Code Terminology

Average

Duration

Professional

2013

HealthMan

Practice Cost

Tariff (VAT

Incl.)

HealthMan

RCF

2013

Discovery

Tariffs

(VAT incl.)

DH

RCF

2013

FedHealth

(VAT Incl.)

FedHealth

RCF

2013

GEMS

Tariffs

(VAT Incl.)

GEMS

RCF

2013

Profmed

Profmed

RCF

Units R R R R R R R R R R

Consultations:

See the Notes below for All Tariffs

0109 Hospital follow-up visit 15 586.80 39.122 170.20 11.347 241.00 16.070 243.60 16.243 244.50 16.298

0129 Prolonged first/follow-up consultation : 15 min 15 586.80 39.122 237.40 15.827 241.00 16.070 243.60 16.243 244.50 16.298

0130 Telephone consultation (all hours) 12 469.50 39.122 190.00 15.833 192.90 16.077 194.90 16.243 195.60 16.298

0132 Repeat Script 5 195.60 39.122 79.10 15.820 80.50 16.091 81.20 16.243 81.50 16.298

0133 Writing of special motivations 9 352.10 39.122 142.30 15.811 144.60 16.065 146.20 16.243 146.70 16.298

0145 Consultation : Away from doctor's room 6 234.70 39.122 95.10 15.850 96.40 16.065 97.50 16.243 97.80 16.298

0146 Unscheduled consultation: Emergency (cons.room) 8 313.00 39.122 126.60 15.825 128.50 16.065 129.90 16.243 130.40 16.298

0147 Unscheduled consultation:Emergency(not cons.room) 14 547.70 39.122 221.70 15.836 224.90 16.065 227.40 16.243 228.20 16.298

0151 Pre-anaesthetic assessment: 10 and 20 minutes 39.122 - - - - - 16.298

0173 Hospital Consultation 15 586.80 39.122 269.40 17.960 273.20 18.211 276.10 18.408 423.70 28.247

0174 Hospital Consultation 30 1,173.70 39.122 269.40 8.980 273.20 9.105 276.10 11.028 423.70 14.123

0175 Hospital Consultation 45 1,760.50 39.122 269.40 5.987 273.20 6.070 276.10 7.352 423.70 9.416

0190 Consultation 15 586.80 39.122 303.10 20.207 273.20 18.211 276.10 18.408 423.70 28.247

0191 Consultation 30 1,173.70 39.122 303.10 10.103 273.20 9.105 276.10 11.028 423.70 14.123

0192 Consultation 45 1,760.50 39.122 303.10 6.736 273.20 6.070 276.10 7.352 423.70 9.416

0199 Chronic Medicine Forms 21.43 838.40 39.122 339.20 15.828 344.30 16.066 348.10 16.243 349.30 16.298

Procedures

`

0008 Specialist surgeon assistant - - - - - - - - -

0009 Assistant - - - - - - - - -

0011 Emergency Procedures - - - - - - - - -

0018 Physical treatment - - - - - - - - -

0051

Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone

grafting 77 3,012.40 39.122 754.70 9.801 - - 774.60 10.060 777.20 10.093

0303 Stitching of soft-tissue injuries: Deep laceration involving extensive muscle damage 128 5,007.60 39.122 1,254.50 9.801 1,273.70 9.951 1,287.60 10.060 1,291.90 10.093

0304 Major debridement of wound, sloughectomy or secondary suture 50 1,956.10 39.122 490.10 9.801 497.60 9.951 503.00 10.060 504.70 10.093

0376 Dupuytren's contracture: Fasciectomy 218 8,528.60 39.122 2,136.60 9.801 2,169.30 9.951 2,193.00 10.060 2,200.30 10.093

0389 Fracture (reduction under general anaesthetic): Humerus 77 3,012.40 39.122 754.70 9.801 1,110.50 14.422 1,122.80 14.582 777.20 10.093

0391 Fracture (reduction under general anaesthetic): Radius and/or Ulna 77 3,012.40 39.122 754.70 9.801 766.30 9.952 774.60 10.060 777.20 10.093

0392 Fracture (reduction under general anaesthetic): Open reduction of both radius and ulna 210 8,215.60 39.122 2,058.20 9.801 2,089.80 9.951 2,112.50 10.060 2,119.50 10.093

0405 Fracture (reduction under general anaesthetic): Open treatment of metacarpal: Simple 118.3 4,628.10 39.122 1,159.50 9.801 1,177.20 9.951 1,190.10 10.060 1,194.00 10.093

0421 Fracture (reduction under general anaesthetic): Femur: Neck or Shaft 237 9,271.90 39.122 2,322.80 9.801 2,358.50 9.951 2,384.10 10.060 2,392.00 10.093

0429 Fracture (reduction under general anaesthetic): Tibia with or without fibula 128 5,007.60 39.122 1,254.50 9.801 1,273.70 9.951 1,287.60 10.060 1,291.90 10.093

