| 001 | Item 8101 refers to a Full Mouth Examination, charting and treatment planning and no further examination fees shall be chargeable until the treatment plan resulting from this consultation is completed with the exception of Item 8102. This includes the issuing of a prescription where only medication is prescribed. Item 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. |
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| 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 item. | ||||||||||
| 003 | In the case of a prolonged or costly dental service or procedure, the dental practitioner shall ascertain beforehand from the Commissioner whether he will accept financial responsibility in respect of such treatment. | ||||||||||
| 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 item. | ||||||||||
| 005 | Save 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 under 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 account for treatment under the Act to the employer of the employee concerned. | ||||||||||
| 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 and Modifier 8004 must be shown against any such item. Benefits in respect of specialists charging treatment procedures not listed in the schedule for that speciality, shall be allocated as follows: General Dental Practitioners Schedule 100% Other Dental Specialists Schedule 2/3 |
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| 010 | Fees charged by dental technicians for their services (PLUS L) shall be shown 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 complied 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, item 8231 is specified as follows:
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| 011 | Modifiers may only be used where (M/W) appears against the item in the schedule. 8001 33 1/3 % of the appropriate scheduled fee (see Note 4 - preamble to Maxillo-facial and oral surgery schedule). 8002 The appropriate scheduled fee + 50% (see Note 1 - preamble to Maxillo-facial and oral surgery schedule). 8003 The appropriate scheduled fee + 10% (see Note 5 - preamble to Perio schedule). 8004 Two-thirds of appropriate scheduled fee (see Rule 009). 8005 The appropriate scheduled fee up to a maximum of R171.20 (see Note 2 - preamble to Maxillo-facial and oral surgery schedule). 8006 50% of the appropriate scheduled fee (see Note 3 - preamble to Maxillo-facial and oral surgery schedule). 8007 15% of the appropriate scheduled fee with a maximum of R86.90 (see preamble(s) under "oral surgery" in the schedule for GP's and the schedule for specialists in Maxillo-facial and oral surgery). 8008 The appropriate scheduled fee + 25% (see Note 5 - preamble to Maxillo-facial and oral surgery schedule, GP's schedule). 8009 75% of the appropriate scheduled fee (see Note 3 under the preamble of the Maxillo-facial and oral surgery schedule). 8010 The appropriate scheduled fee plus 75%. |
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| 012 | In cases where treatment is not listed in the schedule for dentists in general practice or specialists then the appropriate fee listed in the medical schedules shall be charged and the relevant item in the medical schedules must be indicated. | ||||||||||
| 013 | Cost of material (VAT inclusive): This item provides for a charge for material where indicated against the relative item codes by the words (See Rule 013). Material to be charged for at cost plus a handling fee not exceeding 35%, up to R1433.80. A maximum handling fee of 10% shall apply above a cost of R1433.80. A maximum handling fee of R2150.70 will apply. Note: Item 8220 (suture) is applicable to all registered persons. |
2. Additions, deletions and revisions
A summary listing of additions, deletions and revisions applicable to this Schedule is found in Appendix A.
New code numbers added to the Schedule are identified with the symbol . placed before the code number.
In instances where a code has been revised, the symbol * is placed before the code number.
3. Tooth identification
Tooth identification is compulsory for all invoices rendered. Tooth identification is only applicable to procedures identified with the letter (T) in the mouth part (MP) column. The International Standards Organisation (ISO) in collaboration with the FDI designated system for teeth and areas of the oral cavity, should be used.
4. Abbreviations used in the Schedule
+D Add fee for denture
+L Add laboratory fee
GP General practitioner
M/W Modifier
MP Mouth part
Na Not applicable
T Tooth
5. VAT
Fees are VAT inclusive.
(1) The dental procedure codes for general dental practitioners are divided into twelve (12) categories of services. The procedures have been grouped under the category with which the procedures are most frequently identified. The categories are solely for convenience in using the Schedule and should not be interpreted as excluding certain types of Oral Care Providers from performing or reporting such procedures. These categories are similar to the Current Dental Terminology Second Edition (CDT-2).
(2)(M/W) Procedures not described in the general practitioner's schedule should be reported by referring to the relevant specialist's schedule. 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 and Modifier 8004 must be shown against any such item (See Rules 009 and 011). There are no specific codes for orthodontic treatment in the current general practitioner's schedule, and the general practitioner must refer to the specialist orthodontist's schedule.
(3)(M/W) Oral and maxillo-facial surgery (Section J of the Schedule): The fee payable to a general practitioner assistant shall be calculated as 15% of the fee of the practitioner performing the operation, with the indicated minimum (see Modifier 8007). The patient must be informed beforehand that another dentist will be assisting at the operation and that a fee will be payable to the assistant. The assistant's name must appear on the invoice rendered to the patient.
(SeeRule 011)
1.(M/W) If extractions (code 8201 and 8202) are carried out by specialists in maxillo-facial and oral surgery, the fees shall be equal to the appropriate tariff fee plus 50 per cent (See Modifier 8002).
2.(M/W) The fee for more than one operation or procedure performed through the same incision shall be calculated as the fee for the major operation plus the tariff fee for the subsidiary operation to the indicated maximum for each subsidiary operation or procedure (See Modifier 8005).
3.(M/W) The fee for more than one operation or procedure performed under the same anaesthetic but through another incision shall be calculated on the tariff fee for the major operation plus:
75% for the second procedure/operation (Modifier 8009)
50% for the third and subsequent procedures/operations (Modifier 8006)
This rule shall not apply where two or more unrelated operations are performed by practitioners in different specialities, in which case each practitioner shall be entitled to the full fee for his operation.
If, within four months, a second operation for the same condition or injury is performed, the fee for the second operation shall be half of that for the first operation.
The fee for an operation shall, unless otherwise stated, include normal post-operative care for a period not exceeding four months. If a practitioner does not himself complete the post-operative care, he shall arrange for it to be completed without extra charge: provided that in the case of post-operative treatment of a prolonged or specialised nature, such fee as may be agreed upon between the practitioner and the scheme may be charged.
4.(M/W) The fee payable to a general practitioner assistant shall be calculated as 15% of the fee of the practitioner performing the operation, with the indicated minimum (See Modifier 8007). The assistant's fee payable to a maxillo-facial and oral surgeon shall be calculated at 33,33% of the appropriate scheduled fee (Modifier 8001). The assistant's name must appear on the invoice rendered to the patient.
5.(M/W) The additional fee to all members of the surgical team for after hours emergency surgery shall be calculated by adding 25% to the fee for the procedure or procedures performed (8008).
6. In cases where treatment is not listed in this schedule for general practitioners or specialists, the appropriate fee listed in the medical schedule(s) shall be charged, and the relevant medical tariff item must be indicated (See Rule 0012).