ZIMBABWE RELATIVE VALUE SCHEDULE Page 1

INTRODUCTION

This Tariff of Fees is based on a relative value study. Relative values are numerical unit
designations, which express the relationship, the value one professional service bears to another.
These values are, in effect, reflections of the time and effort expended to perform these services, as
well as the experience and competence of medical practitioners who provide the service.
The relative value assigned in this schedule to any procedure may be subject to alteration from time
to time to ensure that its value is suitable for continued usage in a changing scientific environment.
The relative value of a procedure will also be subject to alteration if it is established through further
information that the assigned relative value is incorrect.

Components

There are four basic parts to a relative value study:

(a) Code - a five-digit code for identifying the procedures and services.

(b) Nomenclature - the listing and description of procedures and services.

(c) Unit values - the assignment of the relative values in terms of numerical units.

(d) Co-efficient - the application of a monetary value to the relative values to transform them
into a schedule of fees.

Segmentation

There are five principal segments in this tariff, being those segments which are subject to negotiation
by and between representatives of the Zimbabwe Medical Association and the Association of
Healthcare Funders of Zimbabwe

(a) a section describing consultations and medical services and establishing relative values for
consultations and medical procedures;

(b) a similar section for anaesthetics;

(c) a similar section for surgical procedures;

(d) a section for pathological procedures;

(e) a section for radiological procedures.

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These five sections have been allocated units on an entirely separate basis. Therefore, relative values
from one section cannot be used to evaluate or to establish fees in another.

Additional segments are not subject to negotiation with the Zimbabwe Medical Association.

Unit Value Modifiers

Listed values for most procedures may be modified under certain circumstances. When applicable,
the modifying circumstances should be identified by the addition of the appropriate "modifier code
number" as listed in the general rules of the Tariff after the usual Tariff item number.

By Report Items

BR in the unit value column indicates that the value of the service is to be determined "by report"
because the service is too unusual or variable to be assigned a unit value. Pertinent information
concerning the nature, extent and need for the procedure or service, the time, and the skill necessary
is to be furnished. Wherever possible the nearest procedure(s) in the Tariff should be listed by its
Tariff item number(s).

Fee For Service Items

F.F.S. in the unit value column indicates that the value is to be calculated as the sum of the various
services rendered, e.g. office or hospital visits.

General Rules

00101 It is accepted that the basic contract for medical services and their remuneration is between
the patient and the medical practitioner. This remuneration may be met by the patient's
medical aid society or medical aid fund in terms of the National Tariff of Fees and the terms
and conditions applicable thereto.

The following details the National Tariff of Fees and the terms and conditions applicable
thereto, to which any person registered as a medical practitioner and any medical aid society
or medical aid fund which is a member of AHFoZ may agree to adhere.

00102 Notwithstanding that a medical practitioner and a medical aid society may not have expressly
in writing agreed to adhere to the Tariff, an agreement between the medical practitioner and
the medical aid society to adhere to the Tariff shall be presumed to be in existence whenever
a medical practitioner submits a claim in respect of treatment or other services rendered by

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him, to that medical aid society which accepts liability to pay such claim directly to the
medical practitioner.

00103 Where a member of a partnership of medical practitioners has agreed to adhere to the Tariff,
such agreement shall be binding on all members of that partnership.

00104 A medical practitioner who intends to adhere to the Tariff will, in respect of services
rendered to or on behalf of a patient who is a member of a medical aid society, complete the
relevant claim form prescribed by the medical aid society and provide therein, in respect of
each attendance of each patient, such information concerning attendance as the medical aid
society may require, in particular specifically identifying his charge by the relevant code
number in the Tariff. The form shall be submitted to the medical aid society within 90 days
of the date of each particular attendance or within such longer period as may be exceptionally
agreed to, in writing, by the medical aid society and the medical practitioner.

00105 A medical aid society which has agreed with a medical practitioner to adhere to the Tariff
shall provide its members with a readily available form of identification and shall throughout
the duration of such agreement and as soon as possible, but within ninety (90) days from the
date of receipt of a claim made by a medical practitioner in terms of general rule 00104, or
within such longer period as may be expressly agreed to in writing between the medical
practitioner and the medical aid society, pay to the medical practitioner the fees due to him
by the patient in respect of whom he rendered the service, provided that:-

(a) the claim is in accordance with the scale of fees provided for by the Tariff and
otherwise in accordance with the provisions of the Tariff; and

(b) the medical practitioner complies in full and timeously with the reasonable
procedures from time to time prescribed by the medical aid society for the
submission of claims; and

(c) the medical aid society is satisfied, in its discretion, as to the validity of the claim,
and that the patient in respect of whom the fee relates was at the time of the service
for which the claim was rendered by the medical practitioner a bona fide, fully paid
up member, in good standing, of the society.

