5
HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016 COMPARATIVE TARIFFS: Scheme Rates Code Terminology Average Duration Professional HealthMan Private Tariff (VAT Incl) HealthMan RCF Discovery Tariffs (VAT Incl) DH RCF GEMS Tariffs (VAT Incl) GEMS RCF KeyHealth (VAT Incl) KeyHealth RCF Medihelp (VAT Incl) Medihelp RCF Profmed (VAT Incl) Profmed RCF Units R R R R R R R R R R R R MODIFIERS 0001 The 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. Individual medical schemes may require a motivation to accompany the claim. 12.49 TBC TBC - - 59.40 4.756 60.50 4.843 57.20 4.577 60.50 4.844 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 12.3 TBC TBC 57.00 4.634 58.60 4.764 59.60 4.843 56.30 4.577 59.60 4.844 003 Limb 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) 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 005 Smith-Petersen or equivalent control, in theatre 134.6 TBC TBC 624.20 4.637 640.50 4.759 651.90 4.843 616.10 4.577 652.00 4.844 007 Stress studies, e.g. joint 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 009 Length studies per right and left pair of long bones 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 011 Skeletal survey under 5 years 48.5 TBC TBC 224.80 4.635 230.80 4.759 234.90 4.843 222.00 4.577 234.90 4.844 013 Skeletal survey over 5 years 52.3 TBC TBC 242.60 4.639 249.00 4.761 253.30 4.843 239.40 4.577 253.30 4.844 015 Arthrography per joint 39.5 TBC TBC 183.10 4.635 188.00 4.759 191.30 4.843 180.80 4.577 191.30 4.844 1.2 SPINAL COLUMN 017 Per region, e.g. cervical, sacral, coccygeal, one region thoracic 24.6 TBC TBC 114.20 4.642 117.20 4.764 119.10 4.843 112.60 4.577 119.20 4.844 021 Stress studies 10 TBC TBC 46.50 4.650 47.70 4.770 48.40 4.843 45.80 4.577 48.40 4.844 025 Scoliosis studies 39.3 TBC TBC 182.30 4.639 187.10 4.761 190.30 4.843 179.90 4.577 190.40 4.844 027 Pelvis (sacro-iliac or hip joints only to be added where an extra set of views is required) 17 TBC TBC 78.80 4.635 81.10 4.771 82.30 4.843 77.80 4.577 82.30 4.844 MYELOGRAPHY 029 Lumbar 43.1 TBC TBC 199.90 4.638 205.20 4.761 208.70 4.843 197.30 4.577 208.80 4.844 031 Thoracic 40.1 TBC TBC 186.00 4.638 190.90 4.761 194.20 4.843 183.50 4.577 194.20 4.844 033 Cervical 59.4 TBC TBC 275.30 4.635 282.80 4.761 287.70 4.843 271.90 4.577 287.70 4.844 035 Multiple (lumbar, thoracic, cervical): Same fee as for first segment (no additional introduction of contrast medium) - - - - - - - - - - - - - 037 Discography 31.5 TBC TBC 146.20 4.641 149.80 4.756 152.60 4.843 144.20 4.577 152.60 4.844 1.3 SKULL 039 Skull studies 32.3 TBC TBC 149.80 4.638 153.70 4.759 156.40 4.843 147.80 4.577 156.50 4.844 041 Paranasal sinuses 17 TBC TBC 78.80 4.635 81.10 4.771 82.30 4.843 77.80 4.577 82.30 4.844 043 Facial bones and/or orbits 34.9 TBC TBC 161.90 4.639 165.90 4.754 169.00 4.843 159.70 4.577 169.10 4.844 045 Mandible 26 TBC TBC 120.40 4.631 123.80 4.762 125.90 4.843 119.00 4.577 125.90 4.844 047 Nasal bone 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 049 Mastoid: Bilateral 50 TBC TBC 231.70 4.634 237.90 4.758 242.20 4.843 228.90 4.577 242.20 4.844 TEETH 051 One quadrant 7.7 TBC TBC 35.70 4.636 36.60 4.753 37.30 4.843 35.20 4.577 37.30 4.844 053 Two quadrants 8.5 TBC TBC 39.40 4.635 40.50 4.765 41.20 4.843 38.90 4.577 41.20 4.844 055 Full mouth 10.8 TBC TBC 50.20 4.648 51.50 4.769 52.30 4.843 49.40 4.577 52.30 4.844 057 Rotation tomography of the teeth and jaws 14.6 TBC TBC 67.60 4.630 69.40 4.753 70.70 4.843 66.80 4.577 70.70 4.844 059 Temporo-mandibular joints: Per side 19.2 TBC TBC 88.90 4.630 91.20 4.750 93.00 4.843 87.90 4.577 93.00 4.844 061 Tomography: Per side 30.5 TBC TBC 141.30 4.633 145.10 4.757 147.70 4.843 139.60 4.577 147.70 4.844 063 Localisation of foreign body in the eye 30.7 TBC TBC 142.50 4.642 146.20 4.762 148.70 4.843 140.50 4.577 148.70 4.844 065 Ventriculography 37.4 TBC TBC 173.60 4.642 178.10 4.762 181.10 4.843 171.20 4.577 181.20 4.844 067 Post-nasal studies: Lateral neck 10 TBC TBC 46.50 4.650 47.70 4.770 48.40 4.843 45.80 4.577 48.40 4.844 069 Maxillo-facial cephalometry 26.9 TBC TBC 124.50 4.628 128.00 4.758 130.30 4.843 123.10 4.577 130.30 4.844 071 Dacryocystography 24.2 TBC TBC 112.40 4.645 115.30 4.764 117.20 4.843 110.80 4.577 117.20 4.844 Base Rates

HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016 radiography... · HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016 COMPARATIVE TARIFFS: Scheme Rates Code Terminology Average

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HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016

COMPARATIVE TARIFFS: Scheme Rates

Code Terminology

Average

Duration

Professional

HealthMan

Private Tariff

(VAT Incl)

HealthMan

RCF

Discovery

Tariffs

(VAT Incl)

DH

RCF

GEMS Tariffs

(VAT Incl) GEMS RCF

KeyHealth

(VAT Incl)

KeyHealth

RCF

Medihelp

(VAT Incl)

Medihelp

RCF

Profmed

(VAT Incl)

Profmed

RCF

Units R R R R R R R R R R R R MODIFIERS

0001

The 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. Individual medical schemes may require a

motivation to accompany the claim. 12.49 TBC TBC - - 59.40 4.756 60.50 4.843 57.20 4.577 60.50 4.844

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 SKELETON1.1 LIMBS

001 Finger, toe 12.3 TBC TBC 57.00 4.634 58.60 4.764 59.60 4.843 56.30 4.577 59.60 4.844

003

Limb 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) 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 005 Smith-Petersen or equivalent control, in theatre 134.6 TBC TBC 624.20 4.637 640.50 4.759 651.90 4.843 616.10 4.577 652.00 4.844 007 Stress studies, e.g. joint 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 009 Length studies per right and left pair of long bones 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 011 Skeletal survey under 5 years 48.5 TBC TBC 224.80 4.635 230.80 4.759 234.90 4.843 222.00 4.577 234.90 4.844 013 Skeletal survey over 5 years 52.3 TBC TBC 242.60 4.639 249.00 4.761 253.30 4.843 239.40 4.577 253.30 4.844 015 Arthrography per joint 39.5 TBC TBC 183.10 4.635 188.00 4.759 191.30 4.843 180.80 4.577 191.30 4.844

1.2 SPINAL COLUMN017 Per region, e.g. cervical, sacral, coccygeal, one region thoracic 24.6 TBC TBC 114.20 4.642 117.20 4.764 119.10 4.843 112.60 4.577 119.20 4.844 021 Stress studies 10 TBC TBC 46.50 4.650 47.70 4.770 48.40 4.843 45.80 4.577 48.40 4.844 025 Scoliosis studies 39.3 TBC TBC 182.30 4.639 187.10 4.761 190.30 4.843 179.90 4.577 190.40 4.844 027 Pelvis (sacro-iliac or hip joints only to be added where an extra set of views is required) 17 TBC TBC 78.80 4.635 81.10 4.771 82.30 4.843 77.80 4.577 82.30 4.844

