Schedule 1
Practice notes on application of UPFS tariffs
1.1The following practice notes apply to tariffs applicable to patients:1.1.1The facility fee includes all consumables and ward stock pharmaceuticals, but excludes medication dispensed to a patient by a pharmacy and consumables specified as "Consumables not included in the facility fee".1.1.2.The professional fee depends on the level of the ultimate professional responsible for the rendering of the service (ultimate responsible professional rule), and when more than one professional at different levels is involved in the rendering of services, the fee for the highest level professional is charged.1.1.3.The tariff to be charged depends into which category a procedure falls.1.2Tariffs1.2.1Anaesthesia tariff1.2.1.1This tariff applies to the administration of a general - or other anaesthetic (conscious sedation, spinal- or epidural injections and anaesthetic blocks), administered by a health care professional other than the person doing the procedure.1.2.1.2This tariff is based on the type of procedure for which the anaesthetic is administered. The tariff is divided into three groups based on the complexity and average duration of the anaesthetic procedure.1.2.1.3The category of the anaesthetic is determined by applying the procedure codebook as set out in Schedule 3.2 of these regulations.1.2.1.4No additional charge is levied for supplies, drugs or gasses used in the course of the anaesthesia with the exception of high cost drugs or gasses that will be itemised according to pharmaceutical tariff.1.2.1.5There is no facility component for this tariff, since anaesthesia supplies are included in the facility component of the relevant procedure tariffs.1.2.2Confinement tariff1.2.2.1This tariff applies to the following:1.2.2.1.1all models of delivery, including caesarean section1.2.2.1.2inductions of labour1.2.2.1.3intrapartum paracervical and pudendal blocks1.2.2.1.4intrapartum amnioscopy1.2.2.1.5foetal blood sampling1.2.2.1.6application of scalp leads1.2.2.1.8manual removal of placenta1.2.2.1.9repair of cervical tears1.2.2.1.10correction of uterine intervention1.2.2.1.11drainage of vulva haematoma1.2.2.1.12repair of second degree tear1.2.2.1.13repair of third degree tear1.2.2.1.14repair if episiotomy1.2.2.1.15resuscitation of new-born by an obstetrician, and1.2.2.1.16tracheal intubation of neonate1.2.2.2The inpatient stay of the mother is charged additional to the confinement tariff according to the inpatient tariff.1.2.2.3No inpatient tariff may be charged for the new-born baby, unless the baby is admitted into a high care unit or intensive care unit.1.2.2.4The category of the health care professional with overall responsibility for the confinement determines the tariff to be charged by the professional component of this tariff.1.2.2.5The anaesthetic tariff and imaging tariff must be charged additionally, where applicable.1.2.2.6False labour must be charged according to the inpatient tariff. – or outpatient visit (pending on whether the patient was admitted or evaluated as an outpatient) and services recorded accordingly.1.2.3Dialysis tariff1.2.3.1.1This tariff must be charged per treatment session for peritoneal dialysis and includes the cost of the connection of a catheter, and all other consumables utilized but exclude dialysate1.2.3.1.2In the case of haemodialysis, the tariff to be charged is oer treatment day and includes the preparation of the AV shunts, treatment, dialysate and all consumables1.2.3.2A patient issued with dialysate or other related consumables for use at home, must be charged on an itemised basis according to the pharmaceutical tariff.1.2.3.3If a patient requires continuous veno-venous haemodialysis (CVVHD), the haemodialysis tariff is charged per day and the consumable utilized are itemised.1.2.3.4Plasmapheresis: Its blood purification procedure used to treat several autoimmune diseases. In the case of plasmapheresis, the tariff to be charged is per day and this includes the preparation of the machine and lines. The insertion of the catheter (eg CVP) must be charged separately.1.2.4Medical report tariff1.2.4.1The tariff applies for the completion of a medical report for insurance or any other purpose.1.2.4.2If a consultation or procedure, above that required for the purpose of the report, is performed, the relevant consultation tariff or procedure tariff must also be charged.1.2.4.3The tariff for copies of reports and notes are payable strictly in advance.1.2.5Imaging tariff1.2.5.1This tariff includes all radiological, gamma camera, ultrasound and nuclear imaging modalities.1.2.5.2The