(d) in the event of a query arising in respect of one or more of the above provisions and a
claim is required to be held pending confirmation or investigation, the medical aid
society shall, as soon as possible, advise the medical practitioner accordingly giving
full details.

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00106 When a medical practitioner who has agreed to adhere to the Tariff has submitted a valid
claim form on three occasions to a patient for completion and the patient has failed to
provide the medical practitioner with the completed claim form, that medical practitioner
may, notwithstanding the absence of the completed claim form, submit a claim for his fees to
the patient's medical aid society, provided that:-

(a) the medical aid society is provided with proof in the form of a registered notice of
posting of the third attempt made by the medical practitioner to have the claim form
completed by the patient; and

(b) the claim for payment of his fees is made by the medical practitioner to the medical
aid society within one hundred and twenty (120) days of the date upon which the
medical practitioner rendered the services set out in the claim; and

(c) the medical aid society is satisfied, in accordance with the provisions of general rule
00105, as to the validity of the claim.

If the above provisions are satisfied, the medical aid society shall, without delay,
meet the claim in accordance with the provisions of general rule 00105.

00107 Where a medical practitioner and a medical aid society have agreed to adhere to the Tariff,
the society shall pay the practitioner the fees prescribed in the Tariff for the services rendered
to a bona fide, fully paid up member in good standing of the society, irrespective of the
society's own rules which may impose a limitation on awards to the members, subject to the
following:-

(a) this general rule shall not apply to any scheme which has been exempted from certain
provisions of the Tariff by agreement in writing between a medical aid society and
National Tariff and Liaison Committee;

(b) the cost of treatment, or any portion thereof, covered by road traffic accident
insurance or by a Workers' Compensation Scheme established in terms of the
(National Social Security Act (Chapter 17:04) is excluded from the provisions of this
general rule)
(c) the cost of cosmetic and contraceptive procedures, reversal of surgical sterilization
and medical examinations in respect of insurance, emigration and employment are
excluded from the provisions of this general rule;

(d) payment for sterilization by whatever method is not to be excluded by reason of any
limitations imposed by the rules of a particular society.

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00108 Every medical practitioner who submits a claim to a medical aid society in accordance with
the foregoing provisions will ensure that the services provided by him for a particular patient
do not exceed those normally required for the reasonable treatment of the ailment suffered by
the patient.

00109 Medical practitioners and medical aid societies who have agreed to adhere to the Tariff
thereby confirm that the co-efficients applicable to the Tariff have been negotiated by and
between the Zimbabwe Medical Association and the National Association of Medical Aid
Societies, and they also confirm that the duty of interpreting and from time to time updating
the Tariff has been delegated to the National Tariff and Liaison Committee which is a
committee composed of representatives of the Zimbabwe Medical Association and the
National Association of Medical Aid Societies.

Such medical practitioners and medical aid societies agree that in the event of any dispute or
disagreement arising between them in regard to the interpretation or usage of the Tariff, such
dispute or disagreement shall be submitted for determination by the National Tariff and
Liaison Committee and they undertake to provide such Committee timeously with all
information which may be required by it for the purpose of the speedy determination of the
dispute or disagreement and agree to be bound by the decision of the Committee in regard
thereto.

00110 Medical practitioners and medical aid societies who have agreed to adhere to the Tariff
accept that it shall be a function of National Tariff and Liaison Committee to encourage an
awareness among medical practitioners and medical aid societies of the costs of medical care
and that, for this purpose the Committee shall establish a Cost Containment Committee
consisting of such persons as the National Tariff and Liaison Committee may, from time to
time, appoint thereto.

00111 In the event of a complaint by, or being received by, a medical aid society as to the services
rendered or being rendered by a medical practitioner who has agreed to adhere to the Tariff
or in the event of a dispute arising between a medical aid society and a medical practitioner
as to the cost of services provided by a medical practitioner and claimed from a medical aid
society by that medical practitioner, the medical aid society and the medical practitioner
concerned, as a consequence of their said agreement and failure to mutually resolve their
dispute, undertake to submit such complaints or dispute for consideration and determination
by the aforementioned Cost Containment Committee; to provide such Committee timeously
with all information which may be required by it for the purpose of the speedy determination
of such complaints or dispute, and to be bound by the decision of such Committee in regard
to the complaints or dispute.

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00112 Notwithstanding anything to the contrary contained or implied in the foregoing general rules,
any medical practitioner may terminate his agreement to adhere to the Tariff with any
particular medical aid society on giving one (1) month's notice in writing to that medical aid
society, which notice shall be given by registered post.