MYELOGRAPHY029 Lumbar 43.1 TBC TBC 199.90 4.638 205.20 4.761 208.70 4.843 197.30 4.577 208.80 4.844 031 Thoracic 40.1 TBC TBC 186.00 4.638 190.90 4.761 194.20 4.843 183.50 4.577 194.20 4.844 033 Cervical 59.4 TBC TBC 275.30 4.635 282.80 4.761 287.70 4.843 271.90 4.577 287.70 4.844

035

Multiple (lumbar, thoracic, cervical): Same fee as for first segment (no additional introduction of

contrast medium) - - - - - - - - - - - - - 037 Discography 31.5 TBC TBC 146.20 4.641 149.80 4.756 152.60 4.843 144.20 4.577 152.60 4.844

1.3 SKULL039 Skull studies 32.3 TBC TBC 149.80 4.638 153.70 4.759 156.40 4.843 147.80 4.577 156.50 4.844 041 Paranasal sinuses 17 TBC TBC 78.80 4.635 81.10 4.771 82.30 4.843 77.80 4.577 82.30 4.844 043 Facial bones and/or orbits 34.9 TBC TBC 161.90 4.639 165.90 4.754 169.00 4.843 159.70 4.577 169.10 4.844 045 Mandible 26 TBC TBC 120.40 4.631 123.80 4.762 125.90 4.843 119.00 4.577 125.90 4.844 047 Nasal bone 16.2 TBC TBC 75.00 4.630 77.20 4.765 78.50 4.843 74.10 4.577 78.50 4.844 049 Mastoid: Bilateral 50 TBC TBC 231.70 4.634 237.90 4.758 242.20 4.843 228.90 4.577 242.20 4.844

TEETH051 One quadrant 7.7 TBC TBC 35.70 4.636 36.60 4.753 37.30 4.843 35.20 4.577 37.30 4.844 053 Two quadrants 8.5 TBC TBC 39.40 4.635 40.50 4.765 41.20 4.843 38.90 4.577 41.20 4.844 055 Full mouth 10.8 TBC TBC 50.20 4.648 51.50 4.769 52.30 4.843 49.40 4.577 52.30 4.844 057 Rotation tomography of the teeth and jaws 14.6 TBC TBC 67.60 4.630 69.40 4.753 70.70 4.843 66.80 4.577 70.70 4.844 059 Temporo-mandibular joints: Per side 19.2 TBC TBC 88.90 4.630 91.20 4.750 93.00 4.843 87.90 4.577 93.00 4.844 061 Tomography: Per side 30.5 TBC TBC 141.30 4.633 145.10 4.757 147.70 4.843 139.60 4.577 147.70 4.844 063 Localisation of foreign body in the eye 30.7 TBC TBC 142.50 4.642 146.20 4.762 148.70 4.843 140.50 4.577 148.70 4.844 065 Ventriculography 37.4 TBC TBC 173.60 4.642 178.10 4.762 181.10 4.843 171.20 4.577 181.20 4.844 067 Post-nasal studies: Lateral neck 10 TBC TBC 46.50 4.650 47.70 4.770 48.40 4.843 45.80 4.577 48.40 4.844 069 Maxillo-facial cephalometry 26.9 TBC TBC 124.50 4.628 128.00 4.758 130.30 4.843 123.10 4.577 130.30 4.844 071 Dacryocystography 24.2 TBC TBC 112.40 4.645 115.30 4.764 117.20 4.843 110.80 4.577 117.20 4.844

Base Rates

HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016

COMPARATIVE TARIFFS: Scheme Rates

Code Terminology

Average

Duration

Professional

HealthMan

Private Tariff

(VAT Incl)

HealthMan

RCF

Discovery

Tariffs

(VAT Incl)

DH

RCF

GEMS Tariffs

(VAT Incl) GEMS RCF

KeyHealth

(VAT Incl)

KeyHealth

RCF

Medihelp

(VAT Incl)

Medihelp

RCF

Profmed

(VAT Incl)

