4372 Fluoride in biological fluids and water 80 15.620 161.50 80 10.410 107.60 - - -

4374 Trace metals in biological fluid: Atomic absorption 80 18.130 187.40 80 12.090 125.00 - - -

4375 Calcium in fluid: Spectrophotometric 80 3.620 37.40 80 2.410 24.90 - - -

4376 Calcium in fluid: Atomic absorption 80 7.250 74.90 80 4.830 49.90 - - -

4377 Gallstone analysis: (Bilirubin, Ca, P, Oxalate, Cholesterol) 80 21.880 226.20 80 14.590 150.80 - - -

4378 Urea breath test 80 58.000 599.50 80 38.670 399.70 - - -

4380 Lecithin in amniotic fluid: L/S ratio 80 27.000 279.10 80 18.000 186.10 - - -

4381 Lamellar body count in amniotic fluid 80 10.000 103.40 80 6.700 69.30 - - -

4390 Foam test: Amniotic fluid 80 3.150 32.60 80 2.100 21.70 - - -

4391 Renal calculus: Chemistry 80 5.400 55.80 80 3.600 37.20 - - -

4392 Renal calculus: Crystallography 80 16.250 168.00 80 10.800 111.60 - - -

4395 Sweat: Sodium 80 3.620 37.40 80 2.410 24.90 - - -

4396 Sweat: Potassium 80 3.620 37.40 80 2.410 24.90 - - -

4397 Sweat: Chloride 80 2.590 26.80 80 1.730 17.90 - - -

4399 Sweat collection by iontophoresis (excluding collection material) 80 4.500 46.50 80 3.000 31.00 - - -

4400 Tryptophane loading test 80 22.050 227.90 80 14.700 151.90 - - -

21.10 Cerebrospinal fluid - - - - - - - - -

4401 Cell count 80 3.450 35.70 80 2.300 23.80 - - -

4407 Cell count, protein, glucose and chloride 80 7.650 79.10 80 5.100 52.70 - - -


253 • Version 4_21




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Value R

CF Units Value

R

4409 Chloride 80 2.590 26.80 80 1.730 17.90 - - -

4416 Sodium 80 3.620 37.40 80 2.410 24.90 - - -

4417 Protein: Qualitative 80 0.900 9.30 80 0.600 6.20 - - -

4419 Protein: Quantitative 80 3.110 32.10 80 2.070 21.40 - - -

4421 Glucose 80 3.620 37.40 80 2.410 24.90 - - -

4423 Urea 80 3.620 37.40 80 2.410 24.90 - - -

4425 Protein electrophoresis 80 12.600 130.20 80 8.400 86.80 - - -

21.11 RNA/DNA based tests and andrology - - - - - - - - -

21.11.1 RNA/DNA based tests and andrology: RNA/DNA based tests - - - - - - - - -

4424 HLA test for specific allele DNA-PCR 80 36.000 372.10 80 24.000 248.10 - - -

4426 HLA typing low resolution Class I DNA-PCR per locus 80 100.000 1 033.60 80 67.000 692.50 - - -

4427 HLA typing low resolution Class II DNA-PCR per locus 80 74.000 764.90 80 49.300 509.60 - - -

4428 HLA typing high resolution Class I or II DNA-PCR per locus 80 66.000 682.20 80 44.000 454.80 - - -

4429 Quantitative PCR (DNA/RNA) 80 84.300 871.30 80 56.200 580.90 - - -

4430 Recombinant DNA technique 80 25.000 258.40 80 16.670 172.30 - - -

4431 Ribosomal RNA targeting for bacteriological identification 80 35.000 361.80 80 23.330 241.10 - - -

4432 Ribosomal RNA amplification for bacteriological identification 80 75.000 775.20 80 50.000 516.80 - - -

4433 Bacteriological DNA identification (LCR) 80 25.000 258.40 80 16.670 172.30 - - -

4434 Bacteriological DNA identification (PCR) 80 75.000 775.20 80 50.000 516.80 - - -

4439 Quantitative PCR - viral load (not HIV) - hepatitis C, hepatitis B, CMV, etc. 80 150.000 1 550.40 80 100.000 1 033.60 - - -

21.11.2 RNA/DNA based tests and andrology: Andrology - - - - - - - - -

4435 Mixed antiglobulin reaction: Semen 80 6.600 68.20 80 4.400 45.50 - - -

4436 Friberg test: Semen 80 14.500 149.90 80 9.670 100.00 - - -

4437 Kremer test: Semen 80 3.600 37.20 80 2.400 24.80 - - -

4440 Semen analysis: Cell count 80 7.650 79.10 80 5.100 52.70 - - -

4441 Semen analysis: Cytology 80 7.200 74.40 80 4.800 49.60 - - -

4442 Semen analysis: Viability + motility - 6 hours 80 6.000 62.00 80 4.000 41.30 - - -

4443 Semen analysis: Supravital stain 80 5.440 56.20 80 3.630 37.50 - - -

4445 Seminal fluid: Alpha glucosidase 80 20.000 206.70 80 13.330 137.80 - - -

4446 Seminal fluid fructose 80 3.150 32.60 80 2.100 21.70 - - -


254 • Version 4_21




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Value R

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R

4447 Seminal fluid: Acid phosphatase 80 5.180 53.50 80 3.450 35.70 - - -

21.12 Immunology - - - - - - - - -

4448 HCG: Latex agglutination: Qualitative (side room) 80 4.000 41.30 80 2.670 27.60 - - -

4449 HCG: Latex agglutination: Semi-quantitative (side room) 80 9.310 96.20 80 6.210 64.20 - - -

4450 HCG: Monoclonal immunological: Qualitative 80 10.000 103.40 80 6.670 68.90 - - -

4451 HCG: Monoclonal immunological: Quantitative 80 12.400 128.20 80 8.270 85.50 - - -

4452 Bone Specific Alk Phosphatase 80 20.000 206.70 80 13.330 137.80 - - -

4455 Anti IgE receptor antibody test (10 samples and dilution) 80 161.560 1 669.90 80 107.710 1 113.30 - - -

4456 Eosinophil cationic protein 80 27.810 287.40 80 18.540 191.60 - - -

4457 Mast cell tryptase 80 96.870 1 001.30 80 64.580 667.50 - - -

4458 Micro-albuminuria: Radio-isotope method 80 12.420 128.40 80 8.300 85.80 - - -

4459 Acetyl choline receptor antibody 80 158.120 1 634.30 80 105.410 1 089.50 - - -

4460 CA-199 tumour marker 80 20.000 206.70 80 13.330 137.80 - - -

4461 Nuclear Matrix Protein 22 80 35.000 361.80 80 23.330 241.10 - - -

4462 CA-125 tumour marker 80 20.000 206.70 80 13.330 137.80 - - -

4463 C6 complement functional essay 80 45.000 465.10 80 30.000 310.10 - - -

4466 Beta-2-microglobulin 80 12.420 128.40 80 8.280 85.60 - - -

4467 Chromograqnin A 80 47.000 485.80 80 31.330 323.80 - - -

4468 CA-549 80 20.000 206.70 80 13.300 137.50 - - -

4469 Tumour markers: Monoclonal immunological (each) 80 20.000 206.70 80 13.330 137.80 - - -

4470 CA-195 tumour marker 80 20.000 206.70 80 13.330 137.80 - - -

4471 Carcino-embryonic antigen 80 20.000 206.70 80 13.330 137.80 - - -

4473 TSH Receptor Ab 80 17.480 180.70 80 11.650 120.40 - - -

4474 Cast Per Allergen 80 27.810 287.40 80 18.540 191.60 - - -

4475 CA-724 80 20.000 206.70 80 13.330 137.80 - - -

4477 Neuron specific enolase 80 20.000 206.70 80 13.330 137.80 - - -

4478 Osteocalcin 80 31.400 324.60 80 20.930 216.30 - - -

4479 Vitamin B12-absorption: Shilling test 80 11.700 120.90 80 7.800 80.60 - - -

4480 Serotonin 80 18.750 193.80 80 12.500 129.20 - - -

4482 Free thyroxine (FT4) 80 17.480 180.70 80 11.650 120.40 - - -


255 • Version 4_21




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code CF Units Value

RCF Units

Value R

CF Units Value

R

4484 Thyrotropin (TSH) + Free Thyroxine (FT4) 80 37.080 383.30 80 24.720 255.50 - - -

4485 Insulin 80 12.420 128.40 80 8.280 85.60 - - -

4486 C-Peptide 80 12.420 128.40 80 8.280 85.60 - - -

4487 Calcitonin 80 18.900 195.40 80 12.600 130.20 - - -

4488 B-Type Natriuretic Peptide 80 47.040 486.20 80 31.360 324.10 - - -

4490 Releasing hormone response 80 50.000 516.80 80 33.350 344.70 - - -

4491 Vitamin B12 80 12.420 128.40 80 8.280 85.60 - - -

4492 Vitamin D3: Calcitroil (RIA) 80 75.000 775.20 80 50.000 516.80 - - -

4493 Drug concentration: Quantitative 80 12.420 128.40 80 8.280 85.60 - - -

4494 Free hormone assay 80 17.480 180.70 80 11.650 120.40 - - -

4495 Growth hormone 80 12.420 128.40 80 8.280 85.60 - - -

4496 Hormone concentration: Quantitative 80 12.420 128.40 80 8.280 85.60 - - -

4497 Carbohydrate deficient transferrin 80 29.060 300.40 80 19.370 200.20 - - -

4499 Cortisol 80 12.420 128.40 80 8.280 85.60 - - -

4500 DHEA sulphate 80 12.420 128.40 80 8.280 85.60 - - -

4501 Testosterone 80 12.420 128.40 80 8.280 85.60 - - -

4502 Free testosterone 80 17.480 180.70 80 11.650 120.40 - - -

4503 Oestradiol 80 12.420 128.40 80 8.280 85.60 - - -

4505 Oestriol 80 10.800 111.60 80 7.200 74.40 - - -

4506 Multiple antigen specific IgE screening test for Atopy 80 37.260 385.10 80 24.800 256.30 - - -

4507 Thyrotropin (TSH) 80 19.600 202.60 80 13.070 135.10 - - -

4508 Combined antigen specific IgE 80 24.480 253.00 80 16.600 171.60 - - -

4509 Free tri-iodothyronine (FT3) 80 17.480 180.70 80 11.650 120.40 - - -

4511 Renin activity 80 18.900 195.40 80 12.600 130.20 - - -

4512 Parathormone 80 17.080 176.50 80 11.390 117.70 - - -

4513 IgE: Total 80 12.420 128.40 80 8.280 85.60 - - -

4514 Antigen specific IgE 80 12.420 128.40 80 8.280 85.60 - - -

4515 Aldosterone 80 12.420 128.40 80 8.280 85.60 - - -

4516 Follitropin (FSH) 80 12.420 128.40 80 8.280 85.60 - - -

4517 Lutropin (LH) 80 12.420 128.40 80 8.280 85.60 - - -


256 • Version 4_21




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code CF Units Value

RCF Units

Value R

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R

4518 Soluble transferrin receptor 80 11.250 116.30 80 7.500 77.50 - - -

4519 Prostate specific antigen 80 14.490 149.80 80 9.660 99.90 - - -

4520 17 Hydroxy progesterone 80 12.420 128.40 80 8.280 85.60 - - -

4521 Progesterone 80 12.420 128.40 80 8.280 85.60 - - -

4522 Alpha-feto protein 80 12.420 128.40 80 8.280 85.60 - - -

4523 ACTH 80 21.740 224.70 80 14.490 149.80 - - -

4524 Free PSA 80 20.000 206.70 80 13.330 137.80 - - -

4526 Sex hormone binding globulin 80 12.420 128.40 80 8.280 85.60 - - -

4527 Gastrin 80 12.420 128.40 80 8.280 85.60 - - -

4528 Ferritin 80 12.420 128.40 80 8.280 85.60 - - -

4529 Anti-DNA antibodies 80 12.420 128.40 80 8.280 85.60 - - -

4530 Antiplatelet antibodies 80 15.300 158.10 80 10.200 105.40 - - -

4531 Hepatitis: Per antigen or antibody 80 14.490 149.80 80 9.660 99.90 - - -

4532 Transcobalamine 80 12.420 128.40 80 8.280 85.60 - - -

4533 Folic acid 80 12.420 128.40 80 8.280 85.60 - - -

4534 Prostatic acid phosphatase 80 12.420 128.40 80 8.280 85.60 - - -

4536 Erythrocyte folate 80 17.480 180.70 80 11.650 120.40 - - -

4537 Prolactin 80 12.420 128.40 80 8.280 85.60 - - -

4538 Procalcitonin: Semi-quantitative 80 32.000 330.80 80 21.330 220.50 - - -

4539 Procalcitonin: Quantitative 80 46.000 475.50 80 30.670 317.00 - - -

4540 HCG: Quantitative as used for Down’s screen 80 15.000 155.00 80 10.000 103.40 - - -

4546 First trimester Downs screen 80 53.500 553.00 80 35.670 368.70 - - -

4552 Second Trimester Down’s screen 80 33.620 347.50 80 22.410 231.60 - - -

4553 Thyroglubulin 80 20.000 206.70 80 13.330 137.80 - - -

4554 SCC marker 80 20.000 206.70 80 13.330 137.80 - - -

21.13 Clinical pathology: Miscellaneous - - - - - - - - -

4544 Attendance in theatre 80 27.000 279.10 - - - - - -

4547After-hours service: (Monday to Friday) 17:00 to 08:00, Saturday 13:00 to Monday 08:00 and public holidays - Refer to General Rule B.

- - - - - - - - -


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R

4551

Unlisted pathology service: Fees for items not listed in the current Pathology schedule (sections 21, 22 and 23) will be based on the fee for a comparable service in the coding structure. Please contact the SA Medical Association (SAMA) Private Practice Unit via e-mail on [email protected] to obtain a comparable code for the unlisted pathology service which will be based on the fee for a comparable service in the coding structure. New items for these unlisted services should be added to the coding structure within six months or that specific unlisted pathology service should no longer be performed. Please note General Rule C and item 6999 are not applicable to pathology services (sections 21, 22 and 23)

- - - - - - - - -

4555Where pharmacological preparations (hormones, etc.) are administered as part of metabolic function tests, the cost of such preparation shall be charged separately

- - - - - - - - -

22 Anatomical Pathology - - - - - - - - -

Please note: The calculated amounts in this section are calculated according to the anatomical pathology unit values

- - - - - - - - -

22.1 Exfoliative cytology - - - - - - - - -

4561 Sputum, all body fluids and tumour aspirates: First unit 90 13.400 159.70 90 8.900 106.10 - - -

4563 Sputum, all body fluids and tumour aspirates: Each additional unit 90 7.800 93.00 90 5.200 62.00 - - -

4564 Performance of fine-needle aspiration for cytology 90 15.000 178.80 - - - - - -

4565 Examination of fine needle aspiration in theatre 90 90.000 1 072.70 90 60.000 715.10 - - -

4566 Vaginal or cervical smears, each 90 11.000 131.10 90 7.000 83.40 - - -

22.2 Histology - - - - - - - - -

4567 Histology per sample 95 20.000 225.70 95 13.300 150.10 - - -

4571 Histology per additional block, each 95 11.600 130.90 95 7.700 86.90 - - -

4575 Histology and frozen section in laboratory 95 22.700 256.20 95 15.100 170.40 - - -

4577 Histology and frozen section in theatre 95 90.000 1 015.60 95 60.000 677.00 - - -

4578 Second and subsequent frozen sections, each 95 20.000 225.70 95 13.400 151.20 - - -

4579 Attendance in theatre - no frozen section performed 95 45.000 507.80 95 30.000 338.50 - - -

4582 Serial step sections (including item 4567) 95 23.300 262.90 95 15.600 176.00 - - -

4584 Serial step sections per additional block, each 95 13.500 152.30 95 9.000 101.60 - - -

4587 Histology consultation 95 10.100 114.00 95 6.700 75.60 - - -

4589 Special stains 95 6.700 75.60 95 4.500 50.80 - - -


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code CF Units Value

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R

4591 Immunofluorescence studies 95 20.700 233.60 95 13.800 155.70 - - -

4592 Immunoperoxidase studies 95 40.000 451.40 95 26.670 300.90 - - -

4593 Electron microscopy 95 94.000 1 060.70 95 63.000 710.90 - - -

4595 Foetal autopsy excluding histology 95 73.000 823.70 95 48.670 549.20 - - -

23 Human Genetics - - - - - - - - -

Please note: The calculated amounts in this section are calculated according to the human genetics unit values

- - - - - - - - -

23.1 Cytogenitc - - - - - - - - -

4750 Cell culture: Lymphocytes, cord blood 100 15.000 158.80 100 15.000 158.80 - - -

4751Cell culture: Amniotic fluid, fibroblasts, leukaemia bloods, bone marrow, other specialised cultures

100 45.000 476.40 100 45.000 476.40 - - -

4752 Cell culture: Chorionic villi 100 60.000 635.20 100 60.000 635.20 - - -

4754Cytogenetic analysis: Lymphocytes: Idiograms, karyotyping, one staining technique

100 135.000 1 429.10 100 135.000 1 429.10 - - -

4755Cytogenetic analysis: Amniotic fluid, fibroblasts, chorionic villi, products of conception, bone marrow, leukamia bloods: Idiograms, karyotyping, one straining technique

100 270.000 2 858.20 100 270.000 2 858.20 - - -

4757Specified additional analysis e.g. mosaicism, Fanconi anaemia, Fra X, additional staining techniques

100 70.000 741.00 100 70.000 741.00 - - -

4760 FISH procedure, including cell culture 100 115.000 1 217.40 100 115.000 1 217.40 - - -

4761 FISH analysis per probe system 100 35.000 370.50 100 35.000 370.50 - - -

23.2 DNA-testing - - - - - - - - -

4763 Blood: DNA extraction 100 45.000 476.40 100 45.000 476.40 - - -

4764 Blood: Genotype per person: Southern blotting 100 89.000 942.20 100 89.000 942.20 - - -

4765 Blood: Genotype per person: PCR 100 60.000 635.20 100 60.000 635.20 - - -

4766 HIV Drug Resistance Testing 100 513.000 5 430.60 100 342.000 3 620.40 - - -

4767 Prenatal diagnosis: Amniotic fluid or chorionic tissue: DNA extraction 100 90.000 952.70 100 90.000 952.70 - - -

4768Prenatal diagnosis: Amniotic fluid or chorionic tissue: Genotype per person: Southern blotting

100 188.000 1 990.20 100 188.000 1 990.20 - - -

4769 Prenatal diagnosis: Amniotic fluid or chorionic tissue: Genotype per person: PCR 100 120.000 1 270.30 100 120.000 1 270.30 - - -

3711 Arneth count 2.250 23.30 1.500 15.50 - - -


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R

3742 Coagulation factor assay: Immunological - 4.500 46.50 - 3.000 31.00 - - -

3751 Osmotic fragility (screen) - 2.250 23.30 - 1.500 15.50 - - -

3752 Osmotic fragility test: Quantitative - 10.000 103.40 - 6.650 68.70 - - -

3771 Factor III-availability test - 5.850 60.50 - 3.900 40.30 - - -

3781 Heparin tolerance - 7.200 74.40 - 4.800 49.60 - - -

3796 Platelet antibodies: Agglutination - 5.400 55.80 - 3.600 37.20 - - -

3807 Recalcification time - 2.250 23.30 - 1.500 15.50 - - -

3898 Bacterial exotoxin production (in vitro assay) - 4.500 46.50 - 3.000 31.00 - - -

3917 Mycoplasma culture: Limited - 2.250 23.30 - 1.500 15.50 - - -

3957 Paul Bunnell: Absorption - 4.500 46.50 - 3.000 31.00 - - -

3962 Rebuck skin window - 5.400 55.80 - 3.600 37.20 - - -

3977 Counter immuno-electrophoresis - 6.750 69.80 - 4.500 46.50 - - -

3996 Serum Amyloid A - 8.280 85.60 - 5.520 57.10 - - -

3997 Acid phosphatase fractionation - 1.800 18.60 - 1.200 12.40 - - -

4047 Hollander test - 24.750 255.80 - 16.500 170.50 - - -

4111 Phospholipids - 3.150 32.60 - 2.100 21.70 - - -

4126 Secretin-pancreozymin response - 26.100 269.80 - 17.400 179.80 - - -

4129 Glutamate dehydrogenase (GDH) - 5.400 55.80 - 3.600 37.20 - - -

4142 Red cell enzymes: Each - 7.800 80.60 - 5.200 53.70 - - -

4160 Vitamin C (ascorbic acid) - 2.250 23.30 - 1.500 15.50 - - -

4203 Phenol - 3.600 37.20 - 2.400 24.80 - - -

4206 Calcium: Absorption and excretion studies - 25.000 258.40 - 16.700 172.60 - - -

4220 Klinolab Newborn Screen - 36.560 377.90 - 24.370 251.90 - - -

4229 Uric acid clearance - 7.650 79.10 - 5.100 52.70 - - -

4239 5-Hydroxy-indole-acetic acid: Quantitative - 6.750 69.80 - 4.500 46.50 - - -

4267 Total organic matter screen: Infrared - 31.250 323.00 - 20.830 215.30 - - -

4300 Indican or indole: Qualitative - 3.150 32.60 - 2.100 21.70 - - -

4307 Ammonium chloride loading test - 22.050 227.90 - 14.700 151.90 - - -

4322 Fluoride - 5.180 53.50 - 3.450 35.70 - - -

4337 Hydroxyproline: Quantitative - 18.900 195.40 - 12.600 130.20 - - -


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CF Units Value

R

4361 Stercobilin - 2.250 23.30 - 1.500 15.50 - - -

4364 Chymotrypsin determination: Enzymatic - 7.470 77.20 - 4.980 51.50 - - -

4373 Breast milk analysis - 6.750 69.80 - 4.500 46.50 - - -

4382 Bilirubin in amniotic fluid: Spectrophotometric essay - 9.450 97.70 - 6.300 65.10 - - -

4386 Oestrogen/Progesterone receptors: Fluorescent method - 20.700 214.00 - 13.800 142.60 - - -

4387 Oestrogen/Progesterone receptors: Cytosol radio-isotope technique - 230.000 2 377.30 - 153.000 1 581.40 - - -

4388 Gastric contents: Maximal stimulation test - 27.000 279.10 - 18.000 186.00 - - -

4389 Gastric fluid: Total acid per specimen - 2.250 23.30 - 1.500 15.50 - - -

4393 Saliva: Potassium - 3.620 37.40 - 2.410 24.90 - - -

4394 Saliva: Sodium - 3.620 37.40 - 2.410 24.90 - - -

4415 Potassium - 3.620 37.40 - 2.410 24.90 - - -

4464 House dust mite antigen ELIZA - 20.310 209.90 - 13.540 139.90 - - -

4472 MCA antigen tumour marker - 20.000 206.70 - 13.330 137.80 - - -

4476 Neopterin - 20.000 206.70 - 13.330 137.80 - - -

IV. Travelling Expenses - - - - - - - - -

P.

Travelling fees: (a) Where, in cases of emergency, a practitioner was called out from his residence or rooms to a patient’s home or the hospital, travelling fees can be charged according to the section on travelling expenses (section IV) if he had to travel more than 16 kilometres in total. (b) If more than one patient would be attended to during the course of a trip, the full travelling expenses must be divided between the relevant patients. (c) A practitioner is not entitled to charge for any travelling expenses or travelling time to his rooms. (d) Where a practitioner’s residence would be more than 8 kilometres away from a hospital, no travelling fees may be charged for services rendered at such hospitals, except in cases of emergency (services not voluntarily scheduled). (e) Where a practitioner conducts an itinerant practice, he is not entitled to charge fees for travelling expenses except in cases of emergency (services not voluntarily scheduled). (f) For voluntarily scheduled services, fees for travelling expenses may only be charged where the patient and the practitioner have entered into an agreement to this effect. Medical scheme benefits will not be applicable in such instances.

- - - - - - - - -


261 • Version 4_21




Code: 11400


Code: 11000

code CF Units Value

RCF Units

Value R

CF Units Value

R

5003The indicated amount for each kilometre in excess of 16 kilometres travelled in own car e.g. where a practitioner has to travel 19 kilometres in total to visit a patient, the fees shall be calculated as follows: 19-16=3 X Indicated amount

20 1.000 8.90 20 1.000 8.90 - - -

5005 Normal hours: Specialist: 18,00 clinical procedure units per hour or part thereof 20 18.000 160.90 - - - - - -

5007Normal hours: General practitioner: 18,00 clinical procedure units per hour or part thereof

- - - 20 18.000 160.90 - - -

5013Travelling fees are not payable to practitioners who assisted at operations on cases referred to surgeons by them

- - - - - - - - -

V.LIST OF PROCEDURES WHICH ARE OFTEN DONE IN THE DOCTORS’ ROOMS TO WHICH MODIFIER 0004 SHOULD NOT BE APPLIED

- - - - - - - - -

Modifier 0004 is not applicable to the following sections: All anaesthetic services Section 19: Radiology Section 20: Radiation Oncology Section 21: Clinical Pathology (except for items 3719, 3720 and 3721 where modifier 0004 may be applied) Section 22: Anatomical Pathology Section 23: Human Genetic Please note : This is not a conclusive list and practitioners should not be penalised when patients need to be admitted to hospital for these procedures.

- - - - - - - - -


262 • Version 4_21

Medical Practitioner Consultative Services

GEMS TARIFF FOR CONSULTATIVE SERVICES BY MEDICAL PRACTITIONERS, EFFECTIVE FROM 1 JANUARY 2011


0190New and established patient: Consultation/visit of new or established patient of an average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to item 0173-0175 or item 0109) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure

0191New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to item 0173-0175 or item 0109) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure

0192New and established patient: Consultation/visit of new or established patient of long duration and/or high complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to item 0173-0175 or item 0109) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure

0173First hospital consultation/visit of an average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

0174First hospital consultation/visit of a moderately above average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

0175First hospital consultation/visit of long duration and/or high complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

0109Hospital follow-up visit to patient in ward or nursing facility - Refer to general rule G(a) for post-operative care) (may only be charged once per day) (not to be used with items 0111, 0145, 0146, 0147 or ICU items 1204-1214)

0111Paediatric hospital follow-up visits (excluding neonates) by paediatricians or paediatric cardiologists (may only be charged once per day) (not to be used with items 0109 or ICU items 1204-1214). For a healthy neonate please use item 0109 for a hospital follow-up visit

0129Prolonged face-to-face attendance to a patient: ADD to either item 0192, item 0175, item 0164 or item 0169 as appropriate, for each 15-minute period only if service extends 10 minutes or more into the next 15-minute period following on the first 60 minutes

0145For consultation/visit away from the doctor’s home or rooms (non-emergency): ADD only to the consultation/visit items 0190-0192, items 0173-0175, items 0161-0164 or items 0166-0169, as appropriate. Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

0146For an unscheduled emergency consultation/visit at the doctors’ home or rooms, all hours: ADD only to the consultation/visit items 0190-0192, items 0161-0164 or items 0151-0153, as appropriate (refer to general rule B). Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

0147For an emergency consultation/visit away from the doctor’s home or rooms, all hours: ADD only to the consultation/visit items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or items 0151-0153, as appropriate. Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

0148For elective after-hours services on request of the patient or family (non emergency) (refer to general rule B): ADD 50% of the fee for the appropriate consultation/visit item (only to be used with items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or items 0151-0153) and reflect this as a separate item 0148. Usage: This item is used when, for example, a patient or the family request the doctor for a non-emergency consultation/visit outside of the normal hours period as reflected in general rule B.


263 • Version 4_21


0149After-hours bona fide emergency consultation/visit (21:00-6:00 daily): ADD 25% of the fee for the appropriate consultation/visit item (only to be used with items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or items 0151-0153) and reflect this as a separate item 0149. Note: The after-hour period applicable to this item is from Monday to Sunday 21:00-6:00

I.e Pre-anaesthetic assessment

0151Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient (all hours). Problem focused history and clinical examination and straightforward decision making for minor problem. Typically occupies the doctor face-to-face with the patient for between 10 and 20 minutes

0152Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient (all hours). Detailed history and clinical examination and straightforward decision making and counselling. Typically occupies the doctor face-to-face with the patient for between 20 and 35 minutes

0153Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient or other consultative service. Consultation with detailed history, complete examination and moderate complex decision making and counselling. Typically occupies the doctor face-to-face for between 30 and 45 minutes

I.f Prenatal visits and new born attendance

0107New born attendance: Exclusive attendance to baby at Caesarean section, normal delivery or visit in the ward (once per patient) (items 0109, 0111, 0113, 0145, 0146 and/or 0147 may not be added to item 0107)

Item 0107 can be used once only for given confinement

0113 New born attendance: Emergency attendance to newborn at all hours (once per patient) (items 0107, 0109, 0111, 0145, 0146 and/or 0147 may not be added to item 0113)

I.g Consultative services: Miscellaneous

0130 Telephone consultation (all hours)

0132Consulting service e.g. writing of repeat scripts or requesting routine pre-authorisation without the physical presence of the patient (needs not be face-to-face contact) (“Consultation” via SMS or electronic media included)

0133Writing of special motivations for procedures and treatment without the physical presence of a patient (includes report on the clinical condition of a patient) requested by or on behalf of a third party funder or its agent

0199 Completion of chronic medication forms by medical practitioners with or without the physical presence of the patient requested by or on behalf of a third party funder or its agent


264 • Version 4_21


Code Description Consultative services

0190 0191 0192 0173 0174 0175 0109 0111 0129 0145 0146 0147 0148 0149 0151 0152 0153 0107 0113 0130 0132 0133 0199

11000 Anaesthesiology - - - - - - - - - - - - - - - 231.00 231.00 231.00 - - - - -

11200 Dermatology 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

11400 General Medical Practice 242,80 242,80 242,80 242,80 242,80 242,80 216,50 216,50 86,60 115,50 202,10 - - 258,90 258,90 258,90 476,40 649,60 173,20 72,20 129,90 309,40

11600 Obstetrics and Gynaecology 259.90 259.90 259.90 259.90 259.90 259.90 - - - - - - - - - - - - - 173.20 - - -

11700 Pulmonology 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

11800 Medicine (Specialist Physician) 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

11900 Gastroenterology 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

12000 Neurology 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

12100 Cardiology 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

12300 Medical Oncology 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

12400 Neurosurgery 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

12500 Nuclear Medicine 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

12600 Opthalmology 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

12800 Orthopaedics 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

13000 Otorhinolaryngology 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

13100 Rheumatology 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

13200 Paediatrics 375.30 375.30 375.30 375.30 375.30 375.30 - 324.80 - - - - - - - - - - - 259.90 - - -

13300 Paediatric Cardiology 375.30 375.30 375.30 375.30 375.30 375.30 - 324.80 - - - - - - - - - - - 259.90 - - -

13400 Physical Medicine 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 259.90 - - -

13600Plastic and Reconstructive

Surgery 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

13800 Radiology 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

14000 Radiation Oncology 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

14200 Surgery 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

14400 Cardiothoracic Surgery 375.30 375.30 375.30 375.30 375.30 375.30 - - - - - - - - - - - - - 245.40 - - -

14600 Urology 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

15200 Pathology (Clinical) 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -

15300 Pathology (Anatomical) 245.40 245.40 245.40 245.40 245.40 245.40 - - - - - - - - - - - - - 173.20 - - -


265 • Version 4_21

Medical Scientist

GEMS TARIFF FOR MEDICAL SCIENTISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Medical Scientist:

Genetic Counselling Code: 36901

code CF Units Value

R


- - -

GENERAL RULES - - -

01

Each practitioner must acquaint him-/herself with the provisions of the Medical Schemes Act, as amended, and the regulations promulgated under the Act and shall render a monthly account in respect of any service rendered during the month, irrespective of whether or not the treatment has been completed. NB. Every account shall contain the following particulars · The name and practice code number of the referring practitioner. · The name of the member. · The name of the patient. · The name of the medical scheme. · The membership number of the member. · The nature of the treatment. · The date on which the service was rendered. · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - -

ITEMS - - -


- - -

200 Genetic counselling. Duration: 1-10min. 370 0.500 40.20









Sample extraction - - -

300 DNA extraction - Blood 370 - -


266 • Version 4_21

GEMS TARIFF FOR MEDICAL SCIENTISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Medical Scientist:

Genetic Counselling Code: 36901

code CF Units Value

R

310 DNA extraction - Tissue (other than blood and including CVS and amniotic fluid) 370 - -

320 DNA extraction - Tissue (paraffin blocks) 370 - -

330 RNA extraction - Blood 370 - -

340 RNA extraction - Tissue (other than blood and including CVS and amniotic fluid) 370 - -

350 RNA extraction - Tissue (paraffin blocks) 370 - -

PCR - - -

400 PCR-basic (up to four PCR primer sets) 370 - -

410 PCR-multiplex (five or more primer sets) 370 - -

420 PCR-realtime 370 - -

430 PCR-reverse transcriptase 370 - -

Detection Methods - - -

500 Diagnostic electrophoresis (agarose and polyacrylamide gel electrophoresis and capillary electrophoresis) 370 - -

510 Restriction enzyme digestion (use multiples based on cost of enzyme) 370 - -

520 Probe hybridisation assays 370 - -

530 dHPLC 370 - -

540 MLPA 370 - -

Southern Blotting - - -

610 DNA probe labelling (including hybridisation and autoradiography) 370 - -

600 Southern blot (digest, gel and blotting) 370 - -

Other - - -

700 Protein truncation test 370 - -

730 Interpretation and reporting 370 - -

720 DNA sequencing 370 - -

710 Maternal contamination test (prenatal testing) 370 - -


267 • Version 4_21

Medical Technology

GEMS TARIFF FOR SERVICES BY MEDICAL LABORATORY TECHNOLOGISTS, WITH EFFECT FROM 1 JANUARY 2011Practice Type: Medical Technology

Code: 37600

code CF Units Value

R


- - -

Preamble - - -

It is recommended that, when such benefits are granted, the following should be clearly specified in the Scheme’s rules. - Services must only be on referral.

- - -

General Rules - - -

001

Each practitioner must acquaint him-/herself with the provisions of the Medical Schemes Act, and the regulations promulgated under the Act and shall render a monthly account in respect of any service rendered. NB: Every account shall contain the following particulars : The account or statement contemplated in section 59(1) of the Act must contain the following - (a) The surname and initials of the member; (b) the surname, first name and other initials, if any, of the patient; (c) the name of the scheme concerned; (d) the membership number of the member; (e) the practice code number, group practice number and individual provider registration number issued by the registering authorities for providers, if

applicable, of the supplier of service and, in the case of a group practice, the name of the practitioner who provided the service;(f) the relevant diagnostic and such other item code numbers that relates to such relevant health service;(g) the date on which each relevant health service was rendered; (h) the nature and cost of each relevant health service rendered, including the supply of medicine to the member concerned or to a dependant of that

member; and the name, quantity and dosage of and net amount payable by the member in respect of, the medicine;

- - -

002 No “shopping list” must be distributed to doctors and no group tests will be carried out. - - -

003 No charge to be raised in respect of services such as sample handling and after hours services. - - -

004Interaction with patient for collecting of specimens shall be limited to those specimens that are physiologically expelled, such as sputum and urine and taking of venous and peripheral blood.

