SPEECH THERAPY AND AUDIOLOGY (Practice Type 082)

Rule

Rule Description

001

Pre-Authorisation are required for all Hearing Aid services

002

A request for hearing aids must be accompanied by a referral letter from the treating medical practitioner. The referral letter must clearly indicate reasons and the relationship to the original injury or disease.

003

Motivation from the treating medical practitioner will be required for renewal of hearing aids outside of warranty. Hearing aids still within the manufacturers warranty should be replaced or repaired at no cost to the patient or the Fund

004

A copy of the Referral letter shall be required from the treating for Speech Therapy.

005

Newly hospitalised patients will be allowed up 10 sessions without pre-authorisation. If further treatment is necessary after a series of 10 treatment sessions for the same condition, the treating doctor must submit a motivation with treatment plan to the Fund for considering further authorisation.

No pre-authorisation is required for patients in ICU and High Care Units.

006

Unless timely steps are taken (at least two hours) to cancel an appointment for a consultation the relevant consultation fee shall be payable by the employee.

007

It is recommended that, when such benefits are granted, drugs, consumables and disposable items used during a procedure or issued to a patient on discharge will only be reimbursed by the Fund if the appropriate code is supplied on the medical invoice.

Tariff Codes

Code

Code Description

1.

Speech Therapy

1.1

Speech Therapy Consultations, Assessment and Treatment

1020

Speech therapy consultation. Duration 5 - 15 mins

149.04

1021

Speech therapy consultation. Duration 16 - 30 mins

335.51

1022

Speech therapy consultation. Duration 31 - 45 mins

558.51

1.2

Assessment & Treatment

1.2.1

Speech Therapy Assessment & Treatment

1050

Speech therapy assessment and treatment. Duration 5 - 15 mins

149.04

1051

Speech therapy assessment and treatment. Duration 16 - 30 mins

335.51

1052

Speech therapy assessment and treatment. Duration 31 - 45 mins

558.51

1.3

Speech, Voice and Language Disorder

0007

Group therapy: per patient at rooms (Maximum of 3 patients per therapy per day).

Limit of two sessions and thereafter a motivation letter is required.

Note: Professional Group Consultations - no fee to be charged.

218.56

0009

Preparation of a home programme tariff code can be used once per life-time.

Note: This category is to prepare the home programme prior to consultation with patient or care giver.

218.56

2.

Audiology

2.1

Audiology Consultation, Assessment & Treatment

1011

Audiology consultation. Duration 16 - 30 mins

330.03

1012

Audiology consultation. Duration 31 - 45 mins

550.46

1013

Audiology consultation. Duration 46 - 60 mins

770.78

2.2

Audiology Evaluations

A.

Peripheral Hearing Evaluation

1100

Pure Tone Audiogram (Air conduction) (3273- Pure tone audiometry (air conduction)- Doctor's file

Tariff code 3273 cannot be used with code 1110

248.36

1105

Pure Tone Audiogram (Bone conduction) (3274 -Pure tone audiometry (bone conduction with masking) - Doctor's file

Tariff code cannot be used with code 1110

198.69

1110

Full Speech Audiogram including speech reception threshold and discrimination at two or more levels. (3277 - Speech audiometry: Item includes speech audiogram, speech reception threshold, discrimination score) - Doctor's file

Tariff code cannot be used with code 1100 and 1105

248.36

B.

Middle Ear Function Evaluation

1200

lmmittance Measurements (Impedance / Tympanometry)

Tariff code cannot be used with code 1205 and 1210

132.46

1205

Immittance Measurements -Impedance / Stapedial reflex (3276 - Impedance audiometry (stapedial reflex) - no code for volume, compliance etc.- Doctor's file Limited reflex spectrum (e.g. 1-2 frequencies)

Tariff code cannot be used with code 1200 and 1210

66.23

1210

Immittance Measurements -Impedance / Stapedial reflex (3276 - Impedance audiometry (stapedial reflex) - no code for volume, compliance etc.- Doctor's file Extended reflex spectrum (250-800Hz e.g. 4-8 frequencies)

Tariff code cannot be used with code 1200 and 1205

198.69

1220

Eustachian Tube Function Test - multiple tympanograms - bilateral

Tariff code can only be used once during a consultation or visit

198.69

1225

Rinné & Weber tests

66.23

C.