Similarly, and notwithstanding anything to the contrary contained or implied in the foregoing
general rules, any medical aid society may terminate its agreement to adhere to the Tariff
with any particular medical practitioner on giving him one (1) month's notice in writing of
such termination, which notice shall be given by registered post addressed to the medical
practitioner at the address last recorded in respect of him by the medical aid society.

A medical aid society which terminates an agreement with a medical practitioner shall not be
required to pay that medical practitioner direct for any services which were rendered by him
to or on behalf of a patient on a date later than that upon which the agreement with such
medical practitioner was terminated by reason of the (1) month's notice.

01006 Wherever a Tariff item is charged "At cost", a medical aid society may request a certified
invoice.

01007 Except under special circumstances, awards will not be made in respect of professional
services rendered by a medical practitioner to his/her dependants or immediate family.

01008 Consultations and treatment shall normally be undertaken in consulting rooms, a hospital or a
clinic, with home visits, except in chronic disabling illness (Tariff items 90067 and 90068),
being restricted to appropriate situations only.

Where home visits are used for routine consultation purposes the appropriate consulting
room fee, (as listed in the Tariff items 90050 and 90051) shall apply.

01009 Specialist Fees: Unless specifically stated to the contrary, the listed values in the Tariff are
in respect of procedures and services performed by a registered specialist.

01010 Specialist Awards: In order to qualify for a specialist award the patient must be specifically
referred to the registered specialist by another registered medical practitioner for particular
consultation and/or treatment within the specialty for which the specialist is registered.

If the patient has not been so referred, the award will be as for a general practitioner.

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01011 Evidence of Having Been Referred: All claims for specialist consultation and/or treatment
must show evidence that the patient has been referred and societies may, if they wish, require
the claim to be counter-signed by the referring doctor or to include substantiated evidence on
a "By Report" basis of specialist consultation and/or treatment being required.

01012 Where a patient has been referred by one medical practitioner to another medical practitioner,
the medical practitioner who referred the patient may not claim fees, other than where
provided for in the Tariff, for the same patient for the same or similar condition at the same
time unless specifically consulted by the medical practitioner to whom the patient was
referred.

01013 General Practitioner Fees:

(a) Consultation Fees: The general practitioner initial consultation fee is (as listed) is
70% of the average of the fees for a physician’s initial and two subsequent
consultations. The general practitioner subsequent consultation fee (as listed) is 85%
of the general practitioner initial consultation.

Subsequent Consultations: Where a patient is seen by the general practitioner

within twenty-one days subsequent to the initial consultation, for the same illness or
condition, at either his rooms or at a hospital, clinic or nursing home, the fee shall be
the appropriate subsequent consultation fee.

Except for the routine management of a chronic illness or condition, where a patient
is seen by the general practitioner more than twenty-one days after the initial or any
subsequent consultation, for the same illness or condition, the fee shall be the initial
consultation fee.

Where a patient is seen by the general practitioner for the routine management of a
chronic illness or condition more than twenty-one days after the initial or any
subsequent consultation, the fee shall be the appropriate subsequent consultation fee.

Where a patient is seen by the general practitioner within twenty-one days subsequent
to an initial consultation, but for a different illness or condition, at either his rooms or
at a hospital or nursing home, the fee shall be the initial consultation fee.

(b) Procedure and Surgery Fees: The fee and award for any procedure or surgery
performed by a general practitioner, unless stated to the contrary, shall be 70% of the
listed award, which has a unit value greater than 2.36(S) units in the Surgical Section
of the Tariff and 45.83(M) units in the Medical Section of the Tariff.

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Use modifier 10 when the unit value is greater than 2.36(S) or 45.83(M) units,
provided that, if the minimum fee so calculated is less than $15,512.00, omit
modifier 10.

(c) Minor Procedure Fees: A general practitioner may claim the full fee and award as
listed for any procedure or surgery which has a unit value of 2.36(S) units or less, or
45.83(M) units or less except as provided in general rule 01038 – add modifier 11.
(current value of 2.36(S) and 45.83(M) units equals $15,512.00

01015 Maternity Care and Delivery, Fees Chargeable: The fees chargeable by a specialist
obstetrician for maternity care and delivery shall be as listed. The fees chargeable by a
general practitioner, unless stated to the contrary, shall be as listed for any procedure which
has a unit value of 2,36(S) units or less and 70% of the listed fee which has a unit value
greater than 2.36(S) units, with the exception of Tariff items 59439 and 59494 for which the
listed fee may be charged. (Current value of 2.36(S) units equals $15,512.00)

In the case of a difficult or prolonged confinement which is, in due course, referred to
specialist care during delivery, a charge may be made "per service" at hospital visiting rates
for visits during the labour and may include detention time as provided in general rule 01032.
Total maximum units which may be raised under this category are 31.44(M) units. (Current
value of 31.44(M) units equals $10,641.00).

