Counsellors’ costs | | |
C1 | Consultation provided by a counsellor who is a specialist | | |
C2 | Consultation provided by a counsellor | | |
Dentists’ costs | | |
| Examination | | |
DE1 | Dental consultation, including examination | | 46.59 |
DE2 | Periodic oral examination or review | | 29.96 |
DE3 | Extended initial examination (complex cases relating to dental implants, orthodontics, and advanced restorative work), including study models, photographs, and tomography | | 128.64 |
| Radiological examination and interpretation | | |
DX1 | Periapical or bitewing film (each) | | 23.29 |
DX2 | Occlusal (each) | | 23.29 |
DX3 | Panorex | | 60.88 |
DX4 | Other additional images (per treatment episode) | | 9.19 |
DX7 | Acute sedation (IV only) (initial consultation only) | | 160.79 |
| Emergency temporary cover | | |
DT1 | Emergency temporary cover | | 45.11 |
| General oral surgery | | |
| Extractions | | |
DG1 | Extraction of permanent or rooted deciduous tooth (per first tooth) | | 120.32 |
DG2 | Surgical removal of tooth, including insertion and removal of sutures | | 192.95 |
DG4 | Extraction of subsequent permanent or deciduous tooth in the same quadrant arch as for DG1 | | 65.75 |
| Surgery | | |
DG5 | Management of lacerations by suturing (per operative site) | | 125.42 |
DG7 | Incision and drainage abscess cellulitis | | 141.49 |
DG8 | Excision of traumatic mucous cyst | | 167.23 |
DG10 | Splint application or removal (for 3 splint units) | | 96.47 |
DG11 | Cleaning of wound and removal of debris | | 44.10 |
DG14 | Reduction of fractured alveolar process | | 93.92 |
DG15 | Repositioning of displaced tooth (per tooth) or replacing avulsed tooth | | 46.95 |
DG17 | Occlusal adjustment (simple) | | 31.28 |
DG22 | Minor surgical operations not otherwise covered by this schedule | | 134.69 |
DG23 | Provision of bite splints | | 192.95 |
| Restorative | | |
DR1 | Amalgam 1 surface filling (including 2 fillings on the one surface) | | 85.45 |
DR2 | Amalgam 2 surface filling (approximo-occlusal) | | 111.77 |
DR3 | Complex amalgam restoration | | 161.70 |
DR6 | Non-metallic simple fillings (including 2 fillings on the one surface) | | 98.58 |
DR7 | Non-metallic filling (2 or more surfaces per tooth) | | 131.47 |
DR8 | Rebonding tooth fragment or coronal portion | | 88.38 |
DR9 | Complex reconstruction in composite resin (direct) | | 175.54 |
| Prosthodontics | | |
DP1 | Plastic denture (1 tooth—material of choice) | | 492.15 |
DP2 | Each additional tooth (all dentures) | | 22.05 |
DP5 | Metal-framed partial denture (1 tooth) | | 1,127.05 |
DP7 | Transitional denture replacing missing tooth or teeth | | 448.38 |
DP8 | Full upper or lower denture | | 735.04 |
DP11 | Reline or rebase denture | | 230.11 |
DP13 | Repair (all types) | | 75.16 |
DP14 | Addition of tooth to existing denture (includes additional tooth) | | 138.05 |
| Crown and bridge | | |
| Inlay or onlay and veneers | | |
DC3 | Indirect inlay or onlay | | 280.64 |
DC6 | Porcelain veneer | | 826.19 |
DC7 | Composite resin veneer | | 180.08 |
DC8 | Post (wrought or preformed) | | 96.47 |
DC9 | Composite or amalgam core | | 115.78 |
DC11 | Cast post and core (metal or ceramic) | | 221.25 |
| Crowns | | |
DC15 | All ceramic crown | | 976.88 |
DC16 | Porcelain fused to metal crown | | 939.38 |
DC17 | Cast gold crown (full and three-quarters) | | 883.06 |
