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HEALTHMAN REFERENCE PRICE LIST FOR SERVICES BY PODIATRISTS, EFFECTIVE FROM
1 JANUARY 2007 |
Version |
Units |
Value (VAT incl.) |
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The following reference price list is not a set of tariffs that must be
applied by medical schemes and/or providers. It is rather intended to serve
as a baseline against which medical schemes can individually determine
benefit levels and health service providers can individually determine fees
charged to patients. Medical schemes may, for example, determine in their
rules that their benefit in respect of a particular health service is
equivalent to a specified percentage of the national health reference price
list. It is especially intended to serve as a basis for negotiation between
individual funders and individual health care providers with a view to
facilitating agreements which will minimise balance billing against members
of medical schemes. Should individual medical schemes wish to determine
benefit structures, and individual providers determine fee structures, on
some other basis without reference to this list, they may do so as well.
In calculating the prices in this schedule, 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.
VAT EXCLUSIVE PRICES APPEAR IN BRACKETS. |
2007.01 |
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General Rules |
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A |
All accounts must be presented with the following information clearly
stated:
· name of practitioner
· qualifications of the practitioner;
· BHF practice number;
· postal address and telephone number;
· date on which service(s) were provided;
· The relevant diagnostic codes and NHRPL 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. |
2007.01 |
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B |
The 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. |
2007.01 |
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Modifiers |
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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. |
2007.01 |
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0004 |
Consultation or treatment in a nursing facility/hospital |
2007.01 |
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ITEMS |
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Modifier 0004 must be quoted for consultation or treatment rendered in a
nursing home or hospital. |
2007.01 |
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CONSULTATIONS. |
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301 |
Consultation (initial or follow up) 5-10 minutes |
2007.01 |
7.500 |
R 72.98 |
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302 |
Consultation (initial or follow up) 11-20 minutes |
2007.01 |
15.000 |
R 145.95 |
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303 |
Consultation (initial or follow up) 21-30 minutes |
2007.01 |
25.000 |
R 243.25 |
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304 |
Consultation (initial or follow up) 31-45 minutes |
2007.01 |
37.500 |
R 364.88 |
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006 |
More than one patient seen at a residence (See note below). |
2007.01 |
8.500 |
R 82.71 |
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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. |
2007.01 |
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101 |
Appointments 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). |
2007.01 |
- |
R - |
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INJECTIONS. |
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009 |
Administration of injection, per administration |
2007.01 |
1.300 |
R 12.65 |
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ROUTINE TREATMENTS. |
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010 |
General 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 |
2007.01 |
7.500 |
R 72.98 |
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011 |
General 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 |
2007.01 |
17.500 |
R 170.28 |
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012 |
Extended care for chronic disease management or ulcer management (applicable
to diabetes, arthritis and peripheral vascular diseases) |
2007.01 |
7.400 |
R 72.00 |
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013 |
General podiatric care more than 30 minutes (a combination of items 010 and
011)
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2007.01 |
25.000 |
R 243.25 |
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VERRUCA TREATMENTS. |
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Note : No consultation fee shall be charged for the same session unless the
procedure is performed at the time of the initial consultation |
2007.01 |
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014 |
Verruca Pedis (Chemotherapy first lesion). |
2007.01 |
10.000 |
R 97.30 |
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015 |
Subsequent lesion. |
2007.01 |
7.000 |
R 68.11 |
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016 |
Cryotherapy first lesion. |
2007.01 |
10.000 |
R 97.30 |
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017 |
Subsequent lesion. |
2007.01 |
7.000 |
R 68.11 |
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018 |
Diathermy first lesion. |
2007.01 |
10.000 |
R 97.30 |
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019 |
Subsequent lesion. |
2007.01 |
7.000 |
R 68.11 |
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Nail Surgery. |
