Healthman Ophthalmology Costing Guide 2016: Comparative Tariffs: Scheme Rates Base Rates

HEALTHMAN OPHTHALMOLOGY COSTING GUIDE 2016
COMPARATIVE TARIFFS: Scheme Rates

Base Rates
Code
Terminology
Average
Duration
Professional
Units
HealthMan
Private
Discovery
Tariff
HealthMan BankMed BankMed Tariffs
(VAT Incl)
RCF
(VAT Incl)
RCF
(VAT Incl)
R
DH
RCF
R
GEMS
FedHealth FedHealth Tariffs
(VAT Incl)
RCF
(VAT Incl)
R
GEMS
RCF
Profmed
(Incl VAT)
Profmed
RCF
Consultations:
0109
0129
0132
0145
0146
0147
0148
0149
0173
0174
0175
0190
0191
0192
0199
See the Notes below for All Tariffs

Hospital follow-up visit
Prolonged first/follow-up consultation : 15 min
Repeat Script
Consultation : Away from doctor's room
Unscheduled consultation: Emergency (cons.room)
Unscheduled consultation:Emergency(not cons.room)
Elective after-hours services(+50%)
Emergency after-hours services(+25%)
Hospital Consultation
Consultation
Consultation
Consultation
Chronic Medicine Forms
15.00
15.00
5.00
6.00
8.00
14.00
15.00
30.00
45.00
15.00
30.00
45.00
21.43
609.50
609.50
203.20
243.80
325.10
568.80
609.50
1 219.00
1 828.40
609.50
1 219.00
1 828.40
870.70
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
288.40
288.40
96.20
115.30
153.70
269.70
326.80
326.80
326.80
326.80
326.80
326.80
412.20
19.227
19.227
19.240
19.217
19.213
19.264
21.787
10.893
7.262
21.787
10.893
7.262
19.235
200.80
280.00
93.20
112.10
149.40
261.60
317.80
317.80
317.80
357.60
357.60
357.60
400.30
13.387
18.667
18.640
18.683
18.675
18.686
21.187
10.593
7.062
23.840
11.920
7.947
18.679
284.10
284.10
94.70
113.60
151.50
265.20
322.60
322.60
322.60
322.60
322.60
322.60
405.90
18.940
18.940
18.940
18.940
18.940
18.940
21.505
10.753
7.168
21.505
10.753
7.168
18.940
287.40
287.40
95.90
115.00
153.40
268.30
317.60
317.60
317.60
317.60
317.60
317.60
361.50
19.160
19.160
19.180
19.167
19.175
19.164
21.173
10.587
7.058
21.173
10.587
7.058
16.869
292.50
292.50
97.50
117.00
156.00
273.00
507.00
507.00
507.00
507.00
507.00
507.00
417.90
19.503
19.503
19.503
19.503
19.503
19.503
33.800
16.900
11.267
33.800
16.900
11.267
19.503
7.00
7.00
7.00
11.68
12.00
7.00
284.40
284.40
284.40
138.60
487.60
284.40
40.632
40.632
40.632
11.869
40.632
40.632
83.36
83.36
83.36
139.09
142.90
83.36
11.908
11.908
11.908
11.908
11.908
11.908
80.90
80.90
80.90
135.10
138.80
80.90
11.563
11.563
11.563
11.563
11.563
11.563
82.00
82.00
82.00
136.80
140.50
82.00
11.710
11.710
11.710
11.710
11.710
11.710
83.10
83.10
83.10
138.60
142.40
83.10
11.869
11.869
11.869
11.869
11.869
11.869
84.50
84.50
84.50
141.10
144.90
84.50
12.078
12.078
12.078
12.078
12.078
12.078
74.00
16.00
878.30
650.10
11.869
40.632
881.19
190.53
11.908
11.908
855.70
185.00
11.563
11.563
866.50
187.40
11.710
11.710
878.30
189.90
11.869
11.869
893.80
193.20
12.078
12.078
46.00
546.00
11.869
547.77
11.908
531.90
11.563
538.70
11.710
546.00
11.869
555.60
12.078
9.00
68.00
21.00
40.00
365.70
807.10
249.20
474.80
40.632
11.869
11.869
11.869
107.17
809.74
250.07
476.32
11.908
11.908
11.908
11.908
104.10
786.30
242.80
462.50
11.563
11.563
11.563
11.563
105.40
796.30
245.90
468.40
11.710
11.710
11.710
11.710
106.80
807.10
249.20
474.80
11.869
11.869
11.869
11.869
108.70
821.30
253.60
483.10
12.078
12.078
12.078
12.078
Procedures
3003
3004
3006
3009
3013
3014
3017
3018
3020
3021
3022
3027
3028
3036
3037
3039
3041
3047
3049
3052
3059
3061
3075
3097
3098
3099
3120
3121
Fundus contact lens or 90 D lens examination