| Bridges | | |
DC19 | Maryland bridge | | 680.66 |
DC20 | Composite bridge (per unit) | | 225.10 |
DC25 | Re-cementing crown, bridge, veneer, or inlay | | 33.81 |
DC26 | Non-composite bridge (on injured teeth that meet the requirement for a crown) (3 units) | | 2,300.69 |
DC27 | Replacement of non-composite bridge | | 2,752.74 |
| Endodontics | | |
DN1 | Pulpotomy or pulpectomy | | 128.64 |
DN2 | Irrigation and dressing of root canal system | | 130.57 |
DN3 | Complete preparation and obturation of root canal (per canal)—open or closed apex | | 289.43 |
DN5 | Apicectomy and retrograde filling (per canal) | | 281.78 |
DN6 | Removal of root filling (per canal) | | 226.07 |
DN7 | Removal of post, post crown, or crown | | 226.07 |
DN8 | Bleaching, 1 non-vital tooth (per treatment) | | 160.79 |
DN9 | Pulp capping | | 37.57 |
DN10 | Removal of fractured post or instrument | | 226.07 |
DN11 | Repair of perforation | | 226.07 |
DN13 | Negotiation of calcified canal (can be used with item DN3) | | 226.07 |
| Periodontics | | |
DD1 | Gingivectomy | | 107.72 |
DD2 | Crown lengthening (per tooth) | | 225.10 |
DD4 | Subgingival curettage (per tooth) | | 89.88 |
DD7 | Site preparation for dental implant | | 328.73 |
DD8 | Placement of membrane | | 352.20 |
DD9 | Substitute bone material | | 140.87 |
| Dental implants | | |
DM1 | Resilient linings (tooth or teeth) | | 67.63 |
DM2 | Fixture head impressions and copings (per fixture) | | 361.59 |
DM3 | Dental implant crown (per single unit) | | 1,127.07 |
DM4 | Dental stent and guide (per fixture) | | 122.11 |
DM5 | Definitive abutment (per fixture) | | 361.59 |
DM6 | Temporary abutment (per fixture) | | 45.08 |
DM7 | Repairs to abutments (per fixture) | | 78.23 |
| Claimants under 18 years old | | |
DY1 | Dental consultation (including examination) | | 60.65 |
DY14 | Temporary crown | | 112.71 |
DY15 | Temporary bridge | | 112.71 |
DY21 | Surgical decoronation | | 394.48 |
DY22 | Removal of deciduous teeth | | 27.56 |
Hyperbaric oxygen treatment costs | | |
H1 | Neurological assay before recompression | | 89.83 |
H2 | Neurological assay after recompression | | 80.82 |
H3 | In-chamber treatment supervision (per hour) | | 93.91 |
H4 | Out-of-chamber treatment supervision (per hour) | | 46.03 |
Medical practitioners’, nurses’, and nurse practitioners’ costs | | |
| Burn or abrasion | | |
MB1 | Treatment of burn not exceeding 4 cm² | | 31.44 |
MB2 | Treatment of burn at single site exceeding 4 cm² | | 61.91 |
MB3 | Treatment of significant abrasions not exceeding 4 cm² at single site | | 31.45 |
MB4 | Treatment of significant abrasions exceeding 4 cm² at single site | | 61.91 |
MB5 | Significant burns or abrasions (not including fractures) at multiple sites (exceeding 4 cm²): necessary wound cleaning, preparation, and dressing | | 90.21 |
| Dislocation | | |
MD1 | Dislocation of finger or toe with splint or strapping | | 36.43 |
MD2 | Dislocation of thumb: closed reduction and immobilisation | | 102.09 |
MD3 | Dislocation of elbow with radiological confirmation: closed reduction and immobilisation | | 94.55 |
MD4 | Dislocation of shoulder: closed reduction and collar and cuff immobilisation | | 68.11 |
MD5 | Dislocation of patella: closed reduction and cast immobilisation | | 162.05 |
| Fracture | | |
