Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers - 2024Dental Services Gazette 2024Dental 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 |
|