0437 Fracture (reduction under general anaesthetic): Fracture-dislocation of ankle 128 5,007.60 39.122 1,254.50 9.801 1,273.70 9.951 1,287.60 10.060 1,291.90 10.093

0465 Fractures involving large joints (includes the item for the relative bone) 288 11,267.10 39.122 2,822.70 9.801 2,865.80 9.951 2,897.20 10.060 2,906.80 10.093

0473

Percutaneous insertion plus subsequent removal of Kirschner wires or Steinmann pins (no after-

care) 43 1,682.20 39.122 421.40 9.801 427.80 9.949 432.60 10.060 434.00 10.093

0475

Bonegrafting or internal fixation for malunion or non-union: Femur, Tibia, Humerus, Radius and

Ulna 282 11,032.40 39.122 2,763.90 9.801 2,806.10 9.951 2,836.80 10.060 2,846.20 10.093

0479 Bonegrafting or internal fixation for malunion or non-union: Other bones 154 6,024.80 39.122 1,509.40 9.801 1,532.40 9.951 1,549.20 10.060 1,554.30 10.093

0497 Resection of bone or tumour with or without grafting (benign) 282 11,032.40 39.122 2,763.90 9.801 2,806.10 9.951 2,836.80 10.060 2,846.20 10.093

HEALTHMAN ORTHOPAEDICS COSTING GUIDE 2013

COMPARATIVE TARIFFS: Scheme Rates

Base Rates

Code Terminology

Average

Duration

Professional

2013

HealthMan

Practice Cost

Tariff (VAT

Incl.)

HealthMan

RCF

2013

Discovery

Tariffs

(VAT incl.)

DH

RCF

2013

FedHealth

(VAT Incl.)

FedHealth

RCF

2013

GEMS

Tariffs

(VAT Incl.)

GEMS

RCF

2013

Profmed

Profmed

RCF

Units R R R R R R R R R R

HEALTHMAN ORTHOPAEDICS COSTING GUIDE 2013

COMPARATIVE TARIFFS: Scheme Rates

Base Rates

0499 Grafts to cysts: Large bones 192 7,511.40 39.122 1,881.80 9.801 1,910.70 9.951 1,931.50 10.060 1,937.90 10.093

Code Terminology

Average

Duration

Professional

2013

HealthMan

Practice Cost

Tariff (VAT

Incl.)

HealthMan

RCF

2013

Discovery

Tariffs

(VAT incl.)

DH

RCF

2013

FedHealth

(VAT Incl.)

FedHealth

RCF

2013

GEMS

Tariffs

(VAT Incl.)

GEMS

RCF

2013

Profmed

Profmed

RCF

Units R R R R R R R R R R

HEALTHMAN ORTHOPAEDICS COSTING GUIDE 2013

COMPARATIVE TARIFFS: Scheme Rates

Base Rates

0503 Grafts to cysts: Cartilage graft 206 8,059.10 39.122 2,019.00 9.801 2,049.90 9.951 2,072.30 10.060 2,079.20 10.093

0507 Removal of autogenous bone for grafting 50 1,956.10 39.122 490.10 9.801 497.60 9.951 503.00 10.060 504.70 10.093

0521 Osteotomy: Femoral: Proximal (modifier 0051 is applicable) 320 12,519.00 39.122 3,136.30 9.801 3,184.30 9.951 3,219.10 10.060 3,229.80 10.093

0527 Osteotomy: Knee region 320 12,519.00 39.122 3,136.30 9.801 3,184.30 9.951 3,219.10 10.060 3,229.80 10.093

0537 Exostosis: Excision: Less accessible sites 96 3,755.70 39.122 940.90 9.801 955.40 9.952 965.70 10.060 968.90 10.093

0545 Biopsy: Open (modifier 0005 is not applicable): Less accessible site 96 3,755.70 39.122 940.90 9.801 955.40 9.952 965.70 10.060 968.90 10.093

0578 Operations for dislocations: Recurrent dislocation of shoulder 200 7,824.40 39.122 1,960.20 9.801 1,990.20 9.951 2,011.90 10.060 2,018.60 10.093

0583

Capsulotomy or arthrotomy or biopsy or drainage of joint: Large joint (including three weeks after-

care) 96 3,755.70 39.122 940.90 9.801 955.40 9.952 965.70 10.060 968.90 10.093

0592 Synovectomy: Large joint 160 6,259.50 39.122 1,568.20 9.801 1,592.10 9.951 1,609.50 10.060 1,614.90 10.093

0593 Tendon synovectomy 203.7 7,969.20 39.122 1,996.50 9.801 2,027.00 9.951 2,049.20 10.060 2,055.90 10.093

0600 Arthrodesis: Digital joint 128 5,007.60 39.122 1,254.50 9.801 1,273.70 9.951 1,287.60 10.060 1,291.90 10.093

0614 Arthroplasty: Debridement large joints 160 6,259.50 39.122 1,568.20 9.801 1,592.10 9.951 1,609.50 10.060 1,614.90 10.093