tariff includes all radiological, gamma camera, lithotripsy and ultrasound and is inclusive of all consumables, films, and medication but excludes contrast media used.1.2.5.3Imaging procedures are divided into categories and the tariff to be charged depends on the category into which the procedure falls.1.2.5.4The codebook must be applied to determine the procedure and the category of the tariff as set out in Schedule 3.3 of these regulations.1.2.5.5If a radiologist or general practitioner report (written or interpretation) on the image, the professional component of the tariff must be charged.1.2.5.6In the event of private practitioners (responsible for the treatment in his/her rooms) refer the patient for radiological procedures to the public facility, the public facility shall levy both the facility and professional fee. If reporting is required, levy against the relevant professional fee, if not, the health care therapist rate applies.1.2.6Inpatient tariff1.2.6.1The inpatient tariffs apply when a patient is admitted on prescription of a medical officer to a bed in a ward or where the patient requires inpatient treatment.1.2.6.2This tariff includes all medication consumables dispensed from ward stock to the patient for the duration of their stay.1.2.6.3The charge excludes theatre procedures, radiology and laboratory investigations, physiotherapy treatment, high cost pharmaceuticals (buy-outs) and discharge medication (TTO’s) as well as consumables not included in the facility fee and blood and blood products etc.1.2.6.4The type of ward into which a patient is admitted and the length of stay calculated as 12-hour unit shall determine the tariff to be charged.1.2.6.5The inpatient boarder tariff applies to a person accompanying a patient, and receiving, accommodation and meals from the hospital.1.2.6.6The inpatient boarder tariffs are charged on a daily rate and are required to be settled in advance, unless prior arrangements have been made with the DOH facility.1.2.6.7An inpatient whos admitted and discharged on the same day before 23:00 must be charged the day patient tariff.1.2.6.8If an inpatient is admitted as a day patient and is discharged after 23:00 on the same day, the day patient fee must be cancelled and the applicable inpatient tariff must be charged.1.2.6.9If a patient is admitted before 12:00, and not discharged the same day, a tariff for the full day fee must be charged.1.2.6.10If a patient is admitted after 12:00, the half-day tariff must be charged for the day admission.1.2.6.11If the patient is transferred between different ward types during the same 24-hour period, the higher of the applicable inpatient tariff must be charged during the relevant 12-hour period in which the patient is transferred.1.2.6.12If a patient is discharged before 12h00, the half day tariff for the day of discharge must be charged.1.2.6.13If a patient is discharged after 12h00, a tariff for the full day must be charged for the day of discharge.1.2.6.14The intensive care tariff is charged when the unit is specially equipped and set up for the intensive care of seriously ill patients and where health care professionals and specially trained professional nursing staff are available at all times.1.2.6.15The specialised intensive care tariff is limited to 24hours on the prescription of the treating health care professional.1.2.6.16The high care is charged in a specially equipped unit where specially trained professional nursing staff is available at all times, supported by health care professionals on a standby basis.1.2.6.17Medication taken home by a patient must be charged as the same tariff as contemplated in the pharmacy tariff.1.2.6.18The professional fee depends on the level of the professional responsible for the ward to which the patient is admitted.1.2.7Mortuary tariff1.2.7.1This tariff applies to the storage of a corpse and the tariff must be charged at a daily rate, after the first 48 hours once the post-mortem and identification process have been completed. The aforementioned in respect of the 48 hours includes weekends and public holidays.1.2.8Pharmacy tariff1.2.8.1This tariff applies when medicines are dispensed by a pharmacist / pharmacy to patients on the basis of a prescription. This implies the itemisation of medication that is generally not included in a specific facility’s ward stock and or high cost pharmaceuticals.1.2.8.2The itemised cost of such medication and the facility fee tariff must be charged per prescription.1.2.8.3The facility fee tariff is determined according to the level of the facility. Only one pharmacy facility fee per 