- - -


- - -

Haematology - - -

3705 Alkali resistant haemoglobin 350 4.500 38.60

3709 Antiglobulin test (Coombs’ or trypsinzied red cells) 350 3.650 31.30

3710 Antibody titration 350 7.200 61.80


268 • Version 4_21


Code: 37600

code CF Units Value

R

3712 Antibody identification 350 8.450 72.50

3713 Bleeding time (does not include the cost of the simplate device) 350 6.940 59.60

3714 Blood volume, dye method 350 7.200 61.80

3715 Buffy layer examination 350 19.900 170.80

3717 Bone marrow cytological examination only 350 19.900 170.80

3722 Capillary fragility: Hess 350 2.020 17.30

3723 Circulating anticoagulants 350 5.850 50.20

3724 Coagulation factor inhibitor assay 350 57.560 493.90

3726 Activated protein C resistance 350 26.000 223.10

3727 Coagulation time 350 3.160 27.10

3729 Cold agglutinins 350 3.600 30.90

3730 Protein S: Functional 350 37.500 321.80

3731 Compatibility for blood transfusion 350 3.600 30.90

3732 Cryoglobulin 350 3.600 30.90

3734 Protein C (chromogenic) 350 30.290 259.90

3735 Anti-thrombin III (chromogenic) 350 22.000 188.80

3736 Plasminogen (chromogenic) 350 61.650 529.00

3737 Lupus Russel Viper method 350 17.000 145.90

3738 Lupus Kaolin Exner method 350 25.000 214.50

3739 Erythrocyte count 350 2.250 19.30

3740 Factors V and VII: Qualitative 350 7.200 61.80

3741 Coagulation factor assay: Functional 350 9.450 81.10

3743 Erythrocyte sedimentation rate 350 3.000 25.70

3744 Fibrin stabilizing factor (urea test) 350 4.500 38.60

3746 Fibrin monomers 350 2.700 23.20

3753 Osmotic fragility (before and after incubation) 350 18.000 154.50

3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) 350 10.500 90.10

3756 Full cross match 350 7.200 61.80

3757 Coagulation factors: Quantitative 350 32.200 276.30

3758 Factor VIII related antigen 350 60.460 518.80

3759 Coagulation factor correction study 350 11.720 100.60


269 • Version 4_21


Code: 37600

code CF Units Value

R

3762 Haemoglobin estimation 350 1.800 15.50

3763 Contact activated product assay 350 16.200 139.00

3764 Grouping: A B and O antigens 350 3.600 30.90

3765 Grouping: Rh antigen 350 3.600 30.90

3767 Euglobulin Lysis time 350 25.580 219.50

3768 Haemoglobin A2 (column chromatography) 350 15.000 128.70

3769 Haemoglobin electrophoresis 350 26.820 230.10

3770 Haemoglobin-S (solubility test) 350 3.600 30.90

3772 Haptoglobin: Quantitative 350 9.450 81.10

3773 Ham’s acidified serum test 350 8.000 68.70

3775 Heinz bodies 350 2.250 19.30

3776 Haemosiderin in urinary sediment 350 2.250 19.30

3783 Leucocyte differential count 350 6.200 53.20

3785 Leucocytes: Total count 350 1.800 15.50

3786 QBC malaria concentration and fluorescent staining 350 25.000 214.50

3787 LE-cells 350 8.300 71.20

3789 Neutrophil alkaline phosphatase 350 28.000 240.30

3791 Packed cell volume: Haematocrit 350 1.800 15.50

3792 Plasmodium falciparum: Monoclonal immunological identification 350 9.000 77.20

3793 Plasma haemoglobin 350 6.750 57.90

3795 Platelet aggregation per aggregant 350 12.140 104.20

3797 Platelet count 350 2.250 19.30

3799 Platelet adhesiveness 350 4.500 38.60

3801 Prothrombin consumption 350 5.850 50.20

3803 Prothrombin determination (two stages) 350 5.850 50.20

3805 Prothrombin index 350 6.000 51.50

3806 Therapeutic drug level: Dosage 350 4.500 38.60

3809 Reticulocyte count 350 3.000 25.70

3810 Schumm’s test 350 3.600 30.90

3811 Sickling test 350 2.250 19.30

3814 Sucrose lysis test for PNH 350 3.600 30.90


270 • Version 4_21


Code: 37600

code CF Units Value

R

3816 T and B-cells EAC markers (limited to ONE marker only for CD4/8 counts) 350 21.100 181.10

3820 Thrombo - Elastogram 350 26.000 223.10

3825 Fibrinogen titre 350 3.600 30.90

3829 Glucose 6-phosphate-dehydrogenase: Qualitative 350 8.000 68.70

3830 Glucose 6-phosphate-dehydrogenase: Quantitative 350 16.000 137.30

3832 Red cell pyruvate kinase: Quantitative 350 16.000 137.30

3834 Red cell Rhesus phenotype 350 9.900 85.00

3835 Haemoglobin F in blood smear 350 5.850 50.20

3837 Partial thromboplastin time 350 5.850 50.20

3841 Thrombin time (screen) 350 7.160 61.40

3843 Thrombin time (serial) 350 7.650 65.60

3847 Haemoglobin H 350 2.250 19.30

3851 Fibrin degeneration products (diffusion plate) 350 10.350 88.80

3853 Fibrin degeneration products (latex slide) 350 4.500 38.60

3854 XDP (Dimer test or equivalent latex slide test) 350 8.500 72.90

3855 Haemagglutination inhibition 350 9.900 85.00

Microscopic and miscellaneous tests - - -

3863 Autogenous vaccine 350 12.600 108.10

3864 Entomological examination 350 20.700 177.60

3865 Parasites in blood smear 350 5.600 48.10

3867 Miscellaneous (body fluids, urine, exudate, fungi, puss, scrapings, etc.) 350 4.900 42.10

3868 Fungus identification 350 8.300 71.20

3869 Faeces (including parasites) 350 4.900 42.10

3875 Inclusion bodies 350 4.500 38.60

3878 Crystal identification polarized light microscopy 350 4.500 38.60

3879 Campylobacter in stool: Fastidious culture 350 9.900 85.00

3880 Antigen detection with polyclonal antibodies 350 4.500 38.60

3881 Mycobacteria 350 3.000 25.70

3882 Antigen detection with monoclonal antibodies 350 10.800 92.70

3883 Concentration techniques for parasites 350 3.000 25.70

3884 Dark field, phase or interference contrast microscopy, Nomarski or Fontana 350 6.300 54.10


271 • Version 4_21


Code: 37600

code CF Units Value

R

3885 Cytochemical stain 350 5.450 46.80

Bacteriology - - -

3887 Antibiotic susceptibility test: Per organism 350 8.000 68.70

3888 Adhesive tape preparation 350 2.700 23.20

3889 Clostridium difficile toxin: Monoclonal immunological 350 12.400 106.40

3890 Antibiotic assay of tissues and fluids 350 13.900 119.30

3891 Blood culture: Aerobic 350 5.850 50.20

3892 Blood culture: Anaerobic 350 5.850 50.20

3893 Bacteriological culture: Miscellaneous 350 6.300 54.10

3894 Radiometric blood culture 350 10.800 92.70

3895 Bacteriological culture: Fastidious organisms 350 9.900 85.00

3896 In vivo culture: Bacteria 350 16.000 137.30

3897 In vivo culture: Virus 350 16.000 137.30

3899 Bacterial exotoxin production (in vivo assay) 350 20.700 177.60

3901 Fungal culture 350 4.500 38.60

3902 Clostridium difficile (cytotoxicity neutralisation) 350 30.000 257.40

3903 Antibiotic level: Biological fluids 350 11.700 100.40

3904 Rotavirus latex slide test 350 5.620 48.20

3905 Identification of virus or rickettsia 350 20.700 177.60

3906 Identification: Chlamydia 350 16.000 137.30

3907 Culture for staphylococcus aureus 350 2.250 19.30

3908 Anaerobe culture: Comprehensive 350 9.900 85.00

3909 Anaerobe culture: Limited procedure 350 4.500 38.60

3911 Beta-lactamase assay 350 4.500 38.60

3914 Sterility control test: Biological method 350 4.500 38.60

3915 Mycobacterium culture 350 4.500 38.60

3916 Radiometric tuberculosis culture 350 10.800 92.70

3918 Mycoplasma culture: Comprehensive 350 9.900 85.00

3919 Identification of mycobacterium 350 9.900 85.00

3920 Mycobacterium: Antibiotic sensitivity 350 9.900 85.00

3921 Antibiotic synergistic study 350 20.700 177.60


272 • Version 4_21


Code: 37600

code CF Units Value

R

3922 Viable cell count 350 1.350 11.60

3923 Biochemical identification of bacterium: Abridged 350 3.150 27.00

3924 Biochemical identification of bacterium: Extended 350 12.500 107.30

3925 Serological identification of bacterium: Abridged 350 3.150 27.00

3926 Serological identification of bacterium: Extended 350 10.200 87.50

3927 Grouping for streptococci 350 7.300 62.60

3928 Antimicrobic substances 350 3.800 32.60

3929 Radiometric mycobacterium identification 350 14.000 120.10

3930 Radiometric mycobacterium antibiotic sensitivity 350 25.000 214.50

3931 Helicobacter: Monoclonal immunological 350 12.400 106.40

4650 Antibiotic MIC per organism per antibiotic 350 8.000 68.70

4651 Non-radiometric automated blood cultures 350 13.900 119.30

4652 Rapid automated bacterial identification per organism 350 15.000 128.70

4653 Rapid automated antibiotic susceptibility per organism 350 17.000 145.90

4654 Rapid automated MIC per organism per antibiotic 350 17.000 145.90

Serology - - -

3959 Rose Waaler agglutination test 350 4.500 38.60

3960 Gonococcal, listeria or echinococcus agglutination 350 9.500 81.50

3961 Slide agglutination test 350 2.630 22.60

3963 Serum complement level: Each component 350 3.150 27.00

3967 Auto-antibody: Sensitized erythrocytes 350 4.500 38.60

3968 Herpes virus typing: Monoclonal immunological 350 20.690 177.50

3969 Western blot technique 350 74.000 635.00

3970 Epstein-Barr virus antibody titer 350 6.750 57.90

3932 Antibodies to human immunodeficiency virus (HIV): ELISA 350 14.100 121.00

3933 IgE: Total: EMIT or ELISA 350 11.700 100.40

3934 Auto antibodies by labelled antibodies 350 16.000 137.30

3935 Sperm antibodies 350 16.000 137.30

3936 Virus neutralisation test: First antibody 350 75.000 643.60

3937 Virus neutralisation test: Each additional antibody 350 15.000 128.70

3938 Precipitation test per antigen 350 4.500 38.60


273 • Version 4_21


Code: 37600

code CF Units Value

R

3939 Agglutination test per antigen 350 5.500 47.20

3940 Haemagglutination test: Per antigen 350 9.900 85.00

3941 Modified Coombs’ test for brucellosis 350 4.500 38.60

3943 Antibody titer to bacterial exotoxin 350 3.600 30.90

3944 IgE: Specific antibody titer: ELISA/EMIT: Per Ag 350 12.400 106.40

3945 Complement fixation test 350 5.850 50.20

3946 IgM: Specific antibody titer:ELISA/EMIT: Per Ag 350 14.050 120.60

3947 C-reactive protein 350 10.840 93.00

3948 IgG: Specific antibody titer: ELISA/EMIT: Per Ag 350 12.950 111.10

3949 Qualitative Kahn, VDRL or other flocculation 350 2.250 19.30

3950 Neutrophil phagocytosis 350 25.200 216.20

3951 Quantitative Kahn, VDRL or other flocculation 350 3.600 30.90

3952 Neutrophil chemotaxis 350 67.950 583.10

3953 Tube agglutination test 350 4.150 35.60

3955 Paul Bunnell: Presumptive 350 2.250 19.30

3956 Infectious mononucleosis latex slide test (Monospot or equivalent) 350 8.500 72.90

3971 Immuno-diffusion test: Per antigen 350 3.150 27.00

3972 Respiratory syncytial virus (ELISA technique) 350 35.000 300.30

3973 Immuno electrophoresis: Per immune serum 350 9.450 81.10

3974 Polymerase chain reaction 350 75.000 643.60

3975 Indirect immuno-fluorescence test (bacterial, viral, parasitic) 350 12.000 103.00

3978 Lymphocyte transformation 350 51.700 443.60

4601 Panel typing: Antibody detection: Class I 350 36.000 308.90

4602 Panel typing: Antibody detection: Class II 350 44.000 377.60

4603 HLA test for specific locus/antigen - serology 350 27.000 231.70

4604 HLA typing: Class I - serology 350 52.000 446.20

4605 HLA typing: Class II - serology 350 52.000 446.20

4606 HLA typing: Class I & II - serology 350 90.000 772.30

4607 Cross matching T-cells (per tray) 350 18.000 154.50

4608 Cross matching B-cells 350 38.000 326.10

4609 Cross matching T- & B-cells 350 48.000 411.90


274 • Version 4_21


Code: 37600

code CF Units Value

R

Biochemical tests: Blood - - -

3991 Abnormal pigments: Qualitative 350 4.500 38.60

3993 Abnormal pigments: Quantitative 350 9.000 77.20

3995 Acid phosphate 350 5.180 44.50

3998 Amino acids Quantitative (Post derivatisation HPLC) 350 78.120 670.40

3999 Albumin 350 4.800 41.20

4000 Alcohol 350 12.400 106.40

4001 Alkaline phosphatase 350 5.180 44.50

4002 Alkaline phosphatase-iso-enzymes 350 11.700 100.40

4003 Ammonia: Enzymatic 350 7.710 66.20

4004 Ammonia: Monitor 350 4.500 38.60

4005 Alpha-1-antitrypsin: Total 350 7.200 61.80

4006 Amylase 350 5.180 44.50

4007 Arsenic in blood, hair or nails 350 36.250 311.10

4009 Bilirubin: Total 350 4.770 40.90

4010 Bilirubin: Conjugated 350 3.620 31.10

4014 Cadmium: Atomic absorption 350 18.120 155.50

4016 Calcium: Ionized 350 6.750 57.90

4017 Calcium: Spectrophotometric 350 3.620 31.10

4018 Calcium: Atomic absorption 350 7.250 62.20

4019 Carotene 350 2.250 19.30

4020 Carnitine (Total or free) in biological fluid: Each 350 11.690 100.30

4021 Carnitine (Total or free) in muscle: Each 350 23.380 200.60

4022 Acyl Carnitine 350 23.380 200.60

4023 Chloride 350 2.590 22.20

4026 LDL cholesterol (chemical determination) 350 6.900 59.20

4027 Cholesterol total 350 5.340 45.80

4028 HDL cholesterol 350 6.900 59.20

4029 Cholinesterase: Serum or erythrocyte: Each 350 7.480 64.20

4030 Cholinesterase phenotype (Dibucaine or fluoride each) 350 9.000 77.20

4031 Total CO2 350 5.180 44.50


275 • Version 4_21


Code: 37600

code CF Units Value

R

4032 Creatinine 350 3.620 31.10

4040 Homocysteine (random) 350 15.300 131.30

4041 Homocysteine (after Methionine load) 350 18.100 155.30

4042 D-Xylose absorption test: Two hours 350 13.150 112.80

4045 Fibrinogen: Quantitative 350 3.600 30.90

4049 Glucose tolerance test (2 specimens) 350 8.970 77.00

4050 Glucose strip-test with photometric reading 350 1.800 15.50

4051 Galactose 350 11.250 96.50



4057 Glucose: Quantitative 350 3.620 31.10


4062 Galactose-1-phosphate uridyl transferase 350 16.000 137.30

4063 Fructosamine 350 7.200 61.80

4064 HbA1C 350 14.250 122.30

4066 Immunofixation: Total protein, IgG, IgA, IgM, Kappa, Lambda 350 46.880 402.30

4067 Lithium: Flame ionisation 350 5.180 44.50

4068 Lithium: Atomic absorption 350 7.480 64.20

4071 Iron 350 6.750 57.90

4073 Iron-binding capacity 350 7.650 65.60

4078 Oximetry analysis: MetHb, COHb, O2Hb, RHb, SulfHb 350 6.750 57.90

4079 Ketones in plasma: Qualitative 350 2.250 19.30

4081 Drug level-biological fluid: Quantitative 350 10.800 92.70

4083 Lysosomal enzyme assay 350 36.560 313.70

4085 Lipase 350 5.180 44.50

4091 Lipoprotein electrophoresis 350 9.000 77.20

4093 Osmolality: Serum or urine 350 6.750 57.90

4094 Magnesium: Spectrophotometric 350 3.620 31.10

4095 Magnesium: Atomic absorption 350 7.250 62.20

4096 Mercury: Atomic absorption 350 18.120 155.50

4098 Copper: Atomic absorption 350 18.120 155.50


276 • Version 4_21


Code: 37600

code CF Units Value

R

4105 Protein electrophoresis 350 9.000 77.20

4106 IgG sub-class 1, 2, 3 or 4: Per sub-class 350 20.000 171.60

4109 Phosphate 350 3.620 31.10

4113 Potassium 350 3.620 31.10

4114 Sodium 350 3.620 31.10

4117 Protein: Total 350 3.110 26.70

4121 pH, pCO2 or pO2: Each 350 6.750 57.90

4123 Pyruvic acid 350 4.500 38.60

4125 Salicylates 350 4.500 38.60

4127 Caeruloplasmin 350 4.500 38.60

4128 Phenylalanine: Quantitative 350 11.250 96.50

4130 Aspartate aminotransferase (AST) 350 5.400 46.30

4131 Alanine aminotransferase (ALT) 350 5.400 46.30

4132 Creatine kinase (CK) 350 5.400 46.30

4133 Lactate dehidrogenase (LD) 350 5.400 46.30

4134 Gamma glutamyl transferase (GGT) 350 5.400 46.30

4135 Aldolase 350 5.400 46.30

4136 Angiotensin converting enzyme (ACE) 350 9.000 77.20

4137 Lactate dehydrogenase isoenzyme 350 10.800 92.70

4138 CK-MB: Immunoinhibition/precipitation 350 10.800 92.70

4139 Adenosine deaminase 350 5.400 46.30

4143 Serum/plasma enzymes 350 5.400 46.30

4144 Transferrin 350 11.700 100.40

4146 Lead: Atomic absorption 350 15.000 128.70

4147 Triglyceride 350 7.930 68.10

4149 Red cell magnesium 350 11.700 100.40

4151 Urea 350 3.620 31.10

4152 CK-MB: Mass determination: Quantitative (Automated) 350 12.400 106.40

4153 CK-MB: Mass determination: Quantitative (Not automated) 350 17.470 149.90

4154 Myoglobin quantitative: Monoclonal immunological 350 12.400 106.40

4155 Uric acid 350 3.780 32.40


277 • Version 4_21


Code: 37600

code CF Units Value

R

4157 Vitamin A-saturation test 350 15.300 131.30

4158 Vitamin E (tocopherol) 350 3.600 30.90

4159 Vitamin A 350 6.300 54.10

4161 Troponin isoforms: Each 350 20.000 171.60

4163 Apoprotein AI: Turbidometric method 350 8.280 71.10

4165 Apoprotein AII: Turbidometric method 350 8.280 71.10

4167 Apoprotein B: Turbidometric method 350 8.280 71.10

4170 Lipoprotein (a)(Lp(a)) assay 350 12.420 106.60

4171 Sodium + potassium + chloride + CO2 + urea 350 15.840 135.90

4172 ELISA/EMIT technique 350 12.420 106.60

4181 Quantitative protein estimation: Mancini method 350 7.760 66.60

4182 Quantitative protein estimation: Nephelometer or Turbidometeric method 350 8.280 71.10

4183 Quantitative protein estimation: Labelled antibody 350 12.420 106.60

4185 Lactose 350 10.800 92.70

4187 Zinc: Atomic absorption 350 18.120 155.50

Biochemical tests: Urine - - -

4188 Urine dipstick, per stick (irrespective of the number of tests on stick) 350 1.500 12.90

4189 Abnormal pigments 350 4.500 38.60

4193 Alkapton test: Homogentisic acid 350 4.500 38.60

4194 Amino acids: Quantitative (Post derivatisation HPLC) 350 78.120 670.40

4195 Amino laevulinic acid 350 18.000 154.50

4197 Amylase 350 5.180 44.50

4198 Arsenic 350 18.120 155.50

4199 Ascorbic acid 350 2.250 19.30

4201 Bence-Jones protein 350 2.700 23.20

4204 Calcium: Atomic absorption 350 7.250 62.20

4205 Calcium: Spectrophotometric 350 3.620 31.10

4209 Lead: Atomic absorption 350 15.000 128.70

4211 Bile pigments: Qualitative 350 2.250 19.30

4213 Protein: Quantitative 350 2.250 19.30

4216 Mucopolysaccharides: Qualitative 350 3.600 30.90


278 • Version 4_21


Code: 37600

code CF Units Value

R

4217 Oxalate 350 9.380 80.50

4218 Glucose: Quantitative 350 2.250 19.30

4219 Steroids: Chromatography (each) 350 7.200 61.80

4221 Creatinine 350 3.620 31.10

4223 Creatinine clearance 350 7.650 65.60

4227 Electrophoresis: Qualitative 350 4.500 38.60

4237 5-Hydroxy-indole-acetic acid: Screen test 350 2.700 23.20

4247 Ketones: Excluding dip-stick method 350 2.250 19.30

4248 Reducing substances 350 1.800 15.50

4251 Metanephrines: Column chromatography 350 22.050 189.20

4253 Aromatic amines (gas chromatography/mass spectrophotometry) 350 27.000 231.70

4254 Nitrosonaphtol test for tyrosine 350 2.250 19.30

4263 pH: Excluding dip-stick method 350 0.900 7.70

4265 Thin layer chromatography: One way 350 6.750 57.90

4266 Thin layer chromatography: Two way 350 11.250 96.50

4268 Organic acids: Quantitative: GCMS 350 109.380 938.60

4269 Phenylpyruvic acid: Ferric chloride 350 2.250 19.30

4271 Phosphate excretion index 350 22.050 189.20

4272 Porphobilinogen qualitative screen: Urine 350 5.000 42.90

4273 Porphobilinogen/ALA: Quantitative each 350 15.000 128.70

4283 Magnesium: Spectrophotometric 350 3.620 31.10

4284 Magnesium: Atomic absorption 350 7.250 62.20

4285 Identification of carbohydrate 350 7.650 65.60

4287 Identification of drug: Qualitative 350 4.500 38.60

4288 Identification of drug: Quantitative 350 10.800 92.70

4293 Urea clearance 350 5.400 46.30

4297 Copper: Spectrophotometric 350 3.620 31.10

4298 Copper: Atomic absorption 350 18.120 155.50

4301 Chloride 350 2.590 22.20

4309 Urobilinogen: Quantitative 350 6.750 57.90

4313 Phosphates 350 3.620 31.10


279 • Version 4_21


Code: 37600

code CF Units Value

R

4315 Potassium 350 3.620 31.10

4316 Sodium 350 3.620 31.10

4319 Urea 350 3.620 31.10

4321 Uric acid 350 3.620 31.10

4323 Total protein and protein electrophoresis 350 11.250 96.50

4325 VMA: Quantitative 350 11.250 96.50

4326 Catecholamines (HPLC) 350 78.120 670.40

4327 Immunofixation: Total protein, IgG, IgA, IgM, Kappa, Lambda 350 46.880 402.30

4335 Cystine: Quantitative 350 12.600 108.10

4336 Dinitrophenol hydrazine test: Ketoacids 350 2.250 19.30

Biochemical tests: Faeces - - -

4339 Chloride 350 2.590 22.20

4343 Fat: Qualitative 350 3.150 27.00

4345 Fat: Quantitative 350 22.050 189.20

4347 Ph 350 0.900 7.70

4351 Occult blood: Chemical test 350 2.250 19.30

4352 Occult blood: Monoclonal antibodies 350 10.000 85.80

4357 Potassium 350 3.620 31.10

4358 Sodium 350 3.620 31.10

4362 Elastase quantitative ELISA 350 47.000 403.30

4363 Stercobilinogen: Quantitative 350 6.750 57.90

Biochemical tests: Miscellaneous - - -

4366 Porphyrin screen qualitative: Urine, stool, red blood cells: Each 350 5.000 42.90

4367 Porphyrin qualitative analysis by TLC: Urine, stool, red blood cells: Each 350 20.000 171.60

4368 Porphyrin: Total quantisation: Urine, stool, red blood cells: Each 350 20.000 171.60

4369 Porphyrin quantitative analysis by TLC/HPLC: Urine, stool, red blood cells: Each 350 30.000 257.40

4370 Drug level in biological fluid: Monoclonal immunological 350 12.400 106.40

4371 Amylase in exudate 350 5.180 44.50

4372 Fluoride in biological fluids and water 350 15.620 134.00

4374 Trace metals in biological fluid: Atomic absorption 350 18.130 155.60

4375 Calcium in fluid: Spectrophotometric 350 3.620 31.10


280 • Version 4_21


Code: 37600

code CF Units Value

R

4376 Calcium in fluid: Atomic absorption 350 7.250 62.20

4377 Gallstone analysis: (Bilirubin, Ca, P, Oxalate, Cholesterol) 350 21.880 187.80

4380 Lecithin in amniotic fluid: L/S ratio 350 27.000 231.70

4390 Foam test: Amniotic fluid 350 3.150 27.00

4391 Renal calculus: Chemistry 350 5.400 46.30

4392 Renal calculus: Crystallography 350 16.250 139.40

4395 Sweat: Sodium 350 3.620 31.10

4396 Sweat: Potassium 350 3.620 31.10

4397 Sweat: Chloride 350 2.590 22.20

4399 Sweat collection by iontophoresis (excluding collection material) 350 4.500 38.60

4400 Tryptophane loading test 350 22.050 189.20

Cerebrospinal fluid - - -

4401 Cell count 350 3.450 29.60

4407 Cell count, protein, glucose and chloride 350 7.650 65.60

4409 Chloride 350 2.590 22.20

4416 Sodium 350 3.620 31.10

4417 Protein: Qualitative 350 0.900 7.70

4419 Protein: Quantitative 350 3.110 26.70

4421 Glucose 350 3.620 31.10

4423 Urea 350 3.620 31.10

4425 Protein electrophoresis 350 12.600 108.10

RNA/DNA based tests and andrology - - -

RNA/DNA based tests and andrology: RNA/DNA based tests - - -

4430 Recombinant DNA technique 350 25.000 214.50

4431 Ribosomal RNA targeting for bacteriological identification 350 35.000 300.30

4432 Ribosomal RNA amplification for bacteriological identification 350 75.000 643.60

4433 Bacteriological DNA identification (LCR) 350 25.000 214.50

4434 Bacteriological DNA identification (PCR) 350 75.000 643.60

RNA/DNA based tests and andrology: Andrology - - -

4435 Mixed antiglobulin reaction: Semen 350 6.600 56.60

4436 Friberg test: Semen 350 14.500 124.40


281 • Version 4_21


Code: 37600

code CF Units Value

R

4437 Kremer test: Semen 350 3.600 30.90

4440 Semen analysis: Cell count 350 7.650 65.60

4441 Semen analysis: Cytology 350 7.200 61.80

4442 Semen analysis: Viability + motility - 6 hours 350 6.000 51.50

4443 Semen analysis: Supravital stain 350 5.440 46.70

4445 Seminal fluid: Alpha glucosidase 350 20.000 171.60

4446 Seminal fluid fructose 350 3.150 27.00

4447 Seminal fluid: Acid phosphatase 350 5.180 44.50

Immunology - - -

4448 HCG: Latex agglutination: Qualitative (side room) 350 4.000 34.30

4449 HCG: Latex agglutination: Semi-quantitative (side room) 350 9.310 79.90

4450 HCG: Monoclonal immunological: Qualitative 350 10.000 85.80

4451 HCG: Monoclonal immunological: Quantitative 350 12.400 106.40

4455 Anti IgE receptor antibody test (10 samples and dilution) 350 161.560 1 386.40

4456 Eosinophil cationic protein 350 27.810 238.60

4457 Mast cell tryptase 350 96.870 831.20

4458 Micro-albuminuria: Radio-isotope method 350 12.420 106.60

4459 Acetyl choline receptor antibody 350 158.120 1 356.80

4460 CA-199 tumour marker 350 20.000 171.60

4462 CA-125 tumour marker 350 20.000 171.60

4463 C6 complement functional essay 350 45.000 386.20

4466 Beta-2-microglobulin 350 12.420 106.60

4468 CA-549 350 20.000 171.60

4469 Tumour markers: Monoclonal immunological (each) 350 20.000 171.60

4470 CA-195 tumour marker 350 20.000 171.60

4471 Carcino-embryonic antigen 350 20.000 171.60

4477 Neuron specific enolase 350 20.000 171.60

4479 Vitamin B12-absorption: Shilling test 350 11.700 100.40

4480 Serotonin 350 18.750 160.90

4482 Free thyroxine (FT4) 350 17.480 150.00

4485 Insulin 350 12.420 106.60


282 • Version 4_21


Code: 37600

code CF Units Value

R

4490 Releasing hormone response 350 50.000 429.10

4491 Vitamin B12 350 12.420 106.60

4492 Vitamin D3: Calcitroil (RIA) 350 75.000 643.60

4493 Drug concentration: Quantitative 350 12.420 106.60

4494 Free hormone assay 350 17.480 150.00

4495 Growth hormone 350 12.420 106.60

4496 Hormone concentration: Quantitative 350 12.420 106.60

4497 Carbohydrate deficient transferrin 350 29.060 249.40

4499 Cortisol 350 12.420 106.60

4500 DHEA sulphate 350 12.420 106.60

4501 Testosterone 350 12.420 106.60

4502 Free testosterone 350 17.480 150.00

4503 Oestradiol 350 12.420 106.60

4505 Oestriol 350 10.800 92.70

4506 Multiple antigen specific IgE screening test for Atopy 350 37.260 319.70

4507 Thyrotropin (TSH) 350 19.600 168.20

4508 Combined antigen specific IgE 350 24.480 210.10

4509 Free tri-iodothyronine (FT3) 350 17.480 150.00

4512 Parathormone 350 17.080 146.60

4513 IgE: Total 350 12.420 106.60

4514 Antigen specific IgE 350 12.420 106.60

4515 Aldosterone 350 12.420 106.60

4516 Follitropin (FSH) 350 12.420 106.60

4517 Lutropin (LH) 350 12.420 106.60

4519 Prostate specific antigen 350 14.490 124.30

4520 17 Hydroxy progesterone 350 12.420 106.60

4521 Progesterone 350 12.420 106.60

4522 Alpha-feto protein 350 12.420 106.60

4523 ACTH 350 21.740 186.60

4526 Sex hormone binding globulin 350 12.420 106.60

4527 Gastrin 350 12.420 106.60


283 • Version 4_21


Code: 37600

code CF Units Value

R

4528 Ferritin 350 12.420 106.60

4529 Anti-DNA antibodies 350 12.420 106.60

4530 Antiplatelet antibodies 350 15.300 131.30

4531 Hepatitis: Per antigen or antibody 350 14.490 124.30

4532 Transcobalamine 350 12.420 106.60

4533 Folic acid 350 12.420 106.60

4534 Prostatic acid phosphatase 350 12.420 106.60

4536 Erythrocyte folate 350 17.480 150.00

4537 Prolactin 350 12.420 106.60

4540 HCG: Quantitative as used for Down’s screen 350 15.000 128.70

Clinical pathology: Miscellaneous - - -

4544 Attendance in theatre 350 27.000 231.70

Exfoliative cytology - - -

4561 Sputum, all body fluids and tumour aspirates: First unit 351 13.400 132.60

4563 Sputum, all body fluids and tumour aspirates: Each additional unit 351 7.800 77.20

4564 Performance of fine-needle aspiration for cytology 351 15.000 148.40

4565 Examination of fine needle aspiration in theatre 351 90.000 890.60

4566 Vaginal or cervical smears, each 351 11.000 108.90

Human Genetics - - -

Cytogenitc - - -

4750 Cell culture: Lymphocytes, cord blood 352 15.000 131.80

4751 Cell culture: Amniotic fluid, fibroblasts, leukaemia bloods, bone marrow, other specialised cultures 352 45.000 395.40

4752 Cell culture: Chorionic villi 352 60.000 527.20

4754 Cytogenetic analysis: Lymphocytes: Idiograms, karyotyping, one staining technique 352 135.000 1 186.10

4755Cytogenetic analysis: Amniotic fluid, fibroblasts, chorionic villi, products of conception, bone marrow, leukamia bloods: Idiograms, karyotyping, one straining technique

352 270.000 2 372.20

4757 Specified additional analysis e.g. mosaicism, Fanconi anaemia, Fra X, additional staining techniques 352 70.000 615.00

4760 FISH procedure, including cell culture 352 115.000 1 010.40

4761 FISH analysis per probe system 352 35.000 307.50

DNA-testing - - -

4763 Blood: DNA extraction 352 45.000 395.40


284 • Version 4_21


Code: 37600

code CF Units Value

R

4764 Blood: Genotype per person: Southern blotting 352 89.000 782.00

4765 Blood: Genotype per person: PCR 352 60.000 527.20

4767 Prenatal diagnosis: Amniotic fluid or chorionic tissue: DNA extraction 352 90.000 790.70

4768 Prenatal diagnosis: Amniotic fluid or chorionic tissue: Genotype per person: Southern blotting 352 188.000 1 651.80

4769 Prenatal diagnosis: Amniotic fluid or chorionic tissue: Genotype per person: PCR 352 120.000 1 054.30


285 • Version 4_21

Mental Health Institutions

GEMS TARIFF IN RESPECT OF MENTAL HEALTH CARE FACILITIES WITH EFFECT FROM 1 JANUARY 2011Practice Type: Mental Health

Institutions Code: 55500

code CF Units Value

R


- - -

GENERAL RULES - - -

AIt is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by the Scheme if the appropriate code is supplied on the account.

- - -

CAll accounts submitted by mental health institutions shall comply with all of the requirements in terms of the Medical Schemes Act, Act No. 131 of 1999. Where possible, such accounts shall also reflect the practice code numbers and names of the surgeon, the anaesthetist and of any assistant surgeon who may have been present during the course of an operation.

- - -

DAll accounts shall be accompanied by a copy of the relevant theatre accounts specifying all details of items charged, as well as all the procedures performed. Photocopies of all other documents pertaining to the patients account must be provided on request. The scheme shall have the right to inspect the original source documents at the rehabilitation hospital concerned.

- - -

EAll accounts containing items which are subject to a discount in terms of the recommended benefit shall indicate such items individually and shall show separately the gross amount of the discount.

- - -

E.3.3Mental Institutions refers to all institutions registered with the Department of Health in terms of the Mental Health Care Act 17 of 2002 having practice code numbers commencing with the digits 55.

- - -


286 • Version 4_21

GEMS TARIFF IN RESPECT OF MENTAL HEALTH CARE FACILITIES WITH EFFECT FROM 1 JANUARY 2011Practice Type: Mental Health

Institutions Code: 55500

code CF Units Value

R

F

Accommodation fees includes the services listed below: A. The minimum services that are required are items 3, 5 and 6. B. If managed care organisations or medical schemes request any of the other services included in this list, no additional charge may be levied

by the hospital.1 Pre-authorisation (up to the date of admission) of: · length of stay · level of care · theatre procedures2 Provision of ICD-10 and CPT-4 codes when requesting pre-authorisation3 Notification of admission4 Immediate notification of changes to: · length of stay · level of care · theatre procedures5 Reporting of length of stay and level of care · In standard format for purposes of creating a minimum dataset of information to be used in defining an alternative reimbursement system.6 Discharge ICD-10 and CPT-4 coding · In standard format for purposes of creating a minimum dataset of information to be used in defining an alternative reimbursement system. · Including coding of complications and co-morbidity. To be done as accurately as practically possible by the hospital. 7 Case management by means of standard documentation and liaison between scheme and hospital appointed case managers · Liaison means communication and sharing of information between case managers, but does not include active case management by the

hospital.

- - -

SCHEDULE - - -

8 INSTITUTIONS REGISTERED IN TERMS OF THE MENTAL HEALTH ACT 1973 WITH A PRACTICE NUMBER COMMENCING WITH “55” - - -

004 General ward fee: with overnight stay 470 10.000 1 066.80

005 General ward fee: without overnight stay 470 7.355 784.70

006 General ward fee: under 5 hours stay 470 3.808 406.30

045

Ward and dispensary drugs. The amount charged in respect of dispensed medicines and scheduled substances shall not exceed the limits prescribed in the Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances, dated 30 April 2004, made in terms of the Medicines and Related Substances Act, 1965 (Act No 101 of 1965). In relation to other ward stock (materials and/or medicines), the amount charged shall not exceed the net acquisition price (inclusive of VAT) plus 30% up to a maximum of R30.00

470 - -

055 Electroconvulsive therapy (ECT) (No theatre fee chargeable) 470 4.997 533.10

231 Monitors 470 1.463 156.10

273To take out. Dispensed items including ampoules, over the counter and proprietary items issued to patients. All items must be shown on accounts. Dispensed items including ampoules, over the counter and proprietary items issued to patients. The same principles as in code 045 apply.

470 - -


287 • Version 4_21

Naturopathy

GEMS TARIFF FOR SERVICES BY NATUROPATHS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Naturopathy

Code: 41100

code CF Units Value

R


- - -

RULES - - -

01

All accounts must be presented with the following information clearly stated: - name of naturopath - qualifications of the naturopath - PCNS Practice Number - Postal address and telephone number - Date on which the service(s) were provided - Applicable item codes - The nature of the treatment - The surname and initials of the member - The first name of the patient - The name of the medical scheme - The membership number of the patient - The name and practice number of the referring practitioner

- - -

ITEMS - - -


10010 Consultation (initial or follow up). Duration 5 - 15 mins 570 10.000 -

10020 Consultation (initial or follow up). Duration 16 - 30 mins 570 22.500 -

10090 Consultation, each additional full 15 mins, to a maximum of 60 mins 570 15.000 -

2. Diagnostic Procedures - - -

20010 Vega testing 570 15.000 -

20020 Life blood testing 570 15.000 -

3. Treatment Procedures - - -

30010 Hydrotherapy 570 30.000 -

30011 Hydrotherapy, each additional full 15 mins, after initial 30 mins, to a maximum of 60 mins 570 15.000 -

30020 Electrotherapy 570 15.000 -


288 • Version 4_21

GEMS TARIFF FOR SERVICES BY NATUROPATHS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Naturopathy

Code: 41100

code CF Units Value

R

30021 Electrotherapy, each additional full 15 min, after initial 15 min, to a maximum of 60 mins 570 15.000 -

30030 Vibration therapy 570 15.000 -

30031 Vibration therapy, each additional full 15 min, after initial 15 min, to a maximum of 60 mins 570 15.000 -

30040 Light therapy 570 15.000 -

30041 Light therapy, each additional full 15 min, after initial 15 min, to a maximum of 60 mins 570 15.000 -

30050 Thermal therapy 570 15.000 -

30051 Thermal therapy, each additional full 15 min, after initial 15 min, to a maximum of 60 mins 570 15.000 -

30060 Massage therapy 570 30.000 -

30061 Massage therapy, each additional full 15 min, after initial 30 mins, to a maximum of 60 mins 570 15.000 -

30070 Exercise therapy 570 15.000 -

30071 Exercise therapy, each additional full 15 min, after initial 15 min, to a maximum of 60 mins 570 15.000 -

30080 Reflex therapy 570 15.000 -

30081 Reflex therapy, each additional full 15 min, after initial 15 min, to a maximum of 60 mins 570 15.000 -

4. Medicines and Materials - - -

40100 Proprietary Naturopathic medicine, appropriate NAPPi codes to be charged 570 - -

40200 Non-proprietary Naturopathic medicine 570 - -

40300 Naturopathic ointments / creams 570 - -

40400 Naturopathic syrups and tonics 570 - -


289 • Version 4_21

Occupational Arts Therapy

GEMS TARIFF FOR SERVICES BY OCCUPATIONAL AND ART THERAPISTS, EFFECTIVE FROM 1 JANUARY 2011

Practice Type: Occupational Therapy

Code: 36600

Practice Type: Arts TherapyCode: 36700

code CF Units Value

RCF Units

Value R


- - - - - -

REGULATIONS DEFINING THE SCOPE OF THE PROFESSION OF OCCUPATIONAL THERAPY (R2145 - 31 July 1992)

- - - - - -

GENERAL RULES - - - - - -

006

Where emergency treatment is provided: a. during working hours, and the provision of such treatment requires the practitioner to leave her or his

practice to attend to the patient in hospital; or b. after working hours the fee for such visits shall be the total fee plus 50%. For purposes of this rule: a. “emergency treatment” means a bona fide, justifiable emergency occupational therapy procedure,

where failure to provide the procedure immediately would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy; and

b. “working hours” means 8h00 to 17h00, Monday to Friday. Modifier 0006 must be quoted after the appropriate code number(s) to indicate that this rule is applicable. Rule 006 does not apply to art therapy.

- - - - - -

008

The provision of assistive devices shall be charged (exclusive of VAT) at net acquisition price plus – - 30% of the net acquisition price where the net acquisition price of that appliance is less than one

hundred rands; - a maximum of R30 where the net acquisition price of that appliance is greater than or equal to one

hundred rands.Modifier 0008 must be quoted after the appropriate code numbers to show that this rule is applicable.

- - - - - -


290 • Version 4_21



Code: 36600


code CF Units Value

RCF Units

Value R

009

Materials used in the construction of orthoses or pressure garments shall be charged (exclusive of VAT) at net acquisition price plus - - 30% of the net acquisition price where the net acquisition price of that material is less than one

hundred rands; - a maximum of R30 where the net acquisition price of that material is greater than or equal to one

hundred rands. Modifier 0009 must be quoted after the appropriate code numbers to show that this rule is applicable. Rule 009 does not apply to art therapy.

- - - - - -

010

Materials used in treatment shall be charged (exclusive of VAT) at net acquisition price plus - - 30% of the net acquisition price where the net acquisition price of that material is less than one


hundred rands. Modifier 0010 must be quoted after the appropriate code numbers to show that this rule is applicable.

- - - - - -

011

Where the therapist performs treatments away from the treatment rooms, travelling costs to be charged according to AA rates e.g. for domicilliary treatments or treatments in nursing homes. Modifier 0011 must be quoted after the appropriate code numbers to show that this rule is applicable. Please note that GEMS does not accept responsibility for the payment of transport expenses.

- - - - - -

012

Every practitioner shall render a monthly account in respect of any service rendered during the month, irrespective of whether or not the treatment has been completed. NB. Every account shall contain the following particulars: i The name and practice number of the consulting occupational or art therapist. ii The name of the member. iii The name of the patient. iv The name of the medical scheme. v The membership number of the patient. vi The nature of the treatment. vii The date on which the service was rendered. viii The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - - - - -


291 • Version 4_21



Code: 36600


code CF Units Value

RCF Units

Value R

013

It is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by a medical scheme if the appropriate code is supplied on the account.Please note: In the case of occupational therapy, a code will only be required when a standard proprietary (off the shelf) product is used. When a splint or support is made by the occupational therapist using or modifying one or more components, a code cannot accurately identify this non-standard product. Please refer to annexure itemising the most commonly made non-standard products used in occupational therapy and bill accordingly.The Occupational Therapy Association of S A has made available a generic list of non-proprietary splints and pressure garments commonly made by practitioners. The type of materials used to manufacture these products is at the discretion of the practitioner concerned. Price of splints and pressure garments may vary. See Annexures A & B.

