Momentum Health: Mouthpart Abbreviation Codes
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Medical Aid
GEMS Contracted-in Dentist Note
Good afternoon,
The GEMS Dental Management team monitor monthly claims data of dental service providers who form part of the GEMS Dental Network. This is to ensure that the correct rates are charged for applicable dental procedure codes.
Common procedure codes charged above the GEMS Dental Network contract tariff amounts.
We have noted that most dental providers who use your EDI system charge above the contracted rates for mostly restorative procedure codes on the low benefit options. Kindly note the following for members belonging to Tanzanite One for 2024:
Restorative codes for Tanzanite One members are covered as below:
| Procedure codes | Descriptions | Limitations | How GEMS covers the procedure codes |
| 8367 | Resin restoration, one surface posterior | Any four resin fillings per beneficiary per year (posterior); limited to four restorations overall | Procedure codes covered on the benefit option but at the same rand value as surface amalgam filling. |
| 8368 | Resin restoration, two surfaces posterior | ||
| 8369 | Resin restoration, three surfaces posterior | ||
| 8370 | Resin restoration, four and more surfaces |
Please note the tariff amounts quoted below is from the tariff list for Contracted Dental Practitioners only, please refer to the attached list for the tariff amounts for the other Practice types.
The above procedure codes for Tanzanite One members will therefore pay as per below:
| Procedure codes | Descriptions | Tariff amounts |
| 8341 | Amalgam – one surface | R 354.80 |
| 8342 | Amalgam – two surfaces | R 436.70 |
| 8343 | Amalgam – three surfaces | R 532.70 |
| 8344 | Amalgam – four or more surfaces | R 593.50 |
Instead of the below tariff amounts confirmed in the 2022 tariff schedule.
| Procedure codes | Descriptions | Tariff amounts |
| 8367 | Resin – one surface, posterior | R 422.00 |
| 8368 | Resin – two surfaces, posterior | R 521.90 |
| 8369 | Resin – three surfaces, posterior | R 630.80 |
| 8370 | Resin – four or more surfaces, posterior | R 678.40 |
I have attached the 2024 GEMS Tariff Lists for ease of reference. Please feel free to contact me should you need any additional information.
Kind Regards
GEMS medical aid options and prices
Here is what GEMS has in store for 2024
Context: GEMS was registered medical aid scheme, membership restricted to public servants. It offers a wide range of coverage to suite their member’s needs, from basic to extensive cover. GEMS offers six (6) healthcare Benefit Options, namely: Tanzanite One, Beryl, Ruby, Emerald Value, Emerald and Onyx.
GEMS medical aid options and prices
| Tanzanite One
Entry Level Care-coordinated Network Option In-Hospital benefits within a defined hospital network subject to an annual hospital limit. Out-of-Hospital benefits subject to GEMS Network and FP nomination and Specialist rules From R 1363 pm
|
BerylEntry Level Network Option
In-Hospital benefits subject to an annual hospital limit. Out-of-Hospital benefits subject to GEMS network
From R 1538 pm
|
RubyMid-Level Savings Option
Comprehensive In-Hospital benefits. Out-of-Hospital benefits subject to a Savings account and Block Benefit
From R 3180 pm
|
| Emerald Value
High Level Care-coordinated Network Option Comprehensive In-Hospital benefits within a defined hospital network.Comprehensive Out-of-Hospital benefits subject to GEMS network, FP nomination. Day-to-day Block Benefit
From R 2975 pm
|
Emerald
High Level Benefit Option
Comprehensive In-Hospital benefits Comprehensive Out-of-Hospital benefits subject to Day-to-day Block Benefit and Primary Care Extender Benefit.
From R 3554 pm
|
Onyx
Top Level Benefit Option
Comprehensive In-Hospital benefits Comprehensive Out-of-Hospital benefits subject to a high value Day-to-day Block Benefit
From R 6162 pm
|
gems medical aid options and prices
If you are a dental provider click here for GEMS rates
Dental Coding Abbreviations Copy
Abbreviations used in Dental Coding
DM Direct Material Column +D Add fee/benefit for denture +L Add laboratory fee +M Add material fee MP Mouth Part Column M Maxilla/Mandible Q Quadrant S Sextant T Tooth TC Treatment Category Column A Advanced dentistry B Basic dentistry S Surgery |
GEMS TARIFFS ARE VAT INCLUSIVE Copy
The schedule 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 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.
Dental Practitioner Type Codes
Practice type codes:
54 General Dental Practitioner
62 Specialist Maxillo Facial and Oral Surgeon
64 Specialist Orthodontist
92 Specialist in Oral Medicine and Periodontics
94 Specialist Prosthodontist
98 Specialist Oral Pathologist
95 Dental Therapist