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Note : No consultation fee shall be charged for the same session unless the
procedure is performed at the time of the initial consultation |
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021 |
Nail wedge resection with matrix phenolisation : one nail - one side. |
2007.01 |
19.000 |
R 184.87 |
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022 |
Two nails - one side. |
2007.01 |
25.000 |
R 243.25 |
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024 |
Two nails - both sides. |
2007.01 |
36.400 |
R 354.17 |
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023 |
One nail - two sides. |
2007.01 |
25.000 |
R 243.25 |
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025 |
Avulsion with matrix phenolisation. |
2007.01 |
19.600 |
R 190.71 |
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031 |
Avulsion without matrix phenolisation. |
2007.01 |
12.800 |
R 124.54 |
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Other. |
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040 |
Infection control, per patient |
2007.01 |
1.200 |
R 11.68 |
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041 |
Remedial therapy. |
2007.01 |
4.900 |
R 47.68 |
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042 |
Sterile pack. |
2007.01 |
5.900 |
R 57.41 |
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044 |
Suturing (includes consultation). |
2007.01 |
7.800 |
R 75.89 |
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046 |
Incision Biopsy. |
2007.01 |
5.900 |
R 57.41 |
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047 |
Removal of foreign body. |
2007.01 |
8.900 |
R 86.60 |
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146 |
Excision biopsy. |
2007.01 |
8.900 |
R 86.60 |
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203 |
Wound dressing material (maximum of 2 per patient) |
2007.01 |
2.000 |
R 19.46 |
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207 |
Moulded Orthotic material fee |
2007.01 |
11.800 |
R 114.81 |
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209 |
Simple insole material fee |
2007.01 |
5.900 |
R 57.41 |
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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. |
2007.01 |
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215 |
Padding and strapping : Digital, per foot |
2007.01 |
2.800 |
R 27.24 |
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217 |
Padding and strapping: Metatarsal, per foot |
2007.01 |
3.500 |
R 34.06 |
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219 |
Padding and strapping: Heel, per foot |
2007.01 |
3.500 |
R 34.06 |
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Appliances and Orthotics |
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(By arrangement with the scheme concerned). |
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043 |
Biomechanical examination. |
2007.01 |
15.700 |
R 152.76 |
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051 |
Neutral impression Plaster of Paris casting |
2007.01 |
8.500 |
R 82.71 |
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052 |
Orthotic repair. |
2007.01 |
12.800 |
R 124.54 |
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053 |
Temporary orthotic or corrective component. |
2007.01 |
12.800 |
R 124.54 |
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054 |
Prescription covering and soft tissue supplements. |
2007.01 |
8.900 |
R 86.60 |
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055 |
Silicone devices: Digital |
2007.01 |
5.400 |
R 52.54 |
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056 |
Computerised gait analysis |
2007.01 |
19.600 |
R 190.71 |
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057 |
Template measurement. |
2007.01 |
2.900 |
R 28.22 |
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058 |
Immobilisation casting |
2007.01 |
10.600 |
R 103.14 |
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059 |
Simple insole - one foot. |
2007.01 |
11.100 |
R 108.00 |
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061 |
Simple insoles - both feet. |
2007.01 |
20.100 |
R 195.57 |
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060 |
Silicone devices: metatarsal |
2007.01 |
10.700 |
R 104.11 |
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064 |
Silicone devices: heel |
2007.01 |
15.900 |
R 154.71 |
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The rates for items 063 and 065 include the cost of instrinsic and extrinsic
posting adjustments |
2007.01 |
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063 |
Prescription orthotic : one foot. |
2007.01 |
19.100 |
R 185.84 |
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065 |
Prescription orthotics : both feet. |
2007.01 |
40.000 |
R 389.20 |
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067 |
Preformed moulded insoles: Adult, both feet |
2007.01 |
22.100 |
R 215.03 |
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069 |
Preformed moulded insoles: Adult, one foot |
2007.01 |
11.000 |
R 107.03 |
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071 |
Preformed moulded insoles: Child, both feet |
2007.01 |
17.000 |
R 165.41 |
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073 |
Preformed moulded insoles: Child, one foot |
2007.01 |
8.500 |
R 82.71 |
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220 |
Materials - charge appropriate NAPPI code |
2007.01 |
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221 |
Local Anaesthetics - charge appropriate NAPPI code |
2007.01 |
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