- - - - - -

Modifiers - - - - - -

0006 Add 50% of the total fee for the procedure. Modifier 0006 does not apply to art therapy. - - - - - -

0008

Assistive devices to be charged (exclusive of VAT) at net acquisition price plus – - 30% of the net acquisition price where the net acquisition price of that appliance is less than one

hundred rands; - a maximum of R30 where the net acquisition price of that appliance is greater than or equal to one

hundred rands.

- - - - - -

0009

Materials used for orthoses or pressure garments to be charged (exclusive of VAT) at net acquisition price plus - 30% of the net acquisition price where the net acquisition price of that material is less than one


hundred rands.See Annexures A & B for non-standard products. Modifier 0009 does not apply to art therapy.

- - - - - -

0010

Materials used in treatment to be charged (exclusive of VAT) at net acquisition price plus - - 30% of the net acquisition price where the net acquisition price of that material is less than one


hundred rands.

- - - - - -

0011Travelling costs according to AA rates. Please note GEMS does not accept responsibility for the payment of transport expenses.

- - - - - -


292 • Version 4_21



Code: 36600


code CF Units Value

RCF Units

Value R

0021Services rendered to hospital inpatients: Quote modifier 0021 on all accounts for services performed on hospital inpatients.

- - - - - -

ITEMS - - - - - -

1 PROCEDURES OF INTERVIEWING, GUIDANCE AND CONSULTANCY - - - - - -

108 Interview, guidance or consultation: 30 minute duration. 171 21.250 151.30 380 21.250 82.80

109Interview, guidance or consultation. Each additional 15 mins. A maximum of four instances of this code may be charged per session.

171 10.630 75.70 380 10.625 41.40

Time based items in this section exclude time spent on procedures charged in addition to the consultation - - - - - -

107Appointment not kept (GEMS will not grant benefits in respect of this item, it will fall into the “By arrangement with Patient own account” category).

171 - - 380 - -

110Reports. To be used to motivate for therapy and/or give a progress report and/or a pre-authorisation report, where such a report is specifically required by the medical scheme.

171 16.500 117.50 380 22.140 86.30

501 Treatment in nursing home or other health care facilities. Relevant fee plus (once per day) 171 10.000 71.20 380 10.000 39.00

503 Domicillary treatments: Relevant fee plus 171 20.000 142.40 380 20.000 78.00

2 PROCEDURES OF INITIAL EVALUATION TO DETERMINE THE TREATMENT.

201 Observation and screening. 171 7.500 53.40 380 10.000 39.00

203 Specific evaluation for a single aspect of dysfunction (Specify which aspect). 171 7.500 53.40 380 10.000 39.00

205Specific evaluation of dysfunction involving one part of the body for a specific functional problem (Specify part and aspects evaluated)

171 22.500 160.20 380 30.000 116.90

207 Specific evaluation for dysfunction involving the whole body (Specify condition and which aspects evaluated). 171 45.000 320.40 380 60.000 233.90

209 Specific in depth evaluation of certain functions affecting the total person (Specify the aspects assessed). 171 75.000 534.00 380 100.000 389.80

211 Comprehensive in depth evaluation of the total person (Specify aspects assessed) 171 105.000 747.60 380 140.000 545.70

Measurement for designing. - - - - - -

213 Measurement for designing a static or dynamic orthosis 171 7.500 53.40 - - -

217 A pressure garment for one limb. 171 7.500 53.40 - - -

219 A pressure garment for one hand. 171 7.500 53.40 - - -

221 A pressure garment for the trunk. 171 7.500 53.40 - - -

223 A pressure garment for the face (chin strap only). 171 7.500 53.40 - - -

225 A pressure garment for the face (full face mask). 171 7.500 53.40 - - -

The whole body or part thereof will be the sum total of the parts - - - - - -

227 Specific built-in musical aids - - - 380 10.000 39.00


293 • Version 4_21



Code: 36600


code CF Units Value

RCF Units

Value R

3 PROCEDURES OF THERAPY. - - - - - -

301 Group treatment in a task-centered activity, per patient (Treatment time 60 minutes or more). 171 10.000 71.20 381 8.840 55.40

303Placement of a patient in an appropriate treatment situation requiring structuring the environment, adapting equipment and positioning the patient. This does not require individual attention for the whole treatment session, per patient)

171 15.000 106.80 380 10.000 39.00

305 Groups directed to achieve common aims, per patient) (Treatment time 60 minutes or more). 171 20.000 142.40 381 16.500 103.50

307Simultaneous treatment with two to four patients, each with specific problems, utilising individual activities, per patient (Treatment time 60 minutes or more)

171 20.000 142.40 380 20.000 78.00

308Simultaneous treatment with two to four neuro-behavioural and stress related conditions or severe head injury patients, each with specific problems, utilising individual activities, per patient (Treatment time 90 minutes or more)

171 30.000 213.60 380 30.000 116.90

Individual and undivided attention during treatment sessions utilising specific activity and/or techniques in an integrated treatment session

- - - - - -

309 On level one (15 minutes). 171 10.000 71.20 381 10.000 62.70

311 On level two (30 minutes). 171 20.000 142.40 381 20.000 125.40

313 On level three (45 minutes). 171 30.000 213.60 381 30.000 188.10

315 On level four ( 60 minutes). 171 40.000 284.80 381 40.000 250.80

317 On level five (90 minutes). 171 50.000 356.00 381 50.000 313.50

319 On level six (120 minutes). 171 60.000 427.20 381 60.000 376.20

4 PROCEDURES REQUIRED TO PROMOTE TREATMENT. - - - - - -

401Recommendations as regards to assistive devices, environmental adaptations, alternative/compensatory methods, handling the patient

171 15.000 106.80 381 10.000 62.70

Designing and constructing a custom-made adaptation, assistive device, splint or simple pressure garment for treatment in a task-centered activity (specify the adaptation, assistive device, splint or simple pressure garment)

- - - - - -

403 On level one. 171 10.000 71.20 381 10.000 62.70

405 On level two. 171 20.000 142.40 381 20.000 125.40

407 On level three. 171 30.000 213.60 381 30.000 188.10

409 On level four. 171 40.000 284.80 381 40.000 250.80

411 On level five. 171 50.000 356.00 381 50.000 313.50

413 On level six. 171 60.000 427.20 381 60.000 376.20

415 Designing and constructing a static orthosis. 171 60.000 427.20 - - -


294 • Version 4_21



Code: 36600


code CF Units Value

RCF Units

Value R

417 Designing and constructing a dynamic orthosis. 171 120.000 854.40 - - -

Designing and constructing pressure garment for: - - - - - -

419 Limb. 171 60.000 427.20 - - -

421 Face (chin strap only). 171 45.000 320.40 - - -

423 Face (full face mask). 171 60.000 427.20 - - -

425 Trunk. 171 90.000 640.80 - - -

427 Hand. 171 90.000 640.80 - - -

The whole body or part thereof will be the sum total of the parts for the first garment and 75% of the fee for any additional garments made on the same pattern

- - - - - -

431 Planning and preparing in depth home programme on a monthly basis. 171 90.000 640.80 380 120.000 467.80

434Hiring equipment: 1% of the current replacement value of the equipment per day. Total charge not to exceed 50% of replacement value. Description of equipment to be supplied.

- - - - - -

Payment of this item is at the discretion of GEMS, and should be considered in instances where cost savings can be achieved. By prior arrangement with the Scheme.

- - - - - -

List of splints and pressure garments exempted from NAPPI codes - - - - - -

Annexure A - - - - - -

Numbers and names of splints to be used with modifier 0009 - - - - - -

701 Static finger extension/flexion splint 170 - - - - -

702 Dynamic finger extension/flexion 170 - - - - -

703 Buddy strap 170 - - - - -

704 DIP/PIP flexion strap 170 - - - - -

705 MP, PIP, DIP flexion strap 170 - - - - -

706 Hand based static finger extension/flexion 170 - - - - -

707 Hand based static thumb extension/flexion/opposition/ abduction 170 - - - - -

708 Hand based dynamic finger flexion/extension 170 - - - - -

709 Hand based dynamic thumb flexion/extension/opposition/abduction 170 - - - - -

710 Static wrist extension/flexion 170 - - - - -

711 Dynamic wrist extension/flexion 170 - - - - -

712 Flexion glove 170 - - - - -

713 Forearm based dynamic finger flexion/extension 170 - - - - -


295 • Version 4_21



Code: 36600


code CF Units Value

RCF Units

Value R

714 Forearm based dorsal protection 170 - - - - -

715 Forearm based volar resting 170 - - - - -

716 Static elbow extension/flexion 170 - - - - -

717 Dynamic elbow flexion/extension splint 170 - - - - -

718 Shoulder abduction splint 170 - - - - -

719 Static rigid neck splint 170 - - - - -

720 Static soft neck splint/brace 170 - - - - -

721 Static knee extension 170 - - - - -

722 Static foot dorsiflexion 170 - - - - -

Annexure B - - - - - -

Numbers and names of pressure garments to be used with modifier 0009 - - - - - -

801 Glove to wrist 170 - - - - -

802 Glove to elbow 170 - - - - -

803 Gauntlet (Glove with palm and thumb only) 170 - - - - -

804 Sleeve: Upper/forearm 170 - - - - -

805 Sleeve: full 170 - - - - -

806 Vest + sleeves 170 - - - - -

807 Sleeveless vest 170 - - - - -

808 Upper leg 170 - - - - -

809 Lower leg 170 - - - - -

810 Full leg 170 - - - - -

811 Pants (trunk and full legs) 170 - - - - -

812 Briefs 170 - - - - -

813 Anklet 170 - - - - -

814 Knee length stocking 170 - - - - -

815 Chin strap 170 - - - - -

816 Full face mask 170 - - - - -

817 Neck only 170 - - - - -

818 Finger sock 170 - - - - -

Annexure C - - - - - -


296 • Version 4_21



Code: 36600


code CF Units Value

RCF Units

Value R

List of materials used in treatment under modifier 0010 - - - - - -

901 Therapeutic putty 170 - - - - -

902 Wood, leather, sisal 170 - - - - -

903 Sponge 170 - - - - -

904 Elastonet 170 - - - - -

905 Silicon gel sheeting 170 - - - - -

Annexure D - - - - - -

Assistive devices made by the therapist her/himself to be used with modifier 0008 - - - - - -

1001 Hip abduction cushion 170 - - - - -

1002 Sponge on a stick 170 - - - - -

1003 Hand grips (for utensils) 170 - - - - -

1004 Bath bench 170 - - - - -

1005 Bath seat 170 - - - - -

1006 Transfer board 170 - - - - -

1007 Plate surround 170 - - - - -

1008 Wheelchair strap 170 - - - - -


297 • Version 4_21

Orthoptists

GEMS TARIFF IN RESPECT OF ORTHOPTISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Orthoptists

Code: 37400

code CF Units Value

R


- - -

ITEMS - - -

001 Orthoptic consultation (Ocular motility assessment, comprehensive examination) 330 10.000 109.40

003 Orthoptic treatment (Ocular motility imbalance) 330 8.700 95.20

005 Orthoptic consultation (Hess chart) 330 11.100 121.50

007 Orthoptic visual fields charting or field of binocular single vision 330 21.700 237.40

107 Appointment not kept (GEMS will not grant benefits in respect of this item, it will fall into the “By arrangement with Patient own account” category). 330 - -


298 • Version 4_21

Osteopathy

GEMS TARIFF FOR SERVICES BY OSTEOPATHS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Osteopathy

Code: 41200

code CF Units Value

R


- - -

RULES - - -

01

All accounts must be presented with the following information clearly stated: - name of osteopath - qualifications of the osteopath - PCNS Practice Number - Postal address and telephone number - Date on which the service(s) were provided - Applicable item codes - The nature of the treatment - The surname and initials of the member - The first name of the patient - The name of the medical scheme - The membership number of the patient - The name and practice number of the referring practitioner

- - -

02The fee of more than one procedure performed at the same consultation or visit, shall be the fee for the major procedure plus the fee in respect of each additional procedure, but under no circumstances will additional fees be charged for more than three additional procedures carried out in the treatment of any one condition.

- - -

03After a series of 10 treatments in respect of one patient for the same condition, the practitioner concerned shall report to the Scheme as soon as possible if further treatment is necessary. Payment for treatment in excess of the stipulated number may be granted by the Scheme after receipt of a letter from the practitioner concerned, motivating the need for such treatment.

- - -

04It is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed if the correct NAPPI code is supplied on the account.

- - -

ITEMS - - -

1. Consultation, Spinal or Joint Manipulation - - -

001 Initial consultation/manipulation (fee covering history, examination and treatment) 500 16.000 -

COIDS - Full case history, physical exam & use of diagnostic equipment, but excluding remedies, immobilisation, and manipulative procedure - - -

002 Subsequent manipulation/examination (fee covering subsequent examination and treatment / manipulation for the same condition) 500 8.000 -


299 • Version 4_21


Code: 41200

code CF Units Value

R

COIDS - Subsequent consultation & examination not requiring treatment - - -

003 Consultation/examination where no treatment is required - - -

COIDS - Spinal or extra-spinal joint manipulation ONLY. - - -

600 Lifestyle Advice / Counselling 500 5.000 -

2. High Velocity, Low Amplitude Thrust (HVLAT) Techniques - - -

410 Cervical Spine High Velocity, Low Amplitude Thrust (HVLAT) Techniques 500 3.000 -

420 Lumbar Spine High Velocity, Low Amplitude Thrust (HVLAT) Techniques 500 4.000 -

430 Peripheral Joint High Velocity, Low Amplitude Thrust (HVLAT) Techniques 500 3.000 -

440 Thoracic Spine High Velocity, Low Amplitude Thrust (HVLAT) Techniques 500 3.000 -

3. Other Osteopathic Techniques - - -

510 Cranio-Sacral Osteopathic Technique 500 20.000 -

520 General Body Adjustment (GBA) 500 22.000 -

530 General Osteopathic Treatment (GOT) 500 20.000 -

540 Muscle Energy Techniques (MET) 500 5.000 -

550 Passive Joint Articulation 500 6.000 -

4. Modalities/Adjunctive Therapy - - -

Soft Tissue Manipulation - - -

101 Massage 500 10.000 -

103 Myofacial pain therapy 500 6.000 -

Superficial Heating Therapy - - -

121 Hydrocollator/Ice pack - Hot or cold packs 500 4.000 -

123 Infra-Red Treatment 500 8.000 -

Non-heating Modalities - - -

145 Ultrasound 500 8.000 -

149 Interferential treatment 500 10.000 -

155 Vibration therapy 500 7.000 -

161 TENS 500 9.000 -

165 Traction: Mechanical/Static, etc. 500 10.000 -

Cold Applications - - -

173 Cold packs 500 4.000 -

Therapeutic Exercise - - -


300 • Version 4_21


Code: 41200

code CF Units Value

R

187 Proprioceptive neuromuscular facilitation 500 6.000 -

189 Gait Analysis & Training 500 15.000 -

Immobilisation - - -

203 Supportive strapping, bracing, splinting and taping 500 8.000 -


301 • Version 4_21

Physiotherapy

GEMS TARIFF IN RESPECT OF PHYSIOTHERAPISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Physiotherapy

Code: 37200

code CF Units Value

R


- - -

REGULATIONS DEFINING THE SCOPE OF THE PROFESSION OF PHYSIOTHERAPY (R2301 - 3 December 1976) - - -

SCHEDULE - - -

General rules governing the scale of benefits - - -

001Unless timely steps (i.e. 24 hours prior to the appointment) are taken to cancel an appointment the relevant fee may be charged, but shall not be payable by medical schemes. Each case shall, however, be considered on merit and, if circumstances warrant, no fee shall be charged. Modifier 0001 to be quoted

- - -

002In exceptional cases where the fee is disproportionately low in relation to the actual services rendered by the practitioner, the practitioner shall provide motivation for a higher fee and such higher fee as may be agreed upon between the practitioner and the Scheme may be charged

- - -

003Where a practitioner uses equipment which is not owned by that practitioner, a reduction of 15% of the relevant rate will be applicable. Modifier 0003 must be quoted when this rule is applied

- - -

004In the case of prolonged or costly treatment, the practitioner should first ascertain from the Scheme concerned whether it will accept financial responsibility in respect of such treatment, since the member may be subject to maximum annual benefits

- - -

005After a series of 20 treatments in respect of one patient for the same condition, the practitioner concerned shall report to the Scheme as soon as possible if further treatment is necessary. Payment for treatments in excess of the stipulated number may be granted by the Scheme after receipt of a letter from the practitioner concerned, motivating the need for such treatment

- - -

006

Where emergency treatment is provided: a. during working hours, and the provision of such treatment requires the practitioner to leave her or his practice to attend to the patient in

hospital; or b. after working hours the fee for such visits shall be the total fee plus 50%. For purposes of this rule: a. “emergency treatment” means a bona fide, justifiable emergency physiotherapy procedure, where failure to provide the procedure immediately

would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy; and

b. “working hours” means 8h00 to 17h00, Monday to Friday. Modifier 0006 must be quoted after the appropriate code number(s) to indicate that this rule is applicable.

- - -


302 • Version 4_21


Code: 37200

code CF Units Value

R

007Practitioners are reminded that a lower fee than that appearing in the scale of benefits shall be charged if the customary fee in the area is less than that charged. Reduced fees shall also be charged where the practitioner would have reduced his/her fee in private practice in particular cases. Prolonged treatment or exceptional cases should also receive special consideration in accordance with the usual medical practice

- - -

008

The fee in respect of more than one procedure (excluding evaluation and visiting items 407, 501, 502, 503, 507, 509, 701, 702, 703, 704, 705, 706, 707, 708, 801, 803, 901 and 903) performed at the same consultation or visit, shall be the fee for the major procedure plus half the fee in respect of each additional procedure, but under no circumstances may fees be charged for more than three procedures carried out in the treatment of any one condition. Modifier 0008 must then be quoted after the appropriate code numbers for the additional code numbers for the additional procedures to indicate that this rule is applicable.

- - -

009When more than one condition requires treatment and each of these conditions necessitates an individual treatment, they shall be charged as individual treatments. Full details of the nature of the treatments and the diagnosis or diagnostic codes shall be stated. Modifier 0009 must then be quoted after the appropriate code number to indicate that this rule is applicable.

- - -

010When the treatment times of two completely separate and different conditions overlap, the fee shall be the full fee for one condition and 50% of the fee for the other condition. Both conditions must be specified. Modifier 0010 must then be quoted after the appropriate code number to indicate that this rule is applicable.

- - -

011

Every physiotherapist must acquaint himself with the provisions of the Medical Schemes Act, 1998 and the regulations promulgated under the Act in connection with the rendering of accounts. Every account shall contain the following particulars : · The name and practice code number of the referring practitioner (where applicable). · The name of the member. · The name of the patient. · The name of the medical scheme. · The membership number of the member. · The practice code number and name of practitioner · The nature and cost of the treatment. · The date on which the service was rendered. · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - -

012 NB: Rounding off does not apply to amounts occurring once the modifiers are used. - - -

013Where the physiotherapist performs treatment away from the treatment rooms, travelling costs being more than 16 kilometres in total) to be charged according to the AA-rate. Modifier 0013 must be quoted after the appropriate code numbers to show that this rule is applicable. Please note that although only some medical schemes accept responsibility for the payment of transport expenses, others do so in exceptional cases only.

- - -

014 Physiotherapy services rendered in a nursing home or hospital. Modifier 0014 must be quoted after each code. - - -

016It is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by the Scheme if the appropriate code is supplied on the account.

- - -

Modifiers - - -

0001 Appointment not kept (GEMS will not grant benefits in respect of this item, it will fall into the “By arrangement with Patient own account” category). - - -


303 • Version 4_21


Code: 37200

code CF Units Value

R

0003 15% of the relevant rate to be deducted where equipment used is not owned by the practitioner - - -

0006 Add 50% of the total fee for the treatment - - -

0008 Only 50% of the fee for these additional procedures may be charged - - -

0009 The full fee for the additional condition may be charged - - -

0010 Only 50% of the fee for the second condition may be charged - - -

0013Travelling costs (being more than 16 kilometres in total) according to AA-rate. Please note that although only some medical schemes accept responsibility for the payment of transport expenses, others do so in exceptional cases only.

- - -

0014 Physiotherapy services rendered to an in-patient in a nursing home or hospital. - - -

1 RADIATION THERAPY / MOIST HEAT / CRYOTHERAPY - - -

001 Infra-red, Radiant heat, Wax therapy Hot packs 260 5.000 33.90

005 Ultraviolet light 260 10.000 67.80

006 Laser beam 260 15.000 101.70

007 Cryotherapy 260 5.000 33.90

2 LOW FREQUENCY CURRENTS - - -

103 Galvanism, Diodynamic current, Tens. 260 10.000 67.80

105 Muscle and nerve stimulating currents. 260 12.000 81.40

107 Interferential Therapy. 260 10.000 67.80

3 HIGH FREQUENCY CURRENTS - - -

201 Shortwave diathermy. 260 5.000 33.90

203 Ultrasound. 260 10.000 67.80

205 Microwave. 260 5.000 33.90

4 PHYSICAL MODALITIES - - -

300 Vibration 260 10.000 67.80

301 Percussion 260 16.100 109.20

302 Massage 260 10.000 67.80

303 Myofacial release/soft tissue mobilisation, one or more body parts 260 20.090 136.20

304 Acupuncture 260 15.000 101.70

305 Re-education of movement/Exercises (excluding ante- and post-natal exercises) 260 10.000 67.80

307 Pre- and post-operative exercises and/or breathing exercises 260 10.000 67.80

308 Group exercises (excluding ante- and post-natal exercises - maximum of 10 in a group) 260 10.000 67.80

309 Isokinetic treatment. 260 10.000 67.80


304 • Version 4_21


Code: 37200

code CF Units Value

R

310 Neural tissue mobilisation 260 20.000 135.60

313 Ante and post natal exercises/counselling 260 10.000 67.80

314 Lymph drainage 260 5.000 33.90

315 Postural drainage. 260 10.000 67.80

317 Traction. 260 10.000 67.80

318 Upper respiratory nebulisation and/or lavage 260 10.000 67.80

319 Nebulisation 260 10.000 67.80

321 Intermittent positive pressure ventilation. 260 10.000 67.80

323 Suction: Level 1 (including sputum specimen taken by suction) 260 5.000 33.90

325 Suction: Level 2 (Suction with involvement of lavage as a treatment in a special unit situation or in the respiratory compromised patient) 260 20.090 136.20

327 Bagging (used on the intubated unconscious patient or in the severely respiratory distressed patient). 260 5.000 33.90

328 Dry needling 260 15.000 101.70

5 MANIPULATION/MOBILISATION OF JOINTS OR IMMOBILISATION - - -

401 Spinal. 260 15.000 101.70

402 Pre meditated manipulation 260 10.000 67.80

405 All other joints. 260 15.000 101.70

407 Immobilisation (excluding materials). Rule 008 does not apply. 260 15.000 101.70

6 REHABILITATION - - -

501 Rehabilitation where the pathology requires the undivided attention of the physiotherapist. Rule 008 does not apply. Duration: 30min. 260 25.000 169.50

502 Hydrotherapy where the pathology requires the undivided attention of the physiotherapist. Rule 008 does not apply. Duration: 30min. 260 25.000 169.50

503Rehabilitation for Central Nervous System disorders - condition to be clearly stated and fully documented (No other treatment modality may be charged in conjunction with this). Duration: 60min.

260 55.000 373.00

504 EMG Biofeedback treatment 260 15.000 101.70

505Group rehabilitation. Treatment of a patient with disabling pathology in an appropriate facility requiring specific equipment and supervision, without individual attention for the whole treatment session, no charge may be levied by facility

260 12.000 81.40

506 Stress management 260 20.000 135.60

507 Respiratory Re-education and Training. Duration: 30min. 260 15.000 101.70

509Rehabilitation. Each additional full 15 mins. Where the pathology requires the undivided attention of the physiotherapist. (Rule 0008 does not apply.) Can only be used with codes 501, 502, 507 or 503 to indicate the completion of an additional 15 minutes. A maximum of two instances of this code may be charged per session.

260 15.000 101.70

7 EVALUATION - - -


305 • Version 4_21


Code: 37200

code CF Units Value

R

701 Evaluation/counselling at the first visit only (to be fully documented) 260 15.000 101.70

702 Complex evaluation/counselling at the first visit only (to be fully documented). 260 30.000 203.40

703 One complete re-assessment of a patient’s condition during the course of treatment. To be used only once per episode of care. 260 15.000 101.70

704 Lung function: Peak flow (once per treatment). 260 5.000 33.90

705 Computerised/Electronic test for lung pathology 260 15.000 101.70

706Reports. To be used to motivate for therapy and/or give a progress report and/or a pre-authorisation report, where such a report is specifically required by the medical scheme.

260 15.000 101.70

707 Physical Performance test. Must be fully documented. 260 20.000 135.60

708 Interview, guidance or consultation with the patient or his family. To be used only once per episode of care. 260 15.000 101.70

801 Electrical test for diagnostic purposes (including IT curve and Isokinetic tests) for a specific medical condition 260 35.000 237.30

803 Effort test - multistage treadmill. 260 35.000 237.30

8 VISITING CODES - - -

901 Treatment at a nursing home : Relevant fee plus (to be charged only once per day and not with every hospital visit 260 10.000 67.80

903 Domicilliary treatments : Relevant fee plus. 260 20.000 135.60

10 OTHER - - -


260 - -

937 Bird or equivalent freestanding nebuliser excluding oxygen at hospital per day. 260 10.000 67.80

938 Bird or equivalent freestanding nebuliser excluding oxygen domicilliary per day. 260 10.000 67.80

939Cost of material: Items to be charged (exclusive of VAT) at net acquisition price plus - 30% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; a maximum of R30 where the net acquisition price of that material is greater than or equal to one hundred rands.

260 - -

940Cost of appliances: Items to be charged (exclusive of VAT) at net acquisition price plus- 30% of the net acquisition price where the net acquisition price of that appliance is less than one hundred rands; a maximum of R30 where the net acquisition price of that appliance is greater than or equal to one hundred rands.

260 - -

941Hiring equipment: 1% of the current replacement value of the equipment per day. Total charge not to exceed 50% of replacement value. Description of equipment to be supplied.

- - -

Payment of this item is at the discretion of medical scheme concerned, and should be considered in instances where cost savings can be achieved. By prior arrangement with the Scheme.

- - -


306 • Version 4_21

Phytotherapy

GEMS TARIFF FOR SERVICES BY PHYTOTHERAPISTS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Phytotherapy

Code: 41300

code CF Units Value

R


- - -

RULES - - -

ITEMS - - -

Consultations - - -

Consultation encompasses consultation, history taking, patient examination and assessment, side room diagnostic tests, counseling and/or preparation of medicines.

- - -





134 Consultation, each additional full 15 mins, to a maximum of 60 mins 510 15.000 91.20

Preparation and Dispensing of Medicaments - - -

Medicaments - - -

The amount charged in respect of proprietary medicines shall be at net acquisition price. In relation to all other materials, items are to be charged (exclusive of VAT) at net acquisition price plus - * 30% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; and * a maximum of R30 where the net acquisition price of that material is greater than or equal to one hundred rands.

- - -

310 Tinctures, per 10 ml 520 2.700 3.80

320 Tea mixes, per 10g 520 1.000 1.40

330 Capsules/tablets, per capsule 520 3.400 4.80

340 Creams/Ointments, per 10ml 520 20.100 28.30

350 Syrups, per 10ml 520 2.800 3.90

360 Medicinal oils, per 10ml 520 1.300 1.80

390 Proprietary materials 520 - -

395 Proprietary medicines 520 - -


307 • Version 4_21

Podiatry

GEMS TARIFF FOR SERVICES BY PODIATRISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Podiatry

Code: 36800

code CF Units Value

R


- - -

General Rules - - -

A

All accounts must be presented with the following information clearly stated: · name of practitioner · qualifications of the practitioner; · PCNS Practice Number; · postal address and telephone number; · date on which service(s) were provided; · The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered; · the surname and initials of the member; · the first name of the patient; · the name of the Scheme; · the membership number of the member; and . the name and practice number of the referring practitioner, if applicable.

- - -

BThe rate in respect of more than one procedure performed at the same consultation or visit, shall be the full rate for the major procedure plus half the rate in respect of each additional procedure carried out in the treatment of any one condition.

- - -

CIt is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by the Scheme if the appropriate code is supplied on the account.

- - -

D

The amount charged in respect of medicines and scheduled substances shall not exceed the limits prescribed in the Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances, dated 30 April 2004, made in terms of the Medicines and Related Substances Act, 1965 (Act No 101 of 1965). In relation to all other materials, items are to be charged (exclusive of VAT) at net acquisition price plus - * 30% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; and * a maximum of R30 where the net acquisition price of that material is greater than or equal to one hundred rands.

- - -

Modifiers - - -

0002 For procedures 021 to 031 carried out in a day clinic or unattached operating theatre unit, the rate shall be reduced to two-thirds. - - -

0004 Consultation or treatment in a nursing facility/hospital - - -

0006 Consultation or treatment at the patient’s recidence - - -

ITEMS - - -

Modifier 0004 must be quoted for consultation or treatment rendered in a nursing home or hospital. - - -


308 • Version 4_21


Code: 36800

code CF Units Value

R

Modifier 0006 must be quoted for consultations or treatment rendered at the patient’s residence. - - -

CONSULTATIONS. - - -

301 Consultation (initial or follow up) 5-10 minutes 274 7.500 77.30




006 More than one patient seen at a residence (See note below). 270 8.500 79.10

NOTE : This code is a blanket code for home visits away from the practitioners rooms where more than one but up to and including six patients are treated. The code may be used again if seven to twelve patients are seen.

- - -

101 Appointment not kept (GEMS will not grant benefits in respect of this item, it will fall into the “By arrangement with Patient own account” category). 270 - -

INJECTIONS. - - -

009 Administration of injection, per administration 270 1.300 12.10

ROUTINE TREATMENTS. - - -

010General podiatric care up to 15 minutes including the following: Trim nails, Debride and cut dystrophic nails; one to five, Evacuation of sub-ungual haematoma, Paring or cutting of benign hyperkeratotic lesion; single lesion, Drain paronychia; one nail and Nail spike removal; single

270 3.900 36.30

011General podiatric care (30 minutes) including the following: Debride and cut dystrophic nails: six or more, Nail spike removal; two to four, Paring or cutting of benign hyperkeratotic lesion; two to four lesions, Paring or cutting of benign hyperkeratotic lesion; more than four lesions, Reduction of heel fissures, Enucleation of interdigital corns; more than two

270 7.800 72.60

012 Extended care for chronic disease management or ulcer management (applicable to diabetes, arthritis and peripheral vascular diseases) 270 7.400 68.90

013 General podiatric care more than 30 minutes (a combination of items 010 and 011) 270 11.800 109.90

VERRUCA TREATMENTS. - - -

Note : No consultation fee shall be charged for the same session unless the procedure is performed at the time of the initial consultation - - -

014 Verruca Pedis (Chemotherapy first lesion) (consultation and treatment). 270 5.900 54.90

015 Subsequent lesion. 270 2.900 27.00

016 Cryotherapy first lesion (consultation and treatment). 270 7.800 72.60


018 Diathermy first lesion (consultation and treatment). 270 6.900 64.30


Nail Surgery. - - -

Note : No consultation fee shall be charged for the same session unless the procedure is performed at the time of the initial consultation - - -

021 Nail wedge resection with matrix phenolisation : one nail - one side (including consultation). 270 19.600 182.50


309 • Version 4_21


Code: 36800

code CF Units Value

R

022 Two nails - one side. 270 25.500 237.40

024 Two nails - both sides. 270 36.400 338.90

023 One nail - two sides (including consultation). 270 25.500 237.40

025 Avulsion with matrix phenolisation (including consultation). 270 19.600 182.50

031 Avulsion without matrix phenolisation (including consultation). 270 12.800 119.20

Other. - - -

040 Infection control, per patient 270 1.200 11.20

041 Remedial therapy. 270 4.900 45.60

042 Sterile pack. 270 5.900 54.90

044 Suturing (includes consultation). 270 7.800 72.60

046 Incision Biopsy. 270 5.900 54.90

047 Removal of foreign body. 270 8.900 82.90

048 Suturing / Wound closure material : Cost of material plus 10% 270 - -

146 Excision biopsy. 270 8.900 82.90

201 Sterile Surgical Blades (maximum of 2 per patient) 270 1.000 9.30

203 Wound dressing material (maximum of 2 per patient) 270 2.000 18.60

205 Plaster of Paris bandage roll (maximum of 2 per patient). At net acquisition price. 270 - -

207 Moulded Orthotic material fee 270 11.800 109.90

209 Simple insole material fee 270 5.900 54.90

211 Local anaesthetic medication per ampoule (maximum of 5 per patient) 270 2.000 18.60

213 Injection medication fee (other than local anaesthetic). At net acquisition price. 270 - -

Items 215, 217 or 219 may be used for corrective or supportive strapping or padding placed into footwear. The area of the foot must be specified. - - -

215 Padding and strapping : Digital, per foot 270 2.800 26.10

217 Padding and strapping: Metatarsal, per foot 270 3.500 32.60

219 Padding and strapping: Heel, per foot 270 3.500 32.60

Appliances and Orthotics - - -

(By arrangement with the Scheme concerned). - - -

043 Biomechanical examination. 270 15.700 146.20

051 Neutral impression Plaster of Paris casting 270 8.500 79.10

052 Orthotic repair. 270 12.800 119.20

053 Temporary orthotic or corrective component. 270 12.800 119.20


310 • Version 4_21


Code: 36800

code CF Units Value

R

054 Prescription covering and soft tissue supplements. 270 8.900 82.90

055 Silicone devices: Digital 270 5.400 50.30

056 Computerised gait analysis 270 19.600 182.50

057 Template measurement. 270 2.900 27.00

058 Immobilisation casting 270 10.600 98.70

059 Simple insole - one foot. 270 11.100 103.40

061 Simple insoles - both feet. 270 20.100 187.20

060 Silicone devices: metatarsal 270 10.700 99.60

064 Silicone devices: heel 270 15.900 148.00

The rates for items 063 and 065 include the cost of instrinsic and extrinsic posting adjustments - - -

063 Prescription orthotic : one foot. 270 19.100 177.80

065 Prescription orthotics : both feet. 270 38.300 356.60

067 Preformed moulded insoles: Adult, both feet 270 22.100 205.80

069 Preformed moulded insoles: Adult, one foot 270 11.000 102.40

071 Preformed moulded insoles: Child, both feet 270 17.000 158.30

073 Preformed moulded insoles: Child, one foot 270 8.500 79.10

CONSUMABLE LIST - - -

STERILISING ITEMS - - -

Cold Sterilant e.g. Cidex, Steri 101, Etc. - - -

Ultraviolet Tubes (Replacements) - - -

Autoclave Bags - - -

WASTE DISPOSAL - - -

Sharps Container - - -

Medical Waste Bin - - -

REGULARLY USED ITEMS - - -

Disposable Hand Towels e.g. Kimdri - - -

Disinfecting Handwash e.g. Hibiscrub - - -

Savers - - -

Linen - - -

Cotton - - -

Wool - - -


311 • Version 4_21


Code: 36800

code CF Units Value

R

Gloves: Non-Sterile - - -

Sterile - - -

Gauze: Non-Sterile - - -

Sterile - - -

Tube Gauze (Various Sizes) - - -

Padding e.g. Semi Compressed Felt - - -

Strapping e.g. Hapla, Zopla - - -

Disinfecting Hand Gel e.g. Steri 601 - - -

Surface Disinfectant e.g. Steri 201 - - -

Tongue Depressors - - -

Applicator Sticks - - -

Friars Balsam - - -

Silver Nitrate? - - -

Hibitane Concentrate - - -

Phenol - - -

Silicone & Activator for Devices - - -

Monochloracetic Acid - - -

Salacylic Acid in Lanolin - - -

Dental Needles - - -

Xylotox Se Plain Solution for Injection - - -

Emergency Drugs e.g. Adrenaline/Epipen - - -

Penrose Drains / Tournicot - - -

Hydrogen Peroxide - - -

70% Alcohol - - -

Hibicol - - -

Acetone - - -

Sterile Blades (Various Sizes) - - -

Moores Discs - - -

Sterile Dressing Trays - - -

Sutures - - -

Single Use Sterile Syringes - - -


312 • Version 4_21

Psychiatric Medical Practitioner

GEMS TARIFFFOR CONSULTATIVE SERVICES BY PSYCHIATRIST, EFFECTIVE FROM 1 JANUARY 2011Practice Type:

Psychiatrist Medical PractitionerCode: 12200

code CF Units Value

R

In calculating the GEMS Tariff , the following rounding method is used: Values R10 and below rounded to the nearest cent, R10+ rounded to the nearest 10cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed.

ALL GEMS TARIFFS ARE VAT INCLUSIVE.

- - -

I.b Specialists tiered consultation structure

I.b.1 New and established patients: Consultations/visits by psychiatrists (22) only

0161Psychiatry ('22'): New and established patients: Consultation/visit of new or established patient with problem focused history, clinical examination and straightforward decision making for minor problem. Typically occupies the doctor personally with the patient between 10 and 20 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

11 15,000 R 258,30

0162Psychiatry ('22'): New and established patients: Consultation/visit of new or established patient with detailed history, clinical examination and straightforward decision making and counselling. Typically occupies the doctor personally with the patient between 21 and 35 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

11 27,500 R 473,50

0163Psychiatry ('22'): New and established patients: Consultation/visit of new or established patient with detailed history, complete clinical examination and moderately complex decision making and counselling. Typically occupies the doctor personally with the patient between 36 and 45 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

11 40,000 R 688,70

0164Psychiatry ('22'): New and established patients: Consultation/visit of new or established patient with comprehensive history and clinical examination for complex problem requiring complex decision making and counselling. Typically occupies a doctor personally with the patient between 46 and 60 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

11 52,500 R 904,00

0166Psychiatry (22): First hospital consultation/visit with problem focused history, clinical examination and straightforward decision making for minor problem. Typically occupies the doctor personally with the patient for between 10 and 20 minutes

11 15,000 R 258,30

0167Psychiatry (22): First hospital consultation/visit with detailed history, clinical examination and straightforward decision making and counselling. Typically occupies the doctor personally with the patient for between 21 and 35 minutes

11 27,500 R 473,50

0168Psychiatry (22): First hospital consultation/visit with detailed history, complete clinical examination and moderately complex decision making and counselling. Typically occupies the doctor personally with the patient for between 36 and 45 minutes

11 40,000 R 688,70

0169Psychiatry (22): First hospital consultation/visit with comprehensive history and clinical examination for complex problem requiring complex decision making and counselling. Typically occupies a doctor personally with the patient for between 46 and 60 minutes

11 52,500 R 904,00

Medical psychotherapy

2957 Individual psychotherapy (specify type): Including play therapy for children: Per short session (20 minutes) 11 20,000 R 344,40

2958 Psychoanalytic therapy: Per 60-minute session 11 60,000 R1 033,10

2962 Directive therapy to family, parent(s), spouse: Per 20-minute session 11 20,000 R 344,40


313 • Version 4_21

GEMS TARIFFFOR CONSULTATIVE SERVICES BY PSYCHIATRIST, EFFECTIVE FROM 1 JANUARY 2011Practice Type:

Psychiatrist Medical PractitionerCode: 12200

code CF Units Value

R

2963 Pairs, marriage or sex therapy: Per 20-minute session 11 20,000 R 344,40

2968 Group therapy: Adults (specify number): Tariff per person per 80-minute session; Children (specify number): Tariff per person per 80-minute session 11 26,000 R 447,70

2974 Individual psychotherapy (specify type): Including play therapy for children: Per intermediate session (40 minutes) 11 40,000 R 688,70

2975 Individual psychotherapy (specify type): Including play therapy for children: Per extended session (60 minutes or longer) 11 60,000 R1 033,10

2976 Intermediate treatment where either items 2962 or 2963 are used: Per 40-minute session 11 40,000 R 688,70

2977 Extended treatment where either items 2962 or 2963 are used: Per 60-minute session 11 60,000 R1 033,10

RULES GOVERNING THE SECTION MEDICAL PSYCHOTHERAPY

V.