Peripheral fundus examination with indirect Ophthalmoscope
Keratometry
Basic capital equipment used in own rooms by ophthalmologists.
Ocular motility assessment: Comprehensive examination
Tonometry per test with maximum of 2 tests for provocative tonometry
Retinal threshold test inclusive of computer disc storage for Delta of Statpak
programs
Retinal threshold trend evaluation
Special eye investigations:Pachymetry:Only when own instrument is used, per eye.
Only in addition to corneal surgery.
Special eye investigations:Retinal funtion assessment including refraction after ocular
surgery.Within four months,max 2 exams.
Digital fluorescein video angiography
Fundus photography
Optical Coherent Tomography (OCT) of Optic nerve or macula:Per eye
Corneal topography:For pathological corneas only on special motivation. For
refractive surgery.
Surgical treatment of retinal detachment including vitreous replacement but
excluding vitrectomy
Prophylaxis and treatment of retina and choroid by cryotherapy and/or diathermy
and/or photocoagulation and/or laser per eye.
Pan retinal photocoagulation (per eye): Done in one sitting
Cataract: Extra-capsular (including capsulotomy
Insertion of lenticulus in addition to item 3045 or item 3047 cost on lens excluded
Laser capsulotomy
Insertion of lenticulus when item 3045 or item 3047 was not executed
Drainage operation
Strabismus (whether operation performed on 1 eye or both. Operation on 1 or 2
muscles
Anterior vitrectomy
Removal of silicon from globe
Posterior vitrectomy including anterior vitrectomy,encircling of globe and vitreous
replacement
Excimer laser (per eye) for refractive keratectomy or Holmium laser thermo
keratoplasty (LTK) (For machine hire fee for LTK - Use item 3201
Corneal graft (lamellar or full thickness)
36.00
1 462.80
40.632
428.69
11.908
416.30
11.563
421.60
11.710
427.30
11.869
434.80
12.078
306.90
12 470.00
40.632
3 654.57
11.908
3 548.70
11.563
3 593.80
11.710
3 642.60
11.869
3 706.70
12.078
105.00
150.00
210.00
4 266.40
6 094.80
8 532.70
40.632
40.632
40.632
1 250.34
1 786.20
2 500.68
11.908
11.908
11.908
1 214.10
1 734.50
2 428.20
11.563
11.563
11.563
1 229.60
1 756.50
2 459.10
11.710
11.710
11.710
1 246.20
1 780.40
2 492.50
11.869
11.869
11.869
1 268.20
1 811.70
2 536.40
12.078
12.078
12.078
57.00
105.00
210.00
247.60
2 316.00
4 266.40
8 532.70
10 060.50
40.632
40.632
40.632
40.632
678.76
1 250.34
2 500.68
2 948.42
11.908
11.908
11.908
11.908
659.10
1 214.10
2 428.20
2 863.00
11.563
11.563
11.563
11.563
667.50
1 229.60
2 459.10
2 899.40
11.710
11.710
11.710
11.710
676.50
1 246.20
2 492.50
2 938.80
11.869
11.869
11.869
11.869
688.40
1 268.20
2 536.40
2 990.50
12.078
12.078
12.078
12.078
175.60
280.00
280.00
7 135.00
11 377.00
11 377.00
40.632
40.632
40.632
2 091.04
3 334.24
3 334.24
11.908
11.908
11.908
2 030.50
3 237.60
3 237.60
11.563
11.563
11.563
2 056.30
3 278.80
3 278.80
11.710
11.710
11.710
2 084.20
3 323.30
3 323.30
11.869
11.869
11.869
2 120.90
3 381.80
3 381.80
12.078
12.078
12.078
419.00
17 024.80
40.632
4 989.45
11.908
4 844.90
11.563
4 906.50
11.710
4 973.10
11.869
5 060.70
12.078
150.00
289.00
6 094.80
11 742.60
40.632
40.632
1 786.20
3 441.41
11.908
11.908
1 734.50
3 341.70
11.563
11.563
1 756.50
3 384.20
11.710
11.710
1 780.40
3 430.10
11.869
11.869
1 811.70
3 490.50
12.078
12.078

