PRIVATE HOSPITALS PER DIEM TARIFF OF FEES FROM 1 APRIL 2025

Private Hospital Rules

Submission of a running account is not allowed.

Hospitals are requested to submit a monthly invoices for patients admitted for a prolonged period, i.e., exceeding last day of the month.

Service dates claimed for should not overlap to the following month.

The hospital record may take the form of, but not limited to an admission / discharge forms / records submitted and must be on the hospital letterhead.

Acute Hospital Accommodation

The day admission fee shall be charged in respect of all patients admitted as day patients and discharged before 23:00 on the same date.

Ward fees shall be charged at the full day rate if admission takes place before 12:00 and at the half daily rate if admission takes place after 12:00.

At discharge, ward fees shall be charged at half the daily rate if the discharge takes place before 12:00 and the full daily rate if the discharge takes place after 12:00

Ward fees are inclusive of all pharmaceuticals and equipment that are provided in the accommodation, theatre, emergency room and procedure rooms

Drugs, consumables, and disposable items used during a procedure or issued to a patient on discharge should be claimed for using the appropriate code.

Day Hospital Admissions

Day admission: Chargeable for all patients admitted and discharged before midnight on the same day irrespective of the time of admission.

Overnight Fee: Applicable to licenced day hospitals only. Charged for cases with complications the maximum of one night.

A medical report from the treating doctor indicating reasons for extended of stay must accompany an invoice.

Special Care Units

Hospitals shall obtain a treating doctor's report stating the reason for accommodation in an intensive care unit or a high care ward. The report must include the date and time of admission and discharge from the unit. The report must be forwarded to the Fund together with the invoice.

Pre-drafted and standard certificates of authorisation will not be acceptable.

Theatres and Emergency Units

Theatre and Emergency fees are inclusive of all consumables and equipment. The after-hours fee are included in the normal theatre fee.

A copy of the treating doctor's medical report must be submitted, for treatment provided in emergency units for codes H301, H302 and H303.

Emergency fee - excludes follow-up visits.

Minor Theatre Fee

This shall refer to:

A facility where simple procedures, which require limited instrumentation and drapery, minimum nursing input and local anaesthetic procedures are carried out.

No sophisticated monitoring is required but resuscitation equipment must be available. The exact time of admission to and discharge from the minor theatre must be stated.

Major Theatre Fee

This shall refer to:

A facility where major procedures are performed under general and local anaesthesia.

The exact time of admission to and discharge from the theatre must be stated.

Prosthesis Pricing

A ceiling price of R1 739.32 per prosthesis is included in the theatre tariff.

The combined value of all the components including cement in excess of R1739.32 should be charged separately.

A prosthesis is a fabricated or artificial substitute for a diseased or missing part of the body, surgically implanted, and shall be deemed to include all components such as pins, rods, screws, plates, or similar items, forming an integral part of the device so implanted, and shall be charged as a single unit.

Reimbursement will be at the lowest available manufacturer's price (inclusive of VAT).

List of items to be reflected in the invoice.

Internal Fixators (surgically implanted)

Reimbursement will be at the lowest available manufacturer's price inclusive of VAT.

Hospitals / unattached operating theatre units shall show the name and reference number of each item.

The suppliers’ invoices, each containing the manufacture's name, including the components specified should attached and appear on the medical invoice.

List of items to be reflected in the invoice.

External Fixators

Reimbursement will be at 33% of the lowest available manufacturer's price inclusive of VAT

List of items to be reflected in the invoice.

MEDICAL ARTIFICIAL ITEMS (non-prosthesis)

Hospitals / unattached operating theatre units shall show the name and reference number of each item.

The suppliers' invoices, each containing the manufacturer’s name, including the components specified should be attached and appear on the medical Invoice.

List of items to be reflected in the invoice.

Serious Burns (Acute Hospitals PR 57/58)

Billed at normal fee for service.

Codes H289 and H290 are applicable and must be accompanied by a medical report from the treating doctor.

TTO's should be charged according to code H288.

List of items to be reflected in the invoice.

TTO

TTO issued on discharge and will be reimbursed by the Fund.

List of items to be reflected in the invoice.

Acute and Sub-Acute Rehabilitation

Maximum period for patients stay at Acute rehabilitation (Practice 59) ward is 3 months (12 weeks), then the patient should be discharged or referred to Sub-acute rehabilitation (Practice 49).

For all patients transferred from Acute Rehabilitation to Sub-acute Rehabilitation, a referral letter from the treating doctor is required by the Fund.

All Sub-acute rehabilitation facilities must have a rehabilitation plan for all patients admitted.

General Ward for Acute Rehabilitation Hospitals

All patients transferred from Acute hospital (Practice 57/58), Acute Rehabilitation (Practice 59) or Sub-acute Rehabilitation (Practice 49), a referral letter is required from the treating doctor.