0615 Arthroplasty: Excision medial or lateral end of clavicle 116 4,538.20 39.122 1,136.90 9.801 1,154.30 9.951 1,166.90 10.060 1,170.80 10.093

0617 Shoulder: Acromioplasty 192 7,511.40 39.122 1,881.80 9.801 1,910.70 9.951 1,931.50 10.060 1,937.90 10.093

0620 Shoulder: Total replacement 416 16,274.80 39.122 4,077.20 9.801 4,139.60 9.951 4,184.80 10.060 4,198.70 10.093

0637 Hip: Total replacement 416 16,274.80 39.122 4,077.20 9.801 4,139.60 9.951 4,184.80 10.060 4,198.70 10.093

0641 Hip: Prosthetic replacement of femoral head 288 11,267.10 39.122 2,822.70 9.801 305.30 1.060 2,897.20 10.060 2,906.80 10.093

0645 Knee: Partial replacement 277 10,836.80 39.122 2,714.90 9.801 2,756.50 9.951 2,786.50 10.060 2,795.80 10.093

0646 Knee: Total replacement 416 16,274.80 39.122 4,077.20 9.801 4,139.60 9.951 4,184.80 10.060 4,198.70 10.093

0661 Aspiration of joint or intra-articular injection (not including after-care) 9 352.10 39.122 88.20 9.801 89.50 9.940 90.50 10.060 90.80 10.093

0667 Arthroscopy (excluding after-care) (modifiers 0005 and 0013 are not applicable) 60 2,347.30 39.122 588.10 9.801 597.10 9.952 603.60 10.060 605.60 10.093

0673 Meniscectomy or operation for other internal derangement of knee 109 4,264.30 39.122 1,068.30 9.801 1,084.60 9.950 1,096.50 10.060 1,100.10 10.093

0675 Joint ligament reconstruction or suture: Ankle: Collateral 160 6,259.50 39.122 1,568.20 9.801 1,592.10 9.951 1,609.50 10.060 1,614.90 10.093

0677 Joint ligament reconstruction or suture: Knee: Collateral 160 6,259.50 39.122 1,568.20 9.801 1,592.10 9.951 1,609.50 10.060 1,614.90 10.093

0679 Joint ligament reconstruction or suture: Ligament augmentation procedure of knee 280 10,954.20 39.122 2,744.30 9.801 2,229.00 7.961 2,816.70 10.060 2,826.00 10.093

0680 Joint ligament reconstruction or suture: Digital joint ligament 165 6,455.10 39.122 1,617.20 9.801 1,641.90 9.951 1,659.80 10.060 1,665.30 10.093

0747 Muscle and tendon repair: Rotator cuff 134 5,242.30 39.122 1,313.30 9.801 1,333.50 9.951 1,348.00 10.060 1,352.50 10.093

0748 Muscle and tendon repair: Debridement Rotator cuff 139.7 5,465.30 39.122 1,369.20 9.801 1,390.30 9.952 1,405.30 10.060 1,410.00 10.093

0767 Hand: Flexor tendon suture: Primary (per tendon) 128 5,007.60 39.122 1,254.50 9.801 1,273.70 9.951 1,287.60 10.060 1,291.90 10.093

0771 Extensor tendon suture: Primary (per tendon) 129.7 5,074.10 39.122 1,271.20 9.801 1,290.70 9.951 1,304.70 10.060 1,309.10 10.093

0775 Extensor tendon suture: Primary (per tendon) 160 6,259.50 39.122 1,568.20 9.801 1,592.10 9.951 1,609.50 10.060 1,614.90 10.093

0781 Tendon freeing operation, except where specified elsewhere 64 2,503.80 39.122 627.30 9.801 636.70 9.949 643.80 10.060 646.00 10.093

0782 Carpal tunnel syndrome 98.7 3,861.30 39.122 967.40 9.801 982.20 9.951 992.90 10.060 996.20 10.093

0821 Tennis elbow 96 3,755.70 39.122 940.90 9.801 955.40 9.952 965.70 10.060 968.90 10.093

0825 Hip: Open muscle release 116 4,538.20 39.122 1,136.90 9.801 1,154.30 9.951 1,166.90 10.060 1,170.80 10.093

0829 Knee: Quadriceps plasty 160 6,259.50 39.122 1,568.20 9.801 1,592.10 9.951 1,609.50 10.060 1,614.90 10.093

0831 Knee: Open tenotomy 141 5,516.20 39.122 1,381.90 9.801 1,403.10 9.951 1,418.40 10.060 1,423.10 10.093

0853 Excision: Small bursa or ganglion 80.9 3,165.00 39.122 792.90 9.801 805.00 9.950 813.80 10.060 816.50 10.093

0855 Excision: Compound palmar ganglion or synovectomy 128 5,007.60 39.122 1,254.50 9.801 1,273.70 9.951 1,287.60 10.060 1,291.90 10.093