01016 Maternity Care and Delivery, Awards Payable: Medical aid society awards for normal
care and delivery only constitutes a grant-in-aid equivalent to 70% of the fees chargeable by
medical practitioners, with the exception of Tariff items 59455, 59475, 59476 and 59478
where the full listed fee is payable by the society. Shortfalls arising from a society's limited
awards may be collected by the practitioner from the patient.

01017 Care of the New Born: Any consultation or emergency procedure undertaken on a new-
born infant within the first twenty-four hours after delivery may be charged for against the
mother - add modifier 37.
01018 Anaesthesia By Surgeon: When regional or general anaesthesia is provided by the surgeon,
use the "basic" anaesthesia value without the added value for time - add modifier 39.
No award will be made where local anaesthesia is provided, except as provided for under
Tariff item 96470.

01019 Anaesthetic Fees, General Practitioner: The fee for an anaesthetic administered by a
medical practitioner who is not a specialist anaesthetist shall be 70% of the listed value of the
anaesthetic - add modifier 35.

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No award will be made where local anaesthesia is provided.

01020 Radiology Fees: The fee structure for radiology investigations undertaken by medical
practitioners who are not specialist radiologists is provided for in the preamble to the
Radiology Section of the Tariff.

01021 Follow-up Days: Listed values for all surgical procedures include the surgery, local
infiltration, digital block or topical anaesthesia when used, and the normal uncomplicated
follow-up care for the period indicated in days in the column headed "Follow-up Days", with
day "one" being the day of the operation.

01022 Follow-Up Care, Diagnostic Procedures: The follow-up care involving diagnostic
procedures (eg. endoscopy, injection procedures for radiotherapy, etc.) includes only that care
related to the recovery from the diagnostic surgery itself. Care of the condition for which the
diagnostic procedure was performed or other concomitant conditions are not included and
may be charged for in accordance with the service rendered.

01023 Follow-Up Care, Therapeutic Procedures: Follow-up care involving therapeutic

procedures generally includes all post-operative care. Complications or the reappearance or
presence of other associated conditions requiring services additional to those normally
undertaken during the listed period of normal follow-up care may warrant additional charges
on a fee for service basis - add modifier 43.

01024 Follow-Up Care, Additional Procedures: When additional surgical procedures are carried
out within the listed period of follow-up care for a previous surgery, the follow-up period
will continue concurrently with their normal terminations.

01025 Incidental Surgical Procedures: For incidental procedures (eg. incidental appendicectomy,
incidental scar excision, puncture of ovarian cyst, simple repair of incisional hernia, etc.) an
additional charge is not to be made unless justified under Tariff items 01030 and 01031 in
which case a report is required.
01026 Primary Surgical Services: When the surgical procedure is carried out by a specialist who
will not be providing the complete follow-up care, the value will be 70% of the listed value.
Follow-up services by other medical practitioners, or partial follow-up services by the
specialist and subsequently by other medical practitioners, shall all be listed on a "fee for
services" basis - add modifier 12.

Where a surgical specialist is required to travel to another centre to provide a surgical facility
not otherwise available in that centre, and will not be providing the complete follow-up care,

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the fee and award shall be as listed and shall not be subject to the percentage reduction
otherwise provided for - add modifier 27.

01027 Asterisked Procedures: When an asterisk precedes a surgical Tariff item number and its
value, the following rules apply:-

(a) when the asterisk (*) procedure is carried out at the time of the initial consultation
(new patient), the appropriate consultation fee in addition to the fee for the surgical
procedure may be raised;

(b) when the asterisk (*) procedure is a booked procedure which is carried out
subsequent to the initial consultation, only the fee for the surgical procedure may be
raised;

(c) when the asterisk (*) procedure is carried out at the time of a follow-up consultation
(established patient) in lieu of the consultation fee, add units 3.37(M) to the value of
the surgical procedure - add modifier 13. (Current value of 3,37(M) units equals
$1,141.00)

01028 Two Surgeons: Under certain circumstances, the skills of two surgeons (usually with
different skills) may be required in the management of a specific surgical problem (eg. a
urologist and a general surgeon in the creation of an illeal conduit, etc.). By prior agreement
the total value may be apportioned in relation to the responsibility and work done. The total
value may be increased by 25% in lieu of the assistants' charge - add modifier 14.

01029 Co-Surgeons: Under certain circumstances, two surgeons may function simultaneously as
primary surgeons performing different parts of a total surgical service. By prior agreement,
the total value may be apportioned in relation to the responsibility and work done. The total
value may be increased by 30% in lieu of the assistant's charge. (Usual charges for surgical
assistants may also be awarded if still another medical practitioner is required as part of the
surgical team) - add modifier 15.

