Dear Valued Subscriber,
According to the 2021 Tariff Schedule, GEMS are paying out 8109 @ R92.10
We understand that this is considerably more than any of the other schemes, and presume that it is an allowance for PPE.
If you are not already doing so, we suggest that you bill accordingly, while you are entitled to.
Coding & Tariffs Bible For Private Dentistry
a. A practitioner shall render a monthly invoice for every procedure which has
been completed irrespective of whether the total treatment plan has been
b. An invoice shall contain the following particulars:
i. The surname and initials of the member;
ii. The first name of the patient;
iii. The name of the scheme;
iv. The membership number of the member;
v. The practice number;
vi. The date on which every service was rendered;
vii. The code number, description and fee/benefit of the
procedure or service;
viii. The name of the dentist rendering the service;
ix. The name of the general dental practitioner/specialist assistant
x. The appropriate ICD-10 code(s) for the procedures performed.
Note: Photocopies of original invoices shall be certified by way of a rubber stamp
or the signature of the dentist.
The expenses incurred for direct materials identified in the Schedule may be
billed in addition to the procedure code. These expenses are limited to the net
acquisition cost of the materials and a handling fee. The price of the materials
should be VAT inclusive. Use Modifier 8025 for handling fee.
The tariff schedules includes procedures and services for use by Oral Healthcare
Providers for purposes of keeping accurate patient records, reporting procedures
on patients, and processing oral healthcare related insurance claims.
The procedures are those performed by general dental practitioners, oral pathologists,
prosthodontists, periodontists, orthodontists, maxillo-facial and oral surgeons and
The procedures codes listed in the dental schedule have, for the convenience in using
the schedule, been divided into categories of services, based on the branches
of clinical dental practice.
The procedures are grouped under the category of service with which the procedures
are most frequently identified and should not be interpreted as excluding certain categories
of Oral Healthcare Providers from performing such procedures.
Individual procedure codes consist of a procedure code, procedure description (nomenclature),
and when necessary, a descriptor, that provides further definition and/or guidelines to clarify
the intended use of the procedure code.
Discovery Health is ostensibly sensitive to the impact of the pandemic on dental practices.
Discovery Health has made the decision to make an earlier review on the annual tariff increase.
The scheme will apply the annual tariff increase for professional fees from 1 October 2020 until 31 December 2021. Prior to 2021.
The Covid-19 implementation for PPE under service code 8109 is only effective until 31 December
2020. Further communication regarding the 2021 rate for service code 8109 will be provided in due
|The Discovery Health Medical Scheme Rates are applicable for services rendered from 01 October 2020.|
|‘Blank’: There is no fixed amount for this code. Discovery Health Medical Scheme will pay the claimed amount subject to the Discovery Health Medical Scheme benefit rules, available funds and benefits.|
|R0.00: Discovery Health Medical Scheme does not pay for this procedure code.|
|Please note: This document should be used for obtaining the Discovery Health Rate only and does not contain billing rules and guidelines. All rates are VAT inclusive and in ZAR.|
|For detailed code descriptions please visit: https://dentaltariffs.co.za|