Profmed

RCF

Units R R R R R R R R R R R R

Base Rates

2 ALIMENTARY TRACT073 Sialography (plus 80% for each additional gland) 24.6 TBC TBC 114.20 4.642 117.20 4.764 119.10 4.843 112.60 4.577 119.20 4.844 075 Pharynx and oesophagus 22.8 TBC TBC 105.70 4.636 108.40 4.754 110.40 4.843 104.40 4.577 110.40 4.844

077 Oesophagus, stomach and duodenum (control film of abdomen included) and limited follow through 31.5 TBC TBC 146.20 4.641 149.80 4.756 152.60 4.843 144.20 4.577 152.60 4.844 079 Small bowel meal (control film of abdomen included, except when part of item 081) 27.7 TBC TBC 128.40 4.635 131.80 4.758 134.20 4.843 126.80 4.577 134.20 4.844

081

Barium meal and dedicated gastro-intestinal tract follow through (including control film of the

abdomen, oesophagus, duodenum, small bowel and colon) 47.2 TBC TBC 218.90 4.638 224.60 4.758 228.60 4.843 216.00 4.577 228.60 4.844 083 Barium enema (control film of abdomen included) 50.9 TBC TBC 235.90 4.635 242.20 4.758 246.50 4.843 233.00 4.577 246.60 4.844 085 Biliary tract: ERCP (choledogram and/or pancreatography screening included) 47 TBC TBC 217.90 4.636 223.80 4.762 227.60 4.843 215.10 4.577 227.70 4.844 087 Gastric/oesophageal/duodenal intubation control 20.8 TBC TBC 96.40 4.635 99.00 4.760 100.70 4.843 95.20 4.577 100.80 4.844 089 Hypotonic duodenography (077 included) 57.3 TBC TBC 265.70 4.637 272.80 4.761 277.50 4.843 262.30 4.577 277.60 4.844

3 BILIARY TRACT091 Oral cholecystography 47.8 TBC TBC 221.80 4.640 227.60 4.762 231.50 4.843 218.80 4.577 231.50 4.844 093 Intravenous 58.6 TBC TBC 271.60 4.635 278.90 4.759 283.80 4.843 268.20 4.577 283.90 4.844 095 Operative: First series 58.1 TBC TBC 269.40 4.637 276.60 4.761 281.40 4.843 265.90 4.577 281.40 4.844 097 Subsequent series 24 TBC TBC 111.40 4.642 114.10 4.754 116.20 4.843 109.80 4.577 116.30 4.844 099 Post-operative: T-tube 20.1 TBC TBC 93.10 4.632 95.80 4.766 97.30 4.843 92.00 4.577 97.40 4.844 101 Trans-hepatic, percutaneous 34.6 TBC TBC 160.50 4.639 164.60 4.757 167.60 4.843 158.40 4.577 167.60 4.844 103 Tomography of biliary tract: Add 21.5 TBC TBC 99.80 4.642 102.30 4.758 104.10 4.843 98.40 4.577 104.10 4.844

CHEST105 Larynx (tomography included) 42.4 TBC TBC 196.70 4.639 201.80 4.759 205.30 4.843 194.10 4.577 205.40 4.844 107 Chest (item 167 included) 19.2 TBC TBC 88.90 4.630 91.20 4.750 93.00 4.843 87.90 4.577 93.00 4.844 109 Chest and cardiac studies (item 167 included) 23.1 TBC TBC 107.10 4.636 109.90 4.758 111.90 4.843 105.70 4.577 111.90 4.844 111 Ribs 19.2 TBC TBC 88.90 4.630 91.20 4.750 93.00 4.843 87.90 4.577 93.00 4.844 113 Sternum or sterno-clavicular joints 24.6 TBC TBC 114.20 4.642 117.20 4.764 119.10 4.843 112.60 4.577 119.20 4.844

BRONCHOGRAPHY115 Unilateral 33.5 TBC TBC 155.40 4.639 159.40 4.758 162.20 4.843 153.30 4.577 162.30 4.844 117 Bilateral 56.5 TBC TBC 262.00 4.637 269.00 4.761 273.60 4.843 258.60 4.577 273.70 4.844 119 Pleurography 15.7 TBC TBC 72.90 4.643 74.70 4.758 76.00 4.843 71.90 4.577 76.10 4.844 121 Laryngography 15.7 TBC TBC 72.90 4.643 74.70 4.758 76.00 4.843 71.90 4.577 76.10 4.844 123 Thoracic inlet 15.7 TBC TBC 72.90 4.643 74.70 4.758 76.00 4.843 71.90 4.577 76.10 4.844