0884 Removal of internal fixatives: Less accessible 75.5 2,953.70 39.122 740.00 9.801 751.20 9.950 759.50 10.060 762.00 10.093

0887 Limb cast (excluding after-care) (modifier 0005 is not applicable) 13 508.60 39.122 127.40 9.801 129.30 9.948 130.80 10.060 131.20 10.093

0903 Hammer toe: One toe 99.5 3,892.60 39.122 975.20 9.801 990.10 9.951 1,000.90 10.060 1,004.30 10.093

Code Terminology

Average

Duration

Professional

2013

HealthMan

Practice Cost

Tariff (VAT

Incl.)

HealthMan

RCF

2013

Discovery

Tariffs

(VAT incl.)

DH

RCF

2013

FedHealth

(VAT Incl.)

FedHealth

RCF

2013

GEMS

Tariffs

(VAT Incl.)

GEMS

RCF

2013

Profmed

Profmed

RCF

Units R R R R R R R R R R

HEALTHMAN ORTHOPAEDICS COSTING GUIDE 2013

COMPARATIVE TARIFFS: Scheme Rates

Base Rates

0911 Metatarsal osteotomy or Lapidus or similar or Chevron - stand alone procedure 189.2 7,401.90 39.122 1,854.30 9.801 1,882.80 9.951 1,903.30 10.060 1,909.60 10.093

0930 Posterior osteotomy of spine: One vertebral segment 339 13,262.40 39.122 3,322.50 9.801 3,373.30 9.951 3,410.20 10.060 3,421.50 10.093

0933 Anterior spinal osteotomy with disc removal: One vertebral segment 315 12,323.40 39.122 3,087.30 9.801 3,134.60 9.951 3,168.80 10.060 3,179.30 10.093

0941 Anterior interbody fusion: Each additional level 360 14,083.90 39.122 3,528.40 9.801 402.40 1.118 3,621.50 10.060 3,633.50 10.093

0943 Laminectomy with decompression of nerve roots and disc removal: One level 240 9,389.30 39.122 2,352.20 9.801 268.30 1.118 2,414.30 10.060 2,422.30 10.093

0948 Posterior interbody lumbar fusion: One level 364 14,240.40 39.122 3,567.60 9.801 3,622.00 9.951 3,661.70 10.060 3,673.90 10.093

0962 Posterior segmental instrumentation: 2 to 6 vertebrae 176 6,885.50 39.122 1,725.00 9.801 1,751.40 9.951 1,770.50 10.060 1,776.40 10.093

0968 Anterior instrumentation: 2 to 3 vertebrae 159 6,220.40 39.122 1,558.40 9.801 1,582.20 9.951 1,599.50 10.060 1,604.80 10.093

2802 Procedures for pain relief: Peripheral nerve block 25 978.10 39.122 245.00 9.801 248.80 9.951 251.50 10.060 252.30 10.093

2831 Neurolysis: Major 132 5,164.10 39.122 1,293.70 9.801 1,313.60 9.951 1,327.90 10.060 1,332.30 10.093

2927 Rhizotomy: Extradural, but intraspinal 320 12,519.00 39.122 1,665.00 5.203 3,184.30 9.951 3,219.10 10.060 3,229.80 10.093

2940 Lumbar osteophyte removal 187 7,315.80 39.122 1,832.80 9.801 1,860.80 9.951 1,881.20 10.060 1,887.40 10.093

5102* Ultrasound of joints (e.g. shoulder, hip, knee), per joint 50 479.40 9.589 467.20 9.343 474.20 9.485 479.40 9.589 481.10 9.621

5731 Distal soft tissue procedure for Hallux Valgus 173.6 6,791.60 39.122 1,701.50 9.801 1,727.50 9.951 1,746.40 10.060 1,752.10 10.093

5732 Aitkin procedure or similar 166.8 6,525.50 39.122 1,634.80 9.801 1,659.70 9.951 1,678.00 10.060 1,683.50 10.093

5742 Tendon transfer foot 172 6,729.00 39.122 1,685.80 9.801 1,711.60 9.951 1,730.30 10.060 1,736.00 10.093

5760

Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: One

level 301 11,775.70 39.122 2,950.10 9.801 2,995.20 9.951 3,028.00 10.060 3,038.00 10.093

5763 Anterior disc removal and spinal decompression cervical: One level 344 13,458.00 39.122 3,371.50 9.801 3,423.20 9.951 3,460.50 10.060 3,472.00 10.093

Note:

1.Codes, Descriptors and Unit Values have been extracted from the SAMA Doctors Billing Manual