Base Rates
Code
3125
3130
3131
3132
3134
3163
3171
3181
3196
3198
3201
3202
3203
3631
3632
4980
4981
4983
4985
4986
4988
4989
3013
3038
3040
3123
3168
4981
4983
4988
4989
Terminology
Keratectomy
Pterygium or conjunctival cyst or conjunctival tumour.No conjunctival flap or graft
used
Cornea: Paracentesis
Lamellar keratectomy for refractive surgery (LK,ALK,MLK)
Pterygium or conjunctival cyst or conjunctival tumour.Conjunctival flap or graft used stand alone procedure
Excision of superficial lid tumour
Excision of Meibomian cyst.Additional fee for sterile tray
Entropion or ectropion by Open operation
Diamond Knife: Use of own diamond knife during intraocular surgery
Excimer laser: Hire fee (per eye)
Laser apparatus (ophthalmic): Hire fee for one or both eyes done in one sitting (Not
to be used with IOL Master.)
Phako emulsification apparatus: Hire fee
Vitrectomy apparatus: Hire fee
Ophthalmic examination
Axial length measurement and calculation of intra ocular lens power.Per eye. Not to
be used with item 3034
Corneal transplant: Endothelial
Preparation of corneal endothelial allograft prior to transplantation (backbench)
Lamellar corneal surgery keratome and equipment
Corneal cross linking
Cross linking equipment hire
Endothelial specular microscope for donor corneas
Endothelial specular microscope for clinical use
New Codes & Changes
Sensorimotor examination: With multiple measurements of ocular deviation; one or
both eyes (eg., restrictive or paretic muscle with diplopia) with interpretation and
report, for patients over 7 years of age
report, for children 7 years and younger
Femtosecond Laser: Hire Fee. For one or both eyes done in one sitting
Insertion of intra-corneal or intrascleral prosthesis: Pathological cornea
Removal of foreign body: Embedded, per eyelid (modifier 0005 is applicable)
Average
Duration
Professional
HealthMan
Private
Discovery
Tariff
(VAT Incl)
RCF
(VAT Incl)
RCF
(VAT Incl)
DH
RCF
GEMS
(VAT Incl)
RCF
(VAT Incl)
GEMS
RCF
Profmed
(Incl VAT)
Profmed
RCF
Units
127.00
R
5 160.30
R
40.632
R
1 512.32
R
11.908
R
1 468.50
R
11.563
R
1 487.20
R
11.710
R
1 507.40
R
11.869
R
1 533.90
R
12.078
96.90
53.00
150.00
3 937.20
2 153.50
6 094.80
40.632
40.632
40.632
1 153.89
631.12
1 786.20
11.908
11.908
11.908
1 120.50
612.80
1 734.50
11.563
11.563
11.563
1 134.70
620.60
1 756.50
11.710
11.710
11.710
1 150.10
629.10
1 780.40
11.869
11.869
11.869
1 170.40
640.10
1 811.70
12.078
12.078
12.078
116.30
47.00
20.40
111.50
12.00
284.13
4 725.50
1 909.70
828.90
4 530.50
142.40
3 372.30
40.632
40.632
40.632
40.632
11.869
11.869
1 384.90
559.68
242.92
1 327.74
142.90
3 383.42
11.908
11.908
11.908
11.908
11.908
11.908
1 344.80
543.50
235.90
1 289.30
138.80
3 285.40
11.563
11.563
11.563
11.563
11.563
11.563
1 361.90
550.40
238.90
1 305.70
140.50
3 327.20
11.710
11.710
11.710
11.710
11.710
11.710
1 380.40
557.80
242.10
1 323.40
142.40
3 372.30
11.869
11.869
11.869
11.869
11.869
11.869
1 404.70
567.70
246.40
1 346.70
144.90
3 431.70
12.078
12.078
12.078
12.078
12.078
12.078
109.00
109.00
120.00
50.00
1 293.70
1 293.70
1 424.30
565.60
11.869
11.869
11.869
11.312
1 297.97
1 297.97
1 428.96
567.55
11.908
11.908
11.908
11.351
1 260.40
1 260.40
1 387.60
551.20
11.563
11.563
11.563
11.023
1 276.40
1 276.40
1 405.20
559.00
11.710
11.710
11.710
11.180
1 293.70
1 293.70
1 424.30
565.60
11.869
11.869
11.869
11.312
1 316.50
1 316.50
1 449.40
575.70
12.078
12.078
12.078
11.513
50.00
274.80
565.60
11 165.70
6 094.80
640.90
-
11.312
40.632
40.632
11.869
40.632
11.869
11.869
11.869
567.55
11.351
551.20
11.023
559.00
11.180
565.60
3 261.60
1 780.40
640.90
-
11.312
11.869
11.869
11.869
11.869
11.869
11.869
11.869
575.70
3 319.00
1 811.70
652.20
-
11.513
12.078
12.078
12.078
12.078
12.078
12.078
12.078
19.60
796.40
40.632
45.00
1 828.40
19 129.50
1 446.50
40.632
11.869
40.632
40.632
40.632
40.632
40.632
40.632
150.00
54.00
470.80
35.60