0079When a first consultation/visit proceeds into, or is immediately followed by a medical psychotherapeutic procedure, fees for the procedure are calculated according to the appropriate individual psychotherapy code (items 2957, 2974 or 2975)

Physical treatment methods

2970 Electro-convulsive treatment (ECT): Each time (See rule Va) 11 15,000 R 258,30

Psychiatric examination methods

2972 Narco-analysis (Maximum of 3 sessions per treatment): Per 60 min session 11 60,000 R1 033,10

2973 Psychometry (specify examination): Per session (Maximum of 3 sessions per examination) 11 20,000 R 344,40


314 • Version 4_21

Psychology

GEMS TARIFFFOR SERVICES BY PSYCHOLOGISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type: Psychology

Code: 38600

code CF Units Value

R


- - -

GENERAL RULES - - -

B

Where emergency treatment is provided: a. during working hours, and the provision of such treatment requires the practitioner to leave her or his practice to attend to the patient at another

venue; or b. after working hours the fee for such visits shall be the total fee plus 50%.

For purposes of this rule: a. “emergency treatment” means a bona fide, justifiable emergency psychological procedure, where failure to provide the service immediately would

result in serious or irreparable psychological or functional impairment b. “working hours” means 8h00 to 17h00, Monday to Friday. Modifier 0003 must be quoted after the appropriate code number(s) to indicate that this rule is applicable.

- - -

CIt is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by a medical scheme if the appropriate code is supplied on the account.

- - -

D

Every account shall contain the following particulars: a) The surname and initials of the member; b) The surname, first name and other initials, if any, of the patient; c) The name of the Scheme concerned;. d) The membership number of the member; e) The practice code number, group practice number and individual provider registration number issued by the registering authorities for providers, if

applicable, of the supplier of service and, in the case of a group practice, the name of the practitioner who provided the service;f) The date on which each relevant health service was rendered; g) The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - -

ECompilation of reports is only to be included within billable time if these reports are for purposes of motivating for therapy and/or giving a progress report and/or a pre-authorisation report, and where such a report is specifically required by the Scheme. Maximum billable time for such a report is 15 minutes.

- - -


315 • Version 4_21


Code: 38600

code CF Units Value

R

FWith the exception of compilation of reports as per Rule E, time charged in terms of the codes in this schedule only includes time spent in direct interaction with the patient.

- - -

MODIFIERS - - -

Modifier governing the section Psychological Services - - -

0003 Emergency treatments - Relevant fee plus 50% - - -

0004 Psychology services rendered to an in-patient in a nursing home or hospital. - - -

CONSULTATIVE AND THERAPEUTIC SERVICES - - -


- - -

200 Psychology assessment, consultation, counselling and/or therapy (individual or family). Duration: 1-10min. 280 5.000 58.10









209 Psychology assessment, consultation, counselling and/or therapy (individual or family). Duration: 91-100min. 280 95.000 1 102.90



This code would be used in addition tocode 211. - - -

290 Extended assessment, consultation, counselling and/or therapy (individual or family) - per full 15 minutes in excess of 120 minutes 280 7.500 87.10

GROUP SERVICES - - -

300 Psychology group consultation, counselling and/or therapy, per patient. Duration: 1-10min. 280 1.000 11.60








316 • Version 4_21


Code: 38600

code CF Units Value

R







317 • Version 4_21

Psychometry Registered Councellors

GEMS TARIFFFOR SERVICES BY PSYCHOMETRISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type:

Registered CounsellorsCode: 38100

Practice Type: Psychometry Code: 38500

code CF Units Value

RCF Units

Value R


- - - - - -

GENERAL RULES - - - - - -

A

Every account shall contain the following particulars: a) The surname and initials of the member; b) The surname, first name and other initials, if any, of the patient; c) The name of the Scheme concerned;. d) The membership number of the member; e) The practice code number, group practice number and individual provider registration number issued by

the registering authorities for providers, if applicable, of the supplier of service and, in the case of a group practice, the name of the practitioner who provided the service;

f) The date on which each relevant health service was rendered;g) The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - - - - -

BCompilation of reports is only to be included within billable time if these reports are for purposes of motivating for therapy and/or giving a progress report and/or a pre-authorisation report, and where such a report is specifically required by the Scheme. Maximum billable time for such a report is 15 minutes.

- - - - - -

PSYCHOMETRIC SERVICES - - - - - -

007Appointment not kept (GEMS will not grant benefits in respect of this item, it will fall into the “By arrangement with Patient own account” category).

- - - - - -

200 Psychometric testing. Duration: 1-10min. - - - 285 0.500 29.00










318 • Version 4_21

GEMS TARIFFFOR SERVICES BY PSYCHOMETRISTS WITH EFFECT FROM 1 JANUARY 2011Practice Type:

Registered CounsellorsCode: 38100

Practice Type: Psychometry Code: 38500

code CF Units Value

RCF Units

Value R




290 Psychometric testing - per full 15 minutes in excess of 120 minutes. - - - 285 0.750 43.50

SERVICES RENDERED BY REGISTERED COUNSELLORS - - - - - -

300 Assessment, consultation, counselling and/or therapy (individual or family). Duration: 1-10min. 285 0.500 29.00 - - -









400 Group consultation, counselling and/or therapy, per patient. Duration: 1-10min. 285 0.100 5.80 - - -












490Extended group consultation, counselling and/or therapy - per patient per full 15 minutes in excess of 120 minutes

285 0.150 8.70 - - -


319 • Version 4_21

Radiography

GEMS TARIFF FOR SERVICES BY RADIOGRAPHERS EFFECTIVE FROM 1 JANUARY 2011Practice Type: Radiography

Code: 33900

code CF Units Value

R


- - -

DIAGNOSTIC PROCEDURES - - -

Note : Items 015, 029, 031, 033, 037, 065, 071, 073, 075, 077, 079, 081, 083, 085, 087, 089, 091, 093, 095, 097, 099, 101, 115, 117, 119, 121, 129, 131, 133, 135, 137, 139, 141, 149, 167, 171 and 173 should be only be paid on condition that the radiographer submits the name of the supervising clinician and his/her PCNS Practice Number. Schemes should not pay the radiographer if she/he is supervised by a radiologist.

- - -

GENERAL RULES - - -


- - -

MODIFIERS - - -

0001The specified call-out fee may be charged for any bona-fide, justifiable emergency occurring at any hour which requires the practitioner to travel to the patient. GEMS may require a motivation to accompany the claim.

290 12.490 44.80

0021 Services rendered to hospital patients: Quote modifier 0021 on all accounts for services performed on hospital or day clinic patients. - - -

0080 Multiple examinations: Full fees - - -

0081 Repeat examinations: No reduction - - -

0084 Films should be charged under code 300. - - -

1 SKELETON - - -

1.1 LIMBS - - -

001 Finger, toe 290 12.300 44.10

003Limb per region, e.g. shoulder, elbow, knee, foot, hand, wrist or ankle (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

290 16.200 58.10

005 Smith-Petersen or equivalent control, in theatre 290 134.600 482.50

007 Stress studies, e.g. joint 290 16.200 58.10

009 Length studies per right and left pair of long bones 290 16.200 58.10

011 Skeletal survey under 5 years 290 48.500 173.90

013 Skeletal survey over 5 years 290 52.300 187.50

015 Arthrography per joint 290 39.500 141.60

1.2 SPINAL COLUMN - - -


320 • Version 4_21


Code: 33900

code CF Units Value

R

017 Per region, e.g. cervical, sacral, coccygeal, one region thoracic 290 24.600 88.20

021 Stress studies 290 10.000 35.90

025 Scoliosis studies 290 39.300 140.90

027 Pelvis (sacro-iliac or hip joints only to be added where an extra set of views is required) 290 17.000 61.00

MYELOGRAPHY - - -

029 Lumbar 290 43.100 154.50

031 Thoracic 290 40.100 143.80

033 Cervical 290 59.400 213.00

035 Multiple (lumbar, thoracic, cervical): Same fee as for first segment (no additional introduction of contrast medium) 290 - -

037 Discography 290 31.500 112.90

1.3 SKULL - - -

039 Skull studies 290 32.300 115.80

041 Paranasal sinuses 290 17.000 61.00

043 Facial bones and/or orbits 290 34.900 125.10

045 Mandible 290 26.000 93.20

047 Nasal bone 290 16.200 58.10

049 Mastoid: Bilateral 290 50.000 179.30

TEETH - - -

051 One quadrant 290 7.700 27.60

053 Two quadrants 290 8.500 30.50

055 Full mouth 290 10.800 38.70

057 Rotation tomography of the teeth and jaws 290 14.600 52.30

059 Temporo-mandibular joints: Per side 290 19.200 68.80

061 Tomography: Per side 290 30.500 109.30

063 Localisation of foreign body in the eye 290 30.700 110.10

065 Ventriculography 290 37.400 134.10

067 Post-nasal studies: Lateral neck 290 10.000 35.90

069 Maxillo-facial cephalometry 290 26.900 96.40

071 Dacryocystography 290 24.200 86.80

2 ALIMENTARY TRACT - - -

073 Sialography (plus 80% for each additional gland) 290 24.600 88.20


321 • Version 4_21


Code: 33900

code CF Units Value

R

075 Pharynx and oesophagus 290 22.800 81.70

077 Oesophagus, stomach and duodenum (control film of abdomen included) and limited follow through 290 31.500 112.90

079 Small bowel meal (control film of abdomen included, except when part of item 081) 290 27.700 99.30

081Barium meal and dedicated gastro-intestinal tract follow through (including control film of the abdomen, oesophagus, duodenum, small bowel and colon)

290 47.200 169.20

083 Barium enema (control film of abdomen included) 290 50.900 182.50

085 Biliary tract: ERCP (choledogram and/or pancreatography screening included) 290 47.000 168.50

087 Gastric/oesophageal/duodenal intubation control 290 20.800 74.60

089 Hypotonic duodenography (077 included) 290 57.300 205.40

3 BILIARY TRACT - - -

091 Oral cholecystography 290 47.800 171.40

093 Intravenous 290 58.600 210.10

095 Operative: First series 290 58.100 208.30

097 Subsequent series 290 24.000 86.00

099 Post-operative: T-tube 290 20.100 72.10

101 Trans-hepatic, percutaneous 290 34.600 124.00

103 Tomography of biliary tract: Add 290 21.500 77.10

CHEST - - -

105 Larynx (tomography included) 290 42.400 152.00

107 Chest (item 167 included) 290 19.200 68.80

109 Chest and cardiac studies (item 167 included) 290 23.100 82.80

111 Ribs 290 19.200 68.80

113 Sternum or sterno-clavicular joints 290 24.600 88.20

BRONCHOGRAPHY - - -

115 Unilateral 290 33.500 120.10

117 Bilateral 290 56.500 202.60

119 Pleurography 290 15.700 56.30

121 Laryngography 290 15.700 56.30

123 Thoracic inlet 290 15.700 56.30

5 ABDOMEN - - -

125 Control films of the abdomen (not being part of examination for barium meal, barium enema, pyelogram, cholecystogram, cholangiogram, etc.) 290 17.000 61.00


322 • Version 4_21


Code: 33900

code CF Units Value

R

127 Acute abdomen or equivalent studies 290 30.700 110.10

6 URINARY TRACT - - -

129 Control film included and bladder views before and after micturition 290 67.000 240.20

133 Waterload test: Add 290 20.100 72.10

135 Cystography only or urethrography only (retrograde) 290 37.600 134.80

CYSTO-URETHROGRAPHY - - -

137 Retrograde 290 33.100 118.70

139 Retrograde-prograde pyelography 290 42.400 152.00

141 Aspiration renal cyst 290 17.000 61.00

143 Tomography of renal tract: Add 290 19.200 68.80

7 GYNAECOLOGY AND OBSTETRICS - - -

145 Pregnancy 290 19.200 68.80

147 Pelvimetry 290 35.500 127.30

149 Hysterosalpingography 290 32.000 114.70

8 TOMOGRAPHY AND CINEMATOGRAPHY - - -

151Tomography (conventional except where otherwise specified): Add 100% provided that if it is more than one dimension, fees shall be charged for the additional investigation at 50% of the rate with a maximum of two additional investigations

290 - -

153 Tomography (multi-dimensional in motion): Add 150% 290 - -

9 COMPUTED TOMOGRAPHY

155 Head, single examination, full series 290 262.700 941.80

157 Head, repeat examination at the same visit, after contrast, full series 290 90.200 323.40

159 Chest 290 303.700 1 088.80

161 Abdomen (including base of chest and/or pelvis) 290 353.000 1 265.50

163 Multiple examinations: For an additional part, the lesser fee shall be reduced to 290 82.100 294.30

165 Limbs and other limited examinations 290 82.100 294.30

MODIFIER GOVERNING THIS SPECIFIC SECTION OF THE TARIFFS - - -

0089The number of sections of each examination and the matrix number must be specified. A full series of sections would be 8 or more for brain examinations, 12 or more for chest examinations, and 16 or more for abdomen examinations. Fees for examinations on a matrix number of less than 250 shall be reduced by 50%

- - -

10 MISCELLANEOUS - - -

167 Fluoroscopy: Per half hour: Add (not applicable to items 107 and 109) 290 21.400 76.70


323 • Version 4_21


Code: 33900

code CF Units Value

R

169 Where a C-arm portable x-ray unit is used in hospital or theatre: Per half hour: Add 290 29.600 106.10

171 Sinography 290 44.300 158.80

173 Bone densitometry 290 80.900 290.00

175 Mammography: Unilateral or bilateral 290 58.100 208.30

177 Repeat mammography, unilateral or bilateral for localisation of tumour 290 58.100 208.30

179Attendance at operation in theatre or at radiological procedure performed by a surgeon or physician in x-ray department except 005: Per 1/2 hour: Plus fee for examination performed

290 17.600 63.10

181 Setting of sterile trays 290 3.000 10.80

Films are to be charged (exclusive of VAT) at net acquisition price plus - * 30% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; and * a maximum of R30 where the net acquisition price of that material is greater than or equal to one hundred rands.

- - -

300 X-Ray films - - -

ATTENDANCE IN CATHETERISATION LABORATORY - - -

Use codes 191 to 193 to charge for radiographer input where that is not included in cath lab facility fee - - -

191 Preparation in catheterisation laboratory for purposes of cardiac catheterisation and/or invasive intravascular procedures. 290 43.000 154.20

192 Post-processing in catheterisation laboratory for purposes of cardiac catheterisation and/or invasive intravascular procedures 290 43.000 154.20

193 Coronary angiogram per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

194 Right heart investigation of valve and venous system of the right heart 290 43.000 154.20

195 PTCA per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

196 Left heart investigation of valve of the left heart and ventrical 290 43.100 154.50

197 Stent procedure per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

199 Vascular Study per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

201 Temporary pacemaker procedure per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

203Permanent pacemaker procedure in catheterisation laboratory per 30 minutes or part thereof provided that such part comprises 50% or more of the time

290 43.000 154.20

205 Intra-aortic balloon pump procedure per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

207 Electro-physiological studies per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

209 Bleomycine and other studies per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

211 Intra vascular ultrasound per 30 minutes of part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

213 Rotablator/Laser procedures per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

215 Embolisation per 30 minutes or part thereof provided that such part comprises 50% or more of the time 290 43.000 154.20

RULES - - -


324 • Version 4_21


Code: 33900

code CF Units Value

R

Z No fee to be subject to more than one reduction - - -

11 PORTABLE UNIT EXAMINATIONS - - -

185 Where portable x-ray unit is used in the hospital or theatre: Add 290 19.400 69.60

187 Theatre investigations with fixed installation : Add 290 8.300 29.80


325 • Version 4_21

Radiology

GEMS TARIFF FOR RADIOLOGISTS, EFFECTIVE FROM 1 JANUARY 2011Practice Type: Nuclear Medicine

Code: 12500Practice type: Radiology

Code: 13800

code CF Units Value

RCF Units

Value R


- - - - - -

This schedule is for the exclusive use of registered specialist radiology practices (Pr No “038”) and nuclear medicine practices (Pr No “025”).“025” practices may only charge the codes with a 3rd digit of 9.“038” practices may charge all codes except codes with a 3rd digit of 9.Practitioners registered as both radiologists and nuclear physicians may charge all codes.

- - - - - -

This schedule must be used in conjunction with the Radiological Society of S A Guidelines. Please refer to the PET guidelines in Annexure D.

- - - - - -

Code Structure Framework - - - - - -


326 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

a. The tariff code consists of 5 digits i. 1st digit indicates the main anatomical region or procedural category. • 0 = General (non specific) • 1 = Head • 2 = Neck • 3 = Thorax • 4 = Abdomen and Pelvis (soft tissue) • 5 = Spine, Pelvis and Hips • 6 = Upper limbs • 7 = Lower limbs • 8 = Interventional • 9 = Soft tissue regions (nuclear medicine) • eg “Head” = 1xxxx ii. 2nd digit indicates the sub region within a main region or category eg. • “Head / Skull and Brain” = 10xxx iii. 3rd digit indicates modality • 1 = General (Black and White) x-rays • 2 = Ultrasound • 3 = Computed Tomography • 4 = Magnetic Resonance Imaging • 5 = Angiography • 6 = Interventional radiology • 9 = Nuclear Medicine (Isotopes) eg: “Head / Skull and Brain / General x-ray” = 101xx iv. 4th and 5th digits are specific to a procedure / examination, eg “Head/ Skull and Brain / General /

X-ray of the skull” = 10100.

- - - - - -

Guidelines for use of coding structure - - - - - -

• The vast majority of the codes describe complete procedures / examination and their use for the appropriate studies is self-explanatory.

• Some codes may have multiple applications and their use is described in notes associated with each code• Codes 00510 to 00560 (Angiography machine codes) may only be used by owners of the equipment and

who have registered such equipment with the Board of Healthcare Funders / RSSA. • The machine codes 00510, 00520, 00530, 00540, 00550, 00560 may not be added to 60540, 60550,

70530, 70535 (Antegrade Venography, upper and lower limbs)• Where public sector hospital equipment is used for a procedure, the units will be reduced by 33.33%.

- - - - - -

Consumables - - - - - -


327 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

• Contrast Medium o Prior to the implementation of Act 90, contrast will be billed according to the official 2004 RSSA

reimbursement price list, without mark up. o After the implementation of Act 90, contrast medium will be billed according to the suppliers’ list price,

without mark up.• Angiography catheters, angioplasty balloons, stents, coils and other embolisation materials, guide wires

and drains are to be billed at net acquisition cost, without mark up, until the implementation of Act 90.• All other consumables are to be billed at net acquisition price, until the implementation of Act 90.

Thereafter Act 90 regulations apply. • The cost of film is included in the comprehensive procedure codes and is not billed for separately. • Appropriate codes must be provided for consumables.

- - - - - -

General Comments on Procedural Codes - - - - - -

• All x-ray tomography codes are stand alone studies and may be used as a unique study or in combination with the appropriate regional study if done simultaneously. May not be added to 20130, 42110, 42115.

• Setting of sterile tray is included in all appropriate procedure codes. • Where introduction of contrast is necessary eg. sialography, arthrography, angiography, etc, the codes

used for the procedures are comprehensive and include the introduction of contrast or isotopes. • The use of Doppler or Colour Doppler as an adjunct to a study (eg small parts thyroid) is included in the

code for that study. • CT Angiography (10330, 20330, 32300, 32310, 44300, 44310, 44320, 44330, 60310, 70310, 70320) are

stand alone studies and may not be added to the regional contrasted studies (see 10335, 20340, 20350, 44325 for combined studies).

• Angiography and interventional procedures include selective and super selective catheterization of vessels as are necessary to perform the procedures.

- - - - - -

Codes 00230 (Ultrasound guidance), 00320 (CT guidance) and 00430 (MR guidance) are stand alone procedures that include the regional study and may not be added to any of the ultrasound, CT or MR regional studies

- - - - - -

General Codes - - - - - -

Modifiers - - - - - -

00091 Radiology and nuclear medicine services rendered to hospital inpatients - - - - - -

00092 Radiology and nuclear medicine services rendered to outpatients - - - - - -

00093 A reduction of one third (33.33%) will apply to radiological examinations where hospital equipment it used - - - - - -

Equipment / Diagnostic - - - - - -

00090Consumables used in radiology procedures: cost price PLUS 30% (up to a maximum of R30,00). (Where applicable, VAT should be added to the above).

- - - 410 - -


328 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Appropriate code to be provided. See separate codes for contrast and isotopes - - - - - -

00110 X-ray skeletal survey under five years - - - 410 6.260 534.10

00115 X-ray skeletal survey over five years - - - 410 10.400 887.30

00120 X-ray sinogram any region - - - 410 10.890 929.10

00130 X-ray with mobile unit in other facility - - - 410 1.900 162.10

To be added to applicable procedure codes eg 30100. - - - - - -

00135 X-ray control view in theatre any region - - - 410 5.260 448.80

00140 X-ray fluoroscopy any region - - - 410 2.260 192.80

May only be added to the examination when fluoroscopy is not included in the standard procedure code. May not be added to: • any angiography, venography, lymphangiography or interventional codes. • any contrasted fluoroscopy examination.

- - - - - -

00145 X-ray fluoroscopy guidance for biopsy, any region - - - 410 5.300 452.20

Add to the procedure eg. 80600, 80605, 80610. - - - - - -

00150 X-ray C-Arm (equipment fee only, not procedure) per half hour - - - 410 2.420 206.50

Only to be used if equipment is owned by the radiologist. - - - - - -

00155 X-ray C-arm fluoroscopy in theatre per half hour (procedure only) - - - 410 2.300 196.20

00160 X-ray fixed theatre installation (equipment fee only) - - - 410 2.260 192.80

Only to be used if equipment is owned by the radiologist. - - - - - -

00190 X-ray examination contrast material - - - 410 - -

Identification code for the use of contrast with a procedure. Appropriate codes to be supplied. - - - - - -

00210 Ultrasound with mobile unit in other facility - - - 410 1.840 157.00

Add to the relevant ultrasound examination codes eg 10200. - - - - - -

00220 Ultrasound intra-operative study - - - 410 7.320 624.50

Covers all regions studied. Single code per operative procedure. - - - - - -

00230 Ultrasound guidance - - - 410 12.100 1 032.40

Comprehensive ultrasound code including regional study and guidance. Guided procedure code to be added eg. 80600, 80605, 80610.

- - - - - -

00240 Ultrasound guidance for tissue ablation - - - 410 11.240 959.00

Comprehensive ultrasound code including regional study and guidance. Radiologist assistance (01030) may be added if procedure is performed by a non-radiologist. Guided procedure code to be added if performed by a radiologist. 80620 or 80630.

- - - - - -


329 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

00250 Ultrasound limited Doppler study any region - - - 410 6.500 554.60

Stand alone code may not be added to any other code. - - - - - -

00290 Ultrasound examination contrast material - - - 410 - -


00310 CT planning study for radiotherapy - - - 410 21.370 1 823.30

00591 Radiology prosthetic device - - - - - -

To be used once per planning session for any region - - - - - -

00320 CT guidance (separate procedure) - - - 410 16.920 1 443.60

Comprehensive CT code including regional study and guidance. Guided procedure code to be added eg 80600, 80605, and 80610.

- - - - - -

00330 CT guidance, with diagnostic procedure - - - 410 8.460 721.80

To be added to the diagnostic procedure code. Guided procedure code to be added eg 80600, 80605, 80610.

- - - - - -

00340 CT guidance and monitoring for tissue ablation - - - 410 21.150 1 804.50

May only be used once per procedure for a region. Radiologist assistance (01030) may be added if procedure is performed by a non-radiologist. If performed by radiologist, add procedural code 80620, or 80630.

- - - - - -

00390 CT examination contrast material - - - 410 - -


00410 MR study of the whole body for metastases screening - - - 410 70.400 6 006.40

00420 MR Spectroscopy any region - - - 410 28.900 2 465.70

May be added to the regional study, once only. - - - - - -

00430 MR guidance for needle replacement - - - 410 42.560 3 631.10

Comprehensive MRI code including region studied and guidance. Guided procedure code to be added eg 80600, 80605, 80610.

- - - - - -

00440 MR low field strength imaging of peripheral joint any region - - - 410 12.000 1 023.80

00450 MR planning study for radiotherapy or surgical procedure - - - 410 38.000 3 242.10

00455 MR planning study for radiotherapy or surgical procedure, with contrast - - - 410 47.000 4 010.00

00490 MR examination contrast material - - - 410 - -


00510 Analogue monoplane screening table - - - 410 41.010 3 498.90

A machine code may be added once per complete procedure / patient visit. - - - - - -

00520 Analogue monoplane table with DSA attachment - - - 410 47.500 4 052.60


330 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R


00530 Dedicated angiography suite: Analogue monoplane unit. Once off charge per patient by owner of equipment. - - - 410 47.500 4 052.60


00540 Digital monoplane screening table - - - 410 79.920 6 818.60


00550 Dedicated angiography suite: Digital monoplane unit. Once off charge per patient by owner of equipment. - - - 410 93.030 7 937.10


00560 Dedicated angiography suite: Digital bi-plane unit. Once off charge per patient by owner of equipment. - - - 410 125.000 10 664.80


00590 Angiography and interventional examination contrast material - - - 410 - -


00900 Nuclear Medicine study - Bone, whole body, appendicular and axial skeleton 410 34.920 2 979.30 - - -

00903 Nuclear Medicine study - Bone, whole body, appendicular and axial skeleton and SPECT 410 48.330 4 123.40 - - -

00906 Nuclear Medicine study - Venous thrombosis regional 410 21.540 1 837.80 - - -

00909 Nuclear Medicine study - Tumour whole body 410 34.150 2 913.60 - - -

00912 Nuclear Medicine study - Tumour whole body multiple studies 410 47.560 4 057.70 - - -

00915 Nuclear Medicine study - Tumour whole body and SPECT 410 47.560 4 057.70 - - -

00918 Nuclear Medicine study - Tumour whole body multiple studies & SPECT 410 60.980 5 202.70 - - -

00921 Nuclear Medicine study – Infection whole body 410 31.450 2 683.30 - - -

00924 Nuclear Medicine study – infection whole body with SPECT 410 44.860 3 827.40 - - -

00927 Nuclear Medicine study – infection whole body multiple studies 410 44.860 3 827.40 - - -

00930 Nuclear Medicine study – infection whole body with SPECT multiple studies 410 58.270 4 971.50 - - -

00933 Nuclear Medicine study - Bone marrow imaging limited area 410 24.100 2 056.20 - - -

00936 Nuclear Medicine study - Bone marrow imaging whole body 410 37.510 3 200.30 - - -

00939 Nuclear Medicine study - Bone marrow imaging limited area multiple studies 410 37.510 3 200.30 - - -

00942 Nuclear Medicine study - Bone marrow imaging whole body multiple studies 410 50.920 4 344.40 - - -

00945 Nuclear Medicine study - Spleen imaging only - haematopoietic 410 24.100 2 056.20 - - -

00960 Nuclear Medicine therapy – Hyperthyroidism 410 11.990 1 023.00 - - -

00965 Nuclear Medicine therapy - Thyroid carcinoma and metastases 410 6.470 552.00 - - -

00970 Nuclear Medicine therapy – Intra-cavity radio-active colloid therapy 410 6.470 552.00 - - -

00975 Nuclear Medicine therapy - Interstitial radio-active colloid therapy 410 6.470 552.00 - - -


331 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

00980 Nuclear Medicine therapy - Intravascular radio pharmaceutical therapy particulate 410 6.470 552.00 - - -

00985 Nuclear Medicine therapy - Intra-articular radio pharmaceutical therapy 410 6.470 552.00 - - -

00990 Nuclear Medicine Isotope 410 - - - - -

Identification code for the use of isotope with a procedure. Appropriate codes to be supplied. - - - - - -

00991 Nuclear Medicine Substrate 410 - - - - -

00956 PET/CT scan whole body without contrast - - - 411 165.130 -

00957 PET/CT scan whole body with contrast - - - 411 163.190 -

00950 PET scan local - - - 411 - -

00951 PET/CT local - - - 411 120.000 -

00952 PET/CT local with contrast - - - 411 124.680 -

00955 PET scan whole body - - - 411 - -

Call and assistance - - - - - -

• Emergency call out code 01010 only to be used if radiologist is called out to the rooms to report on an examination after normal working hours. May not be used for routine reporting during extended working hours.

• Emergency call out code 01020 only to be used when a radiologist reports on subsequent cases after having been called out to the rooms to report an initial after hours procedure. This code may also be used for home tele-radiology reporting of an emergency procedure.May not be used for routine reporting during normal or extended working hours.

• Radiologist assistance in theatre code 01030 only to be used if the radiologist is actively involved in assisting another radiologist or clinician with a procedure.

• Radiographer assistance in theatre 01040 may not be used for procedures performed in facilities owned by the radiologist; ie only for attendance in hospital theatres etc. Does not apply to Bed Side Unit (BSU) examinations.

• Second opinion consultations only to be used if a written report is provided as indicated in codes 01050, 01055, 01060. Not intended for ad hoc verbal consultations.

- - - - - -

01010 Emergency call out fee, first case - - - 410 3.000 256.00

01020 Emergency call out fee, subsequent cases same trip - - - 410 2.000 170.60

01030 Radiologist assistance in theatre, per half hour - - - 410 6.000 511.90

01040 Radiographer attendance in theatre, per half hour - - - 410 1.600 136.50

01050 Written report on study done elsewhere, short - - - 410 1.500 128.00

01055 Written report on study done elsewhere, extensive - - - 410 4.200 358.30

01060 Written report for medico legal purposes, per hour - - - 410 9.720 829.30


332 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

01070 Consultation for pre-assessment of interventional procedure - - - 410 4.860 414.70

01100 X-ray procedure after hours, per procedure - - - 410 2.000 170.60

01200 Ultrasound procedure after hours, per procedure - - - 410 4.000 341.30

01300 CT procedure after hours, per procedure - - - 410 10.000 853.20

01400 MR procedure after hours, per procedure - - - 410 14.000 1 194.50

01500 Angiography procedure after hours, per procedure - - - 410 20.000 1 706.40

01600 Interventional procedure after hours, per procedure - - - 410 26.000 2 218.30

01970 Consultation for nuclear medicine study 410 2.200 187.70 - - -

Monitoring - - - - - -

• ECG / Pulse oximetry monitoring (02010). Use for monitoring patients requiring conscious sedation during imaging procedure. Not to be used as a routine.

- - - - - -

02010 ECG/pulse Oximeter monitoring - - - 410 2.000 170.60

Head - - - - - -

Skull and Brain - - - - - -

Codes 10100 (skull) and 10110 (tomography) may be combined. - - - - - -

10100 X-ray of the skull - - - 410 3.860 329.30

10110 X-ray tomography of the skull - - - 410 4.300 366.90

10120 X-ray shuntogram for VP shunt - - - 410 15.360 1 310.50

10200 Ultrasound of the brain – Neonatal - - - 410 7.380 629.70

10210 Ultrasound of the brain including doppler - - - 410 13.220 1 127.90

10220 Ultrasound of the intracranial vasculature, including B mode, pulse and colour doppler - - - 410 15.040 1 283.20

10300 CT Brain uncontrasted - - - 410 22.650 1 932.50

10310 CT Brain with contrast only - - - 410 33.280 2 839.40

10320 CT Brain pre and post contrast - - - 410 40.480 3 453.70

10325 CT brain pre and post contrast for perfusion studies - - - 410 49.100 4 189.10

Stand alone code may not be added to any other CT studies of the brain, except for code 10330 - - - - - -

10330 CT angiography of the brain - - - 410 77.580 6 619.00

10335 CT of the brain pre and post contrast with angiography - - - 410 97.910 8 353.50

10340 CT brain for cranio-stenosis including 3D - - - 410 34.160 2 914.50

10350 CT Brain stereotactic localisation - - - 410 19.360 1 651.80

10360 CT base of skull coronal high resolution study for CSF leak - - - 410 34.900 2 977.60


333 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

10400 MR of the brain, limited study - - - 410 43.560 3 716.50

10410 MR of the brain uncontrasted - - - 410 63.800 5 443.30

10420 MR of the brain with contrast - - - 410 75.940 6 479.10

10430 MR of the brain pre and post contrast - - - 410 104.040 8 876.50

10440 MR of the brain pre and post contrast, for perfusion studies - - - 410 107.440 9 166.60

10450 MR of the brain plus angiography - - - 410 92.200 7 866.30

10460 MR of the brain pre and post contrast plus angiography - - - 410 121.230 10 343.10

10470 MR angiography of the brain uncontrasted - - - 410 58.500 4 991.10

10480 MR angiography of the brain contrasted - - - 410 74.020 6 315.20

10485 MR of the brain, with diffusion studies - - - 410 79.000 6 740.10

10490 MR of the brain, pre and post contrast, with diffusion studies, - - - 410 110.640 9 439.60

10492 MR study of the brain plus angiography plus diffusion, uncontrasted - - - 410 95.000 8 105.20

10495 MR of the brain pre and post contrast plus angiography and diffusion - - - 410 125.440 10 702.30

10500 Arteriography of intracranial vessels: 1 - 2 vessels - - - 410 48.600 4 146.50

10510 Arteriography of intracranial vessels: 3 - 4 vessels - - - 410 82.330 7 024.20

10520 Arteriography of extra-cranial (non-cervical) vessels - - - 410 48.440 4 132.80

10530 Arteriography of intracranial and extra-cranial (non-cervical) vessels - - - 410 118.090 10 075.20

10540 Arteriography of intracranial vessels (4) plus 3 D rotational angiography - - - 410 97.570 8 324.50

10550 Arteriography of intracranial vessels (1) plus 3D rotational angiography - - - 410 37.290 3 181.50

10560 Venography of dural sinuses - - - 410 52.230 4 456.20

10900 Nuclear Medicine study – Bone regional, static 410 21.500 1 834.30 - - -

10905 Nuclear Medicine study – Bone regional, static, with flow 410 27.530 2 348.80 - - -

10910 Nuclear Medicine study – Bone regional, static with SPECT 410 34.920 2 979.30 - - -

10915 Nuclear Medicine study – Bone regional, static, with flow, with SPECT 410 40.940 3 492.90 - - -

10920 Nuclear Medicine study – Brain, planar, complete, static 410 16.920 1 443.60 - - -

10925 Nuclear Medicine study – Brain complete static with vascular flow 410 22.950 1 958.10 - - -

10930 Nuclear Medicine study – Brain, planar, complete, static, with SPECT 410 30.330 2 587.70 - - -

10935 Nuclear Medicine study – Brain, planar, complete, static, with flow, with SPECT 410 36.360 3 102.20 - - -

10940 Nuclear Medicine study - CSF flow imaging cisternography 410 21.600 1 842.90 - - -

10945 Nuclear Medicine study – Ventriculography 410 13.410 1 144.10 - - -

10950 Nuclear Medicine study - Shunt evaluation static, planar 410 13.410 1 144.10 - - -


334 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

10955 Nuclear Medicine study - CFS leakage detection and localisation 410 13.410 1 144.10 - - -

10960 Nuclear medicine study - CSF SPECT 410 13.410 1 144.10 - - -

10970 PET scan of the brain - - - 411 - -

10971 PET/CT scan of the brain uncontrasted - - - 411 110.120 -

10972 PET/CT of the brain contrasted - - - 411 116.110 -

10980 PET perfusion scan of the brain - - - 411 - -

10981 PET/CT perfusion scan of the brain - - - 411 131.070 -

Facial bones and nasal bones - - - - - -

Codes 11100 (facial bones) and 11110 (tomography) may be combined - - - - - -

11100 X-ray of the facial bones - - - 410 3.930 335.30

11110 X-ray tomography of the facial bones - - - 410 4.300 366.90

11120 X-ray of the nasal bones - - - 410 2.390 203.90

11300 CT of the facial bones - - - 410 20.960 1 788.30

11310 CT of the facial bones with 3D reconstructions - - - 410 30.400 2 593.70

11320 CT of the facial bones/soft tissue, pre and post contrast - - - 410 41.260 3 520.20

11400 MR of the facial soft tissue - - - 410 62.400 5 323.80

11410 MR of the facial soft tissue pre and post contrast - - - 410 100.600 8 583.00

11420 MR of the facial soft tissue plus angiography, with contrast - - - 410 110.300 9 410.60

11430 MR angiography of the facial soft tissue - - - 410 74.020 6 315.20

Orbits, lacrimal glands and tear ducts - - - - - -

Code 12130 (tomography) may be added to 12100 or 12110 or 12120 (orbits) or 12140 (dacrocystography). - - - - - -

12100 X-ray orbits less than three views - - - 410 3.560 303.70

12110 X-ray of the orbits, three or more views, including foramina - - - 410 5.300 452.20

12120 X-ray of the orbits for foreign body - - - 410 3.560 303.70

12130 X-ray tomography of the orbits - - - 410 4.300 366.90

12140 X-ray dacrocystography - - - 410 11.200 955.60

12200 Ultrasound of the orbit/eye - - - 410 5.130 437.70

12210 Ultrasound of the orbit/eye including doppler - - - 410 10.970 935.90

12300 CT of the orbits single plane - - - 410 15.700 1 339.50

12310 CT of the orbits, more than one plane - - - 410 20.590 1 756.70

12320 CT of the orbits pre and post contrast single plane - - - 410 36.030 3 074.00


335 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

12330 CT of the orbits pre and post contrast multiple planes - - - 410 39.700 3 387.10

12400 MR of the orbits - - - 410 62.460 5 329.00

12410 MR of the orbitae, pre and post contrast - - - 410 100.640 8 586.40

12900 Nuclear Medicine study – Dacrocystography 410 20.770 1 772.10 - - -

Paranasal sinuses - - - - - -

Code 13120 (tomography) may be added to 13100, 13110 (paranasal sinuses), 13130 (nasopharyngeal). - - - - - -

13100 X-ray of the paranasal sinuses, single view - - - 410 2.740 233.80

13110 X-ray of the paranasal sinuses, two or more views - - - 410 3.660 312.30

13120 X-ray tomography of the paranasal sinuses - - - 410 4.300 366.90

13130 X-ray of the naso-pharyngeal soft tissue - - - 410 2.740 233.80

13300 CT of the paranasal sinuses single plane, limited study - - - 410 7.200 614.30

13310 CT of the paranasal sinuses, two planes, limited study - - - 410 12.400 1 057.90

13320 CT of the paranasal sinuses, any plane, complete study - - - 410 15.420 1 315.60

13330 CT of the paranasal sinuses, more than one plane, complete study - - - 410 20.770 1 772.10

13340 CT of the paranasal sinuses, any plane, complete study: pre and post contrast - - - 410 34.740 2 964.00

13350 CT of the paranasal sinuses, more than one plane, complete study; pre and post contrast - - - 410 41.010 3 498.90

13400 MR of the paranasal sinuses - - - 410 60.270 5 142.10

13410 MR of the paranasal sinuses, pre and post contrast - - - 410 96.590 8 240.90

Mandible, teeth and maxilla - - - - - -

Code 14110 (orthopantomogram) may be combined with 14100 (mandible) if two separate studies are performed. Code 14110 (orthopantomogram) may be combined with 15100 and / or 15110 (TM joint) if complete separate studies are performed. Code 14160 (tomography) may be combined with 14130 or 14140 or 14150 (teeth). Code 14160 (tomography) may be combined with 15100 and / or 15110 (TM joint) if complete separate studies are performed. Code 14330 and 14340 (Dental implants) may be combined if mandible and maxilla are examined at the same visit.