24-hour period may be levied for prescriptions.1.2.8.4The actual purchase price including VAT plus 50% of the total amount must be charges per item dispensed to the patient.1.2.9Oral health tariffs1.2.9.1This tariff applies to medical treatment rendered by an oral health practitioner.1.2.9.2Oral procedures are grouped into categories depending on the complexity and cost of the procedure.1.2.9.3The oral health codebook as set out in Schedule 3.1 of these regulations must be applied to determine the procedure category1.2.9.4Dental Prosthesis used must be charged in addition to the oral health tariff.1.2.10Consultation tariff1.2.10.1The tariff for an outpatient consultation applies when the health care professional personally takes down a patient’s clinical history, performs an appropriate clinical examination or prescribes or administered treatment or assists the patient via advice.1.2.10.2The same tariff applies for each follow-up consultation, by a health care professional of an outpatient.1.2.10.3This tariff includes all consumables used during the consultation, but excludes medication dispensed to the outpatient by the pharmacy. BUT shall exclude consumables as otherwise specified as "Consumables not included in the facility fee" and also excludes medications dispensed to the patient.1.2.10.4An emergency consultation tariff must be charged for consultations in emergency or trauma departments.1.2.10.5The emergency consultation tariff must be charged for any consultation in an emergency or trauma department, irrespective of the time of day such consultation takes place.1.2.10.6If the procedure is performed at the time of the consultation, the consultation tariff and the procedure tariff must be charged.1.2.10.7Triage is the process of determining medical priority of patients with regard to treatment. This is not a chargeable service.1.2.11Minor theatre procedure tariff1.2.11.1This tariff applies to minor theatre procedures, which require limited instrumentation and drapery, and is only doctor driven.1.2.11.2The procedures applicable to this tariff are grouped into four categories depending on the complexity and cost of the procedure.1.2.11.3The tariff to be charged depends into which category a procedure falls.1.2.11.4The tariff to be charged depends into which category a procedure falls as set out in Schedule 3.6 in these regulations.1.2.11.5The level of the ultimate professional performing the procedure determines the professional fee component1.2.12Major theatre procedure tariff1.2.12.1This tariff applies to all procedure performed in an operating theatre.1.2.12.2The tariff includes theatre time, all consumables and medical gasses used during the procedure. The tariff excludes high cost pharmaceuticals e.g. Sevoflurane gas as well as consumables not included in the facility1.2.12.3The procedure applicable to this tariff is grouped into categories depending on the complexity and cost of the procedure.1.2.12.4The tariff to be charged depends on the category into which the procedure falls set out in Schedule 3.2 of these regulations1.2.12.5The level of the ultimate professional performing the procedure determines the professional fee component1.2.12.6In the event of more than one professional at different levels is involved in the procedure, the fee for the highest professional is charged.1.2.12.7Prosthesis used must be charged on an itemised basis in addition to the major theatre procedure tariff.1.2.13Treatment tariff1.2.13.1This tariff applies to all supplementary health treatment performed by an allied health practitioner.1.2.13.2Different charges apply depending on whether the treatment is rendered in a group or individual context.1.2.13.3The adaption and fitting of an assistive device must be charged according to this tariff.1.2.13.4The initial assessment of a patient by an allied health practitioner in respect of an assistive device must be charged as a consultation tariff, and thereafter any subsequent treatment must be charged according to the treatment tariff.1.2.13.5The treatment is applicable to both in-and-outpatients.1.2.13.6The treatment tariff is a rate per contact with the patient.1.2.13.7The treatment facility fee and the nurse professional fee should be charged where a patient is referred to the hospital whenever a Nurse Practitioner has overall responsibility for the treatment of the patient referred for the purpose of the episode on an outpatient basis.1.2.14Emergency medical services tariff1.2.14.1Ambulance transport tariff1.2.14.1.1This tariff is applied to the treatment or transportation of a patient requiring treatment prior to