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Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

Scale of Fees

Annual Increase in Medical Tariffs for Medical Service Providers - 2025

Doctors Gazette 2025

General Medical Doctor and Specialist Tariff of Fees as from 01 April 2025

Part I : New Consultative Services as from 01 April 2025 (GENERAL PRACTITIONERS and ALL SPECIALISTS)

 

I. CONSULTATIVE SERVICES

Specialist

General Practitioner

Anaesthetic


U

R

U

R

U

R

Code

Code Description






NEWLY ADOPTED CONSULTATION CODES






Notes:

Items 0190-0192 and items 0173-0175 (as appropriate) should be used by all medical doctors, except for psychiatrists who should use items 0161- 0163 and items 0166-0169 (as appropriate) for basic consultative services.

(a) Only one of items 0190-0192 and items 0173- 0175 (as appropriate), may be used for a single service and not combinations thereof.
(b) The ICD-10 codes should appear on the invoice.
(c) These services must be face-to-face with the patient and excludes the time spent doing special investigations which receive addition.
(d) Only one of the add-on items 0145, 0146 or 0147 (as appropriate) and not combinations thereof.
(e) A subsequent visit refers to a voluntarily scheduled visit performed for the same condition within four (4) months after the first visit (although the symptoms or complaints may differ from those presented during the first visit).

 

NB!! Item codes 0190-0192 may not be billed with 0184 and 0186

 






OUT OF HOSPITAL CONSULTATION





0190

New and established patient:: Consultation/visit of established patient of an average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to Item 0174 or item 0109 or 7062 - 7064) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to anaesthetic structure

 

17

570.86

15

503.70

16.5

554.07

0191

New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity. Includes counselling with the patient and/or family and co- ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer toitem 0174 or item 0109 or 7062 - 7064) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics

- refer to anaesthetic structure

 

32

1 074.56

30

1 007.40

31.5

1 057.77

1092

New and established patient: Consultation/visit of new or established patient of long duration and/or

high complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (for hospital consultation/visit - refer to item 0173-0175 or item 0109) - not appropriate for pre- anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic  structure

 

36

1 208.88

33

1 108.14

36

1 208.88

HOSPITAL CONSULTATION / VISITS





0173

First hospital consultation/visit of an average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre- anaesthetic assessment followed by the appropriate anaesthetics - refer to new  anaesthetic structure)

 

16.5

543.84

15

494.40

15

494.40

0174

First in hospital consultation/visit: Consultation/visit of a moderately above average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient

 

31.5

1 038.24

30

988.80

15

494.40

0175

First hospital consultation/visit of long duration and/or high complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre- anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

 

36

1 186.58

45

1 483.20


NOTES:

(a) Only one of items 0184 and 0186 as appropriate may be charged for a single service and not combinations thereof
(b) These services must be face-to-face with the patient and excludes the time spent doing special investigations which receive addition.
(c) A subsequent visit refers to a voluntarily scheduled visit performed for the same condition within four (4) months after the first visit {although the symptoms or complains may differ from those presented during the first visit
(d) Items 0184 and 0186 include renumeration for the completion of the first, progress and final medical reports. Item 0186 may be charged for a visit to complete a final medical report
(e) Only one of the add-on items 0145, 0146 or 0147 {as appropriate) and not combinations thereof.

 

NB!!  Item codes 0184 and 0186 may not be billed with 0190-0192

 

FOLLOW-UP VISIT

 

 

 

 

 

 

0184

 

Follow-up visit for the evaluation and management of a patient.

16.5

554.07

15

503.70

16.5

554.07

FINAL VISIT

 

 

 

 

 

 

0186

Follow-up visit for the evaluation and management of a patient with a Final Medical Report (Rule G not applicable)

31.5

1 057.77

30

1 007.40

31.5

1 057.77


 

 

 

 

 

 

ADD-ON CONSULTATIONS SERVICES

 

 

 

 

 

 

0145

For consultation/visit away from the doctors home or rooms: ADD to item 0190. Confirm where visit took place. Please note that item 0145 is not applicable for pre-anaesthetic assessments and may not be added to items 0151/ 0152

 

6

197.76

6

197.76

 

 

0146

Emergency or unscheduled consultation/visit at the doctors home or rooms: ADD to items 0164-0169 or 0190-0192 as appropriate. (General Rule B refers)

 

8

263.68

8

263.68

 

 

0147

For after hours emergency or unscheduled consultation/ visit away from the doctor's home or rooms: ADD to items 0164-0169 or 0190-0192 as appropriate (General Rule B refers)

 

14

461.44

14

461.44

 

 

HOSPITAL CONSULTATION / VISIT

 

 

 

 

 

 

0109

Hospital follow-up visit to patient in ward or nursing facility - (Refer to general rule G(a) for post-operative care) (may only be charged once per day) (not to be used with items 0146 or ICU items 1204-1214)

15

494.40

15

494.40

 

 


 

 

 

 

 

 

PRE-ANAESTHETIC ASSESSMENT

 

 

 

 

 

 

(a) Pre-anaesthetic consultations for all major vascular, cardio-thoracic and orthopaedic cases will attract a unit value of at least 32.00 units
(b) Only item 0146 may be charged by PR:10
(c) Code 0151 may not be billed with 0152
(d) The ICD-10 codes should appear on the invoice.

 

0151

Pre-anaesthetic assessment of patient (all hours). Problem focused history, clinical examination and decision making

 

32

1 074.56

32

1 074.56

32

1 074.56

0152

Pre-anaesthetic assessment:

Pre-anaesthetic assessment of patient (all hours). Detailed history and clinical examination and straightforward decision making and counselling. Typically occupies the doctor face-to-face with the patient for between 20 and 35min

 

31.5

1 057.77

30

1 007.40

30

1 007.40

PSYCHIATRY (22) ONLY

 

 

 

 

 

 

NOTE:

(a) Applicable to PR 22 only .
(b) May not be billed with 0171-0176 and 0190-0192
(c) Only one of the add ons for 0146 or 0147 may be charged as appropriate and not combination thereof
(d) A subsequent visit refers to a voluntary scheduled visit performed for the same condition within (four) 4 months after the 1st visit.
(e) Hospital follow-up visits:Items 0109 may not be used for psychiatrists
(f) Replaces code 0180-0186

 

0164

In rooms Consultation / visits: Psychiatry (22): New and established patients: Consultation/visit of new or established patient with comprehensive history and clinical examination for complex problem requiring complex decision making and counselling. Typically occupies a doctor personally with the patient for between 46 and 60 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166- 0169)

Use code once per event only for first day in hospital. Can be billed together with psychotherapy and other treatment modalities

 

52.5

1 762.95

 

 

 

 

0167

Follow up in hospital:

Psychiatry : New and established patients: Hospital consultation/visit with detailed history, clinical examination and straightforward decision making and counselling. Typically occupies the doctor personally with the patient for between 21 to 35 minutes

 

27.5

906.40

 

 

 

 

0169

First day in hospital:

Psychiatry: New and established patients: Hospital consultation/visit with comprehensive history and clinical examination for complex problem requiring complex decision making and counselling. Typically occupies the doctor personally with the patient for between 45 to 60 minutes

 

52.5

1 730.40

 

 

 

 

GENERAL

 

 

 

 

 

 

0136

Special medical examination requested by the Compensation Commissioner (Section 42)

200

6 592.00

 

 

 

 

0199

Completion of chronic medication forms by medical doctors with or without the physical presence of the patient requested by or on behalf of a third-party funder or its agent

21.43

706.33