- - - - - -

14100 X-ray of the mandible - - - 410 3.660 312.30

14110 X-ray orthopantomogram of the jaws and teeth - - - 410 4.060 346.40

14120 X-ray maxillofacial cephalometry - - - 410 2.770 236.30

14130 X-ray of the teeth single quadrant - - - 410 2.000 170.60


336 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

14140 X-ray of the teeth more than one quadrant - - - 410 2.530 215.90

14150 X-ray of the teeth full mouth - - - 410 3.620 308.90

14160 X-ray tomography of the teeth per side - - - 410 3.230 275.60

14300 CT of the mandible - - - 410 22.280 1 900.90

14310 CT of the mandible, pre and post contrast - - - 410 41.260 3 520.20

14320 CT mandible with 3D reconstructions - - - 410 30.400 2 593.70

14330 CT for dental implants in the mandible - - - 410 27.450 2 342.00

14340 CT for dental implants in the maxilla - - - 410 27.450 2 342.00

14400 MR of the mandible/maxilla - - - 410 63.800 5 443.30

14410 MR of the mandible/maxilla, pre and post contrast - - - 410 98.640 8 415.80

TM Joints - - - - - -

Code 15100 (TM joint) and 15120 (tomography) may be combined. Code 15110 (TM joint) and 15130 (tomography) may be combined. Code 15140 (arthrography) and 15120 (tomography) may be combined. Code 15150 (arthrography) and 15130 (tomography)may be combined. Codes 15320 (CT arthrogram) and 15420 (MR arthrogram) include introduction of contrast (00140 may not be added).

- - - - - -

15100 X-ray tempero-mandibular joint, left - - - 410 3.560 303.70

15110 X-ray tempero-mandibular joint, right - - - 410 3.560 303.70

15120 X-ray tomography tempero-mandibular joint, left - - - 410 4.300 366.90

15130 X-ray tomography tempero-mandibular joint, right - - - 410 4.300 366.90

15140 X-ray arthrography of the tempero-mandibular joint, left - - - 410 15.410 1 314.80

15150 X-ray arthrography of the tempero-mandibular joint, right - - - 410 15.410 1 314.80

15200 Ultrasound tempero-mandibular joints, one or both sides - - - 410 6.560 559.70

15300 CT of the tempero-mandibular joints - - - 410 25.380 2 165.40

15310 CT of the tempero-mandibular joints plus 3D reconstructions - - - 410 34.500 2 943.50

15320 CT arthrogram of the tempero-mandibular joints - - - 410 35.960 3 068.00

15400 MR of the tempero-mandibular joints - - - 410 63.800 5 443.30

15410 MR of the tempero-mandibular joints, pre and post contrast - - - 410 100.840 8 603.50

15420 MR arthrogram of the tempero-mandibular joints - - - 410 74.710 6 374.10

Mastoids and internal auditory canal - - - - - -


337 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Code 16100 (mastoids) and 16120 (tomography) may be combined. Code 16110 (mastoids bilat) and 16130 (tomography) may be combined Code 16140 (IAM’s) and 16150 (tomography) may be combined.

- - - - - -

16100 X-ray of the mastoids, unilateral - - - 410 3.590 306.30

16110 X-ray of the mastoids, bilateral - - - 410 7.180 612.60

16120 X-ray tomography of the petro-temporal bone, unilateral - - - 410 4.300 366.90

16130 X-ray tomography of the petro-temporal bone, bilateral - - - 410 8.600 733.70

16140 X-ray internal auditory canal, bilateral - - - 410 5.230 446.20

16150 X-ray tomography of the internal auditory canal, bilateral - - - 410 4.300 366.90

16300 CT of the mastoids - - - 410 12.600 1 075.00

16310 CT of the internal auditory canal - - - 410 21.470 1 831.80

16320 CT of the internal auditory canal, pre and post contrast - - - 410 34.200 2 917.90

16330 CT of the ear structures, limited study - - - 410 13.400 1 143.30

16340 CT of the middle and inner ear structures, high definition including all reconstructions in various planes - - - 410 43.350 3 698.50

16400 MR of the internal auditory canals, limited study - - - 410 43.560 3 716.50

16410 MR of the internal auditory canals, pre and post contrast, limited study - - - 410 68.930 5 881.00

16420 MR of the internal auditory canals, pre and post contrast, complete study - - - 410 102.640 8 757.00

16430 MR of the ear structures - - - 410 64.400 5 494.50

16440 MR of the ear structures, pre and post contrast - - - 410 102.640 8 757.00

Sella turcica - - - - - -

Code 17100 (sella) and 17110 (tomography) may be combined. - - - - - -

17100 X-ray of the sella turcica - - - 410 3.080 262.80

17110 X-ray tomography of the sella turcica - - - 410 4.300 366.90

17300 CT of the sella turcica/hypophysis - - - 410 17.450 1 488.80

17310 CT of the sella turcica/hypophysis, pre and post contrast - - - 410 42.260 3 605.50

17400 MR of the hypophysis - - - 410 43.560 3 716.50

17410 MR of the hypophysis, pre and post contrast - - - 410 74.030 6 316.10

Salivary glands and floor of the mouth - - - - - -

Code 18100 (calculus) and 18110 (open mouth) may be combined. Codes 18120 (sialography) and 18320 (CT sialography) include introduction of contrast and fluoroscopy (00140 may not be added).

- - - - - -

18100 X-ray of the salivary glands and ducts for calculus - - - 410 2.840 242.30


338 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

18110 X-ray of the salivary ducts, open mouth for calculus - - - 410 1.900 162.10

18120 X-ray sialography, per gland - - - 410 14.080 1 201.30

18200 Ultrasound of the salivary glands/floor of the mouth - - - 410 6.560 559.70

18300 CT of the salivary glands, uncontrasted - - - 410 12.600 1 075.00

18310 CT of the salivary glands/floor of the mouth, pre and post contrast - - - 410 42.100 3 591.90

18320 CT sialography - - - 410 26.280 2 242.20

18400 MR of the salivary glands/floor of the mouth - - - 410 63.200 5 392.10

18410 MR of the salivary glands/floor of the mouth, pre and post contrast - - - 410 100.840 8 603.50

18900 Nuclear Medicine study - Salivary gland imaging 410 20.770 1 772.10 - - -

Soft Tissue - - - - - -

19900 Nuclear Medicine study - Tumour localisation planar, static 410 20.740 1 769.50 - - -

19905 Nuclear Medicine study - Tumour localisation planar, static, multiple studies 410 35.170 3 000.60 - - -

19910 Nuclear Medicine study - Tumour localisation planar, static and SPECT 410 34.150 2 913.60 - - -

19915 Nuclear Medicine study - Tumour localisation planar, static, multiple studies and SPECT 410 47.560 4 057.70 - - -

19920 Nuclear medicine study - Infection localisation planar, static 410 18.040 1 539.10 - - -

19925 Nuclear medicine study - Infection localisation planar, static, multiple studies 410 31.450 2 683.30 - - -

19930 Nuclear medicine study - Infection localisation planar, static and SPECT 410 31.450 2 683.30 - - -

19935 Nuclear medicine study - Infection localisation planar, static, multiple studies and SPECT 410 44.860 3 827.40 - - -

Neck - - - - - -

Code 20120 (laryngography) includes fluoroscopy (00140 may not be added). Code 20130 (speech) includes tomography and cinematography (00140 may not be added). Code 20450 (MR Angiography) may be combined with 10410 (MR brain).

- - - - - -

20100 X-ray of soft tissue of the neck - - - 410 2.740 233.80

20110 X-ray of the larynx including tomography - - - 410 9.390 801.10

20120 X-ray laryngography - - - 410 8.280 706.40

20130X-ray evaluation of pharyngeal movement and speech by screening and / or cine with or without video recording

- - - 410 8.300 708.10

20200 Ultrasound of the thyroid - - - 410 6.560 559.70

20210 Ultrasound of soft tissue of the neck - - - 410 6.560 559.70

20220 Ultrasound of the carotid arteries, bilateral including B mode, pulsed and colour doppler - - - 410 15.000 1 279.80

20230Ultrasound of the entire extracranial vascular tree including carotids, vertebral and subclavian vessels with B mode, pulse and colour doppler

- - - 410 21.840 1 863.40


339 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

20240 Ultrasound study of the venous system of the neck including pulse and colour Doppler - - - 410 10.800 921.40

20300 CT of the soft tissues of the neck - - - 410 18.250 1 557.10

20310 CT of the soft tissues of the neck, with contrast - - - 410 38.150 3 254.90

20320 CT of the soft tissues of the neck, pre and post contrast - - - 410 43.810 3 737.80

20330 CT angiography of the extracranial vessels in the neck - - - 410 79.360 6 770.80

20340 CT angiography of the extracranial vessels in the neck and intracranial vessels of the brain - - - 410 107.500 9 171.70

20350CT angiography of the extracranial vessels in the neck and intracranial vessels of the brain plus a pre and post contrast study of the brain

- - - 410 124.430 10 616.10

20400 Mr of the soft tissue of the neck - - - 410 63.600 5 426.20

20410 MR of the soft tissue of the neck, pre and post contrast - - - 410 102.040 8 705.90

20420 MR of the soft tissue of the neck and uncontrasted angiography - - - 410 92.600 7 900.50

20430 MR angiography of the extracranial vessels in the neck, without contrast - - - 410 59.600 5 085.00

20440 MR angiography of the extracranial vessels in the neck, with contrast - - - 410 74.020 6 315.20

20450 MR angiography of the extra and intracranial vessels with contrast - - - 410 116.050 9 901.20

20460 MR angiography of the intra and extra cranial vessels plus brain, without contrast - - - 410 135.170 11 532.40

20470 MR angiography of the intra and extra cranial vessels plus brain, with contrast - - - 410 156.050 13 313.90

20500 Arteriography of cervical vessels: carotid 1 - 2 vessels - - - 410 44.430 3 790.70

20510 Arteriography of cervical vessels: vertebral 1 - 2 vessels - - - 410 50.730 4 328.20

20520 Arteriography of cervical vessels: carotid and vertebral - - - 410 77.630 6 623.20

20530 Arteriography of aortic arch and cervical vessels - - - 410 91.970 7 846.70

20540 Arteriography of aortic arch, cervical and intracranial vessels - - - 410 108.870 9 288.60

20550 Venography of jugular and vertebral veins - - - 410 48.950 4 176.30

Thyroid (Nuclear Medicine) - - - - - -

21900 Nuclear Medicine study - Thyroid, single uptake 410 9.680 825.90 - - -

21910 Nuclear medicine study - Thyroid, multiple uptake 410 14.690 1 253.30 - - -

21920 Nuclear medicine study - Thyroid imaging with uptake 410 17.720 1 511.80 - - -

21930 Nuclear medicine study - Thyroid imaging 410 12.720 1 085.20 - - -

21940 Nuclear medicine study - Thyroid imaging with vascular flow 410 18.740 1 598.90 - - -

21950 Nuclear medicine study - Thyroid suppression/stimulation 410 12.720 1 085.20 - - -

21960 PET scan of the thyroid - - - 411 - -

Parathyroid (Nuclear Medicine) - - - - - -


340 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

22900 Nuclear Medicine study - Parathyroid, planar, static 410 16.520 1 409.50 - - -

22910 Nuclear medicine study - Parathyroid, planar, static, multiple 410 28.910 2 466.50 - - -

22920 Nuclear medicine study - Parathyroid, planar, static with subtraction technique 410 21.880 1 866.80 - - -

22930 Nuclear medicine study - Parathyroid SPECT 410 13.410 1 144.10 - - -

22940 PET scan of the parathyroid - - - 411 - -


29900 Nuclear Medicine study - Tumour localisation planar, static 410 20.740 1 769.50 - - -

29905 Nuclear medicine study - Tumour localisation planar, static, multiple studies 410 35.170 3 000.60 - - -

29910 Nuclear medicine study - Tumour localisation planar, static and SPECT 410 34.150 2 913.60 - - -

29915 Nuclear medicine study - Tumour localisation planar, static, multiple studies and SPECT 410 47.560 4 057.70 - - -

29920 Nuclear medicine study - Tumour localisation planar, static 410 18.040 1 539.10 - - -



29935 Nuclear medicine study - Infection localisation planar, static, multiple studies and SPECT 410 44.860 3 827.40 - - -

29940 Nuclear medicine study - Regional lymph node mapping, static, planar 410 24.100 2 056.20 - - -

29945 Nuclear medicine study - Regional lymph node mapping, static, planar, multiple 410 36.490 3 113.30 - - -

29950 Nuclear medicine study – Lymph node localisation with gamma probe 410 12.390 1 057.10 - - -

29960 PET scan of the soft tissue of the neck - - - 411 - -

29961 PET/CT scan of the soft tissue of the neck uncontrasted - - - 411 105.870 -

29962 PET/CT scan of the soft tissue of the neck contrasted - - - 411 111.690 -

Thorax - - - - - -

Chest wall, pleura, lungs and mediastinum - - - - - -

Code 30140 (tomography) may be combined with 30100 or 30110 (chest) or 30150 or 30155 (ribs) or 30160 (thoracic inlet). Codes 30170 (Sterno-clavicular) and 30175 (tomography) may be combined. Code 30180 (sternum) and 30185 (tomography) may be combined. Code 30340 (CT limited high resolution) may be combined with 30310 or 30320 or 30330 (CT chest). Motivation may be required. Code 30350 (high resolution) is a stand alone study. Code 30360, (CT chest for pulmonary embolism) is a complete examination and includes the preceding uncontrasted CT scan of the chest, and may not be combined with 40330 or 40333 (CT abdomen and pelvis). Code 30370 (CT pulmonary embolism plus CT venography) may not be combined with 70230 (Doppler).

- - - - - -


341 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

30100 X-ray of the chest, single view - - - 410 3.040 259.40

30110 X-ray of the chest two views, PA and lateral - - - 410 3.840 327.60

30120 X-ray of the chest complete with additional views - - - 410 4.240 361.80

30130 X-ray of the chest complete including fluoroscopy - - - 410 4.480 382.20

30140 X-ray tomography of the chest - - - 410 4.300 366.90

30150 X-ray of the ribs - - - 410 4.790 408.70

30155 X-ray of the chest and ribs - - - 410 6.420 547.70

30160 X-ray of the thoracic inlet - - - 410 2.560 218.40

30170 X-ray of the sterno-clavicular joints - - - 410 4.210 359.20

30175 X-ray tomography of the sterno-clavicular joint - - - 410 4.300 366.90

30180 X-ray of the sternum - - - 410 4.210 359.20

30185 X-ray tomography of the sternum - - - 410 4.300 366.90

30200 Ultrasound of the chest wall, any region - - - 410 6.560 559.70

30210 Ultrasound of the pleural space - - - 410 6.560 559.70

30220 Ultrasound of the mediastinal structures - - - 410 6.560 559.70

30300 CT of the chest, limited study - - - 410 9.500 810.50

30310 CT of the chest uncontrasted - - - 410 26.600 2 269.50

30320 CT of the chest contrasted - - - 410 42.430 3 620.00

30330 CT of the chest, pre and post contrast - - - 410 45.700 3 899.00

30340 CT of the chest, limited high resolution study - - - 410 11.200 955.60

30350 CT of the chest, complete high resolution study - - - 410 24.010 2 048.50

30355 CT of the chest, complete high resolution study with additonal prone and expiratory studies - - - 410 33.300 2 841.10

30360 CT of the chest for pulmonary embolism - - - 410 57.120 4 873.40

30370 CT of the chest for pulmonary embolism with CT venography of abdomen, pelvis and lower limbs - - - 410 80.280 6 849.30

30400 MR of the chest - - - 410 63.600 5 426.20

30410 MR of the chest with uncontrasted angiography - - - 410 92.600 7 900.50

30420 MR of the chest, pre and post contrast - - - 410 102.040 8 705.90

30900 Nuclear Medicine study - Lung perfusion 410 21.540 1 837.80 - - -

30910 Nuclear Medicine study - Lung ventilation, aerosol 410 21.500 1 834.30 - - -

30920 Nuclear Medicine study - Lung perfusion and ventilation 410 42.030 3 585.90 - - -

30930 Nuclear Medicine study - Lung ventilation using radio-active gas 410 14.170 1 209.00 - - -


342 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

30940 Nuclear Medicine study - Lung perfusion and ventilation using radio-active gas 410 34.690 2 959.70 - - -

30950 Nuclear medicine study - Muco-ciliary clearance study dynamic 410 26.510 2 261.80 - - -

30960 Nuclear medine study - alveolar permeabillity 410 26.510 2 261.80 - - -

Stand alone code. Not to be combined with 30910. - - - - - -

30970 Nuclear medicine study - quantitative evaluation of lung perfusion and ventilation 410 6.020 513.60 - - -

Stand alone code. Not to be combined with 30920. - - - - - -

30980 PET scan of the chest - - - 411 - -

30981 PET/CT scan of the chest uncontrasted - - - 411 111.440 -

30982 PET/CT scan of the chest contrasted - - - 411 117.420 -

30983 PET/CT scan of the chest pre and post contrast - - - 411 148.320 -

Oesophagus - - - - - -

Codes 31100, 31110, 31120 (swallow) include fluoroscopy (00140 may not be added). - - - - - -

31100 X-ray barium swallow - - - 410 6.600 563.10

31105 Xray 3 phase dynamic contrasted swallow - - - 410 12.600 1 075.00

31110 X-ray barium swallow, double contrast - - - 410 7.920 675.70

31120 X-ray barium swallow with cinematography - - - 410 10.070 859.20

Aorta and large vessels - - - - - -

Codes 32210 and 32220 (Ivus) may be combined - - - - - -

32200 Ultrasound intravascular arterial or venous assessment for intervention, once per complete procedure - - - 410 4.200 358.30

32210 Ultrasound intravascular (IVUS) first vessel - - - 410 8.440 720.10

32220 Ultrasound intravascular (IVUS) subsequent vessels - - - 410 5.300 452.20

32300 CT angiography of the aorta and branches - - - 410 79.080 6 747.00

32305 CT angiography of the thoracic and abdominal aorta and branches - - - 410 105.500 9 001.10

32310 CT angiography of the pulmonary vasculature - - - 410 79.080 6 747.00

32400 MR angiography of the aorta and branches - - - 410 78.500 6 697.50

32410 MR angiography of the pulmonary vasculature - - - 410 105.270 8 981.40

32500 Arteriography of thoracic aorta - - - 410 28.260 2 411.10

32510 Arteriography of bronchial intercostal vessels alone - - - 410 50.150 4 278.70

32520 Arteriography of thoracic aorta, bronchial and intercostal vessels - - - 410 67.430 5 753.00

32530 Arteriography of pulmonary vessels - - - 410 63.270 5 398.10

32540 Arteriography of heart chambers, coronary arteries - - - 410 44.270 3 777.00


343 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

32550 Venography of thoracic vena cava - - - 410 28.380 2 421.30

32560 Venography of vena cava, azygos system - - - 410 56.310 4 804.30

32570 Venography patency of A-port or other central line - - - 410 19.640 1 675.70

Heart - - - - - -

Codes 33300 (CT anatomy / function) and 33310 (CT Angiography) may be done as stand alone studies or as additive studies if both are performed at the same time.

- - - - - -

33205 Ultrasound study of the heart for foetal or paediatric cases including doppler - - - 410 12.300 1 049.40

Code 33205 is a stand alone study and may not be added to 33200 or 33210. This code is intended for paediatric and foetal cases only

- - - - - -

33200 Ultrasound study of the heart, including Doppler - - - 410 8.200 699.60

33210 Ultrasound study of the heart trans-oesophageal - - - 410 10.520 897.60

33220 Ultrasound intravascular imaging to guide placement of intracoronary stent once per vessel - - - 410 5.200 443.70

33300 CT anatomical/functional study of the heart - - - 410 34.610 2 952.90

33310 CT angiography of heart vessels - - - 410 81.280 6 934.70

33400 MR of the heart, anatomical study - - - 410 62.200 5 306.80

33410 MR of the heart, anatomical and functional study - - - 410 69.000 5 886.90

33420 MR of the heart, pre and post contrast - - - 410 103.040 8 791.20

33430 MR angiography of the heart vessels - - - 410 70.710 6 032.80

33440 MR of the heart, anatomical, functional and coronary angiography - - - 410 106.840 9 115.40

33900 Nuclear Medicine study - Cardiac shunt detection 410 21.500 1 834.30 - - -

33905 Nuclear Medicine study - Cardiac blood pool imaging, ejection fraction plus wall motion single study 410 26.510 2 261.80 - - -

33910 Nuclear Medicine study - Cardiac blood pool imaging, ejection fraction plus wall motion multiple studies 410 34.920 2 979.30 - - -

33915 Nuclear Medicine study - Cardiac blood pool imaging, gated SPECT 410 13.410 1 144.10 - - -

33920 Nuclear medicine study - Cardiac blood pool imaging, first pass technique 410 26.510 2 261.80 - - -

33925 Nuclear medicine study - Myocardial perfusion, single, rest (thallium/mibi) planar, non gated 410 16.520 1 409.50 - - -

33930 Nuclear medicine study - Myocardial perfusion, single, stress (thallium/mibi) planar, non gated 410 16.520 1 409.50 - - -

33935 Nuclear medicine study - Myocardial perfusion, single, rest (thallium/mibi), SPECT (non gated) 410 16.520 1 409.50 - - -

33940 Nuclear medicine study - Myocardial perfusion, single, stress (thallium/mibi), SPECT non gated 410 16.520 1 409.50 - - -

33945 Nuclear medicine study - Myocardial perfusion, single, rest (thallium/mibi), SPECT (gated) 410 28.910 2 466.50 - - -

33950 Nuclear medicine study - Myocardial perfusion, single, stress (thallium/mibi), SPECT (gated) 410 28.910 2 466.50 - - -

33955 Nuclear medicine study - Plus wall movement and ejection fraction, SPECT 410 6.020 513.60 - - -


344 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

33960 Nuclear medicine study - Cardiac hot spot imaging (infarction) planar 410 21.500 1 834.30 - - -

33965 Nuclear medicine study - Cardiac hot spot imaging (infarction) SPECT 410 13.410 1 144.10 - - -

33970 Nuclear Medicine study - Multi stage treadmill ECG test 410 6.660 568.20 - - -

33980 PET scan of the heart - - - 411 - -

33981 PET/CT scan of the heart? - - - 411 153.140 -

Mamma - - - - - -

Codes 34110 (localization), 34120 (stereo-tactic localization) and 34130 (stereo-tactic biopsy) may not be combined. Code 34130 (stereo-tactic biopsy). Add procedural code 80610 (cutting needle) or 34150 (mammotome) Code 34205 (U/S FNA) includes the procedural code (may not be combined with 34150).

- - - - - -

34100 X-ray mammography including ultrasound - - - 410 10.440 890.70

34101 X-Ray mammography unilateral, including ultrasound - - - 410 8.352 712.60

Code 34100 may not be combined with 34205 when these two procedures are done in the same sitting. Code 34100 includes ultrasound. In this situation use code 80605 (fine needle aspiration) with 34100

- - - - - -

34105 X-ray mammography galactography - - - 410 9.400 802.00

Once off fee per visit. May be added to 34100 - - - - - -

34110 X-ray mammography study for localisation - - - 410 7.240 617.70

34120 X-ray stereotactic mammography – localisation - - - 410 10.400 887.30

34130 X-ray stereotactic mammography – biopsy - - - 410 11.600 989.70

34140 X-ray of biopsy specimen of the mamma - - - 410 2.740 233.80

34150 X-ray Mammotome hand held biopsy apparatus - - - 410 9.800 836.10

34200 Ultrasound study of the breast - - - 410 7.900 674.00

34205 Ultrasound guided aspiration FNA/localisation of the breast - - - 410 12.100 1 032.40

34300 Computer assisted diagnosis for mammography - - - 410 1.400 119.50

34400 MR study of the breast - - - 410 62.600 5 340.90

34410 MR study of the breast pre and post contrast - - - 410 100.840 8 603.50

34900 PET scan of the breast/mamma - - - 411 - -


39900 Nuclear medicine study - Tumour localisation planar, static 410 20.740 1 769.50 - - -

39905 Nuclear medicine study - Tumour localisation planar, static, multiple studies 410 35.170 3 000.60 - - -

39910 Nuclear medicine study - Tumour localisation planar, static and SPECT 410 34.150 2 913.60 - - -


345 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

39915 Nuclear medicine study - Tumour localisation planar, static, multiple studies and SPECT 410 47.560 4 057.70 - - -

39920 Nuclear medicine study - Infection localisation planar, static 410 18.040 1 539.10 - - -



39935 Nuclear medicine study - Infection localisation planar, static, multiple studies, SPECT 410 44.860 3 827.40 - - -

39940 Nuclear medicine study - Regional lymph node mapping, static, planar 410 24.100 2 056.20 - - -

39945 Nuclear medicine study - Regional lymph node mapping, static, planar, multiple 410 36.490 3 113.30 - - -


Abdomen and Pelvis - - - - - -

Abdomen/stomach/bowel - - - - - -

Code 40120 (tomography) may be combined with 40100 or 40105 or 40110 (abdomen). Codes 40140 to 40190 (barium studies) include fluoroscopy (00140 may not be added). Code 40190 (intussusception) is a stand alone code and may not be combined with 40160 or 40165 (barium enema), (00140 may not be added).

- - - - - -

40100 X-ray of the abdomen - - - 410 3.320 283.30

40105 X-ray of the abdomen supine and erect, or decubitus - - - 410 5.360 457.30

40110 X-ray of the abdomen multiple views including chest - - - 410 8.100 691.10

40120 X-ray tomography of the abdomen - - - 410 4.300 366.90

40140 X-ray barium meal single contrast - - - 410 8.870 756.80

40143 X-ray barium meal double contrast - - - 410 11.990 1 023.00

40147 X-ray barium meal double contrast with follow through - - - 410 15.800 1 348.00

40150 X-ray small bowel enteroclysis (meal) - - - 410 25.450 2 171.30

Code 40150 excludes duodenal intubation and 40175 (Duodenal intubation) may be added. - - - - - -

40153 X-ray small bowel meal follow through single contrast - - - 410 19.550 1 668.00

40157 X-ray small bowel meal with pneumocolon - - - 410 25.630 2 186.70

40160 X-ray large bowel enema single contrast - - - 410 12.970 1 106.60

40165 X-ray large bowel enema double contrast - - - 410 19.630 1 674.80

40170 X-ray guided gastro oesophageal intubation - - - 410 1.600 136.50

40175 X-ray guided duodenal intubation - - - 410 2.800 238.90

40180 X-ray defaecogram - - - 410 12.970 1 106.60

40190 X-ray guided reduction of intussusception - - - 410 16.270 1 388.10


346 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

40200 Ultrasound study of the abdominal wall - - - 410 5.540 472.70

40210 Ultrasound study of the whole abdomen including the pelvis - - - 410 8.240 703.00

40300 CT study of the abdomen - - - 410 26.410 2 253.30

40310 CT study of the abdomen with contrast - - - 410 44.820 3 824.00

40313 CT study of the abdomen pre and post contrast - - - 410 52.990 4 521.00

40320 CT of the pelvis - - - 410 26.130 2 229.40

40323 CT of the pelvis with contrast - - - 410 47.480 4 050.90

40327 CT of the pelvis pre and post contrast - - - 410 53.870 4 596.10

40330 CT of the abdomen and pelvis - - - 410 38.500 3 284.70

40333 CT of the abdomen and pelvis with contrast - - - 410 62.170 5 304.20

40337 CT of the abdomen and pelvis pre and post contrast - - - 410 67.430 5 753.00

40340 CT triphasic study of the liver, abdomen and pelvis pre and post contrast - - - 410 74.110 6 322.90

40345 CT of the chest, abdomen and pelvis without contrast - - - 410 70.120 5 982.50

40350 CT of the chest, abdomen and pelvis with contrast - - - 410 88.350 7 537.90

40355 CT of the chest triphasic of the liver, abdomen and pelvis with contrast - - - 410 93.050 7 938.80

40360 CT of the base of skull to symphysis pubis with contrast - - - 410 102.730 8 764.70

40365 CT colonoscopy - - - 410 34.780 2 967.40

Stand alone study, may not be added to any code between 40300 and 40360 - - - - - -

40400 MR of the abdomen - - - 410 64.580 5 509.80

40410 MR of the abdomen pre and post contrast - - - 410 100.840 8 603.50

40420 MR of the pelvis, soft tissue - - - 410 64.580 5 509.80

40430 MR of the pelvis, soft tissue, pre and post contrast - - - 410 102.040 8 705.90

40900 Nuclear Medicine study - Gastro oesophageal reflux and emptying 410 21.500 1 834.30 - - -

40905 Nuclear Medicine study - Gastro oesophageal reflux and emptying multiple studies 410 34.920 2 979.30 - - -

40910 Nuclear Medicine study - Gastro intestinal protein loss 410 21.500 1 834.30 - - -

40915 Nuclear Medicine study - Gastro intestinal protein loss multiple studies 410 34.920 2 979.30 - - -

40920 Nuclear Medicine study – Acute GIT bleed static/dynamic 410 21.500 1 834.30 - - -

40925 Nuclear medicine study – Acute GIT bleed multiple studies 410 34.920 2 979.30 - - -

40930 Nuclear medicine study - Meckel’s localisation 410 20.770 1 772.10 - - -

40935 Nuclear medicine study - Gastric mucosa imaging 410 20.770 1 772.10 - - -

40940 Nuclear medicine study - colonic transit multiple studies 410 44.860 3 827.40 - - -


347 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Stand alone code - - - - - -

40950 PET scan of the abdomen and pelvis - - - 411 - -

40951 PET/CT scan of the abdomen and pelvis uncontrasted - - - 411 119.530 -

40952 PET/CT scan of the abdomen and pelvis contrasted - - - 411 129.310 -

40953 PET/CT scan of the abdomen and pelvis pre and post contrast - - - 411 140.500 -

Liver, spleen, gall bladder and pancreas - - - - - -

Code 41110, 41120 and 41130 (cholangiography) include fluoroscopy (00140 may not be added). - - - - - -

41100 X-ray ERCP including screening - - - 410 18.900 1 612.50

41105 X-ray ERCP reporting on images done in theatre - - - 410 2.400 204.80

41110 X-ray cholangiography intra-operative - - - 410 8.450 720.90

41120 X-ray T-tube cholangiography post operative - - - 410 14.050 1 198.70

41130 X-ray transhepatic percutaneous cholangiography - - - 410 32.340 2 759.20

41200 Ultrasound study of the upper abdomen - - - 410 7.000 597.20

41210Ultrasound doppler of the hepatic and splenic veins and inferior vena cava in assessment of portal venous hypertension or thrombosis

- - - 410 9.800 836.10

Code 41210 is a stand alone study and may not be added to 40200, 40210, 41200 or 42200 - - - - - -

41300 CT of the abdomen triphasic study – liver - - - 410 54.900 4 684.00

41400 MR study of the liver/pancreas - - - 410 64.780 5 526.90

41410 MR study of the liver/pancreas pre and post contrast - - - 410 100.840 8 603.50

41420 MRCP - - - 410 49.200 4 197.70

41430 MR study of the abdomen with MRCP - - - 410 92.980 7 932.90

41440 MR study of the abdomen pre and post contrast with MRCP - - - 410 133.600 11 398.50

41900 Nuclear Medicine study - Liver and spleen, planar views only 410 21.500 1 834.30 - - -

41905 Nuclear Medicine study - Liver and spleen, with flow study 410 27.530 2 348.80 - - -

41910 Nuclear Medicine study - Liver and spleen, planar views SPECT 410 34.920 2 979.30 - - -

41915 Nuclear Medicine study - Liver and spleen, with flow study and SPECT 410 40.940 3 492.90 - - -

41920 Nuclear Medicine study - Hepatobiliary system planar static/dynamic 410 21.500 1 834.30 - - -

41925 Nuclear Medicine study – hepatobiliary tract including flow 410 26.510 2 261.80 - - -

41930 Nuclear medicine study – Hepatobiliary system planar, static/dynamic multiple studies 410 34.920 2 979.30 - - -

41935 Nuclear medicine study – Hepatobiliary tract including flow multiple studies 410 39.920 3 405.90 - - -

41940 Nuclear medicine study - Gall bladder ejection fraction 410 6.020 513.60 - - -


348 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

41945 Nuclear medicine study – Biliary gastric reflux study 410 20.770 1 772.10 - - -

Renal tract - - - - - -

42100 X-ray tomography of the renal tract - - - 410 4.300 366.90

Code 42100 (tomography) may not be added to 42110 or 42115 (IVP). Codes 42115 (IVP), 42120 (cystography), 42130 (urethography), 42140 (MCU), 42150 (retrograde), and 42160 (prograde) include fluoroscopy (00140 may not be added).

