HOW TO CLAIM FROM THE MEDICAL AID – 2006 NRPL GDP Fees
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Stick Bond Dental |
HOW TO CLAIM FROM THE MEDICAL AID – 2006 NRPL GDP Fees
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Periodontal splint Diagnostic code: K05.3 Clinical codes: 8768 (per tooth) R201.70 X6
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TOTAL PERIO SPLINT R1210.20
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Orthodontic Permanent Retainer Diagnostic code: K07.3 (or original treatment code) Clinical code: 8849 +L R 201.70 Lab codes: 9301 (model) R 18.00 9327 (infection control) R 12.00 9617 (invisible retainer) R 103.00 9502 (metal substitute) R 466.00 or 9758+9760 Total Lab (8099) R 599.00
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TOTAL Clinical + Lab R 800.70 |
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Fixed Space Maintainer Diagnostic code(s): K00.5/9; K08.1; K01.0 Clinical code: 8173 x 2 (per abutment)+L R 236.00 Lab codes: 9301 (model) R 18.00 9327 (infection control) R 12.00 9572 (basic charge) R 114.00 9622 (space maint./arch) R 41.00 9502 (metal substitute) R 466.00 or 9758 Total lab (8099) R 651.00
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TOTAL Clinical + Lab R 887.00
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Occlusal splinting Diagnostic code(s); K02.1/K05.3 Suggested med. aid codes: 8370 or 8369 or 8768 Fee according to clinical code Cost of everStick Perio fibre material: ± 1,5 cm fibres (splint) Create own code (COF1) value ± R 125.00
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Trauma Splint Diagnostic code: S03.2 Recommended fee R 605.10 Suggested med. Aid codes 8768 (per tooth) R 201.70 X 3 Each additional tooth R 201.70
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Anatomical Fibre Post Diagnostic codes: K04.2/3; K02.1/8 Clinical codes: 8345 + 8379 (r007) R 270.90 8379: Cost per post = R 120.00 + 8025 (R 26.00) = R146.00
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Anatomical post and core Diagnostic codes: K04.2/3; K02.1/8 Clinical codes: 8376 + 8379 (r007) R 492.00 Add code 8355/8409 depending on the procedure
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Note: Code 8379 is paid ‘by arrangement”. You can consider code COF1 or codes 8347 and 8348 (pin reinforcement) adding modifier r007
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Direct Anterior Bridge (Remember to take an impression) Diagnostic codes: K08.1/9 (congenital) Clinical codes: 8383 x 2, 8415+ L (Rule 007) R1725.30 Lab Codes: 9301 (model) R 18.00 9327 (infection control) R 12.00 9501 (ceromer crown/pontic) R 591.00 9502 metal substitute R 466.00 Total lab (8099) R1087.00 TOTAL Clinical + Lab R2813.30
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Direct Posterior Bridge (Remember to take an impression) Diagnostic codes: K08.1/9 (congenital) Clinical codes: 8383 x2, 8415+L (Rule 007) R1725.30 Lab codes: 9301 (model) R 18.00 9327 (infection control) R 12.00 9501 (ceromer crown/pontic) R 591.00 9502 metal substitute R 466.00 Total lab (8099) R1087.00 TOTAL Clinical + Lab R2813.30
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Additional Codes Attaching the fibre: 8352/3 per retainer (direct acid etch), rule 007 apply (?ICD10 not compatible – cannot use filling code for retainer!) Or 8436/7 (Retainer, inlay, porcelain) or 8432/3 (Retainer inlay, metal) rule 007 Or 8382/3 (Retainer, inlay, resin) modifier 8023 – no lab state 8099(m8023) value = 25% of value 8382/3 (Recommended code) Or 8617 (Maryland type retainer) rule 007 and possibly modifier 8023 apply
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Reinforcement of large composite restorations Diagnostic code: K02.1 Clinical codes: 8354/8370 R 242.00 Charge for fibres: 8347/8348 or your own code COF1 (cost of fibres) R 125.00 TOTAL R 367.00 Recommended charge for fibres ± R125.00
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Indirect Techniques - LAB CODES |
INDIRECT CROWN – LAB CODESDiagnostic codes: K02.1; K03.0; K03.9 Clinical code: 8409+L R 726.10 Lab codes: 9301 Model R 18.00 9315 C&B Model R 73.00 9319 Extra die R 17.00 9320 Pindex R 17.00 9327 x 2 Infection control R 24.00 9330 Delivery charge R 30.00 9502 Metal substitute R 466.00 (per crown) 9512 Ceromer crown R 605.00 Total Lab (8099) R1250.00 TOTAL R 1976.10
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Indirect Bridge Construction Diagnostic codes: K08.1/9 (congenital) Clinical codes: retainer 8382/3, pontic 8415 +L (Fee according to clinical code) Lab codes: 9301 Model R 18.00 9315 C&B Model R 73.00 9319 Extra die R 17.00 9320 Pindex R 17.00 9327 x 2 Infection control R 24.00 9330 Delivery charge R 30.00 9512 Retainer R 605.00 9501 Pontic R 591.00 9502 Metal substitute R 466.00 Total Lab (8099) R1841.00
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Indirect Anatomical Fibre Post Diagnostic codes: K04.2/3; K02.1/8 Clinical codes: 8581+L (r007) R 215.60 Lab codes (8099): 9301 Model R 18.00 9315 C&B Model R 73.00 9319 Extra die R 17.00 9320 Pindex R 17.00 9327 x 2 Infection control R 24.00 9330 Delivery charge R 30.00 9545 Post R 237.00 9535 Coping R 332.00 9502 Metal substitute R 466.00 Total Lab (8099) R1214.00 TOTAL Clinical + Lab R 1429.60
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