Use your own amounts for the various codes.
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Please note:
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No specific codes for fibre treatment exists.
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| 2.
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The following list of codes are suggested codes only.
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| 3.
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The following list of fees are recommended and based on the NRPL. You are free to charge accordingly to your own fee structure.
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The existence of a code does not mean that the fee will be paid for by the Medical Aid / Medical Insurance.
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Practitioners are advised to submit a written treatment plan to the patient and obtain a written confirmation from the patient / Medical Aid / Medical Insurance PRIOR to the commencement of the treatment.
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Great care was taken in compiling this list and we would like to thank everyone that contributed.
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1.1 Periodontal Splint
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| DIRECT TECHNIQUE
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Diagnostic code: K05.3/K02,1
Clinical codes:
8768
Or
8727 Provisional intra-coronal splint per tooth (state rule 007)
Or
8352 x 2, 8353 x 4 (Recommended codes)
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| INDIRECT TECHNIQUE
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Diagnostic code: K05.3/K02,1
Clinical codes:
8768 (unlisted periodontal procedure per tooth – state rule 007)
Lab codes: 9301, 9327, 9330, 9463 (fitting lingual bar)
9738 (cost of pre-formed strengthener)
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1.2 Orthodontic Permanent Retainer
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DIRECT TECHNIQUE
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Diagnostic code: K07.3 (or original treatment code)
Clinical code:
8849 + L (R 007)
L = 25% of clinical fee
State 8099 (8023)
Alternatively use code 9099 r 007 (own fee)
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INDIRECT TECHNIQUE
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Diagnostic code: K07.3 (or original treatment code)
Clinical code: 8849 +L
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Lab codes:
9301 (model)
9327 (infection control)
9617 (invisible retainer)
9758 (cost of fibre)
9760 (cost of composite)
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1.3 Fixed Space Maintainer
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DIRECT TECHNIQUE
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Diagnostic code(s): K00.5/9; K08.1; K01.0
Clinical code:
9099 rule 007
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INDIRECT TECHNIQUE
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Diagnostic code(s): K00.5/9; K08.1; K01.0
Clinical code: 8173 x 2 (per abutment) +L
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Lab codes:
9301 (model)
9327 (infection control)
9572 (basic charge)
9622 (space maint. / arch)
9758 (cost of fibre)
9760 (cost of composite)
Total Lab (8099)
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OCCLUSAL SPLINTING (DIRECT TECHNIQUE ONLY)
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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 cm fibres (splint)
Consider creating own code (COF1)
Or
9099 rule 007
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TRAUMA SPLINT (DIRECT TECHNIQUE ONLY)
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Diagnostic code: S03.2
Suggested med. Aid codes 8768 (per tooth)
Or
8725 Provisional extra-coronal splint (wire and resin) per tooth (state rule 007)
Or
9099 rule 007
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Direct Technique
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ANATOMICAL FIBRE POST
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Diagnostic codes: K04.2/3; K02.1/8
Clinical codes: 8345 + 8379 (r007)
8379: Cost per post + 8025
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ANATOMICAL FIBRE POST AND CORE
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Diagnostic codes: K04.2/3; K02.1/8
Clinical codes: 8376 + 8379 (r007)
Add code 8355 / 8409 +L depending on rest of the procedure
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NOTE
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| Code 8379 is paid 'by arrangement.' Not all Medical Aid funds pay for it. Check with each individual Medical Aid.
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| Indirect Technique – see Section 5
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DIRECT BRIDGES
Note: No impression is taken, the bridge is constructed directly in the mouth i.e. temp bridge on implants
Diagnostic codes: K08.1/9 (congenital)
Clinical codes:
Retainers: 8437r007 x 2 + L
Pontic: 8419 (Rule 007)
Lab 8099 = 25% of 8437 x 2
State 8099 (8023)
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INDIRECT BRIDGE (Refer also to Section 5)
Note: You must take an impression, cast a model and construct the bridge on the model
Diagnostic codes: K08.1/9 (congenital)
Clinical codes:
Retainers: 8437r007 x 2
Pontic: 8415 + L (Rule 007)
Lab codes:
9301 (model)
9327 (infection control)
9524 x 2 (comp inlays)
9557 Indirect comp cr/pontic
9758 Cost of fibres
9760 Cost of composite
Total lab (8099)
TOTAL Clinical + Lab
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Additional Codes you can Consider
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 (inlay/onlay, resin) modifier 8023 – no lab state 8099(m8023) value = 25% of value 8382/3 using code for retainer
Or
8617 (Maryland type retainer) rule 007 and possibly modifier 8023 apply
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4.1 DIRECT TECHNIQUE
Diagnostic code: K02.1
Clinical codes:
8354 / 8370
Charge for fibres: your own code COF1 (cost of fibres)
Recommended charge for fibres
Can also consider 8347 and 8348 r007
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4.2 INDIRECT TECHNIQUE
Diagnostic code: K02.1
Clinical codes:
8383 + L
Lab codes:
8099 (8023) = 25% of clinical fee
Or
9301 (model)
9327 (infection control)
9524 (comp inlay)
9758 Cost of fibres
9760 Cost of composite
Total lab (8099)
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INDRECT CROWN
Diagnostic codes: K02.1; K03.0; K03.9
Clinical code:
8409 +L (rule 007)
Lab codes:
9301 Model
9315 C&B Model
9319 Extra die
9320 Pindex
9327 x 2 Infection control
9330 Delivery charge
9557 Indirect comp cr/pontic
9758 Cost of fibre
9760 Cost of composite
Total Lab (8099)
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INDRECT BRIDGE CONSTRUCTION
Diagnostic codes: K08.1/9 (congenital)
Clinical codes:
8437 (r007), pontic 8415 (r007) + L (Fee according to clinical code)
Lab codes:
9301 Model
9315 C&B Model
9319 Extra die
9320 Pindex
9327 x 2 Infection control
9330 Delivery charge
9524 Indirect comp inlay x 2
9557 Indirect comp cr/pontic
9758 Cost of fibre
9760 Cost of composite
Total Lab (8099)
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INDIRECT ANATOMICAL FIBRE POST
Diagnostic code: K04.2/3; K02.1/8
Clinical codes: 8391 + L (r007)
Lab codes (8099):
9301 Model
9315 C&B Model
9319 Extra die
9320 Pindex
9327 x 2 Infection control
9330 Delivery charge
9545 Post
9758 Cost of fibre post material
Total Lab (8099)
Total Clinical + Lab
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Other applicable Clinical Codes:
8137 Emergency crown
8355 Direct composite veneer
8554 Lab resin veneer + L
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Retainer full cover (crowns) code 8443 (r007) corresponding lab code 9557
Retainer Maryland: code 8617 corresponding lab code 9524, report pontic 8415 r007
Please also note that medical schemes have the right to limit the scope, the frequency and/or combinations of dental procedures that is covered or reimbursed. Certain medical schemes may require predetermination for particular procedures and/or when charges are expected to exceed a certain amount.
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