- - - - - -

42110 X-ray excretory urogram including tomography - - - 410 24.860 2 121.00

42115 X-ray excretory urogram including tomography with micturating study - - - 410 32.860 2 803.60

42120 X-ray cystography - - - 410 15.050 1 284.00

42130 X-ray urethrography - - - 410 15.370 1 311.30

42140 X-ray micturating cysto-urethrography - - - 410 19.300 1 646.60

42150 X-ray retrograde/prograde pyelography - - - 410 12.530 1 069.00

42155 X-ray retrograde/prograde pyelography reporting on images done in theatre - - - 410 2.410 205.60

42160 X-ray prograde pyelogram – percutaneous - - - 410 32.670 2 787.30

42200 Ultrasound study of the renal tract including bladder - - - 410 7.420 633.10

42205 Ultrasound doppler for resistive index in vessels of transplanted kidney - - - 410 3.800 324.20

Code 42205 is a stand alone study and may not be added to 42200 - - -

42210 Ultrasound study of the renal arteries including Doppler - - - 410 10.600 904.40

42300 CT of the renal tract for a stone - - - 410 25.150 2 145.80

42400 MR of the renal tract for obstruction - - - 410 47.000 4 010.00

42410 MR of the kidneys without contrast - - - 410 64.580 5 509.80

42420 MR of the kidneys pre and post contrast - - - 410 102.240 8 722.90

42900 Nuclear Medicine study - Renal imaging, static (e.g. DMSA) 410 21.940 1 871.90 - - -

42905 Nuclear Medicine study - Renal imaging, static (e.g. DMSA) with flow 410 27.960 2 385.50 - - -

42910 Nuclear Medicine study - Renal imaging, static (e.g. DMSA) with SPECT 410 35.350 3 016.00 - - -

42915 Nuclear Medicine study - Renal imaging, static (e.g. DMSA), with flow, with SPECT 410 41.370 3 529.60 - - -

42920 Nuclear Medicine study - Renal imaging dynamic (renogram) and vascular flow 410 26.510 2 261.80 - - -

42930 Nuclear Medicine study – Renovascular study, baseline 410 26.510 2 261.80 - - -

42940 Nuclear Medicine study – Renovascular study, with intervention 410 26.510 2 261.80 - - -

42950 Nuclear medicine study - indirect voiding cystogram 410 6.020 513.60 - - -

Reproductive system - - - - - -


349 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Codes 43120 and 43130 (hystero-salpingography) include fluoroscopy (00140 may not be added). Codes 43230 (U/S ova aspiration) and 43240 (amniocentesis) are complete procedure codes.Codes 43230 (U/S ova aspiration) and 43240 (amniocentesis) are complete procedures and may not be combined with 00230 (ultrasound guidance) or 80605 (fine needle aspiration). Code 43240 may be combined with 43260 (second trimester), 43270 (third trimester) and 43273 (third trimester follow up)

- - - - - -

43100 X-ray pelvimetry single - - - 410 4.000 341.30

43110 X-ray pelvimetry multiple views - - - 410 5.800 494.80

43120 X-ray hystero-salpingography - - - 410 10.030 855.70

43130 X-ray hystero-salpingography with introduction of contrast - - - 410 13.530 1 154.40

43200 Ultrasound study of the pelvis transabdominal - - - 410 5.700 486.30

43205 Ultrasound study of the female pelvis transvaginal - - - 410 7.210 615.10

43210 Ultrasound study of the prostate transrectal - - - 410 7.380 629.70

43215 Ultrasound transrectal prostate volume for brachytherapy - - - 410 10.400 887.30

43220 Ultrasound study of the testes - - - 410 7.380 629.70

43225 Ultrasound study for male impotence including doppler and injection of vaso contrictor - - - 410 15.000 1 279.80

Code 43225 is a stand alone study and may not be added to 43200, 43210, 43220 or 44200 - - - - - -

43230 Ultrasound guided transvaginal aspiration for ova - - - 410 13.500 1 151.80

43240 Ultrasound guided amniocenthesis - - - 410 5.840 498.30

43250 Ultrasound study of the pregnant uterus, first trimester - - - 410 4.200 358.30

43260 Ultrasound study of the pregnant uterus, second trimester - - - 410 6.360 542.60

43270 Ultrasound study of the pregnant uterus, third trimester, first visit - - - 410 6.360 542.60

43273 Ultrasound study of the pregnant uterus, third trimester, follow-up visit - - - 410 4.200 358.30

43277 Ultrasound study of the pregnant uterus, multiple gestation, second or third trimester, first visit - - - 410 8.170 697.10

43280 Ultrasound doppler of the umbilical cord for resistive index - - - 410 3.800 324.20

Code 43280 is a stand alone study and may not be added to the following codes: 43250, 43260, 43270, 43273 or 43277

- - - - - -

43300 CT pelvimetry – Topogram - - - 410 6.580 561.40

43400 MR study of pelvic reproductive organs - limited study - - - 410 47.600 4 061.10

43405 MR study for pelvimetry - - - 410 20.000 1 706.40

43410 MR study of pelvic reproductive organs - complete – uncontrasted - - - 410 64.580 5 509.80

43420 MR study of pelvic reproductive organs - complete – pre and post contrast - - - 410 102.240 8 722.90


350 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

43950 Nuclear medicine study - Radio pharmaceutical voiding cystogram 410 21.500 1 834.30 - - -

43960 Nuclear medicine study - Testicular imaging 410 26.510 2 261.80 - - -

43970 Nuclear medicine study - hystero-salpingography 410 26.510 2 261.80 - - -

43961 PET scan of the testis - - - 411 - -

Aorta and vessels - - - - - -

Code 44400 (MR Angiography) may be combined with 40400 (MR abdomen). - - - - - -

44200 Ultrasound study of abdominal aorta and branches including doppler - - - 410 18.320 1 563.00

44205 Ultrasound study of the IVC and pelvic veins including Doppler - - - 410 14.000 1 194.50

This is a stand alone code and may not be added to 44200. - - -

44300 CT angiography of abdominal aorta and branches - - - 410 76.720 6 545.60

44305 CT angiography of the abdominal aorta and branches and pre and post contrast study of the upper abdomen - - - 410 94.320 8 047.20

44310 CT angiography of the pelvis - - - 410 78.640 6 709.40

44320 CT angiography of the abdominal aorta and pelvis - - - 410 89.540 7 639.40

44325CT angiography of the abdominal aorta and pelvis and pre and post contrast study of the upper abdomen and pelvis

- - - 410 119.150 10 165.60

44330 CT portogram - - - 410 74.400 6 347.70

44400 MR angiography of abdominal aorta and branches - - - 410 76.640 6 538.80

44500 Arteriography of abdominal aorta alone - - - 410 28.120 2 399.10

44503 Arteriography of aorta plus coeliac, mesenteric branches - - - 410 75.630 6 452.60

44505 Arteriography of aorta plus renal, adrenal branches - - - 410 63.010 5 375.90

44507 Arteriography of aorta plus non-visceral branches - - - 410 60.790 5 186.50

44510 Arteriography of coeliac, mesenteric vessels alone - - - 410 64.350 5 490.20

44515 Arteriography of renal, adrenal vessels alone - - - 410 49.490 4 222.40

44517 Arteriography of non-visceral abdominal vessels alone - - - 410 54.910 4 684.80

44520 Arteriography of internal and external iliac vessels alone - - - 410 56.720 4 839.20

44525 Venography of internal and external iliac veins alone - - - 410 62.110 5 299.10

44530 Corpora cavernosography - - - 410 25.060 2 138.10

44535 Vasography, vesciculography - - - 410 29.190 2 490.40

44540 Venography of inferior vena cava - - - 410 26.120 2 228.50

44543 Venography of hepatic veins alone - - - 410 53.770 4 587.60

44545 Venography of inferior vena cava and hepatic veins - - - 410 68.910 5 879.30


351 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

44550 Venography of lumbar azygos system alone - - - 410 43.890 3 744.60

44555 Venography of inferior vena cava and lumbar azygos veins - - - 410 65.460 5 584.90

44560 Venography of renal, adrenal veins alone - - - 410 43.990 3 753.10

44565 Venography of inferior vena cava and renal/adrenal veins - - - 410 68.390 5 834.90

44570 Venography of spermatic, ovarian veins alone - - - 410 40.390 3 446.00

44573 Venography of inferior vena cava, renal, spermatic, ovarian veins - - - 410 73.990 6 312.70

44580 Venography indirect splenoportogram - - - 410 48.670 4 152.40

44583 Venography direct splenoportogram - - - 410 31.590 2 695.20

44587 Venography transhepatic portogram - - - 410 66.750 5 695.00


49900 Nuclear Medicine study – Tumour localisation planar, static 410 20.740 1 769.50 - - -

49905 Nuclear Medicine study – Tumour localisation planar, static, multiple studies 410 35.170 3 000.60 - - -

49910 Nuclear Medicine study – Tumour localisation planar, static and SPECT 410 34.150 2 913.60 - - -

49915 Nuclear medicine study – Tumour localisation planar, static, multiple studies and SPECT 410 47.560 4 057.70 - - -

49920 Nuclear medicine study – Infection localisation planar, static 410 18.040 1 539.10 - - -

49930 Nuclear medicine study – Infection localisation planar, static, multiple studies 410 31.450 2 683.30 - - -

49940 Nuclear medicine study – Infection localisation planar, static and SPECT 410 31.450 2 683.30 - - -

49950 Nuclear medicine study – Infection localisation planar, static, multiple studies and SPECT 410 44.860 3 827.40 - - -

49960 Nuclear medicine study – Regional lymph node mapping dynamic 410 5.010 427.40 - - -

49965 Nuclear medicine study – Regional lymph node mapping, static, planar 410 24.100 2 056.20 - - -

49970 Nuclear medicine study – Regional lymph node mapping, static, planar, multiple 410 37.510 3 200.30 - - -

49975 Nuclear medicine study – Regional lymph node mapping SPECT 410 13.410 1 144.10 - - -


Spine, Pelvis and Hips - - - - - -

Code 51340 (CT myelography, cervical), 52330 (CT myelography thoracic) and 53340 (CT myelography lumbar) are stand alone studies and may not be combined with the conventianla myelography codes viz. 51160, 52150, 53160

- - - - - -

General - - - - - -

Code 50130 (Lumbar puncture) and 50140 (cisternal puncture) include fluoroscopy and introduction of contrast (00140 may not be added).

- - - - - -


352 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

50100 X-ray of the spine scoliosis view AP only - - - 410 7.000 597.20

50105 X-ray of the spine scoliosis view AP and lateral - - - 410 12.000 1 023.80

50110 X-ray of the spine scoliosis view AP and lateral including stress views - - - 410 18.540 1 581.80

50120 X-ray bone densitometry - - - 410 11.520 982.90

50130 X-ray guided lumbar puncture - - - 410 4.800 409.50

50140 X-ray guided cisternal puncture cisternogram - - - 410 22.980 1 960.60

50300 CT quantitive bone mineral density - - - 410 11.830 1 009.30

50500 Arteriogram of the spinal column and cord, all vessels - - - 410 127.230 10 855.00

50510 Venography of the spinal, paraspinal veins - - - 410 58.450 4 986.80

Cervical - - - - - -

Code 51100 (stress) is a stand alone study and may not be added to 51110, 51120 (cervical spine), 51160 (myelography) and 51170 (discography). Code 51140 (tomography) may be combined with 51110 or 51120 (spine). Code 51160s (myelography) and 51170 (discography) include fluoroscopy and introduction of contrast (00140 may not be added). Code 51300 (CT) limited- limited to a single cervical vertebral body. Code 51310 (CT) regional study - 2 vertebral bodies and intervertebral disc spaces. Code 51320 (CT) complete study - an extensive study of the cervical spine. Code 51340 (CT myelography) – post myelographic study and includes all disc levels, includes fluoroscopy and introduction of contrast (00140 may not be added).

- - - - - -

51100 X-ray f the cervical spine, stress views only - - - 410 4.140 353.20

51110 X-ray of the cervical spine, one or two views - - - 410 3.010 256.80

51120 X-ray of the cervical spine, more than two views - - - 410 4.280 365.20

51130 X-ray of the cervical spine, more than two views including stress views - - - 410 7.580 646.70

51140 X-ray Tomography cervical spine - - - 410 4.300 366.90

51160 X-ray myelography of the cervical spine - - - 410 27.460 2 342.80

51170 X-ray discography cervical spine per level - - - 410 25.170 2 147.50

51300 CT of the cervical spine limited study - - - 410 9.500 810.50

51310 CT of the cervical spine – regional study - - - 410 13.910 1 186.80

51320 CT of the cervical spine – complete study - - - 410 37.130 3 167.90

51330 CT of the cervical spine pre and post contrast - - - 410 58.850 5 021.00

51340 CT myelography of the cervical spine - - - 410 47.190 4 026.20


353 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

51350 CT myelography of the cervical spine following myelogram - - - 410 21.690 1 850.60

51400 MR of the cervical spine, limited study - - - 410 44.400 3 788.10

51410 MR of the cervical spine and cranio-cervical junction - - - 410 64.820 5 530.30

51420 MR of the cervical spine and cranio-cervical junction pre and post contrast - - - 410 102.140 8 714.40

51900 Nuclear Medicine study – Bone regional cervical 410 21.500 1 834.30 - - -

51910 Nuclear Medicine study – Bone tomography regional cervical 410 13.410 1 144.10 - - -

51920 Nuclear Medicine study – with flow 410 6.020 513.60 - - -

Thoracic - - - - - -

Code 52120 (tomography) may be combined with 52100 or 52110 (spine). Code 52150 (myelography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code 52300 (CT) limited study – limited to a single thoracic vertebral body. Code 52305 (CT) regional study - 2 vertebral bodies and intervertebral disc paces. Code 52310 (CT) complete study - an extensive study of the thoracic spine. Code 52330 (CT myelography)- post myelographic study and includes all disc levels, fluoroscopy and introduction of contrast (00140 may not be added).

- - - - - -

52100 X-ray of the thoracic spine, one or two views - - - 410 3.210 273.90

52110 X-ray of the thoracic spine, more than two views - - - 410 4.000 341.30

52120 X-ray tomography thoracic spine - - - 410 4.300 366.90

52140 X-ray of the thoracic spine, more that two views including stress views - - - 410 6.640 566.50

52150 X-ray myelography of the thoracic spine - - - 410 18.620 1 588.60

52300 CT of the thoracic spine limited study - - - 410 9.500 810.50

52305 CT of the thoracic spine – regional study - - - 410 13.910 1 186.80

52310 CT of the thoracic spine complete study - - - 410 35.780 3 052.70

52320 CT of the thoracic spine pre and post contrast - - - 410 58.850 5 021.00

52330 CT myelography of the thoracic spine - - - 410 48.090 4 102.90

52340 CT myelography of the thoracic spine following myelogram - - - 410 20.370 1 737.90

52400 MR of the thoracic spine, limited study - - - 410 46.600 3 975.80

52410 MR of the thoracic spine - - - 410 64.340 5 489.40

52420 MR of the thoracic spine pre and post contrast - - - 410 101.420 8 653.00

52900 Nuclear Medicine study – Bone regional dorsal 410 21.500 1 834.30 - - -

52910 Nuclear Medicine study – Bone tomography regional dorsal 410 13.410 1 144.10 - - -

52920 Nuclear Medicine study – with flow 410 6.020 513.60 - - -


354 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Lumbar

Code 53100 (stress) is a stand alone study and may not be added to 53110, 53120 (lumbar spine), 53160 (myelography) and 53170 (discography). Code 53140 (tomography) may be combined with 53110 or 53120 (spine). Codes 53160 (myelography) and 53170 (discography) include fluoroscopy and introduction of contrast (00140 may not be added). Code 53300 (CT) limited study – limited to a single lumbar vertebral body. Code 53310 (CT) regional study - 2 vertebral bodies and intervertebral disc spaces. Code 53320 (CT) complete study - an extensive study of the lumbar spine.Code 53340 (CT myelography) - post myelographic study and includes all disc levels, fluoroscopy and introduction of contrast (00140 may not be added).

- - - - - -

53100 X-ray of the lumbar spine – stress study only - - - 410 4.140 353.20

53110 X-ray of the lumbar spine, one or two views - - - 410 3.560 303.70

53120 X-ray of the lumbar spine, more than two views - - - 410 4.460 380.50

53130 X-ray of the lumbar spine, more that two views including stress views - - - 410 7.520 641.60

53140 X-ray tomography lumbar spine - - - 410 4.300 366.90

53160 X-ray myelography of the lumbar spine - - - 410 23.940 2 042.50

53170 X-ray discography lumbar spine per level - - - 410 25.170 2 147.50

53300 CT of the lumbar spine limited study - - - 410 9.500 810.50

53310 CT of the lumbar spine – regional study - - - 410 13.910 1 186.80

53320 Ct of the lumbar spine complete study - - - 410 37.640 3 211.40

53330 CT of the lumbar spine pre and post contrast - - - 410 58.850 5 021.00

53340 CT myelography of the lumbar spine - - - 410 49.110 4 190.00

53350 CT myelography of the lumbar spine following myelogram - - - 410 23.460 2 001.60

53400 MR of the lumbar spine, limited study - - - 410 46.200 3 941.70

53410 MR of the lumbar spine - - - 410 64.320 5 487.70

53420 MR of the lumbar spine pre and post contrast - - - 410 103.290 8 812.50

53900 Nuclear medicine study – Bone regional lumbar 410 21.500 1 834.30 - - -

53910 Nuclear medicine study – Bone tomography regional lumbar 410 13.410 1 144.10 - - -

53920 Nuclear medicine study – with flow 410 6.020 513.60 - - -

Sacrum - - - - - -


355 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Code 54120 (tomography) may be combined with 54100 (sacrum) or 54110 (SI joints). Code 54300 (CT) limited study - limited to single sacral vertebral body. Code 54310 (CT) complete study - an extensive study of the sacral spine.

- - - - - -

54100 X-ray of the sacrum and coccyx - - - 410 3.580 305.40

54110 X-ray of the sacro-iliac joints - - - 410 4.100 349.80

54120 X-ray tomography – sacrum and/or coccyx - - - 410 4.300 366.90

54300 CT of the sacrum – limited study - - - 410 7.600 648.40

54310 CT of the sacrum – complete study – uncontrasted - - - 410 25.610 2 185.00

54320 CT of the sacrum with contrast - - - 410 46.930 4 004.00

54330 CT of the sacrum pre and post contrast - - - 410 52.970 4 519.30

54400 MR of the sacrum - - - 410 65.000 5 545.70

54410 MR of the sacrum pre and post contrast - - - 410 101.040 8 620.50

Pelvis - - - - - -

Codes 55110 (tomography) and 55100 (pelvis) may be combined. Code 55300 (CT) limited study – limited to a small region of interest of the pelvis eg. ascetabular roof or pubic ramus.

- - - - - -

55100 X-ray of the pelvis - - - 410 3.660 312.30

55110 X-ray tomography – pelvis - - - 410 4.300 366.90

55300 CT of the bony pelvis limited - - - 410 9.500 810.50

55310 CT of the bony pelvis complete uncontrasted - - - 410 25.610 2 185.00

55320 CT of the bony pelvis complete 3D recon - - - 410 37.470 3 196.90

55330 CT of the bony pelvis with contrast - - - 410 46.930 4 004.00

55340 CT of the bony pelvis – pre and post contrast - - - 410 52.970 4 519.30

55400 MR of the bony pelvis - - - 410 65.000 5 545.70

55410 MR of the bony pelvis pre and post contrast - - - 410 102.240 8 722.90

55900 Nuclear medicine study – Bone regional pelvis 410 21.500 1 834.30 - - -

55910 Nuclear medicine study – Bone tomography regional pelvis 410 13.410 1 144.10 - - -

55920 Nuclear medicine study – with flow 410 6.020 513.60 - - -

Hips - - - - - -


356 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Code 56130 (tomography) may be combined with 56100 or 56110 or 56120 (hip). Code 56140 (stress) may be combined with 56100 or 56110 or 56120 (hip). Code 56150 (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code 56160 (introduction of contrast into hip joint) to be used with 56310 (CT hip) and 56410 (MR hip) and includes fluoroscopy. The combination of 56150 and 56310 and 56410 is not supported except in exceptional circumstances with motivation. Code 56300 (CT) study limited to small region of interest eg part of femur head.

- - - - - -

56100 X-ray of the left hip - - - 410 3.180 271.30

56110 X-ray of the right hip - - - 410 3.180 271.30

56120 X-ray pelvis and hips - - - 410 6.020 513.60

56130 X-ray tomography – hip - - - 410 4.300 366.90

56140 X-ray of the hip/s – stress study - - - 410 4.380 373.70

56150 X-ray arthrography of the hip joint including introduction contrast - - - 410 15.750 1 343.80

56160 X-ray guidance and introduction of contrast into hip joint only - - - 410 7.410 632.20

56200 Ultrasound of the hip joints - - - 410 6.500 554.60

56300 CT of hip – limited - - - 410 9.500 810.50

56310 CT of hip – complete - - - 410 27.370 2 335.20

56320 CT of hip – complete with 3D recon - - - 410 39.780 3 394.00

56330 CT of hip with contrast - - - 410 43.260 3 690.90

56340 CT of hip pre and post contrast - - - 410 47.880 4 085.00

56400 MR of the hip joint/s, limited study - - - 410 44.900 3 830.80

56410 MR of the hip joint/s - - - 410 64.100 5 468.90

56420 MR of the hip joint/s, pre and post contrast - - - 410 101.640 8 671.70

56900 Nuclear medicine study – Bone regional pelvis 410 21.500 1 834.30 - - -

56910 Nuclear medicine study – Bone limited static plus flow 410 27.530 2 348.80 - - -

56920 Nuclear medicine study – Bone tomography regional 410 13.410 1 144.10 - - -

Upper limbs - - - - - -

General - - - - - -


357 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Code 60100 (stress only) is a stand alone study and may not be combined with other codes. Code 60110 (tomography) may be combined with any one of the defined regional x-ray studies of the upper limb. Motivation may be required for more than one regional tomographic study per visit. Code 60200 (U/S) may only be used once per visit. Code 60300 (CT) limited study – limited to a small region of interest eg. part of humeral head. Code 60400 (MR limited) may only be used once per visit.

- - - - - -

60100 X-ray upper limbs - any region - stress studies only - - - 410 4.520 385.60

60110 X-ray upper limbs - any region – tomography - - - 410 4.300 366.90

60200 Ultrasound upper limb – soft tissue - any region - - - 410 7.380 629.70

60210 Ultrasound of the peripheral arterial system of the left arm including B mode, pulse and colour doppler - - - 410 13.640 1 163.70

60220 Ultrasound of the peripheral arterial system of the right arm including B mode, pulse and colour doppler - - - 410 13.640 1 163.70

60230 Ultrasound peripheral venous system upper limbs including pulse and colour doppler for deep vein thrombosis - - - 410 12.540 1 069.90

60240 Ultrasound peripheral venous system upper limbs including pulse and colour doppler - - - 410 17.260 1 472.60

60300 CT of the upper limbs limited study - - - 410 9.500 810.50

60310 CT angiography of the upper limb - - - 410 78.280 6 678.70

60400 MR of the upper limbs limited study, any region - - - 410 44.800 3 822.30

60410 MR angiography of the upper limb - - - 410 74.660 6 369.80

60500 Arteriogram of subclavian, upper limb arteries alone, unilateral - - - 410 45.670 3 896.50

60510 Arteriogram of subclavian, upper limb arteries alone, bilateral - - - 410 82.670 7 053.20

60520 Arteriogram of aortic arch, subclavian, upper limb, unilateral - - - 410 56.750 4 841.80

60530 Arteriogram of aortic arch, subclavian, upper limb, bilateral - - - 410 88.110 7 517.40

60540 Venography, antegrade of upper limb veins, unilateral - - - 410 26.120 2 228.50

60550 Venography, antegrade of upper limb veins, bilateral - - - 410 49.430 4 217.30

60560 Venography, retrograde of upper limb veins, unilateral - - - 410 31.010 2 645.70

60570 Venography, retrograde of upper limb veins, bilateral - - - 410 54.810 4 676.30

60580 Venography, shuntogram, dialysis access shunt - - - 410 23.790 2 029.70

60900 Nuclear medicine study – Venogram upper limb 410 37.120 3 167.00 - - -

Shoulder - - - - - -

Code 61160 (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code 61170 (introduction of contrast into the shoulder joint) may be combined with 61300 and 61305 (CT), or 61400 and 61405 (MR). The combination of 61160 (arthrography) and 61300 and 61305 (CT) or 61400 and 61405 (MR) is not supported except in exceptional circumstances with motivation.

- - - - - -


358 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

61100 X-ray of the left clavicle - - - 410 3.040 259.40

61105 X-ray of the right clavicle - - - 410 3.040 259.40

61110 X-ray of the left scapula - - - 410 3.040 259.40

61115 X-ray of the right scapula - - - 410 3.040 259.40

61120 X-ray of the left acromio-clavicular joint - - - 410 3.140 267.90

61125 X-ray of the right acromio-clavicular joint - - - 410 3.140 267.90

61128 X-ray of acromio-clavicular joints plus stress studies bilateral - - - 410 7.680 655.20

61130 X-ray of the left shoulder - - - 410 3.480 296.90

61135 X-ray of the right shoulder - - - 410 3.480 296.90

61140 X-ray of the left shoulder plus subacromial impingement views - - - 410 5.920 505.10

61145 X-ray of the right shoulder plus subacromial impingement views - - - 410 5.920 505.10

61150 X-ray of the left subacromial impingement views only - - - 410 3.240 276.40

61155 X-ray of the right subacromial impingement views only - - - 410 3.240 276.40

61160 X-ray arthrography shoulder joint including introduction of contrast - - - 410 15.830 1 350.60

61170 X-ray guidance and introduction of contrast into shoulder joint only - - - 410 7.410 632.20

61200 Ultrasound of the left shoulder joint - - - 410 6.500 554.60

61210 Ultrasound of the right shoulder joint - - - 410 6.500 554.60

61300 CT of the left shoulder joint – uncontrasted - - - 410 24.360 2 078.40

61305 CT of the right shoulder joint – uncontrasted - - - 410 24.360 2 078.40

61310 CT of the left shoulder – complete with 3D recon - - - 410 37.660 3 213.10

61315 CT of the right shoulder – complete with 3D recon - - - 410 37.660 3 213.10

61320 CT of the left shoulder joint - pre and post contrast - - - 410 48.630 4 149.00

61325 CT of the right shoulder joint - pre and post contrast - - - 410 48.630 4 149.00

61400 MR of the left shoulder - - - 410 64.640 5 515.00

61405 MR of the right shoulder - - - 410 64.640 5 515.00

61410 MR of the left shoulder pre and post contrast - - - 410 101.040 8 620.50

61415 MR of the right shoulder pre and post contrast - - - 410 101.040 8 620.50

Humerus - - - - - -

62100 X-ray of the left humerus - - - 410 2.940 250.80

62105 X-ray of the right humerus - - - 410 2.940 250.80

62300 CT of the left upper arm - - - 410 24.360 2 078.40


359 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

62305 CT of the right upper arm - - - 410 24.360 2 078.40

62310 CT of the left upper arm contrasted - - - 410 39.970 3 410.20

62315 CT of the right upper arm contrasted - - - 410 39.970 3 410.20

62320 CT of the left upper arm pre and post contrast - - - 410 48.580 4 144.80

62325 CT of the right upper arm pre and post contrast - - - 410 48.580 4 144.80

62400 MR of the left upper arm - - - 410 64.200 5 477.40

62405 MR of the right upper arm - - - 410 64.200 5 477.40

62410 MR of the left upper arm pre and post contrast - - - 410 102.040 8 705.90

62415 MR of the right upper arm pre and post contrast - - - 410 102.040 8 705.90

62900 Nuclear medicine study – Bone limited/regional static 410 21.500 1 834.30 - - -



Elbow - - - - - -

Code 63120 (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code 63130 (introduction of contrast) may be combined with 63300 and 63305 (CT) or 63400 and 63405 (MR). The combination of 63120 (arthrography) and 63300 and 63305 or 63400 and 63405 (MR) is not supported except in exceptional circumstances with motivation.

- - - - - -

63100 X-ray of the left elbow - - - 410 3.140 267.90

63105 X-ray of the right elbow - - - 410 3.140 267.90

63110 X-ray of the left elbow with stress - - - 410 4.340 370.30

63115 X-ray of the right elbow with stress - - - 410 4.340 370.30

63120 X-ray arthrography elbow joint including introduction of contrast - - - 410 15.890 1 355.70

63130 X-ray guidance and introductionof contrast into elbow joint only - - - 410 7.410 632.20

63200 Ultrasound of the left elbow joint - - - 410 6.500 554.60

63205 Ultrasound of the right elbow joint - - - 410 6.500 554.60

63300 CT of the left elbow - - - 410 24.360 2 078.40

63305 CT of the right elbow - - - 410 24.360 2 078.40

63310 CT of the left elbow – complete with 3D recon - - - 410 37.660 3 213.10

63315 CT of the right elbow – complete with 3D recon - - - 410 37.660 3 213.10

63320 CT of the left elbow contrasted - - - 410 39.970 3 410.20

63325 CT of the right elbow contrasted - - - 410 39.970 3 410.20


360 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

63330 CT of the left elbow pre and post contrast - - - 410 48.630 4 149.00

63335 CT of the right elbow pre and post contrast - - - 410 48.630 4 149.00

63400 MR of the left elbow - - - 410 64.640 5 515.00

63405 MR of the right elbow - - - 410 64.640 5 515.00

63410 MR of the left elbow pre and post contrast - - - 410 101.040 8 620.50

63415 MR of the right elbow pre and post contrast - - - 410 101.040 8 620.50




Forearm - - - - - -

64100 X-ray of the left forearm - - - 410 2.940 250.80

64105 X-ray of the right forearm - - - 410 2.940 250.80

64110 X-ray peripheral bone densitometry - - - 410 1.960 167.20

64300 CT of the left forearm - - - 410 24.360 2 078.40

64305 CT of the right forearm - - - 410 24.360 2 078.40

64310 CT of the left forearm contrasted - - - 410 39.970 3 410.20

64315 CT of the right forearm contrasted - - - 410 39.970 3 410.20

64320 CT of the left forearm pre and post contrast - - - 410 48.580 4 144.80

64325 CT of the right forearm pre and post contrast - - - 410 48.580 4 144.80

64400 MR of the left forearm - - - 410 64.200 5 477.40

64405 MR of the right forearm - - - 410 64.200 5 477.40

64410 MR of the left forearm pre and post contrast - - - 410 98.040 8 364.60

64415 MR of the right forearm pre and post contrast - - - 410 98.040 8 364.60




Hand and Wrist - - - - - -


361 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Code 65120 (finger) may not be combined with 65100 or 65105 (hands). Codes 65130 and 65135 (wrists) may be combined with 65140 or 65145 (scaphoid) respectively if requested and additional views done. Code 65160 (arthrography) includes fluoroscopy and the introduction of contrast (00140 may not be added). Code 65170 (contrast) may be combined with 65300 and 65305 (CT) or 65400 and 65405 (MR). The combination of 65160 (arthrography) and 65300 and 65305 or 65400 and 65405 is not supported except in exceptional circumstances with motivation.

- - - - - -

65100 X-ray of the left hand - - - 410 3.080 262.80

65105 X-ray of the right hand - - - 410 3.080 262.80

65110 X-ray of the left hand – bone age - - - 410 3.080 262.80

65120 X-ray of a finger - - - 410 2.670 227.80

65130 X-ray of the left wrist - - - 410 3.180 271.30

65135 X-ray of the right wrist - - - 410 3.180 271.30

65140 X-ray of the left scaphoid - - - 410 3.300 281.60

65145 X-ray of the right scaphoid - - - 410 3.300 281.60

65150 X-ray of the left wrist, scaphoid and stress views - - - 410 7.560 645.00

65155 X-ray of the right wrist, scaphoid and stress views - - - 410 7.560 645.00

65160 X-ray arthrography wrist joint including introduction of contrast - - - 410 15.930 1 359.10

65170 X-ray guidance and introduction of contrast into wrist joint only - - - 410 7.410 632.20

65200 Ultrasound of the left wrist - - - 410 6.500 554.60

65210 Ultrasound of the right wrist - - - 410 6.500 554.60

65300 CT of the left wrist and hand - - - 410 24.360 2 078.40

65305 CT of the right wrist and hand - - - 410 24.360 2 078.40

65310 CT of the left wrist and hand - complete with 3D recon - - - 410 37.660 3 213.10

65315 CT of the right wrist and hand - complete with 3D recon - - - 410 37.660 3 213.10

65320 CT of the left wrist and hand contrasted - - - 410 39.970 3 410.20

65325 CT of the right wrist and hand contrasted - - - 410 39.970 3 410.20

65330 CT of the left wrist and hand pre and post contrast - - - 410 48.630 4 149.00

65335 CT of the right wrist and hand pre and post contrast - - - 410 48.630 4 149.00

65400 MR of the left wrist and hand - - - 410 64.640 5 515.00

65405 MR of the right wrist and hand - - - 410 64.640 5 515.00

65410 MR of the left wrist and hand pre and post contrast - - - 410 101.040 8 620.50


362 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

65415 MR of the right wrist and hand pre and post contrast - - - 410 101.040 8 620.50

65900 Nuclear Medicine study – bone limited/regional static 410 21.500 1 834.30 - - -

65905 Nuclear Medicine study – bone limited static plus flow 410 27.530 2 348.80 - - -

65910 Nuclear Medicine study – bone tomography regional 410 13.410 1 144.10 - - -


69900 Nuclear medicine study – Tumour localisation planar, static 410 20.740 1 769.50 - - -

69905 Nuclear medicine study – Tumour localisation planar, static, multiple studies 410 35.170 3 000.60 - - -

69910 Nuclear medicine study – Tumour localisation planar, static and SPECT 410 34.150 2 913.60 - - -

69915 Nuclear medicine study – Tumour localisation planar, static, multiple studies and SPECT 410 47.560 4 057.70 - - -

69920 Nuclear medicine study – Infection localisation planar, static 410 18.040 1 539.10 - - -

69925 Nuclear medicine study – Infection localisation planar, static, multiple studies 410 31.450 2 683.30 - - -

69930 Nuclear medicine study – Infection localisation planar, static and SPECT 410 31.450 2 683.30 - - -

69935 Nuclear medicine study – Infection localisation planar, static, multiple studies and SPECT 410 44.860 3 827.40 - - -

69940 Nuclear medicine study – Regional lymph node mapping dynamic 410 6.020 513.60 - - -

69945 Nuclear medicine study – Regional lymph node mapping, static, planar 410 24.100 2 056.20 - - -

69950 Nuclear medicine study – Regional lymph node mapping, static, planar, multiple 410 37.510 3 200.30 - - -

69955 Nuclear medicine study – Regional lymph node mapping SPECT 410 13.410 1 144.10 - - -


Lower Limbs - - - - - -

General - - - - - -

Code 70100 (stress) is a stand alone study and may not be combined with other codes. Code 70110 (tomography) may be combined with any one of the defined regional x-ray studies of the lower limb. Motivation may be required for more than one regional tomographic study per visit. Code 70200 (U/S) may only be billed once per visit. Code 70300 ((CT) limited study – limited to a small region of interest eg part of condyle of the knee. Codes 70310 and 70320 (CT angiography) may not be combined. Code 70400 (MR limited) may only be used once per visit. Code 70410 and 70420 (MR angiography) may not be combined.

- - - - - -

70100 X-ray lower limbs - any region- stress studies only - - - 410 4.520 385.60

70110 X-ray lower limbs - any region-tomography - - - 410 4.300 366.90

70120 X-ray of the lower limbs full length study - - - 410 6.460 551.20

70200 Ultrasound lower limb – soft tissue - any region - - - 410 7.380 629.70


363 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

70210 Ultrasound of the peripheral arterial system of the left leg including B mode, pulse and colour Doppler - - - 410 13.640 1 163.70

70220 Ultrasound of the peripheral arterial system of the right leg including B mode, pulse and colour Doppler - - - 410 13.640 1 163.70

70230 Ultrasound peripheral venous system lower limbs including pulse and colour doppler for deep vein thrombosis - - - 410 13.640 1 163.70

70240Ultrasound peripheral venous system lower limbs including pulse and colour doppler in erect and supine position including all compression and reflux manoeuvres, deep and superficial systems bilaterally

- - - 410 19.660 1 677.40

70300 CT of the lower limbs limited study - - - 410 9.500 810.50

70310 CT angiography of the lower limb - - - 410 79.430 6 776.80

70320 CT angiography abdominal aorta and outflow lower limbs - - - 410 98.340 8 390.20

70400 MR of the lower limbs limited study - - - 410 46.400 3 958.80

70410 MR angiography of the lower limb - - - 410 76.660 6 540.50

70420 MR angiography of the abdominal aorta and lower limbs - - - 410 118.860 10 140.90

70500 Angiography of pelvic and lower limb arteries unilateral - - - 410 40.590 3 463.10

70505 Angiography of pelvic and lower limb arteries bilateral - - - 410 75.920 6 477.30

70510 Angiography of abdominal aorta, pelvic and lower limb vessels unilateral - - - 410 61.230 5 224.00

70515 Angiography of abdominal aorta, pelvic and lower limb vessels bilateral - - - 410 85.660 7 308.30

70520 Angiography translumbar aorta with full peripheral study - - - 410 45.680 3 897.30

70530 Venography, antegrade of lower limb veins, unilateral - - - 410 25.460 2 172.20

70535 Venography, antegrade of lower limb veins, bilateral - - - 410 49.430 4 217.30

70540 Venography, retrograde of lower limb veins, unilateral - - - 410 31.170 2 659.40

70545 Venography, retrograde of lower limb veins, bilateral - - - 410 56.790 4 845.20

70560 Lymphangiography, lower limb, unilateral - - - 410 51.040 4 354.60

70565 Lymphangiography, lower limb, bilateral - - - 410 83.970 7 164.20

70900 Nuclear medicine study – Venogram lower limb 410 37.120 3 167.00 - - -

Femur - - - - - -

71100 X-ray of the left femur - - - 410 2.940 250.80

71105 X-ray of the right femur - - - 410 2.940 250.80

71300 CT of the left femur - - - 410 24.520 2 092.00

71305 CT of the right femur - - - 410 24.520 2 092.00

71310 CT of the left upper leg contrasted - - - 410 41.830 3 568.90

71315 CT of the right upper leg contrasted - - - 410 41.830 3 568.90

71320 CT of the left upper leg pre and post contrast - - - 410 49.710 4 241.20


364 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

71325 CT of the right upper leg pre and post contrast - - - 410 49.710 4 241.20

71400 MR of the left upper leg - - - 410 64.800 5 528.60

71405 MR of the right upper leg - - - 410 64.800 5 528.60

71410 MR of the left upper leg pre and post contrast - - - 410 102.040 8 705.90

71415 MR of the right upper leg pre and post contrast - - - 410 102.040 8 705.90


71905 Nuclear Medicine study – Bone limited static plus flow 410 27.530 2 348.80 - - -

71910 Nuclear Medicine study – Bone tomography regional 410 13.410 1 144.10 - - -

Knee - - -

Codes 72140and 72145 (patella) may not be added to 72100, 72105, 72110, 72115, 72130, 72135 (knee views) Code 72160 (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code 72170 (introduction of contrast) may be combined with 72300 and 72305 (CT) or 72400 and 72405 (MR). The combination of 72160 (arthrography) and 72300 and 72305 (CT) or 72400 and 72405 (MR) is not supported except in exceptional circumstances with motivation.

- - - - - -

72100 X-ray of the left knee one or two views - - - 410 2.770 236.30

72105 X-ray of the right knee one or two views - - - 410 2.770 236.30

72110 X-ray of the left knee, more than two views - - - 410 3.320 283.30

72115 X-ray of the right knee, more than two views - - - 410 3.320 283.30

72120 X-ray of the left knee including patella - - - 410 4.620 394.20

72125 X-ray of the right knee including patella - - - 410 4.620 394.20

72130 X-ray of the left knee with stress views - - - 410 5.820 496.60

72135 X-ray of the right knee with stress views - - - 410 5.820 496.60

72140 X-ray of left patella - - - 410 2.770 236.30

72145 X-ray of right patella - - - 410 2.770 236.30

72150 X-ray both knees standing – single view - - - 410 2.800 238.90

72160 X-ray arthrography knee joint including introduction of contrast - - - 410 15.810 1 348.90

72170 X-ray guidance and introduction of contrast into knee joint only - - - 410 7.410 632.20

72200 Ultrasound of the left knee joint - - - 410 6.500 554.60

72205 Ultrasound of the right knee joint - - - 410 6.500 554.60

72300 CT of the left knee - - - 410 24.520 2 092.00

72305 CT of the right knee - - - 410 24.520 2 092.00


365 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

72310 CT of the left knee complete study with 3D reconstructions - - - 410 35.930 3 065.50

72315 CT of the right knee complete study with 3D reconstructions - - - 410 35.930 3 065.50

72320 CT of the left knee contrasted - - - 410 41.830 3 568.90

72325 CT of the right knee contrasted - - - 410 41.830 3 568.90

72330 CT of the left knee pre and post contrast - - - 410 49.760 4 245.40

72335 CT of the right knee pre and post contrast - - - 410 49.760 4 245.40

72400 MR of the left knee - - - 410 64.100 5 468.90

72405 MR of the right knee - - - 410 64.100 5 468.90

72410 MR of the left knee pre and post contrast - - - 410 100.840 8 603.50

72415 MR of the right knee pre and post contrast - - - 410 100.840 8 603.50

72900 Nuclear Medicine study – Bone limited/regional static 410 21.500 1 834.30 - - -



Lower Leg - - - - - -

73100 X-ray of the left lower leg - - - 410 2.940 250.80

73105 X-ray of the right lower leg - - - 410 2.940 250.80

73300 CT of the left lower leg - - - 410 24.520 2 092.00

73305 CT of the right lower leg - - - 410 24.520 2 092.00

73310 CT of the left lower leg contrasted - - - 410 41.830 3 568.90

73315 CT of the right lower leg contrasted - - - 410 41.830 3 568.90

73320 CT of the left lower leg pre and post contrast - - - 410 49.710 4 241.20

73325 CT of the right lower leg pre and post contrast - - - 410 49.710 4 241.20

73400 MR of the left lower leg - - - 410 64.200 5 477.40

73405 MR of the right lower leg - - - 410 64.200 5 477.40

73410 MR of the left lower leg pre and post contrast - - - 410 102.040 8 705.90

73415 MR of the right lower leg pre and post contrast - - - 410 102.040 8 705.90


73905 Nuclear Medicine study – bone limited static plus flow 410 27.530 2 348.80 - - -

73910 Nuclear Medicine study – bone tomography regional 410 13.410 1 144.10 - - -

Ankle and Foot - - - - - -


366 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Code 74145 (toe) may not be combined with 74120 or 74125 (foot). Code 71450 (sesamoid bones) may be combined with 74120 or 74125 (foot) if requested. Codes 74120 and 74125 (foot) may only be combined with 74130 and 74135 (calcaneus) if specifically requested. Code 74160 (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code 74170 (introduction of contrast) may be combined with 74300 and 74305 (CT) or 74400 and 74405 (MR). The combination of 74160 (arthrography) and 74300 and 74305 (CT) or 74400 and 74405 (MR) are not supported except in exceptional circumstances with motivation.