Ward fees shall be charged at the full daily rate if admission takes place before 12:00 and at the half daily rate if admission takes place after 12:00.

At discharge, ward fees shall be charged at half the daily rate if the discharge takes place before 12:00 and the full daily rate if the discharge takes place after 12:00.

Ward fees are inclusive of all pharmaceuticals and equipment that are provided in the accommodation and procedure rooms.

Sub - Acute Rehabilitation Hospitals

Admission to the facility should be referred by the treating doctor.

Ward fees shall be charged at the full daily rate if admission takes place before 12:00 and at the half daily rate if admission takes place after 12:00.

At discharge, ward fees shall be charged at half the daily rate if the discharge takes place before 12:00 and the full daily rate if the discharge takes place after 12:00.

Ward fees are inclusive of all pharmaceuticals and equipment that are provided in the accommodation and procedure rooms.

Frail Care / Palliative / Hospice (Pr 79)

Hospice or similar approved facilities.

All patients transferred from Acute hospital, Acute Rehabilitation or Sub-acute Rehabilitation, a referral letter from the treating doctor is required.

TARIFF

CODE

DESCRIPTION

ACUTE

HOSPITAL

(PR 57/58)

DAY

HOSPITAL

(PR 77)

*

Can be claimed by a facility

-

Cannot be claimed by a facility

1.

General Wards

H001

Surgical cases: per day

4,624.55

-

H002

Thoracic and neurosurgical cases (including laminectomies and spinal fusion): per day

4,624.55

-

H004

Medical and neurological cases: per day

4,624.55

-

H007

Day admission which includes all patients discharged by 23:00 on date of admission

1,901.67

-

H014

H100

Overnight fee - for complications only (maximum of one night)

Day admission which includes all patients discharged by 23h00 on date of admission

-

-

1,882.66

1,882.66

1.1

Special Care Units

H201

Intensive Care Unit:  per day

28,258.11

-

H215

High Care Ward:  per day

14,582.49

-

2.

Theatres and Emergency Unit

H301

For all emergencies including those requiring basic nursing input, e.g. BP measurement, urine testing, application of simple bandages, administration of injections

1,066,58

1,055.81

H302

For all emergencies which require the use of a procedure room, e.g. for application of plaster, stitching of wounds.

2,163.87

2,142.24

H105

Resuscitation fee charged only if patient has been resuscitated and intubated in a trauma unit.

8,467.63

-

3.

Follow up visit

H303

Follow-up visits:

The Fund will reimburse hospitals for all materials used during follow-up visits. No consultation or facility fee is chargeable. The account is to be billed as for fee for service.

*

-

4.

Minor Theatre Fee

H071

Charge per minute

128.50

128.50

5.

Major Theatre

H081

Charge per minute

380.25

376.45

6.

Prosthesis

H286

Internal and External Fixators (surgically implanted)

*

-

7.

Medical Artificial Items (non-prosthesis)

H287

Examples of items included hereunder shall be art ficial limbs,wheelchairs, crutches and excretion bags.

Copies of invoices shall be supplied to the Fund.

Reimbursement will be at the lowest available manufacturer's price inclusive of VAT.

*

-

Further Non-Prosthetic Medical Artificial items:

8.

Serious Burns

H289

Serious Burns: Fee for service (Inclusive of all services e.g. accommodation, theatre, etc.) except medication whilst hospitalised.

*

-

H290

Serious Burns: Item for medication used during hospitalisation excluding the TTO's.

NB: List of items used to be reflected in the invoice

*

-

9.

TTO

H288

Treatment Taken Out issued at discharge

*

-

10.

ACUTE REHABILITATION HOSPITALS (PR59)

10.1

General Wards

H010

General Rehabilitation ward per day

7,725.48

-

10.2 TTO

H288

Treatment Taken Out issued at discharge

*

-

11.

SUB-ACUTE REHABILIATATION HOSPITALS(PR 049)

11.1

General Wards

H020

Sub-Acute Rehabilitation ward per day

4,215.63

11.2 TTO

H288

Treatment Taken Out issued at discharge

*

-

12.

PSYCHIATRIC HOSPITAL (PR 55)

12.1

General Wards

H008

General Ward for Psychiatric Hospitals

3,602.73

-

12.2 TTO

H288

Treatment Taken Out issued at discharge

*

-

13.

13.1

FRAIL CARE / PALLIATIVE / HOSPICE (PR 79)

General Wards

H950

Frail care / Hospice ward (Daily) (inclusive fee: ward fee, general care management, Doctors, Nursing staff)

2,450.97

H955

Home health care, per visit

585.72

13.2 TTO

H288

Treatment Taken Out issued at discharge

*

-