PAEDIATRICS CMS MODEL 2006

HealthMan has calculated the HRPL based on the contents and requirements of Council for Medical Schemes Circular 69 of 2005. Costs were thoroughly researched and the methodologies to determine tariffs are in terms of Circular 69 of 2005. The HRPL is not a set of tariffs that must be applied by medical schemes and/or healthcare providers. Its objective is to serve as a baseline/benchmark against which medical schemes can individually set benefits and that can be used by healthcare providers to determine individually the fees they charge to patients. Healthcare providers should assess their individual practice costs and patient demographics in determining their fees.

Rand conversion factor (VAT excl) 17.10
Rand conversion factor (VAT incl) 19.50
Code Terminology Average Duration Professional Price (VAT inclusive)
  Consultations:    
0107 Newborn Attendance -Visit in Ward 33.00 643.30
0109 Hospital follow-up visit 15.00 292.40
0111 Hospital visit(exl. Neonates) 22.50 438.60
0113 Newborn Attendance - Emergency at all hours 45.00 877.20
0129 Prolonged first/follow-up consultation : 15 min 15.00 292.40
0132 Repeat Script 5.00 97.50
0190 Consultation :10-20 min. 15.00 292.40
0191 Consultation :20-35 min. 27.50 536.10
0192 Consultation :30-45 min. 40.00 779.70
0193 Consultation :45-60min. 52.50 1,023.40
0145 Consultation : Away from doctor's room 6.00 117.00
0146 Unscheduled consultation: Emergency (cons.room) 8.00 156.00
0147 Unscheduled consultation:Emergency(not cons.room) 14.00 272.90
0148 Elective after-hours services(+50%)   -
0149 Emergency after-hours services(+25%)   -
0173 Hospital Consultation:10-20 min. 15.00 292.40
0174 Hospital Consultation:20-35 min. 27.50 536.10
0175 Hospital Consultation:30-45 min. 40.00 779.70
0176 Hospital Consultation:45-60 min. 52.50 1,023.40
0199 Chronic Medicine Forms 21.43 417.80
  Sub-Total    
  Procedures    
0201 Cost of material in treatment   -
0202 Setting of sterile tray: 10.00 194.90
0205 Intravenous treatment: Intravenous infusions (cut-down or push-in) 12.00 233.90
0206 Intravenous treatment: Intravenous infusions (push-in) 6.00 117.00
0207 Intravenous treatment: Intravenous infusions (cut-down) 8.00 156.00
0210 Collection of blood specimen(s) 3.25 63.40
0211 Exchange transfusion: First and subsequent (including after-care) 80.00 1,559.50
0220 Allergy: Skin-prick tests: Immediate hypersensitivity testing 1.90 37.00
0255 Drainage of subcutaneous abscess 20.00 389.90
0300 Stitching of soft-tissue injuries: Stitching of wound 14.00 272.90
0307 Excision and repair by direct suture 27.00 526.30
1063 Removal of foreign bodies from nose: At rooms 10.00 204.30
1117 Laryngeal intubation 10.00 226.60
1134 Bronchoscopy: Bronchoscopy with laser 75.00 1.625.00
1136 Nebulisation (in rooms) 12.00 233.90
1141 Insertion of intercostal catheter (under water drainage) 50.00 974.70
1143 Paracentesis chest: Diagnostic 8.00 156.00
1145 Paracentesis chest: Therapeutic 13.00 253.40
1186 Flow volume test: Inspiration/expiration 30.00 584.80
1187 Exhaled nitric oxide determination (not for under 4-year old children) 15.00 300.40
1188 Flow volume test: Inspiration/expiration/pre- and post bronchodilator 50.00 1,013.60
1189 Forced expirogram only 10.00 194.90
1190 Determination of resistance to airflow 45.31 883.30
1192 Peak expiratory flow only 5.00 97.50
1202 Insertion of central venous catheter via peripheral vein in neonates 40.00 779.70
1204 Intensive care: Category 1: Cases requiring intensive monitoring 30.00 584.80
1205 Intensive care: Category 2: Cases requiring active system support 100.00 1,949.40
1206 Intensive care: Category 2: (Subsequent days) 50.00 974.70
1207 Intensive care: Category 2: After two weeks, per day 30.00 584.80
1208 Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients: First day 137.00 2,670.60
1209 Intensive care: Category 3 58.00 1,130.60
1210 Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients w Subsequent days 50.00 974.70
1211 Cardio-respiratory resuscitation   -
1212 Ventilation: First day 75.00 1,462.00
1213 Ventilation: Subsequent days, per day 50.00 974.70
1214 Ventilation: After two weeks, per day 25.00 523.30
1215 Insertion of arterial pressure cannula 25.00 487.30
1216 Insertion of Swan Ganz catheter for haemodynamics monitoring 50.00 1,051.60
1217 Insertion of central venous line via peripheral vein 10.00 194.90
1218 Insertion of central venous line via subclavian or jugular veins 25.00 487.30
1219 Hyperalimentation (daily tariff) 15.00 292.40
1227 Prolonged neonatal resuscitation 20.00 389.90
1230 Physician's fee for interpreting an ECG: Without effort 6.00 117.00
1231 Physician's fee for interpreting an ECG: Without and with effort 10.00 194.90
1232 Electrocardiogram: Without effort 9.00 175.40
1233 Electrocardiogram: Without and with effort 13.00 253.40
1236 Electrocardiogram without effort: Under 4 years 18.00 350.90
1585 24 Hour oesophageal pH studies: Interpretation 27.00 526.30
1780 Gastric and duodenal intubation 8.00 156.00
1800 Peritoneal lavage 20.00 389.90
1996 Bladder catheterisation: Male (not at operation) 6.00 117.00
1967 With ureteric meatotomy: Unilateral or bilateral 15.00 326.90
2712 Electro-encephalography: Interpretation 24.00 467.80
2713 Spinal (lumbar) puncture. For diagnosis, drainage of spinal fluid 18.40 358.70
3273 Pure tone audiometry (air conduction) 6.50 126.70
3275 Impedance audiometry (tympanometry) 6.50 126.70
3620 Cardiac examination plus Doppler colour mapping 50.00 974.70
3622 Cardiac examination: 2 Dimensional 50.00 1,030.10
3628 Renal tract 50.00 974.70
3633 Neonatal head scan 50.00 974.70
3719 Bone marrow: Aspiration 8.40 163.80
3720 Bone marrow trephine biopsy 32.60 635.50
4076 Blood gas 19.10 372.30
  Sub-Total    
  Total    
   
 
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