- - - - - -

74100 X-ray of the left ankle - - - 410 3.320 283.30

74105 X-ray of the right ankle - - - 410 3.320 283.30

74110 X-ray of the left ankle with stress views - - - 410 4.520 385.60

74115 X-ray of the right ankle with stress views - - - 410 4.520 385.60

74120 X-ray of the left foot - - - 410 2.800 238.90

74125 X-ray of the right foot - - - 410 2.800 238.90

74130 X-ray of the left calcaneus - - - 410 2.740 233.80

74135 X-ray of the right calcaneus - - - 410 2.740 233.80

74140 X-ray of both feet – standing – single view - - - 410 2.800 238.90

74145 X-ray of a toe - - - 410 2.670 227.80

74150 X-ray of the sesamoid bones one or both sides - - - 410 2.800 238.90

74160 X-ray arthrography ankle joint including introduction of contrast - - - 410 15.910 1 357.40

74170 X-ray guidance and introduction of contrast into ankle joint - - - 410 7.410 632.20

74210 Ultrasound of the left ankle - - - 410 6.500 554.60

74215 Ultrasound of the right ankle - - - 410 6.500 554.60

74220 Ultrasound of the left foot - - - 410 6.500 554.60

74225 Ultrasound of the right foot - - - 410 6.500 554.60

74290 Ultrasound bone densitometry - - - 410 2.040 174.10

74300 CT of the left ankle/foot - - - 410 24.520 2 092.00

74305 CT of the right ankle/foot - - - 410 24.520 2 092.00

74310 CT of the left ankle/foot – complete with 3D recon - - - 410 37.810 3 225.90

74315 CT of the right ankle/foot – complete with 3D recon - - - 410 37.810 3 225.90

74320 CT of the left ankle/foot contrasted - - - 410 41.830 3 568.90

74325 CT of the right ankle/foot contrasted - - - 410 41.830 3 568.90


367 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

74330 CT of the left ankle/foot pre and post contrast - - - 410 49.710 4 241.20

74335 CT of the right ankle/foot pre and post contrast - - - 410 49.710 4 241.20

74400 MR of the left ankle - - - 410 64.100 5 468.90

74405 MR of the right ankle - - - 410 64.100 5 468.90

74410 MR of the left ankle pre and post contrast - - - 410 100.640 8 586.40

74415 MR of the right ankle pre and post contrast - - - 410 100.640 8 586.40

74420 MR of the left foot - - - 410 64.200 5 477.40

74425 MR of the right foot - - - 410 64.200 5 477.40

74430 MR of the left foot pre and post contrast - - - 410 102.040 8 705.90

74435 MR of the right foot pre and post contrast - - - 410 102.040 8 705.90

74900 Nuclear Medicine study – Bone limited/regional static 410 21.500 1 834.30 - - -




79900 Nuclear Medicine study – Tumour localisation planar, static 410 20.740 1 769.50 - - -

79905 Nuclear Medicine study – Tumour localisation planar, static, multiple studies 410 35.170 3 000.60 - - -

79910 Nuclear Medicine study – Tumour localisation planar, static and SPECT 410 34.150 2 913.60 - - -

79915 Nuclear Medicine study – Tumour localisation planar, static, multiple studies & SPECT 410 47.560 4 057.70 - - -

79920 Nuclear Medicine study – Infection localisation planar, static 410 18.430 1 572.40 - - -

79925 Nuclear Medicine study – Infection localisation planar, static, multiple studies 410 31.840 2 716.50 - - -

79930 Nuclear Medicine study – Infection localisation planar, static and SPECT 410 31.840 2 716.50 - - -

79935 Nuclear Medicine study – Infection localisation planar, static, multiple studies and SPECT 410 45.250 3 860.60 - - -

79940 Nuclear Medicine study – Regional lymph node mapping dynamic 410 6.020 513.60 - - -

79945 Nuclear Medicine study – Regional lymph node mapping, static, planar 410 24.100 2 056.20 - - -

79950 Nuclear Medicine study – Regional lymph node mapping, static, planar, multiple studies 410 37.510 3 200.30 - - -

79955 Nuclear Medicine study – Regional lymph node mapping and SPECT 410 13.410 1 144.10 - - -

79960 Nuclear Medicine study – Lymph node localisation with gamma probe 410 13.410 1 144.10 - - -

Intervention - - - - - -

General - - - - - -


368 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Codes 80600, 80605, 80610, 80620, 80630, 81660, 81680, 82600, 84660, 85640, 85645, 86610, 86615, 86620, 86630, (aspiration / biopsy / ablations etc) may be combined with the relevant guidance codes (fluoroscopy, ultrasound, CT, MR) as previously described. The machine codes 00510, 00520, 00530, 00540, 00550, 00560 may not be combined with these codes. If ultrasound guidance (00230) is used for a procedure which also attracts one of the machine codes (00510, 00520, 00530, 00540, 00550, 00560), it may not be billed for separately. Codes 80640, 80645, 87682, 87683 include fluoroscopy. Machine fees may not be added. All other interventional procedures are complete unique procedures describing a whole comprehensive procedure and combinations of different codes will only be supported when motivated.

- - - - - -

80600 Percutaneous abscess, cyst drainage, any region - - - 410 9.370 799.40

80605 Fine needle aspiration biopsy, any region - - - 410 4.220 360.00

80610 Cutting needle, trochar biopsy, any region - - - 410 6.360 542.60

80620 Tumour/cyst ablation chemical - - - 410 25.370 2 164.50

80630 Tumour ablation radio frequency, per lesion - - - 410 21.210 1 809.60

80640 Insertion of CVP line in radiology suite - - - 410 8.990 767.00

80645 Peripheral central venous line insertion - - - 410 12.120 1 034.10

80650 Infiltration of a peripheral joint, any region - - - 410 6.400 546.00

May be combined with relevant guidance (fluoroscopy, ultrasound, CT and MR). May not be combined with machine codes 00510, 00520, 00530, 00540, 00550, 00560 or 86610 (facet joint or SI joint) or arthrogram codes.

- - - - - -

Neuro intervention - - - - - -

81600 Intracranial aneurysm occlusion, direct - - - 410 214.520 18 302.40

81605 Intracranial arteriovenous shunt occlusion - - - 410 254.820 21 740.70

81610 Dural sinus arteriovenous shunt occlusion - - - 410 264.330 22 552.10

81615 Extracranial arteriovenous shunt occlusion - - - 410 157.280 13 418.80

81620 Extracranial arterial embolisation (head and neck) - - - 410 163.120 13 917.10

81625 Caroticocavernous fistula occlusion - - - 410 192.290 16 405.80

81630 Intracranial angioplasty for stenosis, vasospasm - - - 410 126.920 10 828.60

81632 Intracranial stent placement (including PTA) - - - 410 133.720 11 408.70

81635 Temporary balloon occlusion test - - - 410 83.420 7 117.20

Code 81635 does not include the relevant preceding diagnostic study and may be combined with codes 10500, 10510, 10530, 10540, 10550.

- - - - - -

81640 Permanent carotid or vertebral artery occlusion (including occlusiontest) - - - 410 178.180 15 202.00


369 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

81645 Intracranial aneurysm occlusion with balloon remodelling - - - 410 216.350 18 458.60

81650 Intracranial aneurysm occlusion with stent assistance - - - 410 230.450 19 661.50

81655 Intracranial thrombolysis, catheter directed - - - 410 58.940 5 028.60

Code 81655 may be combined with any of the other neuro interventional codes 81600 to 81650 - - - - - -

81660 Nerve block, head and neck, per level - - - 410 7.660 653.50

81665 Neurolysis, head and neck, per level - - - 410 20.140 1 718.30

81670 Nerve block, head and neck, radio frequency, per level - - - 410 19.040 1 624.50

81680 Nerve block, coeliac plexus or other regions, per level - - - 410 9.280 791.80

Thorax - - - - - -

82600 Chest drain insertion - - - 410 8.820 752.50

82605 Trachial, bronchial stent insertion - - - 410 30.360 2 590.30

Gastrointestinal - - - - - -

83600 Oesophageal stent insertion - - - 410 31.220 2 663.60

83605 GIT balloon dilation - - - 410 24.360 2 078.40

83610 GIT stent insertion (non-oesophageal) - - - 410 32.020 2 731.90

83615 Percutaneous gastrostomy, jejunostomy - - - 410 25.360 2 163.70

Hepatobiliary - - - - - -

84600 Percutaneous biliary drainage, external - - - 410 33.980 2 899.10

84605 Percutaneous external/internal biliary drainage - - - 410 37.210 3 174.70

84610 Permanent biliary stent insertion - - - 410 51.220 4 370.00

84615 Drainage tube replacement - - - 410 20.220 1 725.10

84620 Percutaneous bile duct stone or foreign object removal - - - 410 49.980 4 264.20

84625 Percutaneous gall bladder drainage - - - 410 29.580 2 523.70

84630 Percutaneous gallstone removal, including drainage - - - 410 69.250 5 908.30

84635 Transjugular liver biopsy - - - 410 24.930 2 127.00

84640 Transjugular intrahepatic Portosystemic shunt - - - 410 119.470 10 192.90

84645 Transhepatic Portogram including venous sampling, pressure studies - - - 410 81.890 6 986.70

84650 Transhepatic Portogram with embolisation of varices - - - 410 100.810 8 600.90

84655 Percutaneous hepatic tumour ablation - - - 410 15.680 1 337.80

84660 Percutaneous hepatic abscess, cyst drainage - - - 410 13.200 1 126.20

84665 Hepatic chemoembolisation - - - 410 59.440 5 071.30


370 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

84670 Hepatic arterial infusion catheter placement - - - 410 60.300 5 144.70

Urogenital - - - - - -

85600 Percutaneous nephrostomy, external drainage - - - 410 29.970 2 557.00

85605 Percutaneous double J stent insertion including access - - - 410 40.820 3 482.70

85610 Percutaneous renal stone, foreign body removal including access - - - 410 66.790 5 698.40

85615 Percutaneous nephrostomy tract establishment - - - 410 29.270 2 497.30

85620 Change of nephrostomy tube - - - 410 15.900 1 356.60

85625 Percutaneous cystostomy - - - 410 16.520 1 409.50

85630 Urethral balloon dilatation - - - 410 14.240 1 214.90

85635 Urethral stent insertion - - - 410 31.220 2 663.60

85640 Renal cyst ablation - - - 410 11.920 1 017.00

85645 Renal abscess, cyst drainage - - - 410 15.160 1 293.40

85655 Fallopian tube recanalisation - - - 410 45.060 3 844.40

Spinal - - - - - -

86600 Spinal vascular malformation embolisation - - - 410 275.160 23 476.10

86605 Vertebroplasty per level - - - 410 22.300 1 902.60

86610 Facet joint block per level, uni- or bilateral - - - 410 9.540 813.90

Code 86610 may only be billed once per level, and not per left and right side per level - - - - - -

86615 Spinal nerve block per level, uni- or bilateral - - - 410 8.160 696.20

86620 Epidural block - - - 410 9.420 803.70

86625 Chemonucleolysis, including discogram - - - 410 18.320 1 563.00

86630 Spinal nerve ablation per level - - - 410 11.600 989.70

Vascular - - - - - -

Code 87654 (Thrombolysis follow up) may only be used on the days following the initial procedure, 87650 (thrombolysis). If a balloon angioplasty and / or stent placement is performed at more that one defined anatomical site at the same sitting the relevant codes may be combined. However multiple balloon dilatations or stent placements at one defined site will only attract one procedure code.

- - - - - -

87600 Percutaneous transluminal angioplasty: aorta, IVC - - - 410 56.560 4 825.60

87601 Percutaneous transluminal angioplasty: iliac - - - 410 55.760 4 757.30

87602 Percutaneous transluminal angioplasty: femoropopliteal - - - 410 60.160 5 132.70


371 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

87603 Percutaneous transluminal angioplasty: subpopliteal - - - 410 73.340 6 257.20

87604 Percutaneous transluminal angioplasty: brachiocephalic - - - 410 67.120 5 726.50

87605 Percutaneous transluminal angioplasty: subclavian, axillary - - - 410 60.160 5 132.70

87606 Percutaneous transluminal angioplasty: extracranial carotid - - - 410 71.620 6 110.50

87607 Percutaneous transluminal angioplasty: extracranial vertebral - - - 410 73.300 6 253.80

87608 Percutaneous transluminal angioplasty: renal - - - 410 87.690 7 481.50

87609 Percutaneous transluminal angioplasty: coeliac, mesenteric - - - 410 87.690 7 481.50

87620 Aorta stent-graft placement - - - 410 120.750 10 302.20

87621 Stent insertion (including PTA): aorta, IVC - - - 410 73.870 6 302.40

87622 Stent insertion (including PTA): iliac - - - 410 76.370 6 515.70

87623 Stent insertion (including PTA): femoropopliteal - - - 410 77.970 6 652.20

87624 Stent insertion (including PTA): subpopliteal - - - 410 84.550 7 213.60

87625 Stent insertion (including PTA): brachiocephalic - - - 410 98.470 8 401.30

87626 Stent insertion (including PTA): subclavian, axillary - - - 410 86.690 7 396.20

87627 Stent insertion (including PTA): extracranial carotid - - - 410 106.990 9 128.20

87628 Stent insertion (including PTA): extracranial vertebral - - - 410 100.550 8 578.70

87629 Stent insertion (including PTA): renal - - - 410 98.590 8 411.50

87630 Stent insertion (including PTA): coeliac, mesenteric - - - 410 98.590 8 411.50

87631 Stent-graft placement: iliac - - - 410 76.370 6 515.70

87632 Stent-graft placement: femoropopliteal - - - 410 77.970 6 652.20

87633 Stent-graft placement: brachiocephalic - - - 410 98.470 8 401.30

87634 Stent-graft placement: subclavian, axillary - - - 410 82.770 7 061.80

87635 Stent-graft placement: extracranial carotid - - - 410 120.430 10 274.90

87636 Stent-graft placement: extracranial vertebral - - - 410 114.730 9 788.50

87637 Stent-graft placement: renal - - - 410 98.590 8 411.50

87638 Stent-graft placement: coeliac, mesenteric - - - 410 98.590 8 411.50

87650 Thrombolysis in angiography suite, per 24 hours - - - 410 45.820 3 909.30

Code 87650 may be combined with any of the relevant non neuro interventional angiography and interventional codes 10520, 20500, 20510, 20520, 20530, 20540,32500,32530,44500, 44503, 44505, 44507, 44510, 44515, 44517, 44520, 60500, 60510, 60520, 60530, 70500, 70505, 70510, 70515, 87600 to 87638.

- - - - - -


372 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

87651 Aspiration, rheolytic thrombectomy - - - 410 77.670 6 626.70

87652 Atherectomy, per vessel - - - 410 91.890 7 839.90

87653 Percutaneous tunnelled / subcutaneous arterial or venous central or other line insertion - - - 410 28.150 2 401.70

87654 Thrombolysis follow-up - - - 410 23.570 2 011.00

87655 Percutaneous sclerotherapy, vascular malformation - - - 410 21.100 1 800.20

87660 Embolisation, mesenteric - - - 410 100.430 8 568.50

87661 Embolisation, renal - - - 410 99.360 8 477.20

87662 Embolisation, bronchial, intercostal - - - 410 108.340 9 243.40

87663 Embolisation, pulmonary arteriovenous shunt - - - 410 103.220 8 806.50

87664 Embolisation, abdominal, other vessels - - - 410 101.440 8 654.70

87665 Embolisation, thoracic, other vessels - - - 410 97.600 8 327.00

87666 Embolisation, upper limb - - - 410 90.920 7 757.10

87667 Embolisation, lower limb - - - 410 92.140 7 861.20

87668 Embolisation, pelvis, non-uterine - - - 410 117.120 9 992.40

87669 Embolisation, uterus - - - 410 113.880 9 716.00

87670 Embolisation, spermatic, ovaria veins - - - 410 85.820 7 322.00

87680 Inferior vena cava filter placement - - - 410 61.840 5 276.10

87681 Intravascular foreign body removal - - - 410 85.030 7 254.60

87682 Revision of access port (tunnelled or implantable) - - - 410 14.120 1 204.70

87683 Removal of access port (tunnelled or implantable) - - - 410 11.120 948.70

87690 Superior petrosal venous sampling - - - 410 73.010 6 229.10

87691 Pancreatic stimulation test - - - 410 89.790 7 660.70

87692 Transportal venous sampling - - - 410 76.950 6 565.20

87693 Adrenal venous sampling - - - 410 55.010 4 693.30

87694 Parathyroid venous sampling - - - 410 86.660 7 393.70

87695 Renal venous sampling - - - 410 55.010 4 693.30

ANNEXURE A - - - - - -


373 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

Radiology tariff Contrast price effective 1 Jan 2004PER VIAL For use in conjuction with codes: 00190 X-ray examination contrast material 00290 Ultrasound examination contrast material 00390 CT examination contrast material 00490 MR examination contrast material 00590 Angiography and interventional examination contrast materialNote to Funders: The following contrast items may be grouped into various categories e.g. Ionic, non-Ionic, and several items may be appropriate for use within a category.Funders may either reimburse as per identified item or may choose to apply a reference price within a category.For detail of methodology refer to Annexure B.

- - - - - -

ANNEXURE B - - - - - -

Radiology tariff Contrast price effective 1 Jan 2004 PER VIAL - - - - - -

Contrast Index Price Range - 2004 contrast prices - - - - - -

ANNEXURE C - - - - - -

Recommended Isotope and Kit Prices for Nuclear Medicine for 2004 by the Association of Nuclear Medicine Physicians For use in conjuction with codes: 00990 Nuclear Medicine Isotope 00991 Nuclear Medicine Substrate <<Insert object table here>>

- - - - - -

ANNEXURE D. PET GUIDELINES - - - - - -

A. INDICATIONS - - - - - -

For the purposes of this guideline, only established indications for PET-CT are included and this relates to the more common types of malignancies as seen in practice. While some of the less common forms of cancer may also yield advantages with PET-CT imaging, there is as yet insufficient published data to support the general use and these have been excluded in the list below. This situation may change as new research and information becomes available.

- - - - - -


374 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

1. Non-small cell lung carcinoma (NSCC) a) Primary diagnosis of lesions i. >10mm diameter lesions where conventional imaging and biopsy have been inconclusive. b) Staging especially where curative surgery is planned i. Evaluation of primary tumour (T-stage). ii. Suspected nodal disease or characterization of nodal disease iii. Suspected distal metastases of determining extent of metastases. iv. Solitary distal metastasis where metastatectomy is considered. PET-CT is used to exclude

additional lesions which would preclude surgery. c) Investigation of suspected recurrence (restaging) i. Local or regional recurrence ii. Nodal or distal recurrence iii. Determine the extent of proven recurrent disease iv. Differentiate fibrotic mass from active disease d) All patients with proven carcinoma of the lung, who are considered for curative resection, should be

imaged with PETCT prior to surgery. e) Current available literature confirms that PET-CT is more accurate than CT or PET alone for staging

and restaging of NSCC.

- - - - - -

2. Hodgkin’s and Non-Hodgkin’s Lymphoma a) Single most accurate imaging modality for Hodgkins and Non-Hodgkins lymphoma. b) Staging i. All patients prior to commencing treatment as baseline, following diagnosis. ii. Indicated at completion of therapy to confirm complete response. c) Monitoring of response to treatment i. Numerous studies have confirmed that mid-treatment PET scans predict clinical outcome. ii. Prognostic value and role in modification of therapeutic regime. d) Investigation of residual or recurrent disease (restaging) i. Where conventional imaging is equivocal for residual disease. ii. Suspected nodal recurrence. iii. Differentiating recurrent and residual disease from post-therapeutic fibrosis and scarring.

- - - - - -


375 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

3. Thyroid carcinoma a) Not indicated for primary diagnosis. b) Staging i. Primary examination of choice is I-123 whole body scintigraphy. ii. Only indicated for differentiated and medullary carcinoma of the thyroid in patients with negative

I-123, but with a high index of suspicion for nodal or distal metastases on cross sectional imaging or where whole body I-123 scan is equivocal.

c) Investigation of residual or recurrent disease (restaging) i. Elevated thyroglobulin despite negative whole body scintigraphy for differentiated thyroid

carcinoma. ii. Elevated calcitonin levels and equivocal imaging findings for medullary thyroid carcinoma. iii. Solitary distal metastasis where metastatectomy is considered. PET-CT is used to exclude

additional lesions which would preclude surgery.

- - - - - -

4. Head and neck carcinoma a) Primary diagnosis i. There is little, if any, role for PET-CT in primary diagnosis of mucosal lesions. ii. Limited to identifying primary tumour in histologically proven metastatic squamous cell carcinoma in

cervical nodes. b) Staging of the primary tumour prior to therapy i. Local nodes which are equivocal on CI (conventional imaging). ii. Suspected distal adenopathy iii. Suspected distal metastases iv. All patients where uni- or bilateral surgery is planned (may alter management and approach by up

to 50% and is significantly more accurate than CT alone). v. Excellent sensitivity (95%) for local and distal nodal disease (specificity in local disease may be

affected by physiological uptake). c) Investigation of residual or recurrent disease (restaging) i. Differentiating fibrosis and recurrence where routine imaging is equivocal and may reduce the

number of equivocal findings by up to 50%. ii. Following neo-adjuvant therapy for re-staging. iii. Suspected local or distal recurrence. iv. Differentiating post-therapeutic changes from residual or recurrent tumours poses significant

problems for CT and MRI. PET-CT is significantly more accurate than routine cross sectional imaging in this regard.

- - - - - -


376 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

5. Breast cancer a) There is no role for PET-CT in the primary diagnosis, sentinel node mapping or imaging of locally

contained node negative tumours. b) No role for carcinoma-in-situ. c) PET-CT imaging is limited to patients with infiltrating ductal carcinoma. d) Staging i. Only indicated if there is a significant chance of distal disease as determined by axillary dissection or

where conventional imaging is equivocal. ii. Can result in up to 57% change of stage and management compared to other CI (conventional

imaging). iii. High accuracy (86% vs. 77% for CT alone) for nodal and distal metastases in patient with infiltrating

ductal carcinoma. e) Investigation of recurrent disease (restaging) i. Suspected local or regional recurrence. ii. Suspected nodal or distal metastatic recurrence. iii. Differentiate post therapeutic fibrosis from recurrent or residual tumour. iv. Significantly more accurate for nodal and distal recurrence than conventional imaging.

- - - - - -

6. Colorectal cancer a) No role in the diagnosis of the primary tumour. b) Accurate for staging (89%) and restaging (88%) c) Staging i. Suspected distal nodal metastases where conventional imaging is equivocal, particularly distal

nodes. ii. Suspected distal metastases. iii. Evaluation of suspected single metastases considered for curative surgical resection to exclude

concomitant disease. iv. May result in changes in treatment in up to 27% of patients. d) Investigation of residual or recurrent disease (restaging) i. Suspected local pelvic or distal recurrence. ii. Differentiate local and distal post therapeutic changes from residual and recurrent disease. iii. Evaluate and restage following neo-adjuvant therapy. iv. Evaluate patients with rising tumour markers and normal or equivocal conventional imaging.

- - - - - -


377 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

7. Stomach carcinoma - GIST a) In GIST tumours FDG tracer uptake is established. i. Indicated to determine response to treatment as determined by tumour activity on PET-CT measuring tracer uptake (SUV). ii. Paradigm shift in assessing tumour responses to treatment. iii. Response to Imatinib (Gleevec) can be predicted with 18FFDG as early as 24h after commencing treatment and long before any change in tumour size is demonstrated on conventional imaging. iv. Baseline study before commencing treatment is essential to determine degree of tracer uptake for post-treatment comparison. b) Variable uptake of tracer in other stomach tumours, which is difficult to explain and to predict. Routine imaging is not supported in other types of stomach tumours, at this stage.

- - - - - -

8. Testicular Carcinoma a) Complex histology and variable uptake of different histological sub-groups. b) Limited to seminoma and teratoma in the following cases: i. Evaluate residual mass to differentiate residual/recurrent tumour from fibrosis. ii. Suspected recurrence but normal or equivocal conventional imaging findings.

- - - - - -

9. Oesophageal carcinoma a) Not indicated for primary diagnosis. b) Staging for nodal and distal metastases (90% accurate) i. Indicated for N-staging, particularly where there is suspected distal nodal disease or where conventional imaging is equivocal. ii. Indicated for M- staging where distal metastases are suspected. iii. Strongly indicated for patient undergoing curative surgery to exclude distal disease. c) Investigation of residual or recurrent disease (restaging) i. Restaging for patients who have undergone neo-adjuvant chemotherapy. ii. Suspected local or distal recurrent disease. iii. Differentiate post therapeutic fibrosis from recurrent or residual disease.

- - - - - -


378 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

10.Melanoma a) No role in primary diagnosis which is primarily a surgical/histological diagnosis. b) Staging is determined by depth of penetration of the primary tumour and presence of sentinel node at surgery. i. Indicated for Stage 3 and 4 disease where there is a high incidence of distal nodal and metastatic disease. ii. Solitary distal metastasis on conventional imaging where metastatectomy is considered. PET-CT is used to exclude additional lesions which would preclude surgery. iii. Overall N and M staging is significantly more accurate than conventional imaging (97% vs 80%). c) Investigation of recurrent disease (restaging) i. Modality of choice for recurrent nodal and distal metastatic disease. ii. Differentiate post therapeutic fibrosis from recurrent or residual disease. d) PET-CT may alter management in up to 34% of patients with Stage III and IV disease.

- - - - - -

11.Ovarian carcinoma a) Most cases present as advanced disease. b) Recurrence is frequent and the overall 5-y survival for advanced disease is only 17%. c) Diagnosis and initial staging require a laparotomy as small peritoneal deposits may be difficult to demonstrate on imaging i. PET-CT is indicated where surgical or conventional imaging findings are equivocal for primary staging. ii. PET-CT is accurate for demonstrating nodal and distal disease. iii. Sensitivity is limited by size of peritoneal deposits. It is more accurate for macroscopic disease. d) Investigation of recurrent disease (restaging) i. Superior to CT and MRI for recurrence (92% sens. and 75% spec.). ii. Alternative to a second look laparotomy (presents significant cost saving potential). iii. Definite role for patients with rising tumour marker where conventional imaging is negative for recurrence.

- - - - - -

12.Carcinoma of unknown primary a) By definition, unknown primary tumors are those that remain undetected after all diagnostic resources have been used. b) PET-CT may detect up to 57% primary tumours when conventional cross sectional imaging has been negative. c) PET-CT is indicated where conventional imaging has failed to identify a primary malignancy.

- - - - - -

B. LIMITED VALUE AND RELATIVE CONTRAINDICATIONS - - - - - -

These conditions are those where there is variable or poor uptake of the tracer FDG or where imaging is routinely performed with tracers other than FDG which are not locally available. This may result in false negative findings using FDG and the routine use of PET-CT should be discouraged.

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379 • Version 4_21



Code: 13800

code CF Units Value

RCF Units

Value R

1. Urological Malignancy a) No role in diagnosis and staging of renal cell carcinoma b) Prostate limited to suspected recurrence in histologically proven high grade tumours. Prostate is ideally imaged with Choline as tracer. c) No role for diagnosis and staging of bladder carcinoma 2. Broncho-alveolar cell carcinoma 3. Small cell carcinoma of the lung 4. Hepatocellular carcinoma 5. Sarcomas 6. Neuro-endocrine tumours 7. Anaplastic thyroid carcinoma which is Grade 4 by definition, at diagnosis. 8. Suspected brain tumours where MRI is more sensitive and specific. 9. Tumours with large mucinous components. 10.Lobular carcinoma of the breast

- - - - - -

In addition to these tumours, imaging should be used with caution in patients who are diabetic or who have recently used high doses of cortico-steroids.

- - - - - -


380 • Version 4_21

Nursing

GEMS TARIFF FOR SERVICES BY REGISTERED NURSES IN PRIVATE PRACTICE AND NURSING AGENCIES, EFFECTIVE FROM 1 JANUARY 2011

Practice Type: Nursing Agencies/Home Care Services

Code: 48000

Practice Type: Registered NursesCode: 48800

code CF Units Value

RCF Units

Value R


- - - - - -


381 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

A GENERAL INFORMATION - - - - - -

The “RegN” column (Practice Type 48800) of this schedule is a GEMS Tariff for registered nurses and midwives only (not enrolled nurses) in private practice, and may only be charged by the registered nurse performing the procedure, and whose practice number is reflected on the account. The “NAgen” column (Practice Type 48000) of this schedule is a GEMS Tariff for registered accredited nursing agencies and accredited home health care organizations only (not nurses in private practice), i.e. if employed at a nursing agency or home health care organization the private nurse practitioner may not submit claims on his / her practice number. A registered nurse or midwife is a nurse or midwife registered with the South African Nursing Council in terms of the Nursing Act 50 of 1978 (as amended). 1. Agency refers to: a) An accredited business registered / licensed with the S A Nursing Council carrying out the business of

providing Registered and supervised Enrolled Nursing services, as well as surgicals and equipment. b) The agency should also be registered with a representative professional governing body. 2. Home health care organisations refers to: a) An accredited business that provides registered and supervised Enrolled Nursing services, as well as

surgicals and equipment for home care. b) The accredited home care organisation should also be registered with a representative professional

governing body. All accounts must be presented with the following information clearly stated: i. Name of nurse practitioner, agency or home health care organization (whichever is applicable); ii. Pre-authorisation code, when applicable iii. Qualifications of the nurse practitioner iv. PCNS Practice Number v. Section 22A permit number (if applicable) vi. Postal address and telephone number vii. Dates on which services were provided viii. The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service

rendered. ix. Surname and initials of the member x. First name of the patient xi. Name of the scheme xii. Membership number of the member xiii. Where the account is a photocopy of the original, certification by way or rubber-stamp and signature of

the nurse, or in the case of “80” practice numbers, the appropriate representative agent xiv. A statement of whether the account is in accordance with the GEMS Tariff xv. Where the after care is taken over by the nurse practitioner, a letter of referral from the doctor with the

diagnosis and treatment should be attached.

- - - - - -


382 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

B GENERAL RULES - - - - - -

01

CONSULTATION, COUNSELING, PLANNING AND/OR ASSESSMENT: Consultation, counseling and / or assessment (codes 001 and 002 below) encompasses consultation, history taking, patient examination and assessment, observation, treatment planning, after care treatment planning, discharge planning and/or counseling. If a consultation and one or more procedures are performed in the visit, both a consultation code and the relevant procedure code(s) may be charged but the time spent on the procedure shall not be included in the consultation period for purposes of determining the consultation fee. A consultation may not be charged where the sole purpose of the visit was to perform a procedure.

- - - - - -

02

EMERGENCY VISITS Bona-fide, justifiable emergency nursing services rendered to a patient, at any time, may attract an additional fee as specified in item 014. These specifically relate to home visits for procedures which become necessary outside those which have been pre-arranged, such as but not exclusively, blocked urinary catheters, IV therapy which tissues or wound(s) which are draining excessively and require additional dressing. These should be accompanied by a written motivation. NOTE THAT THIS FEE IS ONLY APPLICABLE TO REGISTERED NURSES IN PRIVATE PRACTICE, AND NOT TO NURSING AGENCIES.

- - - - - -

021

SUNDAYS AND PUBLIC HOLIDAYS When codes 036, 037 or 038 are charged for services rendered on a Sunday, the fee in respect of these codes shall be inflated by 50%. Modifier 0007 must be quoted after the appropriate code number(s) to indicate that this rule is applicable. When codes 036, 037 or 038 are charged for services rendered on a public holiday, the fee in respect of these codes shall be inflated by 100%. Modifier 0001 must be quoted after the appropriate code number(s) to indicate that this rule is applicable. NOTE THAT THIS FEE IS ONLY APPLICABLE TO NURSING AGENCIES AND NOT TO REGISTERED NURSES IN PRIVATE PRACTICE.

- - - - - -

03

PROCEDURES If a composite fee or general hourly rate is charged, no additional fee for procedures may be charged. The fee in respect of more than one procedure performed at the same time shall be the fee in respect of the major procedure plus 50% of the fee of each subsidiary or additional procedure. Modifier 0002 to be quoted.

- - - - - -

04

FEES The rate that may be charged in respect of rendering a service not listed in this benefit schedule shall be based on the rate in respect of a comparable service. Modifier 0003 to be quoted with the description of service rendered and the applicable item number used.

- - - - - -


383 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

05

COST OF MEDICINES AND MATERIALS The amount charged in respect of medicines and scheduled substances shall not exceed the limits prescribed in the Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances, dated 30 April 2004, made in terms of the Medicines and Related Substances Act, 1965 (Act No 101 of 1965). In relation to all other materials, items are to be charged (exclusive of VAT) at net acquisition price plus - * 30% of the net acquisition price where the net acquisition price of that material is less than one

hundred rands; and* a maximum of R30.00 where the net acquisition price of that material is greater than or equal to one

hundred rands.Item 301 is to be quoted except for stomal products where item 205 is to be quoted.

- - - - - -

051MEDICINES Scheduled medicines may not be supplied by an institution. Intramascular/Intravenous injection and OPAT may only be administered by a registered nurse.

- - - - - -

06

EQUIPMENT (HIRE AND SALES) Hiring equipment: 1% of the current replacement value of the equipment per day. Total charge not to exceed 50% of replacement value. Description of equipment to be supplied. To be billed in terms of item 302. Payment of this item is at the discretion of GEMS, and should be considered in instances where cost savings can be achieved. By prior arrangement with the Scheme. For equipment that is sold to a member, the net acquisition cost of the equipment may be charged (item 303). This should be on a separate invoice attached to the account as the cost of these items are refunded to the member and not paid to the supplier.

- - - - - -


384 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

07

MIDWIFERY The global fee is to be charged where the midwife and any assistants attend to the entire four stages of delivery. Item 399 or 403 to be quoted. No additional service fee may be levied, but pharmaceuticals may be charged under item 301. Where intravenous infusions (including blood or blood cellular products) are administered as part of the after treatment after confinement, no extra fees will be charged as this is included in the global maternity fees. Should the attending midwife prefer to ask a medical practitioner to perform intravenous infusion, then the midwife (and not the patient) is responsible for remunerating such practitioner for the infusions. When a registered midwife treats a patient in the antenatal period and after starting the confinement requests a doctor to take over the case, the registered midwife shall calculate the fee for work done up to the handover of the case. Should a midwife be required to hand over the case to a medical practitioner due to complications during a home delivery and she is required to assist, item 410 may be used. Where the confinement has not started and the midwife requests a doctor to take over the case, the fee for the visits during early labour shall be charged as item 406. This may not be combined with item 400. Antenatal/postnatal exercise or education classes are generally not covered by the Scheme and payment is the responsibility of the member.

- - - - - -

08TRAVEL FEE Please note that GEMS does not accept the responsibility for transport expenses, as they are deemed to be included in the fee.

- - - - - -

09

WELL BABY CLINICS Where vaccines are issued, check scheme rules to acertain if products are paid for by GEMS. Vaccines may only be purchased, stored and dispensed by nurses with a Section 22A (15) permit. Emergency equipment must be available in the clinic.

- - - - - -

10It is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by the Scheme if the appropriate code is supplied on the account.

- - - - - -

MODIFIERS - - - - - -

0001 Public holidays, add 100%. Nursing agencies only. - - - - - -

0002 Only 50% of the fee in respect of subsidiary/additional procedures may be charged. - - - - - -

0003The fee that may be charged in respect of the rendering of a service not listed in this recommended benefit schedule, shall be based on the fee in respect of a fee for a comparable service. Motivation must be attached.

- - - - - -

0007 Sundays add 50%. Nursing agencies only. - - - - - -

ITEMS - - - - - -


385 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

CONSULTATIONS (the Pathology/Diagnosis must be stated) - - - - - -

005 Individual consultation, counseling, planning and/or assessment. 5 - 15 minutes. 360 2.747 26.30 241 10.000 59.50



002 Individual consultation, counseling, planning and/or assessment. 46+ minutes. 360 14.200 136.00 241 52.500 312.30

014 For emergency consultation/visit, all hours - See General Rule 2. - - - 240 7.700 73.80

SPECIMENS. - - - - - -

020

This must form part of a consultation when a consultation is charged. Where a consultation was not performed and the nurse visited or attended to the patient with the sole purpose of obtaining a specimen, and dispatching to a laboratory or using own machine to test – please state specimen type and, where applicable, machine and test performed.

360 4.600 44.10 240 4.600 44.10

OBSERVATIONS. (Temperature, Pulse Respiration and B.P.) - - - - - -

025Where a consultation was not performed and the nurse attended to the patient with the sole purpose of doing an observation.

360 4.600 44.10 240 4.600 44.10

ADMINISTRATION OF MEDICATION. - - - - - -

030

Where a consultation was not performed and the nurse attended to or visited the patient with the sole purpose of administering intramuscular or intravenous medication. The route of administration of medication to be stated, as well as the name of the medication. Oral, rectal, vaginal medication excluded as well as the application of topical medicine.

360 4.600 44.10 240 4.600 44.10

452 Immunisation - - - 240 3.000 28.70

OPAT (Antibiotics, Chemotherapy, Blood Products and Dehydration) - - - - - -

035All inclusive global fee for the setting up of an IV line and administration of intravenous therapy by a registered nurse.

360 24.300 232.80 240 24.300 232.80

036 When a SRN returns to add medication to an existing IV infusion 360 12.200 116.90 240 12.200 116.90

COMPOSITE FEES - - - - - -

Note : These fees may only be charged by members of an accredited home healthcare organisation for services rendered at patient’s home. (Care givers are not included in the fee).This includes all post hospitalisation/nursing care during a 24 hour period or part thereof. Motivation by a medical practitioner required. Single procedures/visits are not to be charged as a composite fee.

- - - - - -

032 Low intensity care (Presenting problem(s) that are of low severity. The patient is stable, recovering or improving). 360 42.700 409.00 - - -

033Medium intensity care (Presenting problem(s) that are of moderate severity. The patient is responding inadequately to therapy or has developed a minor complication).

360 61.700 591.00 - - -


386 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

034High intensity care (this item presenting problem(s) that are of high complexity. The patient is unstable or has developed a significant new problem). By arrangement with the Scheme.

360 - - - - -

The above fees includes : all nursing intervention in a 24 hour period; all visits of a supervisory nature; non-recoverable items e.g. disinfectants, soaps, towellets, hibitane, aprons, fractions of strapping etc.; all travelling costs; all administrative costs; delivery/courier costs where these are necessary but excludes : any drugs and surgicals required; equipment sale or hire; auxiliary services by paraprofessionals, e.g. OT’s and physiotherapists.

- - - - - -

Note : Item 035 should not represent more than 4% of all claims received. - - - - - -

RECOMMENDED HOURLY RATES FOR REGISTERED NURSING AGENCIES - - - - - -

039 Enrolled nursing assistant, per hour 360 3.700 35.40 - - -

037 Enrolled nurse, per hour 360 5.100 48.90 - - -

038 Registered nurse, per hour 360 6.460 61.90 - - -

1. The fee for 24 hour daily care may not exceed R 420.00 per day (or R 630.00 on a Sunday or R 840.00 on a public holiday) and no other procedure may be charged.

2. In the case of litigation, the registered nurse will be co-responsible for the practice of the enrolled nurse.

3. All services to be re-negotiated with the Scheme every 7 days or such lesser period as stipulated in pre-authorisation.