admission to a hospital or specific care during transportation, in an ambulance.1.2.14.1.2This tariff charged must be calculated from the point of collection to a hospital, and must be charged for every 50 (fifty) kilometres travelled, and are further determined by the level of medical treatment rendered by the emergency medical service to the patient.1.2.14.1.3Three levels of care have been identified;(ii)Intermediate Life Support(iii)Advance Life Support1.2.14.2Patient transport tariff1.2.14.2.1This tariff applies to the transport of patients in a vehicle other than an ambulance where the patient does not require specific care prior to or during transportation.1.2.14.2.2This tariff must be charged for every 100 kilometres travelled and calculated from the point of collecting the patient.1.2.14.3Rescue tariff1.2.14.3.1This tariff applies to the medical rescue of a person1.2.14.3.2A specialised vehicle with appropriately trained rescue staff and specialised equipment that is dispatched to assist with the treatment, disentanglement, recovery and / or extraction of patients. Rescue services are based on a per incident charge, inclusive of all equipment utilised for the said purpose e.g. "Jaws-of-life".1.2.14.3.3This tariff must be charged per incident or rescue1.2.14.4Standby tariff1.2.14.4.1This tariff must be charged for medical standby at special events and is charged at an hourly rate.1.2.14.4.2An additional standby hourly rate must be charged for services provided for by health care professionals, allied health practitioners and nursing practitioners.1.2.14.5Air transport tariff1.2.14.5.1This tariff charged must be calculated by taking the flying hours the patient was transported in the aircraft.1.2.14.5.2Air Treatment and transportation refers to the treatment and transportation of a medical / trauma patient via Air ambulance; (Rotary or fixed wing).1.2.15Assistive device tariff or surgical implanted prosthesis tariff1.2.15.1The assistive device tariff applies when an assistive device is issued to a patient.1.2.15.2The itemised cost of the assistive device forms the facility fee component of the assistive device tariff.1.2.15.3The initial assessment of the patient’s needs in respect of the assistive device must be charges at the outpatient consultation tariff.1.2.15.4Subsequent adaptations and fitting of the assistive device must be charged at the treatment tariff.1.2.15.5The surgically implanted prosthesis tariff applies when prosthesis is surgically implanted into a patient during a formal surgical procedure. The device is encapsulated within the body structure of a patient and includes fixatives such as pins, screws, K-wires, cement (palacos) and plates, as well as joint replacements, and pacemakers.1.2.15.6An assistive device must be charged on an itemised basis. In respect of the surgically implanted prosthesis, the actual purchasing price including VAT plus 15% on the total amount must be charged per item.1.2.15.7Dental laboratory devices/items are charges when dental laboratory items are issued to patients e.g. crowns, bridges and dentures.1.2.16Surgery for non-medical reasons (cosmetic surgery) tariff1.2.16.1This tariff applies to cosmetic surgery procedures on an elective basis for non-medical reasons.1.2.16.2The tariff to be charged depends on the category into which the procedure falls.1.2.16.3The codebooks set out the procedures and category of tariff that must be charged.1.2.16.4A deposit that covers 100% expected cost of such surgery must be paid to the DOH before the patient is admitted1.2.17Labaratory tariff1.2.17.1This tariff applies to laboratory services rendered by the National Health Laboratory Services (NHLS) and the entity shall bill for these services.1.2.17.2The tariff for drawing of blood are set out in Schedule 4.1.2.18Radiation oncology1.2.18.1The tariffs in respect of the above are set out in Schedule 5.1.2.19Nuclear medicine1.2.19.1The tariffs is charged for nuclear procedures and radio isotopes and shall include radiological, gamma camera, and ultrasound – intervention, as well as imaging modalities prescribed and rendered to an inpatient or an outpatient1.2.19.2The tariff and procedures are set out in Schedule 6.1 of these regulations.1.2.20Ambulatory procedure tariff1.2.20.1This tariff applies to simple procedures performed in a procedure room or at the patient’s bedside regardless of the facility available and the tariff shall include consumables used during the procedure except those consumables not included in the facility fee1.2.20.2The tariff may require local anaesthetic (infiltration or topical), but shall