What’s applicable to GEMS Dental Tariffs

Administrative and invoicing rules

Invoices:

a. A practitioner shall render a monthly invoice for every procedure which has
been completed irrespective of whether the total treatment plan has been
concluded.

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
(when applicable);
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.

Cost of direct materials:

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.

For this and more info, refer to our 2021-Dental Tariffs Pack

Issues Around Dental Tariff Codes South Africa

All dental tariffs and rates are VAT inclusive.

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
dental therapists.

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.

For further details and information consult the 2021 Dental Tariffs Pack

What’s the deal with Discovery dental tariffs

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 January 2022.

Tariff code 8109:

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
course.

2023 Dental Tariffs Pack