MF1 | Fractured finger or toe (proximal, middle, or distal phalanx): closed reduction and immobilisation | | 36.43 |
MF2 | Fractured finger or toe (proximal, middle, or distal phalanx): requiring local anaesthetic | | 50.37 |
MF3 | Fractured metatarsal: closed reduction (not requiring cast): closed reduction, immobilisation by strapping | | 36.43 |
MF4 | Fractured metacarpal(s) hand: with or without local anaesthetic, immobilisation by strapping | | 50.37 |
MF5 | Fractured carpal bone, including scaphoid: treatment by cast immobilisation, not requiring reduction | | 113.46 |
MF6 | Fractured tarsal or metatarsal bones (excluding calcaneum or talus): treatment by cast immobilisation | | 162.05 |
MF7 | Fractured calcaneum or talus: treatment by cast immobilisation | | 162.05 |
MF8 | Fractured clavicle | | 68.11 |
MF9 | Fractured distal radius and ulna: cast immobilisation not requiring reduction | | 113.46 |
MF10 | Fractured distal radius and ulna requiring closed reduction, involving regional or other form of anaesthesia | | 135.66 |
MF11 | Fractured shaft radius and ulna: treatment by cast immobilisation | | 113.46 |
MF12 | Fractured distal humerus (supracondylar or condylar): treatment by cast immobilisation | | 113.46 |
MF13 | Fractured proximal or shaft humerus: immobilisation by collar and cuff or U-slab | | 68.81 |
MF14 | Fractured shaft tibia or fibula, or both: treatment by cast immobilisation with reduction | | 162.05 |
MF15 | Fractured distal tibia or fibula, or both: treatment by cast immobilisation with reduction | | 162.05 |
MF16 | Fractured fibula (without tibial fracture): immobilisation with soft tissue strapping | | 68.81 |
| Miscellaneous | | |
MM1 | Abscess or haematoma: drainage with incision (with or without local anaesthetic agent) | | 28.38 |
MM2 | Insertion of IV line for administration of IV medications or electrolytes or transfusion (if provided under local or national guideline approved by the Corporation) | | 56.75 |
MM3 | Nail, simple removal | | 22.72 |
MM4 | Nail, removal or wedge resection requiring the use of digital anaesthesia | | 94.55 |
MM5 | Removal of embedded or impacted foreign body from cornea or conjunctiva (with use of topical anaesthetic), or from auditory canal or nasal passages, or from skin or subcutaneous tissue with incision, or from rectum or vagina | | 30.55 |
MM6 | Pinch skin graft | | 70.95 |
MM7 | Dental anaesthetic | | 26.51 |
MM8 | Epistaxis: arrest during episode by nasal cavity packing with or without cautery | | 41.90 |
| Open wound | | |
MW1 | Closure of open wound (or wounds) less than 2 cm: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing | | 33.41 |
MW2 | Closure of open wound (or wounds) of skin and subcutaneous tissue or mucous membrane 2 cm to 7 cm long: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing | | 63.75 |
MW3 | Closure of open wound (or wounds) of skin and subcutaneous tissue or mucous membrane exceeding 7 cm long: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing | | 84.36 |
MW4 | Amputation of digit, including use of anaesthetic, debridement of bone and soft tissue, and closure of wound | | 94.55 |
| Soft tissue injury | | |
MT1 | Simple soft tissue injuries: management of simple sprain of wrist, ankle, knee, elbow, or other soft tissue injury requiring crepe bandage or similar immobilisation not requiring formal strapping | | 14.84 |
