Discovery Health Physiotherapy Claims

Dear Trading Partner
Currently physiotherapy claims with modifier 0006 are incorrectly paying to the member. Because of this error, physiotherapy claims with modifier 0006 will have a delayed adjudication applied to them.
Claims will be pended from 16 to 23 November 2012, and will be released for payment after 23 November.
We apologise for any inconvenience caused by the pending of these claims.
Laura Myburgh
Teamleader
Electronic Transaction Management
Discovery
Direct:+27 11 529 7451
Mobile:+27 072 758 4789
Mobile:+27 082 606 7451
E-mail:lauram@discovery.co.za
Discovery Health Physiotherapy Claims

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About Medinol:
Medinol is one of the few purpose-built practice management application to meet the unique needs of independent private healthcare providers. Today Medinol helps over 130 providers throughout South Africa run more efficient and profitable practices, while delivering outstanding patient care. As an on-premise software, Medinol and the data it manages, is fully under your control. This enhances your independence and privacy: what happens in your rooms, stays in your rooms. Medinol helps manage your patient information, generates your billings, submits your claims, control your outstandings, and get your accounts paid quickly. Medinol has been in operation since 1984 demonstrating its proven efficacy. Medinol’s mission is to help independent practices succeed in an ever-changing healthcare environment. More information can be found at http://medinol.co.za.

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Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610

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Comments 12

  1. Dear Discovery
    Please could you email me the 2015 Physiotherapy tariffs.
    My Practice No: 7216769
    Thank you
    Holly Hogan (Cell:082 589 2843)

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  4. Please could you email me the physiotherapy tariffs Discovery are prepared to pay out for 2015. Practice Number BHF 0599123

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    Discovery Health 2016 Physiotherapy Tariffs:

    Practice Type Procedure Code Procedure Description Scheme Rate
    72 72001 Infra-red, Radiant heat, Wax therapy Hot packs 43.80
    72 72005 Ultraviolet light 87.70
    72 72006 Laser beam 131.50
    72 72007 Cryotherapy 43.80
    72 72103 Galvanism, Diodynamic current, Tens. 75.40
    72 72105 Muscle and nerve stimulating currents. 90.20
    72 72107 Interferential Therapy. 87.70
    72 72117 Appointment not kept (schemes will not necessarily grant benefits in respect of this item, it will fall into the “By arrangement with the scheme” or “Patient own account” category). 0.00
    72 72201 Shortwave diathermy. 52.80
    72 72203 Ultrasound. 87.70
    72 72205 Microwave. 52.80
    72 72300 Vibration 87.70
    72 72301 Percussion 121.00
    72 72302 Massage 75.40
    72 72303 Myofacial release/soft tissue mobilisation, one or more body parts 150.60
    72 72304 Acupuncture 131.50
    72 72305 Re-education of movement/Exercises (excluding ante- and post-natal exercises) 75.40
    72 72307 Pre- and post-operative exercises and/or breathing exercises 75.40
    72 72308 Group exercises (excluding ante- and post-natal exercises – maximum of 10 in a group) 75.40
    72 72309 Isokinetic treatment. 87.70
    72 72310 Neural tissue mobilisation 150.00
    72 72313 Ante and post natal exercises/counselling 87.70
    72 72314 Lymph drainage 43.80
    72 72315 Postural drainage. 87.70
    72 72317 Traction. 87.70
    72 72318 Upper respiratory nebulisation and/or lavage 75.40
    72 72319 Nebulisation 87.70
    72 72321 Intermittent positive pressure ventilation. 87.70
    72 72323 Suction: Level 1 (including sputum specimen taken by suction) 43.80
    72 72325 Suction: Level 2 (Suction with involvement of lavage as a treatment in a special unit situation or in the respiratory compromised patient) 150.60
    72 72327 Bagging (used on the intubated unconscious patient or in the severely respiratory distressed patient). 43.80
    72 72328 Dry needling 131.50
    72 72401 Spinal. 131.50
    72 72402 Pre meditated manipulation 87.70
    72 72405 All other joints. 131.50
    72 72407 Immobilisation (excluding materials). Rule 008 does not apply. 112.80
    72 72501 Rehabilitation where the pathology requires the undivided attention of the physiotherapist. Rule 008 does not apply. Duration: 30min. 187.30
    72 72502 Hydrotherapy where the pathology requires the undivided attention of the physiotherapist. Rule 008 does not apply. Duration: 30min. 187.30
    72 72503 Rehabilitation for Central Nervous System disorders – condition to be clearly stated and fully documented (No other treatment modality may be charged in conjunction with this). Duration: 60min. 482.10
    72 72504 EMG Biofeedback treatment 131.50
    72 72505 Group rehabilitation. Treatment of a patient with disabling pathology in an appropriate facility requiring specific equipment and supervision, without individual attention for the whole treatment session, no charge may be levied by facility 129.40
    72 72506 Stress management 150.00
    72 72507 Respiratory Re-education and Training. Duration: 30min. 131.50
    72 72509 Rehabilitation. Each additional full 15 mins. Where the pathology requires the undivided attention of the physiotherapist. (Rule 0008 does not apply.) Can only be used with codes 501, 502, 507 or 503 to indicate the completion of an additional 15 minutes. A maximum of two instances of this code may be charged per session. 112.80
    72 72701 Evaluation/counselling at the first visit only (to be fully documented) 131.50
    72 72702 Complex evaluation/counselling at the first visit only (to be fully documented). 263.00
    72 72703 One complete re-assessment of a patient’s condition during the course of treatment. To be used only once per episode of care. 112.80
    72 72704 Lung function: Peak flow (once per treatment). 37.90
    72 72705 Computerised/Electronic test for lung pathology 112.80
    72 72706 Reports. To be used to motivate for therapy and/or give a progress report and/or a pre-authorisation report, where such a report is specifically required by the medical scheme. 131.50
    72 72707 Physical Performance test. Must be fully documented. 175.30
    72 72708 Interview, guidance or consultation with the patient or his family. To be used only once per episode of care. 112.80
    72 72801 Electrical test for diagnostic purposes (including IT curve and Isokinetic tests) for a specific medical condition 262.20
    72 72803 Effort test – multistage treadmill. 262.20
    72 72901 Treatment at a nursing home : Relevant fee plus (to be charged only once per day and not with every hospital visit 75.40
    72 72903 Domicilliary treatments : Relevant fee plus. 150.00
    72 72937 Bird or equivalent freestanding nebuliser excluding oxygen at hospital per day. 87.70
    72 72938 Bird or equivalent freestanding nebuliser excluding oxygen domicilliary per day. 87.70
    72 72939 Cost of material: Items to be charged (exclusive of VAT) at net acquisition price plus -26% of the net acquisition price where the net acquisition price of that material is less than one hundred rands; a maximum of twenty six rands where the net acquisition price of that material is greater than or equal to one hundred rands. Blank
    72 72940 Cost of appliances: Items to be charged (exclusive of VAT) at net acquisition price plus-26% of the net acquisition price where the net acquisition price of that appliance is less than one hundred rands; a maximum of twenty six rands where the net acquisition price of that appliance is greater than or equal to one hundred rands. Blank
    72 72941 Cost of appliances: Items to be charged (exclusive of VAT) at net acquisition price plus- Blank
    72 72720 Essential continuation of Physiotherapy care, in an after-hours situation Blank
    72 72721 Emergency Physiotherapy intervention Blank

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