Base Rates
Code
Terminology
Average
Duration
Professional
Units
HealthMan
Private
Discovery
Tariff
(VAT Incl)
RCF
(VAT Incl)
RCF
(VAT Incl)
R
DH
RCF
R
Note:
1. Codes, Descriptors and Unit Values have been extracted from the SAMA Electronic Medical Doctors Coding Manual (eMDCM) previously known as the SAMA Doctors Billing Manual (DBM).
2. Tariffs may differ due to rounding
3. Above codes are the most frequently used codes and is not all inclusive of all the codes
4. Increases from 2015 are as follow:
a. HealthMan = 2015 Tariff + 7.2%
b. Bankmed = New to Schedule
c. Discovery Health = 2015 Tariff +5%
d. Fedhealth = 2015 Tariff +5.5%
e. GEMS = 2015 Tariff +5%
f. Profmed = 2015 Tariff +6%
6. Payment Arrangement Rates have NOT been split between In-Hospital & Out-Hospital. Use as appropriate.
7. The Healthman tariff for codes that relate to equipment have been retained at GEMS rate*
8. All Tariffs are inlcusive of VAT
9. Please note that GEMS published no Consultation Codes at Scheme Rate and that the GEMS Non-Contracted rates were used
Disclaimer:
The above schedule is based on information avaiable to HealthMan and HealthMan will NOT be held responsible for any losses incurred by practitioners resulting from the use of this schedule.
Legend:
DH = Discovery Health
DPA = Direct Payment Arrangement
Prem = Premier
R = Rand
RCF = Rand Conversion Factor (Rand Value per Unit)
VAT = Value Added Tax
GEMS
(VAT Incl)
RCF
(VAT Incl)
R
GEMS
RCF
Profmed
(Incl VAT)
Profmed
RCF

Base Rates
Code
Terminology
Average
Duration
Professional
Units
Payment Arrangments
BankMed
BankMed
HealthMan
Traditional &
Traditional & BankMed
Private
BankMed Comprehensive Comprehensive
Plus
Tariff
HealthMan Entry Plan
Network
Network
Network
(VAT Incl)
RCF
Network
(IH)
(OH)
(IH)
110%
135%
150%
200%
R
R
R
R
R
R
BankMed
Plus
Network
(OH)
215%
R
DH
Prem A
(IH)
137%
R
DH
Prem A
(OH)
162%
R
DH
Prem B
147%
R
DH
DH
Classic Rate Exec Rate
217%
300%
R
R
FedHealth FedHealth
DPA
DPA
165%
210%
R
R
FedHealth
DPA
300%
R
Consultations:
0109
0129
0132
0145
0146
0147
0148
0149
0173
0174
0175
0190
0191
0192
0199
See the Notes below for All Tariffs

