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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 - 2022

Dental Gazette 2022

Dental Services Tariff of Fees as from 1 April 2022

General Rules

 

The following Rules apply to all practitioners

 

001 Code 8101 refers to a Full Mouth Examination,charting and treatment planning and no further examination fees shall be chargeable for an oral examination (code 8101) or comprehensive examination (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. Item 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.

 

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.

 

004 In exceptional cases where the tariff fee Is disproportionately low in relation to the actual services rendered by a practitioner, such higher fee as may be mutually agreed upon between the dental practitioner and the Commissioner may be charged and Rule 004 must be indicated together with the tariff code.

 

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 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, code 8231is 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 item 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) - 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 code in the medical schedules indicated

 

013 Cost of material (VAT inclusive):This item provides for the charging of material costs where indicated against the relative item   codes by the words "(See Rule 013)". Material should be charged for at cost plus a handling fee not exceeding 35%, up to R4876.67. A maximum handling fee of 10% shall apply above a cost of R4876.67. A maximum handling fee of R7314.88 will apply Note: Item 8220 (suture) is applicable to all registered practitioners.

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

 

Additions, deletions and revisions

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

 

 

 

 


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