2. The Healthman tariff for codes that relate to equipment have been retained at GEMS rate*

3. Tariffs may differ due to rounding

4. Above codes are the most frequently used codes and is not all inclusive of all the codes

5. Increases from 2012 are as follow:

a. GEMS = 2012 Scheme Tariff +5.5%

b. HealthMan Tariff = 2012 Tariff +7%

c. Discovery Health = 2012 Tariff +5.5% for procedures & 6% for consultations (Note that this increase is for the DH Rate only)

d. Profmed = 2012 Tariff +6%

e. Fedhealth = 2012 Tariff +6%

6. Discovery Premier A Procedure Rates have NOT been split between In-Hospital & Out-Hospital. Use as appropriate.

7. Please take note that the HealthMan Practice Cost Tariff is based on our 2008 Cost Studies adjusted with inflation indexes

8. All Tariffs are inlcusive of VAT

Disclaimer:

The above schedule is based on information avaiable to HealthMan and HealthMan will NOT be held responsible for any losses incurred by practitioners resulting from the use of this schedule.

Legend:

DH = Discovery Health

DPA = Direct Payment Arrangement

Prem = Premier

R = Rand

RCF = Rand Conversion Factor (Rand Value per Unit)

VAT = Value Added Tax

Code Terminology

Average

Duration

Professional

2013

HealthMan

Practice Cost

Tariff (VAT

Incl.)

HealthMan

RCF

2013

Discovery

Tariffs

(VAT incl.)

DH

RCF

2013

FedHealth

(VAT Incl.)

FedHealth

RCF

2013

GEMS

Tariffs

(VAT Incl.)

GEMS

RCF

2013

Profmed

Profmed

RCF

Units R R R R R R R R R R

HEALTHMAN ORTHOPAEDICS COSTING GUIDE 2013

COMPARATIVE TARIFFS: Scheme Rates

Base Rates

Code Terminology

Average

Duration

Professional

Units

Consultations:

See the Notes below for All Tariffs

0109 Hospital follow-up visit 15

0129 Prolonged first/follow-up consultation : 15 min 15

0130 Telephone consultation (all hours) 12

0132 Repeat Script 5

0133 Writing of special motivations 9

0145 Consultation : Away from doctor's room 6

0146 Unscheduled consultation: Emergency (cons.room) 8

0147 Unscheduled consultation:Emergency(not cons.room) 14

0151 Pre-anaesthetic assessment: 10 and 20 minutes

0173 Hospital Consultation 15

0174 Hospital Consultation 30

0175 Hospital Consultation 45

0190 Consultation 15

0191 Consultation 30

0192 Consultation 45

0199 Chronic Medicine Forms 21.43

Procedures

0008 Specialist surgeon assistant

0009 Assistant

0011 Emergency Procedures

0018 Physical treatment

0051

Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone

grafting 77

0303 Stitching of soft-tissue injuries: Deep laceration involving extensive muscle damage 128

0304 Major debridement of wound, sloughectomy or secondary suture 50

0376 Dupuytren's contracture: Fasciectomy 218

0389 Fracture (reduction under general anaesthetic): Humerus 77

0391 Fracture (reduction under general anaesthetic): Radius and/or Ulna 77

0392 Fracture (reduction under general anaesthetic): Open reduction of both radius and ulna 210

0405 Fracture (reduction under general anaesthetic): Open treatment of metacarpal: Simple 118.3

0421 Fracture (reduction under general anaesthetic): Femur: Neck or Shaft 237

0429 Fracture (reduction under general anaesthetic): Tibia with or without fibula 128

0437 Fracture (reduction under general anaesthetic): Fracture-dislocation of ankle 128

0465 Fractures involving large joints (includes the item for the relative bone) 288

0473

Percutaneous insertion plus subsequent removal of Kirschner wires or Steinmann pins (no after-

care) 43

0475

Bonegrafting or internal fixation for malunion or non-union: Femur, Tibia, Humerus, Radius and

Ulna 282

0479 Bonegrafting or internal fixation for malunion or non-union: Other bones 154

0497 Resection of bone or tumour with or without grafting (benign) 282

DH

Prem A

In Hosp.

DH

Prem A Out

Hosp.