Hospital follow-up visit
Prolonged first/follow-up consultation : 15 min
Repeat Script
Consultation : Away from doctor's room
Unscheduled consultation: Emergency (cons.room)
Unscheduled consultation:Emergency(not cons.room)
Elective after-hours services(+50%)
Emergency after-hours services(+25%)
Consultation
Consultation
Consultation
Chronic Medicine Forms
15.00
15.00
5.00
6.00
8.00
14.00
15.00
30.00
45.00
15.00
30.00
45.00
21.43
609.50
609.50
203.20
243.80
325.10
568.80
609.50
1 219.00
1 828.40
609.50
1 219.00
1 828.40
870.70
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
40.632
317.20
317.20
105.80
126.80
169.10
296.70
359.50
359.50
359.50
359.50
359.50
359.50
453.40
389.30
389.30
129.90
155.70
207.50
364.10
441.20
441.20
441.20
441.20
441.20
441.20
556.50
432.60
432.60
144.30
173.00
230.60
404.60
490.20
490.20
490.20
490.20
490.20
490.20
618.30
576.80
576.80
192.40
230.60
307.40
539.40
653.60
653.60
653.60
653.60
653.60
653.60
824.40
620.10
620.10
206.80
247.90
330.50
579.90
702.60
702.60
702.60
702.60
702.60
702.60
886.20
275.10
383.60
127.70
153.60
358.40
435.40
435.40
435.40
400.30
325.30
453.60
151.00
181.60
242.00
423.80
579.30
579.30
579.30
400.30
295.20
411.60
137.00
164.80
219.60
384.60
467.20
467.20
467.20
525.70
525.70
525.70
400.30
435.70
607.60
202.20
243.30
324.20
567.70
689.60
689.60
689.60
776.00
776.00
776.00
400.30
602.40
840.00
279.60
336.30
448.20
784.80
953.40
953.40
953.40
1 072.80
1 072.80
1 072.80
400.30
468.80
468.80
156.30
187.40
250.00
437.60
532.30
532.30
532.30
532.30
532.30
532.30
669.70
596.60
596.60
198.90
238.60
318.20
556.90
677.50
677.50
677.50
677.50
677.50
677.50
852.40
852.30
852.30
284.10
340.80
454.50
795.60
967.80
967.80
967.80
967.80
967.80
967.80
1 217.70
7.00
7.00
7.00
11.68
12.00
7.00
284.40
284.40
284.40
138.60
487.60
284.40
40.632
40.632
40.632
11.869
40.632
40.632
91.70
91.70
91.70
153.00
157.20
91.70
112.50
112.50
112.50
187.80
192.90
112.50
125.00
125.00
125.00
208.60
214.30
125.00
166.70
166.70
166.70
278.20
285.80
166.70
179.20
179.20
179.20
299.00
307.20
179.20
110.90
110.90
110.90
185.00
190.10
110.90
131.10
131.10
131.10
218.80
224.80
131.10
119.00
119.00
119.00
198.50
204.00
119.00
175.60
175.60
175.60
293.10
301.10
175.60
242.80
242.80
242.80
405.20
416.30
242.80
135.30
135.30
135.30
225.70
231.80
135.30
172.20
172.20
172.20
287.30
295.10
172.20
246.00
246.00
246.00
410.40
421.50
246.00
74.00
16.00
878.30
650.10
11.869
40.632
969.30
209.60
1 189.60
257.20
1 321.80
285.80
1 762.40
381.10
1 894.60
409.60
1 172.30
253.50
1 386.20
299.70
1 257.80
272.00
1 856.80
401.50
2 567.00
555.00
1 429.70
309.20
1 819.70
393.50
2 599.50
562.20
46.00
546.00
11.869
602.50
739.50
821.70
1 095.50
1 177.70
728.70
861.70
781.90
1 154.20
1 595.70
888.90
1 131.30
1 616.10
9.00
68.00
21.00
40.00
365.70
807.10
249.20
474.80
40.632
11.869
11.869
11.869
117.90
890.70
275.10
524.00
144.70
1 093.20
337.60
643.00
160.80
1 214.60
375.10
714.50
214.30
1 619.50
500.10
952.60
230.40
1 740.90
537.60
1 024.10
142.60
1 077.20
332.70
633.70
168.60
1 273.80
393.40
749.30
153.00
1 155.80
356.90
679.90
225.80
1 706.20
526.90
1 003.70
312.20
2 358.90
728.50
1 387.60
173.90
1 313.90
405.70
772.90
221.30
1 672.20
516.40
983.60
316.20
2 388.90
737.70
1 405.20
Procedures
3003
3004
3006
3009
3013
3014
3017
3018
3020
3021
3022
3027
3028
3036
3037
3039
3041
3047
3049
3052
3059
3061
3075
3097
3098
3099
3120
3121
Fundus contact lens or 90 D lens examination