5 ABDOMEN

125

Control films of the abdomen (not being part of examination for barium meal, barium enema,

pyelogram, cholecystogram, cholangiogram, etc.) 17 TBC TBC 78.80 4.635 81.10 4.771 82.30 4.843 77.80 4.577 82.30 4.844 127 Acute abdomen or equivalent studies 30.7 TBC TBC 142.50 4.642 146.20 4.762 148.70 4.843 140.50 4.577 148.70 4.844

6 URINARY TRACT129 Control film included and bladder views before and after micturition 67 TBC TBC 310.50 4.634 318.90 4.760 324.50 4.843 306.70 4.577 324.50 4.844 133 Waterload test: Add 20.1 TBC TBC 93.10 4.632 95.80 4.766 97.30 4.843 92.00 4.577 97.40 4.844 135 Cystography only or urethrography only (retrograde) 37.6 TBC TBC 174.40 4.638 178.90 4.758 182.10 4.843 172.10 4.577 182.10 4.844

CYSTO-URETHROGRAPHY137 Retrograde 33.1 TBC TBC 153.60 4.640 157.60 4.761 160.30 4.843 151.50 4.577 160.30 4.844 139 Retrograde-prograde pyelography 42.4 TBC TBC 196.70 4.639 201.80 4.759 205.30 4.843 194.10 4.577 205.40 4.844 141 Aspiration renal cyst 17 TBC TBC 78.80 4.635 81.10 4.771 82.30 4.843 77.80 4.577 82.30 4.844 143 Tomography of renal tract: Add 19.2 TBC TBC 88.90 4.630 91.20 4.750 93.00 4.843 87.90 4.577 93.00 4.844

7 GYNAECOLOGY AND OBSTETRICS145 Pregnancy 19.2 TBC TBC 88.90 4.630 91.20 4.750 93.00 4.843 87.90 4.577 93.00 4.844 147 Pelvimetry 35.5 TBC TBC 164.90 4.645 169.10 4.763 171.90 4.843 162.50 4.577 172.00 4.844 149 Hysterosalpingography 32 TBC TBC 148.40 4.638 152.10 4.753 155.00 4.843 146.50 4.577 155.00 4.844

HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016

COMPARATIVE TARIFFS: Scheme Rates

Code Terminology

Average

Duration

Professional

HealthMan

Private Tariff

(VAT Incl)

HealthMan

RCF

Discovery

Tariffs

(VAT Incl)

DH

RCF

GEMS Tariffs

(VAT Incl) GEMS RCF

KeyHealth

(VAT Incl)

KeyHealth

RCF

Medihelp

(VAT Incl)

Medihelp

RCF

Profmed

(VAT Incl)

Profmed

RCF

Units R R R R R R R R R R R R

Base Rates

8 TOMOGRAPHY AND CINEMATOGRAPHY

151

Tomography (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 - - - - - - - - - - - - - 153 Tomography (multi-dimensional in motion): Add 150% - - - - - - - - - - - - -

9 COMPUTED TOMOGRAPHY155 Head, single examination, full series 262.7 TBC TBC 1 218.00 4.636 1 250.10 4.759 1 272.30 4.843 1 202.40 4.577 1 272.50 4.844 157 Head, repeat examination at the same visit, after contrast, full series 90.2 TBC TBC 418.20 4.636 429.20 4.758 436.80 4.843 412.80 4.577 436.90 4.844 159 Chest 303.7 TBC TBC 1 408.30 4.637 1 445.30 4.759 1 470.80 4.843 1 390.00 4.577 1 471.10 4.844 161 Abdomen (including base of chest and/or pelvis) 353 TBC TBC 1 637.00 4.637 1 679.90 4.759 1 709.60 4.843 1 615.70 4.577 1 709.90 4.844 163 Multiple examinations: For an additional part, the lesser fee shall be reduced to 82.1 TBC TBC 380.60 4.636 390.80 4.760 397.60 4.843 375.80 4.577 397.70 4.844 165 Limbs and other limited examinations 82.1 TBC TBC 380.60 4.636 390.80 4.760 397.60 4.843 375.80 4.577 397.70 4.844