DH

Prem B

DH

Classic Rate

DH

Exec Rate

FedHealth

DPA

FedHealth

DPA

137% 162% 147% 217% 300% 165% 210%

R R R R R R R

233.20 275.70 250.20 369.30 510.60 397.70 506.10

325.20 384.60 349.00 515.20 712.20 397.70 506.10

260.30 307.80 279.30 412.30 570.00 318.30 405.10

108.40 128.10 116.30 171.60 237.30 132.80 169.10

195.00 230.50 209.20 308.80 426.90 238.60 303.70

130.30 154.10 139.80 206.40 285.30 159.10 202.40

173.40 205.10 186.10 274.70 379.80 212.00 269.90

303.70 359.20 325.90 481.10 665.10 371.10 472.30

- -

369.10 - 396.00 584.60 808.20 450.80 573.70

369.10 - 396.00 584.60 808.20 450.80 573.70

369.10 - 396.00 584.60 808.20 450.80 573.70

- 491.00 445.60 657.70 - 450.80 573.70

- 491.00 445.60 657.70 - 450.80 573.70

- 491.00 445.60 657.70 - 450.80 573.70

464.70 549.50 498.60 736.10 1,017.60 568.10 723.00

- - - - - - -

- - - - - - -

- - - - - - -

- - - - - - -

1,033.90 1,222.60 1,109.40 1,637.60 2,264.00 - -

1,718.70 2,032.30 1,844.20 2,722.30 3,763.60 2,101.60 2,674.80

671.40 793.90 720.40 1,063.40 1,470.20 821.00 1,045.00

2,927.20 3,461.30 3,140.80 4,636.50 6,409.90 3,579.30 4,555.50

1,033.90 1,222.60 1,109.40 1,637.60 2,264.00 1,832.30 2,332.10

1,033.90 1,222.60 1,109.40 1,637.60 2,264.00 1,264.40 1,609.20

2,819.70 3,334.30 3,025.60 4,466.30 6,174.60 3,448.20 4,388.60

1,588.50 1,878.30 1,704.40 2,516.00 3,478.40 1,942.40 2,472.10

3,182.30 3,763.00 3,414.60 5,040.60 6,968.50 3,891.50 4,952.90

1,718.70 2,032.30 1,844.20 2,722.30 3,763.60 2,101.60 2,674.80

1,718.70 2,032.30 1,844.20 2,722.30 3,763.60 2,101.60 2,674.80

3,867.10 4,572.80 4,149.40 6,125.20 8,468.10 4,728.60 6,018.20

577.40 682.70 619.50 914.50 1,264.30 705.90 898.40

3,786.50 4,477.50 4,062.90 5,997.60 8,291.60 4,630.10 5,892.80

2,067.80 2,445.20 2,218.80 3,275.30 4,528.10 2,528.50 3,218.00

3,786.50 4,477.50 4,062.90 5,997.60 8,291.60 4,630.10 5,892.80

Payment Arrangments

Code Terminology

Average

Duration

Professional

Units

0499 Grafts to cysts: Large bones 192

DH

Prem A

In Hosp.

DH

Prem A Out

Hosp.

DH

Prem B

DH

Classic Rate

DH

Exec Rate

FedHealth

DPA

FedHealth

DPA

137% 162% 147% 217% 300% 165% 210%

R R R R R R R

Payment Arrangments

2,578.10 3,048.50 2,766.20 4,083.50 5,645.40 3,152.70 4,012.50

Code Terminology

Average

Duration

Professional

Units

0503 Grafts to cysts: Cartilage graft 206

0507 Removal of autogenous bone for grafting 50

0521 Osteotomy: Femoral: Proximal (modifier 0051 is applicable) 320

0527 Osteotomy: Knee region 320

0537 Exostosis: Excision: Less accessible sites 96

0545 Biopsy: Open (modifier 0005 is not applicable): Less accessible site 96

0578 Operations for dislocations: Recurrent dislocation of shoulder 200

0583

Capsulotomy or arthrotomy or biopsy or drainage of joint: Large joint (including three weeks after-

care) 96

0592 Synovectomy: Large joint 160

0593 Tendon synovectomy 203.7

0600 Arthrodesis: Digital joint 128

0614 Arthroplasty: Debridement large joints 160

0615 Arthroplasty: Excision medial or lateral end of clavicle 116

0617 Shoulder: Acromioplasty 192

0620 Shoulder: Total replacement 416

0637 Hip: Total replacement 416

0641 Hip: Prosthetic replacement of femoral head 288

0645 Knee: Partial replacement 277

0646 Knee: Total replacement 416

0661 Aspiration of joint or intra-articular injection (not including after-care) 9

0667 Arthroscopy (excluding after-care) (modifiers 0005 and 0013 are not applicable) 60

0673 Meniscectomy or operation for other internal derangement of knee 109

0675 Joint ligament reconstruction or suture: Ankle: Collateral 160

0677 Joint ligament reconstruction or suture: Knee: Collateral 160

0679 Joint ligament reconstruction or suture: Ligament augmentation procedure of knee 280

0680 Joint ligament reconstruction or suture: Digital joint ligament 165

0747 Muscle and tendon repair: Rotator cuff 134

0748 Muscle and tendon repair: Debridement Rotator cuff 139.7

0767 Hand: Flexor tendon suture: Primary (per tendon) 128

0771 Extensor tendon suture: Primary (per tendon) 129.7

0775 Extensor tendon suture: Primary (per tendon) 160

0781 Tendon freeing operation, except where specified elsewhere 64

0782 Carpal tunnel syndrome 98.7

0821 Tennis elbow 96

0825 Hip: Open muscle release 116

0829 Knee: Quadriceps plasty 160

0831 Knee: Open tenotomy 141

0853 Excision: Small bursa or ganglion 80.9

0855 Excision: Compound palmar ganglion or synovectomy 128

0884 Removal of internal fixatives: Less accessible 75.5

0887 Limb cast (excluding after-care) (modifier 0005 is not applicable) 13

0903 Hammer toe: One toe 99.5

DH

Prem A

In Hosp.