Peripheral fundus examination with indirect Ophthalmoscope
Keratometry
Basic capital equipment used in own rooms by ophthalmologists.
Ocular motility assessment: Comprehensive examination
Tonometry per test with maximum of 2 tests for provocative tonometry
Retinal threshold test inclusive of computer disc storage for Delta of Statpak
programs
Retinal threshold trend evaluation
Special eye investigations:Pachymetry:Only when own instrument is used, per eye.
Only in addition to corneal surgery.
Special eye investigations:Retinal funtion assessment including refraction after ocular
surgery.Within four months,max 2 exams.
Digital fluorescein video angiography
Fundus photography
Optical Coherent Tomography (OCT) of Optic nerve or macula:Per eye
Corneal topography:For pathological corneas only on special motivation. For
refractive surgery.
Surgical treatment of retinal detachment including vitreous replacement but
excluding vitrectomy
Prophylaxis and treatment of retina and choroid by cryotherapy and/or diathermy
and/or photocoagulation and/or laser per eye.
Pan retinal photocoagulation (per eye): Done in one sitting
Cataract: Extra-capsular (including capsulotomy
Insertion of lenticulus in addition to item 3045 or item 3047 cost on lens excluded
Laser capsulotomy
Insertion of lenticulus when item 3045 or item 3047 was not executed
Drainage operation
Strabismus (whether operation performed on 1 eye or both. Operation on 1 or 2
muscles
Anterior vitrectomy
Removal of silicon from globe
Posterior vitrectomy including anterior vitrectomy,encircling of globe and vitreous
replacement
Excimer laser (per eye) for refractive keratectomy or Holmium laser thermo
keratoplasty (LTK) (For machine hire fee for LTK - Use item 3201
Corneal graft (lamellar or full thickness)
36.00
1 462.80
40.632
471.60
578.70
643.00
857.40
921.70
570.30
674.40
611.90
903.30
1 248.80
695.60
885.40
1 264.80
306.90
12 470.00
40.632
4 020.00
4 933.70
5 481.80
7 309.10
7 857.30
4 861.70
5 748.90
5 216.60
7 700.60
10 646.10
5 929.80
7 547.00
10 781.40
105.00
150.00
210.00
4 266.40
6 094.80
8 532.70
40.632
40.632
40.632
1 375.40
1 964.80
2 750.70
1 688.00
2 411.40
3 375.90
1 875.50
2 679.30
3 751.00
2 500.70
3 572.40
5 001.40
2 688.20
3 840.30
5 376.50
1 663.30
2 376.20
3 326.70
1 966.90
2 809.80
3 933.70
1 784.70
2 549.60
3 569.50
2 634.60
3 763.80
5 269.30
3 642.30
5 203.40
7 284.70
2 028.80
2 898.20
4 057.50
2 582.20
3 688.70
5 164.10
3 688.80
5 269.50
7 377.30
57.00
105.00
210.00
247.60
2 316.00
4 266.40
8 532.70
10 060.50
40.632
40.632
40.632
40.632
746.60
1 375.40
2 750.70
3 243.30
916.30
1 688.00
3 375.90
3 980.40
1 018.10
1 875.50
3 751.00
4 422.60
1 357.50
2 500.70
5 001.40
5 896.80
1 459.30
2 688.20
5 376.50
6 339.10
903.00
1 663.30
3 326.70
3 922.30
1 067.70
1 966.90
3 933.70
4 638.10
968.90
1 784.70
3 569.50
4 208.60
1 430.20
2 634.60
5 269.30
6 212.70
1 977.30
3 642.30
7 284.70
8 589.00
1 101.40
2 028.80
4 057.50
4 784.00
1 401.80
2 582.20
5 164.10
6 088.70
2 002.50
3 688.80
7 377.30
8 698.20
175.60
280.00
280.00
7 135.00
11 377.00
11 377.00
40.632
40.632
40.632
2 300.10
3 667.70
3 667.70
2 822.90
4 501.20
4 501.20
3 136.60
5 001.40
5 001.40
4 182.10
6 668.50
6 668.50
4 495.70
7 168.60
7 168.60
2 781.70
4 435.60
4 435.60
3 289.30
5 245.00
5 245.00
2 984.80
4 759.30
4 759.30
4 406.10
7 025.70
7 025.70
6 091.40
9 712.90
9 712.90
3 392.90
5 410.00
5 410.00
4 318.20
6 885.50
6 885.50
6 168.90
9 836.40
9 836.40
419.00
17 024.80
40.632
5 488.40
6 735.80
7 484.20
9 978.90
10 727.30
6 637.50
7 848.70
7 122.00
10 513.40
14 534.70
8 095.70
10 303.70
14 719.50
150.00
289.00
6 094.80
11 742.60
40.632
40.632
1 964.80
3 785.60
2 411.40
4 645.90
2 679.30
5 162.10
3 572.40
6 882.80
3 840.30
7 399.00
2 376.20
4 578.10
2 809.80
5 413.60
2 549.60
4 912.30
3 763.80
7 251.50
5 203.40
10 025.10
2 898.20
5 583.90
3 688.70
7 106.80
5 269.50
10 152.60