MODIFIER GOVERNING THIS SPECIFIC SECTION OF THE TARIFFS

0089

The 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 MISCELLANEOUS167 Fluoroscopy: Per half hour: Add (not applicable to items 107 and 109) 21.4 TBC TBC 99.40 4.645 101.90 4.762 103.60 4.843 97.90 4.577 103.70 4.844 169 Where a C-arm portable x-ray unit is used in hospital or theatre: Per half hour: Add 29.6 TBC TBC 137.40 4.642 140.90 4.760 143.40 4.843 135.50 4.577 143.40 4.844 171 Sinography 44.3 TBC TBC 205.40 4.637 210.80 4.758 214.50 4.843 202.80 4.577 214.60 4.844 173 Bone densitometry 80.9 TBC TBC 375.10 4.637 385.00 4.759 391.80 4.843 370.30 4.577 391.90 4.844 175 Mammography: Unilateral or bilateral 58.1 TBC TBC 269.40 4.637 276.60 4.761 281.40 4.843 265.90 4.577 281.40 4.844 177 Repeat mammography, unilateral or bilateral for localisation of tumour 58.1 TBC TBC 269.40 4.637 276.60 4.761 281.40 4.843 265.90 4.577 281.40 4.844

179

Attendance 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 17.6 TBC TBC 81.50 4.631 83.80 4.761 85.20 4.843 80.60 4.577 85.30 4.844 181 Setting of sterile trays 3 TBC TBC 14.00 4.667 14.30 4.767 14.50 4.843 13.70 4.577 14.50 4.844

Films are to be charged (exclusive of VAT) at net acquisition price plus -

* 26% of the net acquisition price where the net acquisition price of that material is less than one

hundred rands; and

* a maximum of twenty six rands 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. 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

192

Post-processing in catheterisation laboratory for purposes of cardiac catheterisation and/or invasive

intravascular procedures 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

193

Coronary angiogram per 30 minutes or part thereof provided that such part comprises 50% or more of

the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844 194 Right heart investigation of valve and venous system of the right heart 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844 195 PTCA per 30 minutes or part thereof provided that such part comprises 50% or more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844 196 Left heart investigation of valve of the left heart and ventrical 43.1 TBC TBC 199.50 4.629 205.20 4.761 208.70 4.843 197.30 4.577 208.80 4.844

197

Stent procedure per 30 minutes or part thereof provided that such part comprises 50% or more of the

time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

199

Vascular Study per 30 minutes or part thereof provided that such part comprises 50% or more of the

time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

201

Temporary pacemaker procedure per 30 minutes or part thereof provided that such part comprises 50%

or more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016

COMPARATIVE TARIFFS: Scheme Rates

Code Terminology

Average

Duration

Professional

HealthMan

Private Tariff

(VAT Incl)

HealthMan

RCF

Discovery

Tariffs

(VAT Incl)

DH

RCF

GEMS Tariffs

(VAT Incl) GEMS RCF

KeyHealth

(VAT Incl)

KeyHealth

RCF

Medihelp

(VAT Incl)

Medihelp

RCF

Profmed

(VAT Incl)

Profmed

RCF

Units R R R R R R R R R R R R

Base Rates

203

Permanent pacemaker procedure in catheterisation laboratory per 30 minutes or part thereof provided

that such part comprises 50% or more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

205

Intra-aortic balloon pump procedure per 30 minutes or part thereof provided that such part comprises

50% or more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

207

Electro-physiological studies per 30 minutes or part thereof provided that such part comprises 50% or

more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

209

Bleomycine and other studies per 30 minutes or part thereof provided that such part comprises 50% or

more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

211

Intra vascular ultrasound per 30 minutes of part thereof provided that such part comprises 50% or more

of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

213

Rotablator/Laser procedures per 30 minutes or part thereof provided that such part comprises 50% or

more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

215 Embolisation per 30 minutes or part thereof provided that such part comprises 50% or more of the time 43 TBC TBC 199.50 4.640 204.60 4.758 208.20 4.843 196.80 4.577 208.30 4.844