01030 Multiple Procedures Through the Same Incision or Orifice: Unless otherwise identified
in the listing, when multiple procedures add significant time and/or complexity, and when
each procedure is clearly identified and defined, the following values shall prevail:-

a) 100% (full value) for the first or major procedure;

b) 50% for the second procedure - add modifier 18;

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c) 25% for the third and each subsequent procedure - add modifier 19.

01031 Multiple Procedures Performed Through Subsequent Incisions or Orifices: All

procedures performed through the first or primary incision or orifice shall be charged for in
accordance with general rule 01030. Where additional procedures are performed through
subsequent incisions and/or orifices, and providing that such additional procedures add
significant time and/or complexity and providing that such additional procedures are clearly
identified and defined, then, unless otherwise identified in the listing, the following values
shall prevail:-
a) 80% for the first additional procedure performed through any subsequent incision
and/or orifice - add modifier 23;
b) 50% for the second and each subsequent additional procedure performed through any
subsequent incision and/or orifice - add modifier 24.

Where in the listing it specifically states the fee for a second and/or third procedure
or for multiple procedures, general rules 01030 and 01031 do not apply.

01032 Detention Fee: Detention, prolonged with patient requiring attention beyond usual services,
after the first hour add appropriate subsequent consultation unit value for each subsequent
quarter of an hour – add modifier 28.

01033 Surgical Assistant, General Practitioner: Where a procedure allows for a surgical
assistant and the surgeon considers the services of an assistant to be necessary, the services of
the surgical assistant shall be valued and awarded at 14% of the listed value of the surgical
procedure(s) - add modifier 80. Where circumstances warrant two surgical assistants a report
is required (B.R.).

01034 Procedures Not Requiring A Surgical Assistant: All procedures marked with a # and
diagnostic procedures performed at the time of surgery are deemed not to require the services
of a surgical assistant, and normally no surgical assistant fee or award will apply to these
procedures. Where, however, a surgeon considers the services of a surgical assistant to be
necessary, a report is required and an assistant's fee may be raised.

01035 Specialist Surgical Assistant: When the services of a specialist surgeon are required as an
assistant because the nature of the surgical procedure warrants such specialist assistance, the
assistant's fee and award shall be 20% of the listed value of the surgical procedure(s) - add
modifier 82. However, if the assistant is in partnership with the surgeon (except in the case
of ophthalmic surgery), the fee shall be 14% of the listed value of the surgical procedure(s).

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01036 Radiology Procedures Requiring a Surgical Assistant: Procedures marked with a ~ may
require the services of a surgical assistant. Where the services of a surgical assistant are
considered to be necessary a report (B.R.) is required and an assistant fee may be raised.

Procedures not marked with a ~ are deemed not to require the services of a surgical assistant.

01037 Unusual Services: When the services provided are greater or more unusual than those
usually required for the listed procedure - add modifier 29. List modified value. A report
(B.R.) is required.
01038 Electrocardiograms and Vitagrams: The fee and award for procedures listed under Tariff
items 93000, 93010, 93021, 93023, 93024, 93201 and 94001 - 94020 undertaken by a
general practitioner shall be 70% of the listed value.

01039 Pre-Operative Consultations: No charge may be raised for routine pre-operative visits.
Visits may be charged for in the normal way up until the decision to operate is made.
Thereafter no visits may be charged for unless specific pre-operative management is
required. (For pre-operative visits for surgical procedures preceded by an (*) see general rule
01027).

01040 Emergency Cases, Specialists: Where a non-hospital-based registered specialist with the
exception of a specialist anaesthetist, is called to an emergency from outside the hospital to
provide emergency services to either a new or an established patient, the following mutually
exclusive additional fee may be claimed.

(a) increase the consultation fee/procedure by $102580.00 - add modifier 38; or

(b) increase the fees for the total service by 25% - add modifier 44.

Modifiers 38 and 44 cannot be used concurrently for the same patient.

This general rule is not applicable to Tariff items 97081 - 97086, to normal maternity care, to
elective Caesarean sections, to Caesarean sections following trial of labour and normal
deliveries (being those which, with the exception of an episiotomy, do not involve any
surgical interference), between 7am and 5pm, or for services provided by the general
practitioners and pathologists, which services are provided for elsewhere in the Tariff
(general rule 01061, Tariff item 90056, Tariff item 90058, Tariff item 90061, Tariff item
90062 and general rule 01041 respectively).

The emergency fee for a normal delivery between 5pm and 7am, being 25% of the delivery
fee, is as listed under Tariff item 59435.