Base Rates
Code
3125
3130
3131
3132
3134
3163
3171
3181
3196
3198
3201
3202
3203
3631
3632
4980
4981
4983
4985
4986
4988
4989
3013
3038
3040
3123
3168
4981
4983
4988
4989
Terminology
Keratectomy
Pterygium or conjunctival cyst or conjunctival tumour.No conjunctival flap or graft
used
Cornea: Paracentesis
Lamellar keratectomy for refractive surgery (LK,ALK,MLK)
Pterygium or conjunctival cyst or conjunctival tumour.Conjunctival flap or graft used stand alone procedure
Excision of superficial lid tumour
Excision of Meibomian cyst.Additional fee for sterile tray
Entropion or ectropion by Open operation
Diamond Knife: Use of own diamond knife during intraocular surgery
Excimer laser: Hire fee (per eye)
Laser apparatus (ophthalmic): Hire fee for one or both eyes done in one sitting (Not
to be used with IOL Master.)
Phako emulsification apparatus: Hire fee
Vitrectomy apparatus: Hire fee
Ophthalmic examination
Axial length measurement and calculation of intra ocular lens power.Per eye. Not to
be used with item 3034
Corneal transplant: Endothelial
Corneal cross linking
Cross linking equipment hire
New Codes & Changes
report, for patients over 7 years of age
report, for children 7 years and younger
Femtosecond Laser: Hire Fee. For one or both eyes done in one sitting
Insertion of intra-corneal or intrascleral prosthesis: Pathological cornea
Removal of foreign body: Embedded, per eyelid (modifier 0005 is applicable)
Average
Duration
Professional
Units
127.00
BankMed
BankMed
HealthMan
Traditional &
Private
Plus
Tariff
Network
Network
Network
(VAT Incl)
RCF
Network
(IH)
(OH)
(IH)
110%
135%
150%
200%
R
R
R
R
R
R
5 160.30
40.632 1 663.50
2 041.60
2 268.50 3 024.60
Payment Arrangments
BankMed
Plus
Network
(OH)
215%
R
3 251.50
DH
Prem A
(IH)
137%
R
2 011.80
DH
Prem A
(OH)
162%
R
2 379.00
DH
DH
DH
FedHealth FedHealth
Prem B Classic Rate Exec Rate
DPA
DPA
147%
217%
300%
165%
210%
R
R
R
R
R
2 158.70
3 186.60
4 405.50 2 453.90
3 123.10
FedHealth
DPA
300%
R
4 461.60
96.90
53.00
150.00
3 937.20
2 153.50
6 094.80
40.632
40.632
40.632
1 269.30
694.20
1 964.80
1 557.70
852.00
2 411.40
1 730.80
946.70
2 679.30
2 307.80
1 262.20
3 572.40
2 480.90
1 356.90
3 840.30
1 535.00
839.60
2 376.20
1 815.10
992.80
2 809.80
1 647.10
900.90
2 549.60
2 431.40
1 329.90
3 763.80
3 361.40
1 838.50
5 203.40
1 872.30
1 024.00
2 898.20
2 382.90
1 303.30
3 688.70
3 404.10
1 861.80
5 269.50
116.30
47.00
20.40
111.50
12.00
284.13
4 725.50
1 909.70
828.90
4 530.50
142.40
3 372.30
40.632
40.632
40.632
40.632
11.869
11.869
1 523.40
615.60
267.20
1 460.50
157.20
3 721.80
1 869.60
755.60
327.90
1 792.50
192.90
4 567.60
2 077.40
839.50
364.40
1 991.60
214.30
5 075.10
2 769.80
1 119.40
485.80
2 655.50
285.80
6 766.80
2 977.50
1 203.30
522.30
2 854.60
307.20
7 274.40
1 842.30
744.50
323.20
1 766.30
190.10
4 501.00
2 178.50
880.40
382.10
2 088.60
224.80
5 322.30
1 976.80
798.90
346.80
1 895.20
204.00
4 829.50
2 918.20
1 179.30
511.90
2 797.70
301.10
7 129.30
4 034.30
1 630.40
707.70
3 867.80
416.30
9 856.20
2 247.10
908.20
394.20
2 154.40
231.80
5 489.90
2 860.00
1 155.80
501.70
2 742.00
295.10
6 987.10
4 085.70
1 651.20
716.70
3 917.10
421.50
9 981.60
109.00
109.00
120.00
50.00
1 293.70
1 293.70
1 424.30
565.60
11.869
11.869
11.869
11.312
1 427.80
1 427.80
1 571.90
624.30
1 752.30
1 752.30
1 929.10
766.20
1 947.00
1 947.00
2 143.40
851.30
2 595.90
2 595.90
2 857.90
1 135.10
2 790.60
2 790.60
3 072.30
1 220.20
1 726.70
1 726.70
1 901.00
755.10
2 041.80
2 041.80
2 247.80
892.90
1 852.70
1 852.70
2 039.70
810.20
2 735.00
2 735.00
3 011.00
1 196.00
3 781.10
3 781.10
4 162.70
1 653.50
2 106.10
2 106.10
2 318.60
922.40
2 680.40
2 680.40
2 950.90
1 173.90
3 829.20
3 829.20
4 215.60
1 677.00
50.00
274.80
565.60
11 165.70
6 094.80
640.90
-
11.312
40.632
40.632
11.869
40.632
11.869
11.869
11.869
624.30
-
766.20
-
851.30
-
1 135.10
-
1 220.20
-
755.10
-
892.90
-
810.20
-
1 196.00
-
1 653.50
-
922.40
-
1 173.90
-
1 677.00
-
19.60
796.40
40.632
45.00
1 828.40
19 129.50
1 446.50
40.632
11.869
40.632
40.632
40.632
40.632
40.632
40.632
150.00
54.00
470.80
35.60

