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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 - 2024

Dental Services Gazette 2024

Dental Services Tariff of Fees as from 1 April 2024 Practice Type 054 (General Dental), Practice Type 062 (Maxillo-Facial and Oral Surgery), & Practice Type 094 (Prosthodontist)

General Rules

 

GENERAL RULES

 

1        Rules

The following Rules apply to all practitioners

001 Tariff code 8101 refers to a Full Mouth Examination,charting and treatment planning and no further examination fees shall be chargeable for an oral examination (Tariff code 8101) or comprehensive examination (Tariff code 8102) until the treatment plan resulting from these type of examinations is completed.

This includes the issuing of a prescription where only medication is prescribed.

Tariff code 8104 refers to a consultation for a specific problem and not to a full mouth examination, charting and treatment planning.

This includes the issuing of a prescription where only medication is prescribed.

 

002 Except in those cases where the fee is determined "by arrangement", the fee for the rendering of a service which is not listed in this schedule shall be based on the fee in respect of a comparable service that is listed therein and Rule 002 must be indicated together with the tariff code.

 

003 In the case of a prolonged or costly dental service or procedure, the dental practitioner shall ascertain beforehand from the Commissioner whether financial responsibility in respect of such treatment will be accepted.

 

005 Except in exceptional cases the service of a specialist shall be available only on the recommendation of the attending dental or medical practitioner. Referring practitioners shall indicate to the specialist that the patient is being treated in terms of the Compensation for Occupational Injuries and Diseases Act

 

007 "Normal consulting hours" are between 08:00 and 17:00 on weekdays, and between 08:00 and 13:00 on Saturdays

 

008 A Dental Practitioner shall submit his or her invoice for treatment to the employer of the employee concerned and to the Compensation Fund.

 

009 Dentists in general practice shall be entitled to charge two-thirds of the fees of specialists only for treatment that is not listed in the schedule for dentists in general practice.

Benefits in respect of specialists charging treatment procedures not listed in the schedule for that specialty, shall be allocated as follows :

General Dental Practitioners Schedule 100%

Other Dental Specialists Schedules 2/3

 

010 Fees charged by dental technicians for their services (PLUS L) shall be indicated on the dentist's invoice against the tariff code 8099.

Such dentist's invoice shall be accompanied by the actual invoice of the dental technician (or a copy thereof) and the invoice of the dental technician shall bear the signature of the dentist (or the person authorised by him) as proof that it has been compiled correctly.

"L" comprises the fee charged by the dental technician for his services as well as the cost of gold and of teeth.

For example, tariff code 8231 is specified as follows (gold only applicable with prior authorization)


Rc

8231 ............................

X

8099 (8231) ..................

Y

Total  ...........................

R(X+Y)

 

011 Modifiers may only be used where (M/W) appears against the tariff code in the schedule
8001 Assistant Surgeon - Specialist (1/3 of the appropriate benefit)
8002 Specialist fee/benefit (Plus 50% of the appropriate benefit)
8005 Maximum multiple procedures (same incision) - Maxillo-Facial and Oral (MFO) surgeon
8006 Multiple surgical procedures - third and subsequent procedures (50% of the appropriate benefit)
8007 Assistant Surgeon - General Dental Practitioner (15% of the appropriate benefit)
8008 Emergency surgery - after hours (PLUS 25% of the appropriate benefit)
8009 Multiple surgical procedures - second procedure (75% of the appropriate benefit)
8010 Open reduction(PLUS 75% of the appropriate benefit)

 

012 In cases where treatment is not listed in the schedule for Dentists in general practice or Specialists, the appropriate fee listed in the medical schedules shall be charged and the relevant tariff code in the medical schedules Indicated.

 

013 Cost of material (VAT inclusive): This rule provides for the charging of material costs where indicated against the relative tariff codes by the words "(See Rule 013)". Material should be charged for at cost plus a handling fee not exceeding 35%, up to R5638.01

A maximum handling fee of 10% shall apply above a cost of R5638.01

A maximum handling fee of R8456.88 will apply.

Note: Tariff code 8220 (suture) is applicable to all registered practitioners.

 

014 Surgery guidelines:

Follow-up care for therapeutic surgical procedures:

The fee for an operation shall, unless otherwise stated, include normal post-operative care for a period not less than one month.

If a Practitioner does not complete the post-operative care, the Practitioner shall arrange for post-operative care without additional charges.

A fee for post-operative treatment of a prolonged or specialized nature may be charged as agreed upon between the Practitioner and the patient.

 

2        Explanations

Additions, deletions and revisions

A summary listing all additions,deletions and revisions applicable to this schedule is found in Appendix A. New Tariff codes added to the schedule are identified with the symbol * placed before the Tariff code. In instances where a tariff code has been revised, the symbol * is placed before the Tariff code.

 

Tooth identification and designation of areas of the oral cavity:

Tooth identification and designation of areas of the oral cavity is compulsory for all invoices rendered.

Tooth identification is applicable to procedures identified with the letter (T), and other designation of areas of  the oral cavity with the letter (Q) for a quadrant and the letter (M)for the maxillary or mandibular area In the mouth part (MP) column of the Dental Coding.

The International Standards Organisation (ISO) in collaboration with the FDI designated system for teeth and areas of the oral cavity should be used. For supernumeraries, the abbreviation SUP should be used.

 

Treatment categories:

Treatment Categories (TC) of dental procedures are identified in the TC column of the Dental Coding as follows:

Basic Dentistry - designated as (B) in the treatment category column

Advanced Dentistry - designated as (A) in the treatment category column

Surgery - designated as (S) in the treatment category column

 

Abbreviations used in Dental Coding

DM - Direct Material Column

+D - Add fee for denture

+L - Add laboratory fee

+M - Add material fee



MP - Mouth Part Column

M - Maxilla / Mandible

Q - Quadrant

S - Sextant

T - Tooth



TC - Treatment Category Column

A - Advanced Dentistry

B - Basic Dentistry

S - Surgery



Practice type codes:

5400 General Dental Practitioner

6200 Specialist Maxillo Facial and Oral Surgeon

9400 Specialist Prosthodontist



VAT

Fees are VAT exclusive