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01041 Pathology, After Hours Service: Where an "URGENT" or "EMERGENCY" pathology

service is provided outside normal working hours, at the request of the referring practitioner,
add 100% to the fee - add modifier 51. The date and time of the request must be recorded on
the claim. Medical aid societies reserve the right to request a copy of the referring
practitioners laboratory request form at any time.
This general rule is not applicable to routine pathology services provided outside of normal
working hours, or to pathology services routinely provided outside of normal working hours.

01042 Specific Re-Referrals: Initial and Subsequent Consultations

(a) Where a patient is specifically re-referred by his medical practitioner for specialist
consultation the fee shall be the appropriate initial consultation fee, provided the
patient has not been seen by the specialist for the same illness or condition for a
period of sixty days prior to such re-referral - add modifier 61.

(b) Where a patient is seen by the specialist subsequent to the initial consultation for the
same illness or condition within the sixty day period, at either his rooms or at a
hospital, clinic or nursing home, and either with or without re-referral, the fee shall
be the appropriate subsequent consultation fee.

(c) Where the patient is seen by the specialist with the expressed approval of the
referring medical practitioner at subsequent intervals after the sixty days period
without specific re-referral, the fee shall be the appropriate subsequent consultation
fee.
01043 Independent Procedures: Certain of the listed procedures are commonly carried out as an
integral part of a total service, and as such do not warrant a separate charge. When such a
procedure is carried out as a "separate entity" not immediately related to other services, the
indicated value for "independent procedures" is applicable. Where an "independent
procedure" is carried out through a separate incision or orifice at the time of other services,
the indicated value for " independent procedures" is applicable but is subject to modification
in accordance with general rule 01031.

Where an independent procedure is carried out through the same incision, as an integral part
of a total service, but is deemed to warrant a separate charge, the indicated value for the
procedure, modified in accordance with general rule 01030, may be applied on a "by report"
basis (B.R.). Only applicable to Tariff items 44680, 49560 and 49565.

01044 Diagnostic Procedures: Where a diagnostic procedure is performed at the time of surgery
and adds significant time and/or complexity, the value of the diagnostic procedure, modified

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by the appropriate percentage listed under general rule 01030 or 01031, whichever is
applicable, may be added to the fee for the surgical procedure.

Where the diagnostic procedure is a laparoscopy or endoscopy which precedes a

gynaecological procedure, no charge may be raised.

01046 General Practitioner Surgical Fees, Designated Areas: At centres where there is no
surgical specialist, the general practitioner may claim the full fee and award for any
procedure or surgery, with the exception of Tariff items 59400 through to 59497, undertaken
in an emergency – add modifier 83, and 85% of the listed fee and award for non-emergency
cases – add modifier 84. a report is required (B.R.).

01047 Additional Services: Presence of other diseases or injuries requiring additional services
during the listed period of normal follow-up care, may warrant additional charges on a fee for
services basis - add modifier 40.

01048 Supervised Practice: A specialist may charge and be awarded in accordance with the Tariff
for any procedure undertaken on his behalf by another registered medical practitioner,
provided the procedure is carried out in his presence and under his direct instruction and
supervision.

Where the specialist is not actually present, no fee may be raised.

No fee may be raised by the practitioner being supervised.

01049 Microsurgery: Where a full operating microscope is used, plus 50% of fee - add modifier
72. A report is required (B.R.).

This general rule is not applicable to ophthalmology or where operating binoculars are used.

01050 Prophylactic or Cosmetic Surgery: Where items in the Tariff are of a prophylactic or
cosmetic nature or are not covered for any other specific reasons, payment will be considered
where a relevant second opinion of a consultant so justifies for concomitant medical reasons.

01051 Surgical Assistant, Nursing: Where a registered general nurse, or certified nurse is
specifically employed as a surgical assistant, over and above the usual theatre staff and not
during the course of usual theatre duties for which he/she may otherwise be employed, a
surgical assistant fee may be claimed. Where the surgical assistant is a registered general
nurse the fee and award shall be 70% of the value provided for under general rule 01033 -
add modifier 85 - and 56% in respect of a certified nurse - add modifier 86.

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Where the fee is claimed by the surgeon, as opposed to the nurse as an independent
practitioner, the name and medical aid payee number of the nurse must be stated.

01052 Employment of Nursing Personnel: Where a private registered medical practitioner

employs a registered general nurse, enrolled nurse or certified nurse to carry out procedures
and treatments otherwise undertaken by a medical practitioner and the medical practitioner
takes full clinical responsibility, the fee and award for the services of the registered general
nurse shall be 25% of the listed value applicable to general practitioners - add modifier 09 -
and 20% for a certified nurse - add modifier 08.

This general rule is not applicable to Tariff item 96932 where the full fee for dressing
materials shall apply and may only be charged for and claimed by the employing medical
practitioner.

01053 Prosthesis or Implant: Unless stated to the contrary elsewhere in the Tariff, all procedures
exclude the cost of the prosthesis or implant.