Base Rates
Code
Terminology
Average
Duration
Professional
Units
BankMed
BankMed
HealthMan
Traditional &
Private
Plus
Tariff
Network
Network
Network
(VAT Incl)
RCF
Network
(IH)
(OH)
(IH)
110%
135%
150%
200%
R
R
R
R
R
R
Note:
1. Codes, Descriptors and Unit Values have been extracted from the SAMA Electronic Medical Doctors Coding Manual (eMDCM) previously known as the SAMA Doctors Billing Manual (DBM).
2. Tariffs may differ due to rounding
3. Above codes are the most frequently used codes and is not all inclusive of all the codes
4. Increases from 2015 are as follow:
a. HealthMan = 2015 Tariff + 7.2%
b. Bankmed = New to Schedule
c. Discovery Health = 2015 Tariff +5%
d. Fedhealth = 2015 Tariff +5.5%
e. GEMS = 2015 Tariff +5%
f. Profmed = 2015 Tariff +6%
6. Payment Arrangement Rates have NOT been split between In-Hospital & Out-Hospital. Use as appropriate.
7. The Healthman tariff for codes that relate to equipment have been retained at GEMS rate*
8. All Tariffs are inlcusive of VAT
9. Please note that GEMS published no Consultation Codes at Scheme Rate and that the GEMS Non-Contracted rates were used
Disclaimer:
The above schedule is based on information avaiable to HealthMan and HealthMan will NOT be held responsible for any losses incurred by practitioners resulting from the use of this schedule.
Legend:
DH = Discovery Health
DPA = Direct Payment Arrangement
Prem = Premier
R = Rand
RCF = Rand Conversion Factor (Rand Value per Unit)
VAT = Value Added Tax
Payment Arrangments
BankMed
Plus
Network
(OH)
215%
R
DH
Prem A
(IH)
137%
R
DH
Prem A
(OH)
162%
R
DH
Prem B
147%
R
DH
DH
Classic Rate Exec Rate
217%
300%
R
R
FedHealth FedHealth
DPA
DPA
165%
210%
R
R
FedHealth
DPA
300%
R

Healthman Ophthalmology Costing Guide 2016: Comparative Tariffs: Scheme Rates Base Rates

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HEALTHMAN OPHTHALMOLOGY COSTING GUIDE 2016

COMPARATIVE TARIFFS: Scheme Rates

See the Notes below for All Tariffs

Fundus contact lens or 90 D lens examination