Diagnostic Audiological Tests for Differential Diagnosis between Cochlear; Retro-cochlear; Central; Functional and/or Vestibular Pathology

1300

Tone Decay (for retro cochlear pathology)

Tariff code can only be used for head trauma related to occupational injuries/diseases

Motivation letter required

132.46

1305

Reflex decay (for retro cochlear pathology)

Tariff code can only be used for head trauma related to occupational injuries/diseases

Motivation letter required

132.46

1310

SISI (for cochlear pathology)

Tariff code can only be used for head trauma related to occupational injuries/diseases

82.79

1315

Air conduction MCL (Most comfortable levels) & UCL (Uncomfortable levels) - for cochlear pathology and/or for purposes of selection of hearing aid technology or hearing aid programming

Tariff code can only be used for head trauma related to occupational injuries/diseases

132.46

1320

Speech conduction MCL & UCL (for cochlear pathology)

Tariff code can only be used for head trauma related to occupational injuries/diseases

66.23

D.

Electro-Physiological Examinations/Auditory Evoked Potentials (AEP)

1515

Diagnostic Audiological Click ABR (Auditory Brainstem Evoked Response) - Bilateral Air conduction threshold determination using click stimuli

1070.95

1520

Diagnostic Audiological Click ABR-(Auditory Brainstem Response) - Bilateral Bone conduction threshold determination using click stimuli

1427.90

1534

Diagnostic Audiological Tone Burst ABR (Auditory Brainstem Response) - Bilateral Frequency specific threshold determination using tone-burst stimuli at : 4 frequencies

2142.13

1581

OAE (Oto-acoustic emissions) - comprehensive diagnostic evaluation

495.10

E.

Balance/Vestibular Examinations and Treatment

1600

Spontaneous and positional nystagmus using electro-nystagmography (ENG) (3253).

Cannot use with tariff code 1605.

981.95

1605

Spontaneous and positional nystagmus using Video-nystagmography  (VNG).

Cannot use with tariff code 1600.

1033.42

1610

Eye Visualization - spontaneous and positional nystagmus - monocular

556.22

1615

Eye Visualization - spontaneous and positional nystagmus - binocular

578.06

3.

Material

0300

Medication

-

0301

Material

-

F.

Hearing Amplification / Hearing Aids

Rules

Product warranties should be honoured by the supplier

Only out of warranty costs may be considered for funding

Prices excludes professional fee for evaluation, measuring, fitting and adjusting & follow ups

Each description includes the necessary accessories and hardware to make the prescribed hearing aid/accessory/replacement/repair functional as intended by the products IFU (Instruction For Use)

Accessories to new hearing aids should be motivated and clinically relevant

Patients are eligible for new hearing aids every 5 years. Taking the following into account: The quality of the hearing aid, how well it's maintained and wear and tear

Product must be obtained, maintained and serviced in the country at an affordable cost.

A limit of two (2) applies in instances were both ears (Bilateral) require hearing aid devices

Criteria for Hearing Aids

Baseline hearing test  of employee (i.e. baseline test should been done within 30 days of employment and on employees who are going to work in a noise zone for the first time or on employees working in a newly identified noise zone)

A full assessment / evaluation from medical professional i.e. ENT surgeon, Audiologist.

Hearing Tests: Weber Hearing test or Audiogram hearing test or Rinné hearing test or Tympanometry test or Otoacoustic Emissions Hearing loss test and/or Auditory brainstem Response Hearing loss test.

More than 40 decibels is considered to be a hearing impairment for hearing aids.

Less than 40 decibels needs to be motivated

Confirmation of hearing loss being work related from medical professional

Tariff Codes

Code

Code Description

 Rand

1800

Hearing aid evaluation - per ear

238.81

1805

Free Field Hearing Aid Evaluation : Pure tone and speech (with and without lipreading)

Item cannot be used with code 1100, 1105 and 1110

206.97

1810

Insertion gain measurement, per ear

159.21

1815

Re-programming of hearing aid, per ear

159.21

1820

Technical adjustment of hearing aid/device, per ear.

95.52

1824

Hearing Aid Batteries (4)

277.24

1825

Repairs to hearing aids.

-

1830

Global charge for supply and fitting of hearing aid and follow-up

Refer to Rule 001

No other tariff code can be billed with tariff code 1830

-

1831

Basic hearing aid limit

16573.14

1832

Standard hearing aid limit

16908.48

1833

Intermediate hearing aid limit

23673.61

1834

Essential hearing aid limit

19308.37

1835

Advanced hearing aid limit

35495.89