exclude general anaesthetic and conscious sedation1.2.20.3The procedures applicable to this tariff are grouped into two categories depending on the complexity and cost of the procedure.1.2.20.4The tariff to be charged depends into which category of the procedure.1.2.20.5The category of the procedure is determined by applying the procedure codebook and Ambulatory Procedure Guideline as set out in Schedule 3.5 of these regulations.1.2.20.6The professional fee tariff to be charged must be determined by the category of the health care professional responsible for the service In the case of more than one professional responsible for rendering the service, the rule of the ultimate professional fee will still apply.1.2.21Blood and blood products tariff1.2.21.1This tariff applies for blood and blood products administered to patients.1.2.21.2This tariff applies to blood screening, autogeneous transfusion etc.1.2.21.3This tariff shall exclude the specialised administered sets provided by Westen Province Blood Tranfusion Services(WPBTS) and the National Blood Institute(NBI).1.2.22Hyperbaric oxygen therapy1.2.22.1The tariff is defined for the treatment mode in which the patient is entirely enclosed in a pressure chamber of increased atmosphere pressure for medical treatment.1.2.23Consumables1.2.23.1This tariff is for consumables not covered in the facility fee.1.2.23.2This tariff applies to high cost theatre, ward consumables and buy-outs.1.2.23.3This item must be charged on an itemised basis, the actual purchasing price including VAT plus 15% on the total amount must be charged per item.1.2.24Autopsie tariff1.2.24.1This tariff must be charged for the undertaking of a post mortem on a patient that has died in or outside the hospital, if the request is specifically received from the family or another third party.1.2.25Cremation Certificate Tariff1.2.25.1This tariff applies to the completion of a cremation certificate by the DOH/Forensic Pathology and is payable before the issuing of such certificate.1.2.25.2A tariff per certificate for the completion of a cremation certificate must be charged.Schedule 2
Tariff category, income threshold and notes in respect of subsidised and full paying patients
Patients are categorized into the following groups for the purpose of service fee determination and their ability to pay for health services. Patients are classified as a single or family unit. A Family unit includes a couple, a single parent or person with a dependant. A widow or widower with dependants is regarded as a family unit and without dependants a single person.1.1Fully subsidised patients (H0 tarriff category)| Group | Description |
|---|
| Social Pensioners | Recipients of the following types of pension/grants are classified as social pensioners:Grant for Older Persons (OASP)Child support grant (CSG)War Veteran’s Pension(WV)Care dependency grant(CD)Social Relief of Distress grant (SRD)Disability grant (DG)Foster Child care grant (FC) |
| Formally Unemployed | Persons supported by the Unemployment Insurance Fund (UIF).Proof of unemployment from Department of Labour must be produced. |
| Tariff Category | Individual/SingleGross Income per annum | Household/Family UnitGross Income per Annum | Level 1, 2 and 3Tariffs |
|---|
| H1 | Less than R70 000 | Less than R100 000 | As per schedules4, 5, 6 and 7 |
| H2 | Equal to or more than R70 000 but less than R250 000 | Equal to or more than R100 000 but less than R350 000 | As per schedules4, 5, 6 and 7 |
| H3 | Equal to or more than R250 000 | Equal to or more than R350 000 | As per schedules4, 5, 6 and 7 |
Schedule 3.1
Oral health Code Book
Schedule 3.2
UPFS procedure Code Book
Schedule 3.3
Radiology Code Book
Schedule 3.4
Cosmetic surgery Code Book
Schedule 3.5
UPFS Code Book Ambulatory procedures guideline
Schedule 3.6
UPFS Code Book Minor theatre procedures
Schedule 3.7
Nuclear medicine procedure Code Book
Schedule 4.1
Billing tariffs
UPFS fee schedule for full paying patients (externally funded, foreigners, RGP and patients with private doctor incl): 1 April 2018
Schedule 4.2
UPFS tariffs
UPFS fee schedule for H3 patients: 1 April 2018
Schedule 4.3
UPFS tariffs
UPFS fee schedule for subsidised patients (H0, H1 and H2 patients): 1 April 2018
Schedule 5.1
Full paying (externally funded. Foreigners, RGP and patients with private doctor incl.), and H3 patients: radiation oncology 2018
Schedule 5.2
H2 patients: radiation oncology 2018
Schedule 6.1
Full paying (externally funded, foreigners, RGP and patients with private doctor incl.), H3, H2 and H1 patients
Schedule 7.1
Orthotic aids: full paying and subsidised patients
