Copyright Act, 1978
R 385
Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers - 2019Dental ServicesGeneral GuidelinesRules |
RULES
| 1. | The following Rules apply to all practitioners |
| 001 | Code 8101 refers to a Full Mouth Examination, charting and treatment planning and no further examination fees shall be chargeable until the treatment plan resulting from this consultation is completed with the exception of code 8102. This includes the issuing of a prescription where only medication is prescribed Item code 8104 refers to a consultation for a specific problem and not to a full mouth examination, charting and treatment planning. This includes the issuing of a prescription where only medication is prescribed |
| 002 | Except in those cases where the fee is determined "by arrangement ", the fee for the rendering of a service which is not listed in this schedule shall be based on the fee in respect of a comparable service that is listed therein and Rule 002 must be indicated together with the tariff code. |
| 003 | In the case of a prolonged or costly dental service or procedure, the dental practitioner shall ascertain beforehand from the Commissioner whether financial responsibility in respect of such treatment will be accepted. |
| 004 | In exceptional cases where the tariff fee 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 Commissioner may be charged and Rule 004 must be indicated together with the tariff code. |
| 005 | Except in exceptional cases the service of a specialist shall be available only on the recommendation of the attending dental or medical practitioner. Referring practitioners shall indicate to the specialist that the patient is being treated in terms of the Compensation for Occupational Injuries and Diseases Act. |
| 007 | "Normal consulting hours" are between 08:00 and 17:00 on weekdays, and between 08:00 and 13:00 on Saturdays. |
| 008 | A dental practitioner shall submit his account for treatment to the employer of the employee concerned. |
| (M/W) 009 | Dentists in general practice shall be entitled to charge two- thirds of the fees of specialists only for treatment that is not listed in the schedule for dentists in general practice and Modifier 8004 must be shown against any such item code. |
Benefits in respect of specialists charging treatment procedures not listed in the schedule for that speciality, shall be allocated as follows
| General Dental Practitioners Schedule | 100% |
| Other Dental Specialists Schedules | 2/3 |
| 010 | Fees charged by dental technicians for their services (PLUS L) shall be indicated on the dentist's invoice against the code 8099. Such dentist's invoice shall be accompanied by the actual invoice of the dental technician (or a copy thereof) and the invoice of the dental technician shall bear the signature of the dentist (or the person authorised by him) as proof that it has been compiled correctly. "L" comprises the fee charged by the dental technician for his services as well as the cost of gold and of teeth. For example, code 8231 is specified as follows (gold only applicable with prior authorization) |
Rc
| 8231 | X |
| 8099 (8231) | Y |
| Total | R(X+Y) |
011 Modifiers may only be used where (M/W) appears against the item code in the schedule.
| 8001 | 33 1/3% of the appropriate scheduled fee (see Note 4 - preamble to maxillo-facial and oral surgery schedule) |
| 8002 | The appropriate scheduled fee + 50% (see Note 1 - preamble to maxillo-facial and oral surgery schedule) |
8003 The appropriate scheduled fee + 10% (see Note 5 - preamble to periodontal schedule)
8004 Two-thirds of appropriate scheduled fee (see Rule 009)
| 8005 | The appropriate scheduled fee up to a maximum of R633.88 (see Note 2 - preamble to maxillo-facial and oral surgery schedule) |
| 8006 | 50% of the appropriate scheduled fee (see Note 3 - preamble to maxillo-facial and oral surgery schedule) |
| 8007 | 15% of the appropriate scheduled fee with a minimum of R322.34 (See preamble(s) under "oral surgery" in the schedule for GPs and the schedule for specialists in maxillo-facial and oral surgery |
| 8008 | The appropriate scheduled fee + 25% (see Note 5 - preamble to maxillo-facial and oral surgery schedule, GPs' schedule) |
| 8009 | 75% of the appropriate scheduled fee (see Note 3 under the preamble of the maxillo-facial and oral surgery schedule |
| 8010 | The appropriate shedule fee plus 75% |
| 012 | In cases where treatment is not listed in the schedule for dentists in general practice or specialists, the appropriate fee listed in the medical schedules shall be charged and the relevant code in the medical schedules indicated |
| 013 | Cost of material (VAT inclusive): This item provides for the charging of material costs where indicated against the relative item codes by the words "(See Rule 013) ". Material should be charged for at cost plus a handling fee not exceeding 35 %, up to R4618.06. A maximum handling fee of 10% shall apply above a cost of R4618.06. A maximum handling fee of R6926.97 will apply. |
Note: Item 8220 (suture) is applicable to all registered practitioners.
EXPLANATIONS
2. Additions, deletions and revisions
A summary listing all additions, deletions and revisions applicable to this Schedule is found in Appendix A.
New codes added to the Schedule are identified with the symbol – placed before the code.
In instances where a code has been revised, the symbol * is placed before the code.
3. Tooth identification
Tooth identification is compulsory for all invoices rendered. Tooth identification is only applicable to procedures identified with the letter "(T)" in the mouth part (MP) column. The designated system for teeth and areas of the oral cavity of the International Standards Organisation (ISO) in collaboration with the FDI, should be used.
4. Abbreviations used in the Schedule
| +D | Add fee for denture |
| +L | Add laboratory fee |
| GP | General practitioner |
| M/W | Modifier |
| MP | Mouth part |
| na | not applicable |
| T | Tooth |
| 5. | VAT |
Fees are VAT exclusive.
