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Medscheme PPE price changes effective from 01/09/2022

The following communication (UPDATE: Funding of personal protective equipment (PPE) for healthcare providers in the out-of-hospital (OOH) environment),was sent to Family Practitioners, Specialists and Auxiliaries (excl. renal dialysis pr75 service providers).

Dear Healthcare Provider

UPDATE: Funding of personal protective equipment (PPE) for healthcare providers in the out-of-hospital (OOH) environment

Medscheme continues to recognise the safety concerns and preventative measures required during day-to-day interactions at your OOH practice as a result of the COVID-19 pandemic.

However, based on the current situation in respect of the downscaling of the pandemic prevalence and impact, but still supporting provision of PPE in line with national guidelines, the funding and contents of the PPE1 and PPE2 basket covering OOH use of PPE by healthcare providers has been revised. This change is effective from 1 September 2022 and we encourage the appropriate use of the global in-house codes & rates as provided in table 1 below.

The medical schemes listed in table 2 will reimburse healthcare providers for PPE from their risk benefit.

Table 1: Global in-house codes and rates

In-house code Rate of payment Use of PPE codes
PPE1 R3.47
  • Use for Non-Aerosol Generating Procedures (Non-AGPs) and Consults that due to the risk of the pre-symptomatic transmission and asymptomatic nature of COVID-19, healthcare providers still need to protect against possible transmission.
  • PPE1 global fee includes:
    • 1 x surgical 3-ply mask per consult/procedure
    • 1 x pair of disposable surgical gloves per consult/procedure
PPE2 R6.84
  • Use for Aerosol Generating Procedures (AGPs) and Consults which are defined as any medical and patient care procedure that results in the production of airborne particles (aerosols). AGPs therefore create a greater potential for COVID-19 transmission.
  • PPE2 global fee includes:
    • 1 x N95 mask per day
    • 1 x pair of disposable surgical gloves per consult/procedure per day
    • 1 x apron
    • 1 x face shield or goggles (last 15 days and 30 days respectively)

 

Please note:

  1. Additional PPE NAPPI codes will be rejected when billed in addition to the PPE in-house codes.
  2. The PPE in-house codes will be paid from the risk benefit for OOH services.
  3. The appropriate use of the PPE in-house codes will be monitored.
  4. The PPE in-house codes are applicable to Family Practitioners, Specialists, Dentists, Optometrists and most Auxiliary Service Providers where the claims are administered by Medscheme.
  5. Medscheme has secured preferential cost-effective pricing of PPE from MMED. Please visit their website (MMED SHOP (mmedsa.co.za) for their price list.
  6. These recommendations will ensure that the tariff for codes PPE1 and PPE2 will cover the costs of purchasing PPE by a practice.

 

Table 2: Medical schemes applicable for claiming PPE in-house codes 

Medical scheme

AECI Medical Aid Society

Barloworld Medical Scheme

Bonitas Medical Fund

Fedhealth

Horizon Medical Scheme

MBMed Medical Aid Fund

 Parmed Medical Aid Scheme

 POLMED

 SABC Medical Scheme

 SAMWUMED

The revision of PPE funding based on the situation of the COVID-19 pandemic will be revised again in December 2022. Based on the situation nationally, in respect of COVID-19 and prevalence at the time of review, the possible scenario will be the withdrawal of the abovementioned codes. The cost of practice related PPE will possibly revert to pre-COVID and inclusive within practice related costs.

Your safety and financial well-being is our priority.

Kind regards,

Medscheme Health

 

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