Rule

Rule Description

001

Social Workers services account must be accompanied by a referral letter from the treating principal doctor indicating the condition of the employee and the need for such services.

An overall event limit of twelve (10) social worker consultations including group therapy is allowed and only one session /visit is allowed per day.

More than 10 social worker consultations sessions will require pre-authorisation.

007

Modifier 0003 must be quoted after the appropriate code number(s) to indicate that this rule is applicable.

Where emergency treatment is provided:

008

Compilation of reports: Reports are required after every consultation, counselling and/or therapy including group therapy.

022

When the Social Worker administers treatment away from their premises, travelling costs shall be charged at R4,84 per km for each kilometre travelled in own car e.g. 5km total = 5 x R4,84 = R24,20

Refer to Modifier 0022

009

Where a practioner performs treatment away from the treatment rooms, travelling costs being more than 16 km in total to be charged at R4,84 per km for each kilometre travelled in own car e.g. 19 km total= 19 X R4,84 = R91.96.

If more than one employee is attended to during the course of a trip,the full travelling expenses must be pro-rata between the relevant employees (the practitioner will charge for one trip).

A practitioner is not entitled to charge any travelling expenses or travelling time to his/her treatment rooms.

Refer to Modifier 0009