DH

Prem A Out

Hosp.

DH

Prem B

DH

Classic Rate

DH

Exec Rate

FedHealth

DPA

FedHealth

DPA

137% 162% 147% 217% 300% 165% 210%

R R R R R R R

Payment Arrangments

2,766.00 3,270.80 2,967.90 4,381.20 6,057.00 3,382.30 4,304.80

671.40 793.90 720.40 1,063.40 1,470.20 821.00 1,045.00

4,296.80 5,080.80 4,610.40 6,805.80 9,409.00 5,254.10 6,687.00

4,296.80 5,080.80 4,610.40 6,805.80 9,409.00 5,254.10 6,687.00

1,289.00 1,524.30 1,383.10 2,041.70 2,822.70 1,576.40 2,006.30

1,289.00 1,524.30 1,383.10 2,041.70 2,822.70 1,576.40 2,006.30

2,685.50 3,175.50 2,881.50 4,253.60 5,880.60 3,283.80 4,179.40

1,289.00 1,524.30 1,383.10 2,041.70 2,822.70 1,576.40 2,006.30

2,148.40 2,540.40 2,305.20 3,402.90 4,704.50 2,627.00 3,343.40

2,735.20 3,234.30 2,934.80 4,332.30 5,989.40 3,344.60 4,256.70

1,718.70 2,032.30 1,844.20 2,722.30 3,763.60 2,101.60 2,674.80

2,148.40 2,540.40 2,305.20 3,402.90 4,704.50 2,627.00 3,343.40

1,557.60 1,841.80 1,671.30 2,467.10 3,410.70 1,904.60 2,424.00

2,578.10 3,048.50 2,766.20 4,083.50 5,645.40 3,152.70 4,012.50

5,585.80 6,605.10 5,993.50 8,847.60 12,231.60 6,830.30 8,693.20

5,585.80 6,605.10 5,993.50 8,847.60 12,231.60 6,830.30 8,693.20

3,867.10 4,572.80 4,149.40 6,125.20 8,468.10 503.70 641.10

3,719.40 4,398.10 3,990.90 5,891.30 8,144.60 4,548.20 5,788.70

5,585.80 6,605.10 5,993.50 8,847.60 12,231.60 6,830.30 8,693.20

120.80 142.90 129.70 191.40 264.60 147.70 188.00

805.60 952.70 864.40 1,276.10 1,764.20 985.20 1,253.90

1,463.60 1,730.70 1,570.40 2,318.20 3,204.90 1,789.60 2,277.70

2,148.40 2,540.40 2,305.20 3,402.90 4,704.50 2,627.00 3,343.40

2,148.40 2,540.40 2,305.20 3,402.90 4,704.50 2,627.00 3,343.40

3,759.70 4,445.70 4,034.10 5,955.10 8,232.80 3,677.90 4,680.90

2,215.50 2,619.80 2,377.20 3,509.20 4,851.50 2,709.10 3,448.00

1,799.30 2,127.60 1,930.60 2,849.90 3,940.00 2,200.30 2,800.40

1,875.80 2,218.10 2,012.70 2,971.20 4,107.60 2,294.00 2,919.60

1,718.70 2,032.30 1,844.20 2,722.30 3,763.60 2,101.60 2,674.80

1,741.50 2,059.30 1,868.60 2,758.50 3,813.60 2,129.70 2,710.50

2,148.40 2,540.40 2,305.20 3,402.90 4,704.50 2,627.00 3,343.40

859.40 1,016.20 922.10 1,361.20 1,881.80 1,050.60 1,337.10

1,325.30 1,567.10 1,422.00 2,099.20 2,902.10 1,620.60 2,062.60

1,289.00 1,524.30 1,383.10 2,041.70 2,822.70 1,576.40 2,006.30

1,557.60 1,841.80 1,671.30 2,467.10 3,410.70 1,904.60 2,424.00

2,148.40 2,540.40 2,305.20 3,402.90 4,704.50 2,627.00 3,343.40

1,893.30 2,238.70 2,031.50 2,998.80 4,145.80 2,315.10 2,946.50

1,086.30 1,284.50 1,165.60 1,720.60 2,378.70 1,328.30 1,690.50

1,718.70 2,032.30 1,844.20 2,722.30 3,763.60 2,101.60 2,674.80

1,013.80 1,198.80 1,087.80 1,605.70 2,219.90 1,239.50 1,577.50

174.60 206.40 187.30 276.50 382.20 213.30 271.50

1,336.00 1,579.80 1,433.50 2,116.20 2,925.60 1,633.70 2,079.20

Code Terminology

Average

Duration

Professional

Units

0911 Metatarsal osteotomy or Lapidus or similar or Chevron - stand alone procedure 189.2

0930 Posterior osteotomy of spine: One vertebral segment 339

0933 Anterior spinal osteotomy with disc removal: One vertebral segment 315

0941 Anterior interbody fusion: Each additional level 360

0943 Laminectomy with decompression of nerve roots and disc removal: One level 240

0948 Posterior interbody lumbar fusion: One level 364

0962 Posterior segmental instrumentation: 2 to 6 vertebrae 176

0968 Anterior instrumentation: 2 to 3 vertebrae 159