RULESZ No fee to be subject to more than one reduction - - - - - - - - - - - - -

11 PORTABLE UNIT EXAMINATIONS185 Where portable x-ray unit is used in the hospital or theatre: Add 19.4 TBC TBC 90.10 4.644 92.40 4.763 94.00 4.843 88.80 4.577 94.00 4.844 187 Theatre investigations with fixed installation : Add 8.3 TBC TBC 38.50 4.639 39.50 4.759 40.20 4.843 38.00 4.577 40.20 4.844

HEALTHMAN RADIOGRAPHY & SONOGRAPHY COSTING GUIDE 2016

COMPARATIVE TARIFFS: Scheme Rates

Code Terminology

Average

Duration

Professional

HealthMan

Private Tariff

(VAT Incl)

HealthMan

RCF

Discovery

Tariffs

(VAT Incl)

DH

RCF

GEMS Tariffs

(VAT Incl) GEMS RCF

KeyHealth

(VAT Incl)

KeyHealth

RCF

Medihelp

(VAT Incl)

Medihelp

RCF

Profmed

(VAT Incl)

Profmed

RCF

Units R R R R R R R R R R R R

Base Rates

SONOGRAPHY

3615

Routine obstetric ultrasound at 10 to 20 weeks gestational age preferable at 10 to 14 weeks gestational

age to include nuchal translucency assessment 50 TBC TBC CWF CWF 438.00 8.760 CWF CWF CWF CWF CWF CWF3617 Routine obstetric ultrasound at 20 to 24 weeks to include detailed anatomical assessment 50 TBC TBC CWF CWF 438.00 8.760 CWF CWF CWF CWF CWF CWF

3618

Pelvic organs ultrasound transabdominal probe (this is a gynaecological ultrasound examination and

may not be used in pregnancy) 40 TBC TBC CWF CWF 350.50 8.763 CWF CWF CWF CWF CWF CWF3620 Cardiac examination plus Doppler colour mapping 50 TBC TBC CWF CWF 438.00 8.760 CWF CWF CWF CWF CWF CWF3621 Cardiac examination (MMode) 25 TBC TBC CWF CWF 219.10 8.764 CWF CWF CWF CWF CWF CWF3622 Cardiac examination: 2 Dimensional 50 TBC TBC CWF CWF 438.00 8.760 CWF CWF CWF CWF CWF CWF3625 Cardiac examinations + doppler 50 TBC TBC CWF CWF 438.00 8.760 CWF CWF CWF CWF CWF CWF

3627

Ultrasound 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 TBC TBC CWF CWF 525.60 8.760 CWF CWF CWF CWF CWF CWF3629 High definition (small parts) scan: Thyroid, breast lump, scrotum, etc. 50 TBC TBC CWF CWF 438.00 8.760 CWF CWF CWF CWF CWF CWF

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) 78 TBC TBC CWF CWF 683.20 8.759 CWF CWF CWF CWF CWF CWF5100 Pelvic organs ultrasound: Transvaginal or trans rectal probe 50 TBC TBC CWF CWF 438.00 8.760 CWF CWF CWF CWF CWF CWF

5106

Obstetric 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 25 TBC TBC CWF CWF 219.10 8.764 CWF CWF CWF CWF CWF CWF5107 Ultrasound after 24 weeks - motivation required 25 TBC TBC CWF CWF 219.10 8.764 CWF CWF CWF CWF CWF CWF

5114

Peripheral 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 178 TBC TBC CWF CWF 1 247.70 7.010 CWF CWF CWF CWF CWF CWF

Note:

2. Tariffs may differ due to rounding3.HealthMan Tariffs can only be determined once a successful detailed cost study has been completed4. Sonography claims and coding may differ from funders other than GEMS5. All Tariffs are inlcusive of VAT6. Codes other than for Sonography requires your practice prefix "039" before the code

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:CWF = Confirm with FunderDH = Discovery HealthDPA = Direct Payment ArrangementPrem = PremierR = RandRCF = Rand Conversion Factor (Rand Value per Unit)TBC = To be Confirmed (Also refer to Note 3)VAT = Value Added Tax

1. Codes, Descriptors and Unit Values have been extracted from information provided by the Funders