- - - - - -

CARE OF WOUNDS (The pathology must be stated). - - - - - -

040 Treatment of simple wounds/burns requiring dressing only. 360 8.800 84.30 240 8.800 84.30

041 Treatment of extensive wounds/burns requiring extensive nursing management eg irrigation, etc. 360 12.400 118.80 240 12.400 118.80

042 Treatment of moderate wounds/Burns eg drains or fistulas and inserting of sutures 360 11.000 105.40 240 11.000 105.40

045 Laser treatment for wound healing where prescribed by medical practitioner 360 7.670 73.50 240 7.670 73.50

RESPIRATORY SYSTEM. - - - - - -

050 Nebulization/Inhalation. 360 3.800 36.40 240 3.800 36.40

051 Tracheostomy care. 360 7.900 75.70 240 7.900 75.70

052 Peak flow measurement. 360 3.100 29.70 240 3.100 29.70

For ICU trained nurses registered with SANC as such and nurses working in the occupational health setting but not for a company. (Item 053)

- - - - - -

053 Flow volume test: inspiration/expiration using ELF/similar machine. - - - 240 13.100 125.50

CARDIO-VASCULAR SYSTEM. - - - - - -


387 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

Only for ICU trained nurses registered as such with SANC. A medical practitioner must be available in the event of a resuscitation being required. (Items 062 and 063).

- - - - - -

060 Cardiopulmonary resuscitation. - - - 240 23.000 220.30

061 Performing ECG only. - - - 240 4.600 44.10

062 Effort test - bicycle. - - - 240 16.900 161.90

063 Effort test - multistage treadmill. - - - 240 38.400 367.80

MUSCULOSKELETAL SYSTEM. - - - - - -

070 Application or removal splints and prosthesis. 360 3.900 37.40 240 3.900 37.40

071 Application or removal of traction 360 7.700 73.80 240 7.700 73.80

072 Application of skin traction 360 7.700 73.80 240 7.700 73.80

GASTRO INTESTINAL SYSTEM. - - - - - -

080 Nasogastric tube insertion, feeding and removal. 360 9.200 88.10 240 9.200 88.10

082 Enema administration 360 4.800 46.00 240 4.800 46.00

083 Aspiration of stomach/gastric lavage. - - - 240 6.900 66.10

084 Faecal impaction/manual removal. 360 8.700 83.30 240 8.700 83.30

URINARY SYSTEM. - - - - - -

090 Any urinary tract procedure including catheterisation, bladder stimulation and emptying. 360 9.500 91.00 240 9.500 91.00

091 Condom catheter application, penile dressing, catheter care including bag change or catheter removal. 360 5.800 55.60 240 5.800 55.60

093Incontinence management (30 minutes) This fee includes intermittent catheterisation, external sheath drainage, taking of history, providing literature and teaching.

360 9.500 91.00 240 9.500 91.00

GENERAL CARE. - - - - - -

100This includes all aspects of elementary nursing care performed at a patient’s home which may include : Bath/ bedbath, getting patient out of bed, making of bed, hairwash, mouth hygiene, nail care, shave, put patient back to bed, pressure area care, per visit. (irrespective of time spent)

360 16.100 154.20 240 16.100 154.20

STOMALTHERAPY NURSING. - - - - - -

Applicable to stomal therapy trained registered nurses who are working as private practitioners and not for a company other than a registered nursing agency.

- - - - - -

Please Note: Items 200, 201, 202, 204, 205, 079 and 081 may not be used in conjunction with items 230, 234, 238 and 250

- - - - - -

079 Stomal irrigation - 60 minutes. May not be used in conjunction with the global fees. 360 4.800 46.00 240 4.800 46.00


388 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

Colonic lavage - may be performed by all nurse practitioners but only when prescribed by a medical practitioner, and the written prescription is attached.

- - - - - -

081 Colonic lavage 360 4.800 46.00 240 4.800 46.00

200Simple stoma - a well constructed, sited stoma which is easy to pouch. Very little or no peristomal skin excoriation.

360 8.800 84.30 240 8.800 84.30

201Complex stoma - a poorly constructed, non-sited stoma requiring convexity or build up. Difficult to pouch. Severe peristomal skin excoriation.

360 12.400 118.80 240 12.400 118.80

202Moderate stoma - a fairly well constructed, sited stoma which may require straight forward convexity or build up. Mild to moderate peristomal skin excoriation.

360 11.000 105.40 240 11.000 105.40

205 Stoma products charged in accordance with rule 05. 360 - - 240 - -

230

Global fee - Simple Stoma - Permanent: Includes the following: 1 X Pre-op consultation: includes history, stomal siting, counselling 3 X Post-op consultations - includes checking stoma and pouch, teach, advise on management, diet, lifestyle 2 X Clinic visits plus procedure (remove sutures, check stoma, skin integrity, show/teach other pouches, advise on diet and lifestyle: enema/irrigation/intermittent catheterisation) and materials (gloves, linen saver, gauze etc) 6 Month clinic visit and assessment: including materials (gloves, linen saver, gauze, etc)

360 124.900 1 196.30 240 124.900 1 196.30

234

Global fee - Moderate Stoma - Permanent (Includes the following): 1 X Pre-op consultation: includes history, stomal siting, counselling 3 X Post-op consultations - includes checking stoma and pouch, teach, advise on management, diet, lifestyle 2 X Clinic visits plus procedure (remove sutures, check stoma, skin integrity, show/teach other pouches, advise on diet and lifestyle: enema/irrigation/intermittent catheterisation) and materials (gloves, linen saver, gauze etc) 6 Month clinic visit and assessment: including materials (gloves, linen saver, gauze, etc)

360 137.200 1 314.10 240 137.200 1 314.10

238

Global fee: Complex stoma - Permanent (Includes the following): 1 X Pre-op consultation: includes history, stomal siting, counselling 3 X Post-op consultations - includes checking stoma and pouch, teach, advise on management, diet, lifestyle 2 X Clinic visits plus procedure (remove sutures, check stoma, skin integrity, show/teach other pouches, advise on diet and lifestyle: enema/irrigation/intermittent catheterisation) and materials (gloves, linen saver, gauze etc) 6 Month clinic visit and assessment: including materials (gloves, linen saver, gauze, etc)

360 159.900 1 531.50 240 159.900 1 531.50

250 Clinic visits after 6 months per half hour plus one procedure - eg irrigation, enema, etc. - plus material 360 10.000 95.80 240 10.000 95.80

EQUIPMENT - - - - - -

Applicable only to registered nurses who are working as private practitioners and not for a company other than a registered nursing agency.

- - - - - -

302 Equipment hire per day, charged according to rule 06. - - - - - -


389 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

303Equipment sold to a member should be net acquisition cost. This should be on a separate invoice attached to the account as the cost of these items are refunded to the member, and not paid to the supplier.

360 - - 240 - -

MIDWIFERY - - - - - -

Global Obstetric Fees - - - - - -

This is charged where the midwife managed the entire four stages of delivery. - - - - - -

399Global midwife delivery fee in hospital / birthing unit. Includes all care from the time of admission of the patient in labour until discharge from hospital.

- - - 240 210.900 2 020.00

403Global obstetric fee – home birth. (to be charged if the entire confinement is completed at home). Includes all care from commencement of labour until 1 hour after delivery.

- - - 240 275.500 2 638.70

407 Global fee for childbirth education. By arrangement with the Scheme/patient. - - - 240 - -

Where the global fee is not applicable, the following will apply: - - - - - -

400 First Stage Monitoring - - - 240 73.800 706.90

401 Second and Third stage labour. Vaginal delivery including episiotomy/tear and repair and general obstetric care. - - - 240 90.200 863.90

402 Fourth Stage. - - - 240 12.300 117.80

405 Phototherapy, per day - - - 240 15.400 147.50

406 Visit to patient during first stage labour (may not be charged in conjunction with item 400) - - - 240 10.000 95.80

410Assisting at delivery (if a medical practitioner/midwife is requested to take over delivery due to complications during a home delivery)

- - - 240 27.600 264.40

420 Ante natal visits (excluding ante-natal exercises), per visit - - - 240 7.700 73.80

421 Post natal visits (excluding post- natal exercises), per visit - - - 240 11.500 110.20

425 Ante-natal or post-natal exercise classes, per patient - - - 240 6.200 59.40

For advanced midwives registered with SANC only: - - - - - -

404 Cardiotocography - - - 240 10.000 95.80

WELL BABY CLINICS - - - - - -

Emergency equipment must be available in the baby clinic - - - - - -

450 Consultation - - - 240 4.800 46.00

454 Supply of Vaccine (only for nurses with Section 22A (15) Permit) - - - 240 - -

PSYCHIATRIC NURSING THERAPY - - - - - -

Psychiatric Nursing Therapy may only be performed by a nurse with a psychiatric nursing qualification registered as such with the SANC

- - - - - -


390 • Version 4_21



Code: 48000


code CF Units Value

RCF Units

Value R

500 Individual interview/assessment. Adult, child, school, employer - per hour. - - - 240 21.600 206.90

501 Individual therapy. (irrespective of time) - - - 240 30.700 294.00

502 Family/marital/group per patient - specify number. - - - 240 6.200 59.40

503 Play therapy/Home stimulation programme. - - - 240 16.900 161.90

504 Co-therapist. - - - 240 16.900 161.90

RENAL DIALYSIS - - - - - -

092 Peritoneal dialysis per day 360 16.900 161.90 240 16.900 161.90

608 Home dialysis training in centre per 30 minutes 360 16.000 153.30 240 16.000 153.30

610 Home dialysis training or follow up at patient’s home per 30 minutes (to maximum of 24 hours) 360 28.200 270.10 240 28.200 270.10

612

Home dialysis 1. Preparation of extra corporeal equipment 2. Preparation of needling patient’s fistula and attaching patients to Haemodialysis machine or using subclavian catheter/permanent catheter/femerol catheter 3. Observation of patient whilst on dialysis 4. Monitoring Haemodialysis machine readings 5. Doing necessary nursing procedures to patient as required e.g. catheter site/wounds/mouth care, nursing care in general/helping to feed/prepare light meal/tea etc for patient whilst on dialysis 6. Termination of procedures e.g. giving blood back to patient and disposable of extra corporeal lines etc 7. Port dialysis observation of patient 8. Cleaning and sterilisation of dialysis machine and Reverse Osmosis machine

360 64.000 613.00 240 64.000 613.00

MEDICINES AND MATERIALS - - - - - -

301 Consumables used, and charged according to rule 05 360 - - 240 - -


391 • Version 4_21

Social Workers

GEMS TARIFF FOR SERVICESBY SOCIALWORKERS, EFFECTIVEFROM 1 JANUARY 2011Practice Type: Social Workers

Code: 48900

code CF Units Value

R


- - -

GENERAL RULES - - -

005

Every practitioner shall render a monthly account in respect of any service rendered during the month, irrespective of whether or not the treatment has been completed. NB. Every account shall contain the following particulars: a) The surname and initials of the member; b) The surname, first name and other initials, if any, of the patient; c) The name of the scheme concerned;. d) The membership number of the member; e) The practice code number, group practice number and individual provider registration number issued by the registering authorities for providers, if

applicable, of the supplier of service and, in the case of a group practice, the name of the practitioner who provided the service;f) The relevant diagnostic and such other item code numbers that relates to such relevant health service; g) The date on which each relevant health service was rendered; h) The relevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered.

- - -


- - -

007

Where emergency treatment is provided: a. during working hours, and the provision of such treatment requires the practitioner to leave her or his practice to attend to the patient at another venue; or b. after working hours the fee for such visits shall be the total fee plus 50%. For purposes of this rule: a. “emergency treatment” means a bona fide, justifiable emergency social work service, where failure to provide the service immediately would result in

serious or irreparable psychological or functional impairment b. “working hours” means 8h00 to 17h00, Monday to Friday. Modifier 0003 must be quoted after the appropriate code number(s) to indicate that this rule is applicable.

- - -

008Compilation of reports is only to be included within billable time if these reports are for purposes of motivating for therapy and/or giving a progress report and/or a pre-authorisation report, and where such a report is specifically required by the Scheme. Maximum billable time for such a report is 15 minutes.

- - -

Modifiers - - -

0003 Add 50% of the total fee for the treatment - - -


392 • Version 4_21

GEMS TARIFF FOR SERVICESBY SOCIALWORKERS, EFFECTIVEFROM 1 JANUARY 2011Practice Type: Social Workers

Code: 48900

code CF Units Value

R

0021 Services rendered to hospital inpatients: Quote modifier 0021 on all accounts for services performed on hospital inpatients. - - -

0022 Services rendered at patients residence: Quote modifier 0022 on all accounts for services performed at the patients residence. - - -

ITEMS - - -


300 - -

200 Social worker consultation, counselling and/or therapy. Duration: 1-10min. 300 0.500 30.70












Group consultation, counselling or therapy - - -

Group consultation, counselling and/or therapy items are chargeable to a maximum of 12 patients. - - -

300 Social worker group consultation, counselling and/or therapy, per patient. Duration: 1-10min. 300 0.100 6.20













393 • Version 4_21

Speech Therapy & AudiologyGEMS TARIFF FOR SERVICES BY SPEECH THERAPISTS AND AUDIOLOGISTS, EFFECTIVE FROM 1

JANUARY 2011Practice Type: Speech Therapy

Code: 38201Practice type: Audiology

Code: 38202

code CF Units Value

RCF Units

Value R


- - - - - -

General Rules - - - - - -

A

All accounts must be presented with the following information clearly stated: · name of practitioner · qualifications of the practitioner; · PCNS Practice Number; · postal address and telephone number; · date on which service(s) were provided; · Therelevant diagnostic codes and GEMS Tariff item code numbers relating to the health service rendered; · the surname and initials of the member; · the first name of the patient; · the name of the scheme; · the membership number of the member; and . the name and practice number of the referring practitioner, if applicable.

- - - - - -

BThe rate in respect of more than one evaluation under item 1800 shall be the full rate for the first evaluation plus half the rate in respect of each additional evaluation, but under no circumstances may fees be charged for more than three evaluations carried out.

- - - - - -

DIt is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by the Scheme if the appropriate code is supplied on the account.

- - - - - -

E

Materials used in treatment shall be charged (exclusive of VAT) at net acquisition price plus –- 30% of the net acquisition price where the net acquisition price of that material is less than one


hundred rands.Use item 300 for this purpose.

- - - - - -

ITEMS - - - - - -

1. Assessment, Consultation & Treatment - - - - - -


394 • Version 4_21

GEMS TARIFF FOR SERVICES BY SPEECH THERAPISTS AND AUDIOLOGISTS, EFFECTIVE FROM 1 JANUARY 2011

Practice Type: Speech Therapy Code: 38201

Practice type: AudiologyCode: 38202

code CF Units Value

RCF Units

Value R

The time used to conduct any diagnostic or treatment procedure claimed in addition to the codes in this section, can not be considered in determining the duration of the assessment, consultation or treatment claimed

- - - - - -

1.1 Consultations - - - - - -

1.1.1 Audiology Consultations - - - - - -

1010 Audiology consultation. Duration 5 - 15 mins - - - 316 10.000 70.40




1015 Prolonged audiology consultation, each additional full 15 mins, to a maximum of 60 mins - - - 316 15.000 105.60

1.1.2 Speech Therapy Consultations - - - - - -

1020 Speech therapy consultation. Duration 5 - 15 mins 310 10.000 71.50 - - -




1.2 Assessment & Treatment - - - - - -

1.2.1 Speech Therapy Assessment & Treatment - - - - - -

1050 Speech therapy assessment and treatment. Duration 5 - 15 mins 310 10.000 71.50 - - -




2. Speech, Voice, Language and Hearing Disorders - - - - - -

0007 Group therapy: per patient at rooms (Maximum of 3 patients per therapy) 310 15.000 107.20 - - -

Note: Professional Group Consultations - no fee to be charged. - - - - - -

0009 Preparation of a home programme 310 15.000 107.20 - - -

Note: This category is to prepare the home programme prior to consultation with patient or care giver - - - - - -

0020 Report writing 310 30.000 214.40 316 30.000 211.20


310 - - 316 - -

3. Audiology. - - - - - -

A. Peripheral Hearing Evaluation - - - - - -


395 • Version 4_21




code CF Units Value

RCF Units

Value R

1100 Air conduction, pure tone audiogram - - - 313 15.000 120.90

1105 Bone conduction pure tone audiogram - - - 313 12.000 96.70

1110 Full Speech Audiogram including speech reception threshold and discrimination at two or more levels. (3277) - - - 313 15.000 120.90

1115 Speech audiogram screening - - - 313 5.000 40.30

1120 Visual reinforcement audiometry (VRA) - - - 314 40.000 329.40

1121 Conditioning play audiometry - - - 314 40.000 329.40

1122 Select picture audiometry - - - 314 40.000 329.40

1125 Tinnitus Evaluation - - - 313 15.000 120.90

B. Middle Ear Function Evaluation - - - - - -

1200 Tympanometry - - - 312 8.000 60.90

1205 Immittance Measurements - Impedance / Stapedial reflex (3276): Limited reflex spectrum (eg : 1-2 frequencies) - - - 312 4.000 30.50

1210Immittance Measurements - Impedance / Stapedial reflex (3276):Extended reflex spectrum (250-8000Hz e.g. 4-8 frequencies)

- - - 312 12.000 91.40

1215 High Frequency Tympanometry (impedance testing) - for peadiatric population - - - 312 8.000 60.90

1220 Eustachian Tube Function Test - multiple tympanograms - bilateral - - - 312 12.000 91.40

1225 Rinné & Weber tests - - - 313 4.000 32.20

C.Diagnostic Audiological Tests for Differential Diagnosis between Cochlear; Retro-cochlear; Central; Functional and/or Vestibular Pathology

- - - - - -

1300 Tone Decay (for retro cochlear pathology) - - - 313 8.000 64.50

1305 Reflex decay (for retro cochlear pathology) - - - 312 8.000 60.90

1310 Short Increment Sensitivity Index (SISI) - - - 313 5.000 40.30

1315 Most comfortable levels (MCL) & Uncomfortable levels (UCL) : Air conduction - - - 313 8.000 64.50

1320 Most comfortable levels (MCL) & Uncomfortable levels (UCL) : Speech thresholds - - - 313 4.000 32.20

1325 Test for functional hearing loss - - - 313 10.000 80.60

1331 Stenger test, pure tone - - - 313 5.000 40.30

1332 Stenger test, speech - - - 313 5.000 40.30

1335 Fistula test - (for peri-lymph fluid leakage) - - - 313 15.000 120.90

D. Auditory Processing (AP) and Central Auditory Processing Tests (CAP) - - - - - -


396 • Version 4_21




code CF Units Value

RCF Units

Value R

Only tests appropriate to the recommendations of the HPCSA Taskforce on CAPD should be administered i.e. low-linguistically loaded tests are tests of choice. No more than two tests from each category below can be administered. Deviations from this billing guideline requires motivation. No more than two tests from each category below can be administered. Repeat item 1400 for each test done. Deviations from this billing guideline requires motivation.

- - - - - -

PRELIMINARY TEST BATTERY - - - - - -

Scan-C - - - - - -

Scan-A - - - - - -

PSI - - - - - -

DIFFERENTIAL DIAGNOSIS BETWEEN CAPD AND ADHD - - - - - -

Selective Auditory Attention Test - - - - - -

Auditory Continuous Performance Test - - - - - -

TESTS OF MONAURAL LOW REDUNDANCY - - - - - -

Low Pass Filtered Speech - Ivey - - - - - -

Low Pass Filtered Speech - NU-6 Lists 500Hz, 750Hz And 1000Hz - - - - - -

Time Compressed Speech/Time Compressed Speech with Reverberation - - - - - -

SPEECH IN NOISE TESTS - - - - - -

SPIN - - - - - -

SSI-ICM - - - - - -

BKB-SIN - - - - - -

SIN - - - - - -

QuickSIN - - - - - -

DICHOTIC SPEECH TESTS - - - - - -

Dichotic Digits Test - - - - - -

Dichotic Consonant Vowel - - - - - -

SSI-CCM - - - - - -

Staggered Spondaic Word Test - - - - - -

Competing Sentences Test - - - - - -

Dichotic Rhyme Test - - - - - -

Dichotic Sentence Identification Test - - - - - -

TEMPORAL PROCESSING TESTS - - - - - -


397 • Version 4_21




code CF Units Value

RCF Units

Value R

Random Gap Detection Test - - - - - -

TEMPORAL PATTERNING TESTS - - - - - -

Frequency Pattern (Pitch Pattern) Sequence Test - - - - - -

Duration Pattern Sequence Test - - - - - -

BINAURAL INTERACTION TESTS - - - - - -

Masking Level Difference for Speech - - - - - -

Binaural Fusion Test (Ivey, NU-6 or CVC Fusion) - - - - - -

1400 Central Auditory Processing Disorders test, test to be specified. - - - 314 13.000 107.00

E. Electro-Physiological Examinations/Auditory Evoked Potentials (AEP) - - - - - -

1500 Diagnostic Neurological short latency ABR (Auditory Brainstem Response) Bilateral; single decibel (2692) - - - 314 60.000 494.00

1505 AABR - Bilateral (Automated Auditory Brainstem Response). Cannot be charged with 1510 - - - 312 30.000 228.50

1510 Screening ABR - Bilateral (Auditory Brainstem Response) . Cannot be charged with 1505 - - - 312 20.000 152.40

1515Diagnostic Audiological Click ABR (Auditory Brainstem Evoked Response) – BilateralAir conduction threshold determination using click stimuli

- - - 314 60.000 494.00

1520Diagnostic Audiological Click ABR-(Auditory Brainstem Response) – Bilateral Bone conduction threshold determination using click stimuli

- - - 314 80.000 658.70

Combinations of items 1531 to 1534 cannot be billed together. - - - - - -

1531Diagnostic Audiological Tone Burst ABR (Auditory Brainstem Response) – Bilateral Frequency specific threshold determination using tone-burst stimuli at: 1 frequency

- - - 314 30.000 247.00

1532Diagnostic Audiological Tone Burst ABR (Auditory Brainstem Response) – Bilateral Frequency specific threshold determination using tone-burst stimuli at : 2 frequencies

- - - 314 60.000 494.00


- - - 314 90.000 741.10


- - - 314 120.000 988.10


1541Diagnostic Audiological Middle latency & Late Cortical Auditory Evoked responses (2698) – Bilateral Frequency specific threshold determination using tone-burst stimuli at : 1 frequency

- - - 314 25.000 205.90

1542Diagnostic Audiological Middle latency & Late Cortical Auditory Evoked responses (2698) – Bilateral Frequency specific threshold determination using tone-burst stimuli at : 2 frequencies

- - - 314 50.000 411.70

1543Diagnostic Audiological Middle latency & Late Cortical Auditory Evoked responses (2698) – Bilateral Frequency specific threshold determination using tone-burst stimuli at : 3 frequencies

- - - 314 75.000 617.60


398 • Version 4_21




code CF Units Value

RCF Units

Value R

1544Diagnostic Audiological Middle latency & Late Cortical Auditory Evoked responses(2698) – Bilateral Frequency specific threshold determination using tone-burst stimuli at : 4 frequencies

- - - 314 100.000 823.40


1551 ASSER (Auditory Steady State Evoked Response) – Bilateral threshold determination : 1 frequency - - - 314 30.000 247.00

1552 ASSER (Auditory Steady State Evoked Response) – Bilateral threshold determination : 2 frequencies - - - 314 40.000 329.40



1560 P300 Cognitive AEP (Auditory Evoked Potential) or MMN (Mismatch Negativity) - - - 314 35.000 288.20

1565 Electrocochleography: unilateral (2699) - - - 314 45.000 370.50

1570 Electrocochleography: bilateral (2700) - - - 314 90.000 741.10

1575 Cochlear nerve function test - intra-operative monitoring - per 30min - - - 314 30.000 247.00

1580 Evoked otoacoustic emissions (OAE); limited - - - 311 15.000 109.90

1581 Evoked otoacoustic emissions (OAE): comprehensive - - - 312 30.000 228.50

F. Balance/Vestibular Examinations and Treatment - - - - - -

1600 Spontaneous and positional nystagmus using electro-nystagmography (ENG)(3253). - - - 314 55.000 452.90

1605 Spontaneous and positional nystagmus using Video-nystagmography (VNG - - - 315 55.000 476.60

1610 Eye Visualization – spontaneous and positional nystagmus – monocular - - - 311 35.000 256.50

1615Videonystagmoscopy: spontaneous and positional nystagmus. (Only camera/goggles, without computerised VNG software)

- - - 312 35.000 266.60

1620 Oculo-motor/central tests using electro-nystagmography (ENG) - - - 315 25.000 216.70

1625 Oculo-motor/central tests using video-nystagmography (VNG) - - - 315 25.000 216.70

1630 DVA (Dynamic Visual Acuity) test using Video-nystagmography (VNG) - - - 315 10.000 86.70

1635 Caloric test using ENG electro-nystagmography (3255) - - - 315 50.000 433.30

1640 Caloric test using VNG electro-nystagmography (3255) - - - 315 50.000 433.30

1645 Posturography - - - 315 25.000 216.70

1650 Rotational Chair test - - - 312 15.000 114.30

1655 Otolith repositioning/canalith maneuvre - - - 316 25.000 176.00

1660Vestibular rehabilitation (neuromuscular) re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception

- - - 316 25.000 176.00

G. Cochlear Implant Tests - - - - - -

1700 Cochlear Implants: Pre-implant round window promontory testing - - - 312 45.000 342.80


399 • Version 4_21




code CF Units Value

RCF Units

Value R

1710 Cochlear Implants : Electrode mapping : per 15min (max 120min) - - - 315 15.000 130.00

1720 Cochlear Implants : Implant test : Four test modes : intra- or post-operatively - - - 313 5.000 40.30

1725 Cochlear Implants : Neural Response Telemetry : intra-operatively (during cochlear implant surgery) - - - 315 20.000 173.30

1730 Cochlear Implants : Neural Response Telemetry : post-operatively (after cochlear implant surgery) - - - 313 55.000 443.30

1735 Cochlear Implants : Electrical Stapedius Reflex Thresholds : intra-operatively only - - - 315 13.000 112.70

1740Cochlear Implants : Comprehensive speech perception testing, pre- and post-cochlear implant, per 15min (max 45min)

- - - 314 15.000 123.50

H. Hearing Amplification / Hearing Aids - - - - - -

1800 Hearing aid evaluation - per ear - - - 311 15.000 109.90

1805 Free Field Hearing Aid Evaluation : Pure tone and speech (with and without lipreading) - - - 314 13.000 107.00

1810 Insertion gain measurement, per ear - - - 312 10.000 76.20

1815 Re-programming of hearing aid, per ear - - - 311 10.000 73.30

1820 Technical adjustment of hearing aid/device, per ear. - - - 311 6.000 44.00

1825 Repairs to hearing aids - - - 316 - -

1830 Global charge for supply and fitting of hearing aid and follow-up (By arrangement with scheme). - - - 316 - -

I. Occupational Health / Industrial Hearing Assessment - - - - - -

1900 Pure Tone Audiogram (Air conduction). (3237) - - - 316 - -

1905 Pure Tone Audiogram (Bone conduction) (3274) - - - 316 - -

1910 Full Speech Audiogram including speech reception threshold and discrimination at two or more levels (3277) - - - 316 - -

1915 Speech audiogram screening - - - 316 - -

1920 Immittance Measurements (Impedance) (Tympanometry) - - - 316 - -

1925 Immittance Measurements (Impedance) (Stapedial reflex) (3276) - - - 316 - -

4. Material - - - - - -

0300 Medication 310 - - 316 - -

0301 Material 310 - - 316 - -


400 • Version 4_21

Sub-Acute Facilities

GEMS TARIFF IN RESPECT OF PRIVATE SUB ACCUTE FACILITIES WITH A “049” PRACTICE NUMBER, WITH EFFECT FROM 1 JANUARY 2011Practice Type: Sub-Acute Facilities

Code: 54900

code CF Units Value

R


- - -

GENERAL RULES - - -

B The charges are indicated in the relevant column opposite the item codes. - - -

C

Procedure for the classification of private sub-acute facilities: i) Inspections of private sub-acute facilities having practice code numbers commencing with the digits “049” will be conducted by an independent agency on behalf of BHF.Applications to be addressed in writing to BHF. ii) The provisions referred to in D.1.1 shall apply mutatis mutandis to all private sub-acute facilities such as post-natal units, rehabilitation units and psychiatric units.

- - -

DAll accounts submitted by private sub-acute facilities shall comply with all of the requirements of Chapter 2, Regulation 5, promulgated in terms of the Medical Schemes Act, Act No. 131 of 1998. Such accounts shall also reflect the practice code number and name of the attending practitioner.

- - -

EAll accounts containing items, which are subject to a discount in terms of the rates shall indicate such items individually and shall show separately the gross amount of the discount.

- - -

SCHEDULE - - -

1 ACCOMMODATION - - -

Ward Fees - - -

Private sub-acute facilities shall indicate the exact time of admission and discharge on all accounts.Patients admitted as day patients shall be charged half daily rate if discharged before 23h00 on the same date:The following will be applicable to items 001, 010, 013, 015, 017, 105 and 020 On the day of admission: If accommodation is less than 12 hours from time of admission: half the daily rate. If accommodation is more than 12 hours from time of admission: full daily rate. On day of discharge: If accommodation is less than 12 hours: half the daily rate. If accommodation is more than 12 hours: full daily rate.Two half-day fees would be applicable when a patient is transferred internally between any ward and any sub-acute unit.

- - -

1.1 General Wards - - -

001 Ward fee, per day 480 10.000 956.90

1.2 Rehabilitation units - - -


401 • Version 4_21

GEMS TARIFF IN RESPECT OF PRIVATE SUB ACCUTE FACILITIES WITH A “049” PRACTICE NUMBER, WITH EFFECT FROM 1 JANUARY 2011Practice Type: Sub-Acute Facilities

Code: 54900

code CF Units Value

R

The following high function rehabilitation impairment categories will be treated in recognised and accredited specialised rehabilitation units of private sub-acute facilities: Stroke, Brain dysfunction (traumatic and non-traumatic), Spinal cord dysfunction(traumatic and non-traumatic), Orthopaedic (lower joint replacements), Amputation (lower extremity), Cardiac, Pulmonary, Major multiple trauma. Other neurological or orthopaedic impairments will require specific letters of motivation.

- - -

101 General ward/facility fee: under 5 hours stay 480 2.227 213.10

105 General care (ward/supporting facilities and equipment) 480 10.286 984.30

Note: The maxima may be modified in individual cases on specific motivation from the doctor-in-charge. - - -

1.3 Psychiatric Rehabilitation Unit - - -

The following psychiatric categories will be treated in recognised and accredited specialised psychiatric units of private sub-acute facilities: Depression, Bipolar mood disorder, Anxiety disorder, Organic mood disorder, Dementia, Psychological behavioural disorder, Schizophrenia, Mental retardation, Eating disorder, Nonorganic sleep disorder, Sexual disfunction (not by organic disorder) and Mental behaviour disorder (ass pueperium), will require specific letters of motivation. Inclusive of all specialised psychiatric equipment, monitors, etc.

- - -

003 Ward fee: with overnight stay (specific motivation from the doctor-in-charge) (ward/supporting facilities and equipment) 480 10.430 998.00

005 General ward fee: under 5 hours stay 480 2.266 216.80

007 General ward fee: without overnight stay 480 5.392 516.00

2 STANDARD MATERIAL CHARGES - - -

2.1 Ward stock - - -

The amount charged in respect of dispensed medicines and scheduled substances shall not exceed the limits prescribed in the Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances, dated 30 April 2004, made in terms of the Medicines and Related Substances Act, 1965 (Act No 101 of 1965).In relation to other ward stock (materials and/or medicines), the amount charged shall not exceed the net acquisition price (inclusive of VAT) plus 30% up to a maximum of R30.00

- - -

419 Ward stock 440 - -

2.2 Gases - - -

Oxygen, ward use Fee for oxygen, per quarter hour of part thereof. To charged using the appropriate NAPPI code.

- - -

284 PWV area 440 - -

710 Cape Town 440 - -

711 Port Elizabeth 440 - -

712 East London 440 - -

713 Durban 440 - -

714 Other areas 440 - -


402 • Version 4_21

Tissue Transportation

GEMS TARIFFFOR TISSUE TRANSPORTATION, EFFECTIVE FROM 1 JANUARY 2011Practice Type: Accredited Blood

and Blood Product Couriers Code: 50300

code CF Units Value

R

The GEMS tariff valuesfor Tissue Transportation services are obtainable from the Scheme administrator. Please contact GEMS at 0860 00 4367 to be supplied with the applicable tariffs and reimbursement value

- - -

001Items in the section on blood transportation are only chargeable by providers with a “003” practice number (Accredited Blood and Blood Product Couriers)

- - -

1 BLOOD TRANSPORTATION - - -

700Routine compat collection: Collection of patient’s blood compat by courier from hospital / clinic, other than as an emergency.Compat to be delivered to blood bank for cross match.

460 - -

710Routine blood / blood product collection: Collection and delivery of cross-matched blood/blood produce by courier from blood bank, other than as an emergency.Blood/blood product to be taken to hospital/clinic for patient.

460 - -

720Emergency blood / blood product collection: Collection of blood/blood product (without a full cross-match) where the driver has to wait for the blood/blood product and deliver it to the hospital (i.e. ROUND TRIP).

460 - -

The scheme may require verification of emergency and determine the nature of such required verification.May not be billed with 700, 710 or 730.

730

Emergency blood / blood product collection following change of status of request: Collection of blood/blood product (with or without a full cross-match) where, after the original request was delivered to the blood bank by the courier as a routine request, the status of the request was subsequently changed by the hospital or clinic to an emergency necessitating a non-routine collection by the courier.Blood/blood product to be taken to hospital/clinic for patient.

460 - -

The scheme may require verification of change of status and determine the nature of such required verification. Typically billed with 700.May not be billed with 710.

- - -

740Long distance: Additional per km fee for collections further than 50km.This fee applies only to those kilometres in excess of 50 km.Supporting documentation required, illustrating distance traveled.

460 - -


403 • Version 4_21

Additional GEMS TariffsHCT Tariff

code Tariff description 2011 Tariff

15 Blood glucose 32,00

16 Pre-counselling (without going ahead with the HIV Test) 21,30

17 Pre-counselling, screening test, post test counselling, confirmatory test and condoms 85,20

Liquid Based Cytology

Tariff code Tariff description 2011 Tariff

4559 Liquid Based Cytology 204,50

Managed fixed fee services for Sapphire and Beryl

code 2011 Tariff

Reimbursement of Participating Doctors

Participating Doctors classified according to his or her practice profile on the Scheme’s medical practitioner profiling tool as a category 1 Medical Practitioner will be paid an enhanced consultation fee equal to the Scheme rate plus a fee that will be determined annually and communicated to the participating practitioners for out of hospital consultations.

All other Participating Doctors will be paid a consultation fee equal to the Scheme rate for out of hospital consultations.

90011 Consultation Optometry 285,00

93200 - 93201

Single Vision Package (Combined V/Exam, Frame and S/Vision Surfaced) Optometry 505,00

93300 Bifocal Package (Combined V/Exam, Frame and Bifocal) Optometry 798,00

8101 Consultation Dental 144,90

8104 Examination for a specific problem not requiring full mouth examination Dental 70,27

8107 Intra oral radiographs, per film Dental 58,72

8112 Intra oral radiographs, per film Dental 58,72

8159 Scaling and polishing Dental 174,90

8161 Topical application of fluoride Dental 88,93

8163 Fissure sealant, per tooth Dental 58,72

8341 Amalgam one surface Dental 177,02

8342 Amalgam two surfaces Dental 218,25

8343 Amalgam three surfaces Dental 266,06

8344 Amalgam four and more surfaces Dental 296,48

8351 Resin restoration, one surface anterior Dental 194,29


404 • Version 4_21


code 2011 Tariff

8352 Resin restoration, two surface anterior Dental 244,43

8353 Resin restoration, three surface anterior Dental 292,13

8354 Resin restoration, four and more surfaces Dental 325,84

8367 Resin restoration, one surface posterior Dental 210,72

8368 Resin restoration, two surface posterior Dental 260,65

8369 Resin restoration, three surface posterior Dental 315,03

8370 Resin restoration, four and more surfaces Dental 338,77

8307 Amputation of pulp (pulpotomy) Dental 116,17

8132 Root canal therapy - gross pulpal debridement Dental 145,43

8201 Extraction, single tooth. Code 8201 is charged for the first extraction in a quadrant Dental 88,93

8202 Extraction, each add tooth. Code 8202 is charged for each additional extraction in the same quadrant Dental 35,82

8937 Surgical removal of tooth Dental 384,56

8935 Treatment of septic socket Dental 65,19

8109 Infection control / barrier techniques. Codes 8109 includes the provision by the dentist of new rubber gloves, masks, etc for each patient Dental 13,03

8110 Sterilized instrumentation Dental 33,60

8145 Local anaesthetic Dental 56,49

8231 Complete dentures – maxillary and mandibular Dental 1435,66

8232 Complete dentures – maxillary or mandibular Dental 884,99

8233 Partial Denture (resin base) - One tooth Dental 411,49

8234 Partial Denture (resin base) - Two teeth Dental 411,49

8235 Partial Denture (resin base) - Three teeth Dental 615,75

8236 Partial Denture (resin base) - Four teeth Dental 615,75

8237 Partial Denture (resin base) - Five teeth Dental 615,75

8238 Partial Denture (resin base) - Six teeth Dental 816,73

8239 Partial Denture (resin base) - Seven teeth Dental 816,73

8240 Partial Denture (resin base) - Eight teeth Dental 816,73

8241 Partial Denture (resin base) - Nine teeth and more Dental 816,73

8259 Rebase complete or partial dentures (Lab) Dental 335,59

8269 Repair Denture Dental 112,89

8263 Reline complete or partial dentures (chair side) Dental 212,84

8271 Add tooth to existing partial dentures Dental 81,40

8273 Impression to repair / addition. Dental 65,19


405 • Version 4_21


code 2011 Tariff

0191-0192 General practitioner visit - Dispensing doctor - Level 1 General Practitioner 247,00



0191-0192 General practitioner visit - Non-dispensing doctor - Level 1 General Practitioner 186,00



300 Stitching of a wound General Practitioner 184,00

301 Stitching additional wound General Practitioner 63,00

307 Excision and repair General Practitioner 253,00

255 Drainage of subcutaneous abscess and avulsion of nail General Practitioner 184,00

259 Removal of foreign body superficial to deep fascia General Practitioner 184,00

887 Limb cast (including cost of POP and material) General Practitioner 149,00

1725 Drainage external thrombosed pile General Practitioner 149,00

1186* Flow volume test: Inspiration/expiration General Practitioner 149,00

1188* Flow volume test: Inspiration/expiration/pre- and post bronchodilator General Practitioner 149,00

1234* ECG bicycle General Practitioner 173,00

1235* ECG multistage treadmill General Practitioner 173,00

2713 Lumbar puncture General Practitioner 149,00


406 • Version 4_21

GlossaryAbbreviation Description

Code Treatments code or governing rules number

Description The description of the service or rules that govern the respective service

CF Conversion factors that determines the rate of reimbursement

Units Unit allocation for the respective service

Value Rand value for the respective service

GEMS Tariff codes 2011 - PG GROUP MEDICAL SCHEME

Documents