01054 Consecutive Consultations: Where a patient is required to attend a medical practitioner for
consultations at his rooms on more than four consecutive days, the medical aid society may
ask for a report explaining the necessity for the multiple consultations and where possible
this should be substantiated by pathological reports, X-rays and any other ancillary
information that is available.

01055 Consultation with a private patient in a casualty or outpatient department of a hospital, other
than in an emergency or having been called ab initio to casualty/outpatients - add modifier 89
and reduce consultation fee by 0.92(M) units. (Present value of 0.92(M) units is $311.00).
01056 Where a medical practitioner who is not a specialist undertakes or performs a procedure
normally done by a specialist in that field, a full report, with pathological confirmation where
applicable, must be supplied with the claim.

This general rule does not apply to surgery undertaken by general practitioners in designated
areas - see general rule 01046.

01057 Radiological Examination (including CT and MRI Examination): Where a hospital

provides the equipment and radiography and the plates/studies are read/interpreted by a
specialist radiologist or a specialist who is reporting on a radiological examination applicable
to his own speciality, the fee for the examination shall be shared on a 50% - 50% basis - add
modifier 70.

Where the plates are read by a general practitioner or a specialist who is reporting on a

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radiological examination not applicable to his own speciality, the fee to the medical
practitioner or specialist will be 20% - add modifier 69. Not applicable to CT or MRI
examinations.

Where the plates are initially read by a medical practitioner who is not a specialist
radiologist, and are subsequently read and reported on by a specialist radiologist, the fee for
the medical practitioner who is not a specialist radiologist falls away.

01058 Venography/Angiography: Per additional series for Tariff items, 74720, 75505, 75605,
75616, 75785, 75905 and 75970, add 50% to the fee - add modifier 65.

01059 Fibre Optic Flexible Instrument: Where a medical practitioner uses his own fibre optic
flexible endoscopic instrument or flexible urethroscope, an additional 0.52(S) units may be
charged - add modifier 45. (Current value of 0.52(S) units equals $3,418.00).

01060 Subsequent Consultations, Prolonged Hospitalisation: Where a patient is in a hospital or

nursing home for more than sixty consecutive days, any subsequent consultation by a general
practitioner in excess of one per week shall be by report (B.R.).

01061 Emergency Cases, General Practitioners: Where a non-hospital-based general practitioner

is called to an emergency from outside the hospital to provide emergency services to either a
new or an established patient, increase the fees for any surgical or diagnostic procedure by
25% - add modifier 46.

This general rule is not applicable to Tariff items 97081 - 97087 or to normal maternity care,
elective Caesarean sections, or Caesarean sections following trial of labour and normal
deliveries (being those which, with the exception of an episiotomy, do not involve any
surgical interference) on weekdays and non-public holidays between 7am - 5pm.

The emergency fee for a normal delivery on weekdays between 5pm and 7am, on weekends
between Saturday 1 pm to Monday 7am, and on public holidays between 5pm on the day
preceding the public holiday to 7am on the day following the holiday, is as listed under Tariff
item 59435.

01062 Physiotherapy, Rehabilitation Assistants: The fee and award for physiotherapy carried out
by a registered rehabilitation assistant on referral from a medical practitioner shall be 70% of
the listed value - add modifier 77. Where there is no referral from a medical practitioner, the
fee and award shall be 50% of the listed value - add modifier 78.

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01063 Physiotherapy, Other Registered Personnel: Where physiotherapy is carried out by a

practitioner who is not a registered physiotherapist or rehabilitation assistant, the fee and
award shall be 50% of the listed value - add modifier 76.

01064 Intensive Care, Initial Consultation by Specialist Anaesthetist: Where the attending
practitioner is a specialist anaesthetist, the initial consultation fee shall be as for a specialist
physician - add modifier 16.

01065 Triplet Delivery: Third appropriate delivery fee to be reduced by 50% - add modifier 41.

01066 Consultations, Visits and Home Nursing, Nursing Personnel: Unless stated to the
contrary in the Tariff, the fee and award for a registered general nurse shall be as listed in the
Nursing Section of the Tariff. The fee and award for a registered certified nurse shall be 80%
of the listed value - add modifier 30.

01067 Maternity Care and Delivery, Nursing Personnel: Unless stated to the contrary in the
Tariff, the fee for a registered midwife shall be as listed in the Nursing Section of the Tariff,
with the medical aid society award, as a grant-in-aid, being 70% of the listed value for Tariff
items 79221, 79222, 79224 and 79225.

01069 Anaesthetic Fees, Nursing Personnel: Where an anaesthetic is administered by a registered

general nurse who is qualified and registered to practise in the field of anaesthetics and is
specifically employed to administer the anaesthetic, over and above the usual theatre staff
and not during the course of usual theatre duties for which he/she may otherwise be
employed, the fee and award shall be 70% of the value applicable to a general practitioner -
add modifier 34.