2802 Procedures for pain relief: Peripheral nerve block 25

2831 Neurolysis: Major 132

2927 Rhizotomy: Extradural, but intraspinal 320

2940 Lumbar osteophyte removal 187

5102* Ultrasound of joints (e.g. shoulder, hip, knee), per joint 50

5731 Distal soft tissue procedure for Hallux Valgus 173.6

5732 Aitkin procedure or similar 166.8

5742 Tendon transfer foot 172

5760

Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: One

level 301

5763 Anterior disc removal and spinal decompression cervical: One level 344

Note:

1.Codes, Descriptors and Unit Values have been extracted from the SAMA Doctors Billing Manual

2. The Healthman tariff for codes that relate to equipment have been retained at GEMS rate*

3. Tariffs may differ due to rounding

4. Above codes are the most frequently used codes and is not all inclusive of all the codes

5. Increases from 2012 are as follow:

a. GEMS = 2012 Scheme Tariff +5.5%

b. HealthMan Tariff = 2012 Tariff +7%

c. Discovery Health = 2012 Tariff +5.5% for procedures & 6% for consultations (Note that this increase is for the DH Rate only)

d. Profmed = 2012 Tariff +6%

e. Fedhealth = 2012 Tariff +6%

6. Discovery Premier A Procedure Rates have NOT been split between In-Hospital & Out-Hospital. Use as appropriate.

7. Please take note that the HealthMan Practice Cost Tariff is based on our 2008 Cost Studies adjusted with inflation indexes

8. All Tariffs are inlcusive of VAT

Disclaimer:

The above schedule is based on information avaiable to HealthMan and HealthMan will NOT be held responsible for any losses incurred by practitioners resulting from the use of this schedule.

Legend:

DH = Discovery Health

DPA = Direct Payment Arrangement

Prem = Premier

R = Rand

RCF = Rand Conversion Factor (Rand Value per Unit)

VAT = Value Added Tax

DH

Prem A

In Hosp.

DH

Prem A Out

Hosp.

DH

Prem B

DH

Classic Rate

DH

Exec Rate

FedHealth

DPA

FedHealth

DPA

137% 162% 147% 217% 300% 165% 210%

R R R R R R R

Payment Arrangments

2,540.50 3,004.00 2,725.90 4,023.90 5,563.00 3,106.60 3,953.90

4,551.90 5,382.50 4,884.10 7,209.90 9,967.60 5,565.90 7,083.90

4,229.60 5,001.50 4,538.40 6,699.50 9,261.90 5,172.10 6,582.70

4,833.90 5,715.90 5,186.70 7,656.50 10,585.10 664.00 845.00

3,222.60 3,810.60 3,457.80 5,104.40 7,056.70 442.70 563.40

4,887.60 5,779.50 5,244.30 7,741.60 10,702.70 5,976.30 7,606.20

2,363.20 2,794.50 2,535.70 3,743.20 5,174.90 2,889.80 3,677.90

2,135.00 2,524.50 2,290.80 3,381.60 4,675.10 2,610.60 3,322.60

335.70 396.90 360.20 531.70 735.10 410.50 522.50

1,772.40 2,095.80 1,901.80 2,807.40 3,881.20 2,167.40 2,758.60

2,281.00 2,697.20 2,447.50 3,613.00 4,994.90 5,254.10 6,687.00

2,510.90 2,969.10 2,694.20 3,977.10 5,498.40 3,070.30 3,907.70

640.00 756.80 686.70 1,013.70 1,401.50 782.40 995.80

2,331.00 2,756.40 2,501.10 3,692.20 5,104.40 2,850.40 3,627.80

2,239.70 2,648.40 2,403.20 3,547.50 4,904.40 2,738.50 3,485.40

2,309.50 2,731.00 2,478.10 3,658.10 5,057.30 2,824.10 3,594.40

4,041.60 4,779.20 4,336.60 6,401.70 8,850.30 4,942.10 6,289.90

4,619.00 5,461.90 4,956.20 7,316.30 10,114.60 5,648.30 7,188.70

Code Terminology

Average

Duration

Professional

Units

DH

Prem A

In Hosp.

DH

Prem A Out

Hosp.

DH

Prem B

DH

Classic Rate

DH

Exec Rate

FedHealth

DPA

FedHealth

DPA

137% 162% 147% 217% 300% 165% 210%

R R R R R R R

Payment Arrangments