01071 Diagnostic Ultrasound, Radiographer: Where an ultrasound procedure is undertaken by a

registered radiographer practising on an independent basis, the fee and award for the
examination and for tendering an opinion where so requested shall be 50% of the listed value
- add modifier 71. All patients must be referred by a registered medical practitioner.

01072 Diagnostic Ultrasound, General Practitioner: Where an ultrasound procedure is carried

out by a general practitioner and is reported on in writing, the fee and award for the
examination, the interpretation of the examination shall be 70% of the listed value - add
modifier 67.

Where an ultrasound procedure is carried out by a general practitioner, without a written

report, the fee and award for the examination and interpretation of the examination shall be

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50% of the listed value – add modifier 68.

01073 Dressing Procedures: The following rules shall apply to all dressing procedures undertaken
in accordance with Tariff item 90073 (i.e. where the dressing procedure necessitates the
medical practitioner's personal skill):-

(a) except where otherwise stated in the Tariff, when the dressing is carried out at the
time of the initial consultation (new patient), the appropriate consultation fee may be
raised, in addition to the dressing fee plus fees raised under Tariff item 96932 where
applicable;

(b) except where otherwise stated in the Tariff, when the dressing procedure is a booked
procedure which is carried out as a result of the initial consultation and no subsequent
formal consultation is necessary, only the fee for the dressing procedure may be
raised plus fees raised under Tariff item 96932 where applicable;
(c) except where otherwise stated in the Tariff, when the dressing procedure is carried
out at the time of a subsequent consultation (established patient), in addition to the
fee for the dressing procedure and fees raised under Tariff item 96932 where
applicable, the appropriate subsequent consultation fee may be raised;

(d) when the dressing procedure is carried out during a stated follow-up period, no
consultation fee may be raised but the fee for the dressing procedure may be raised
plus fees raised under Tariff item 96932 where applicable;

(e) when the dressing procedure is carried out at the time of a listed procedure no fee
may be raised for the dressing procedure but fees under Tariff item 96932, where
applicable, may be raised.

01074 Pathology Fees: The fee structures for pathology investigations undertaken by a medical
practitioner/laboratory service not under the supervision of a registered specialist pathologist
are provided for in the preamble to the Pathology Section of the Tariff.

01075 Laboratory Tests: Where a repeat test is carried out on the same day for the same patient -
add modifier 53.

01076 Infertility Investigations and In-Vitro Fertilization: When a procedure is undertaken for
the purpose of investigating infertility and/or in association with in-vitro fertilization - add
modifier 54.

01078 Psychiatry, Medical Practitioner: Fees and awards for psychiatric services, including

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consultations and therapy, carried out by a medical practitioner who is not a specialist
psychiatrist shall be 70% of the listed value - add modifier 62.

01079 Physiotherapy, Physiotherapist: The fee and award for physiotherapy carried out by a
registered physiotherapist, on referral from a medical practitioner, shall be as listed. Where
there is no referral from a medical practitioner the fee and award shall be 70% of the listed
value - add modifier 79.

01080 Emergency Cases, Surgical Assistant, Nursing: Where a non-hospital-based registered

general nurse, or certified nurse is called to an emergency from outside the hospital to
provide emergency assistant services to either a new or an established patient, increase the
fee calculated in accordance with general rule 01051 by 25% - add modifier 47.

01081 Emergency Cases, Specialist Anaesthetists: Where a non-hospital based registered

specialist anaesthetist is called to an emergency from outside the hospital to provide
emergency services to either a new or an established patient, increase the fee by 50% - ass
modifier 48.

01082 Magnetic Resonance Imaging: Medical aid awards will only be made where there is
evidence of the examination having been carried out following specialist referral.

For limited studies the following percentage values shall apply:

a) 66% limited series of a specific anatomical region (except bone tumour) - add
modifier 55;

b) 50% contrast studies subsequent to plain study, (except bone tumour) - add
modifier 56. Not applicable to Tariff items 77513, 77521, 77522 and 77523;

c) 100% contrast studies subsequent to plain study, bone tumour - add modifier 59;

d) 66% limited examination of hypophysis - add modifier 57;

e) 50% MRI angiography of large vessels additional to an examination of a particular

anatomical region - add modifier 58;

01083 Computed Tomography, Multiple Areas: Where multiple areas are scanned on the same
date, each area must be separately identified and the following values shall prevail:-

a) 100% (full value) for the first or major study;

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b) 80% for the second or lesser study - add modofier 25;

c) 50% for the third and any subsequent additional study - add modifier 26.

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