MT2 | Soft tissue injury (other than splinting of dislocated or fractured digit), unless specified elsewhere: application of plaster or padded splint or specific strapping within agreed guidelines (includes splinting of Achilles tendon injury and serious ankle sprains) | | 68.81 |
MT3 | Aspiration of inflamed joint, tendon, bursa, or other subcutaneous tissue or space (with or without injection) | | 33.38 |
MT4 | Extensor tendon: primary repair | | 170.20 |
MT5 | Ruptured Achilles tendon: management by plaster immobilisation | | 166.84 |
Radiologists’ costs | | |
| Extremities | | |
RA01 | Sternum | | 59.09 |
RA02 | Sternoclavicular joints | | 67.53 |
RA03 | Clavicle | | 50.65 |
RA04 | Acromio-clavicular joints | | 50.65 |
RA05 | Scapula | | 50.65 |
RA06 | Shoulder | | 54.87 |
RA07 | Humerus | | 54.87 |
RA08 | Elbow joint | | 46.43 |
RA09 | Forearm | | 46.43 |
RA10 | Hand or wrist joint, or both | | 46.43 |
RA11 | Wrist or hand for bone age | | 46.43 |
RA15 | Upper limb (infant) | | 54.87 |
RA21 | Sacroiliac joints | | 54.87 |
RA22 | Pelvis or both hips (1 projection) | | 54.87 |
RA25 | Hip joint (more than 1 projection) | | 59.09 |
RA26 | Femur | | 54.87 |
RA27 | Knee joint | | 50.65 |
RA28 | Knee joint (and intercondylar or axial) | | 59.09 |
RA29 | Tibia and fibula | | 50.65 |
RA30 | Ankle joint | | 54.87 |
RA32 | Foot | | 50.65 |
RA35 | Long legs (hips to ankles), including measurement | | 63.31 |
RA40 | Lower limb (infant) | | 59.09 |
| Head, neck, and spine | | |
RB01 | Cervical spine | | 63.31 |
RB02 | Thoracic spine | | 59.09 |
RB03 | Lumbar spine, including lumbosacral joint | | 59.09 |
RB04 | Sacro-coccygeal spine | | 54.87 |
RB08 | Spine (scoliosis views) | | 63.31 |
RB10 | Skull | | 59.09 |
RB12 | Nasal bones | | 50.65 |
RB13 | Facial bones | | 54.87 |
RB14 | Optic foramina | | 46.43 |
RB16 | Auditory canals (plain films only) | | 59.09 |
RB21 | Nasal sinuses | | 46.43 |
RB22 | Nasopharynx | | 54.87 |
RB23 | Mastoids (bilateral) | | 59.09 |
RB24 | Larynx or trachea, or both | | 50.65 |
RB31 | Upper teeth | | 46.43 |
RB32 | Lower teeth | | 46.43 |
RB33 | Mandible or OPG or lateral cephalogram | | 63.31 |
RB34 | Temporo-mandibular joints | | 63.31 |
RB35 | Salivary gland | | 54.87 |
RB37 | Pharynx | | 54.87 |
| Chest, including breast | | |
RC05 | Thoracic inlet | | 54.87 |
RC06 | Chest (1 view) | | 54.87 |
RC07 | Chest (more than 1 view) | | 54.87 |
RC08 | Chest and thoracic cage | | 67.53 |
RC09 | Chest and both oblique views | | 67.53 |
| Mammography | | |
RC31 | Screening mammogram | | 92.86 |
RC32 | Recall mammogram | | 126.63 |
RC35 | Problem mammogram bilateral | | 185.72 |
RC36 | Problem mammogram unilateral | | 122.40 |
RC40 | Needle localisation | | 249.03 |
RC41 | Galactogram | | 249.03 |
RC45 | Breast aspiration biopsy | | 249.03 |
RC46 | Breast biopsy with stereotaxis | | 249.03 |
| GI, GU, and obstetrics—no contrast modifiers permitted | | |
| Radiology | | |
RD01 | Abdomen (1 projection) | | 54.87 |
RD02 | Abdomen (2 or more projections) | | 54.87 |
RD07 | Pelvimetry (1 view) | | 54.87 |
RD08 | Pelvimetry (2 or more views) | | 54.87 |
| Screening | | |
RD10 | Contrast swallow (oesophagus only) | | 430.53 |
RD11 | Contrast study upper GI tract | | 430.53 |
RD13 | Small bowel meal | | 430.53 |
RD14 | Small bowel enema (enteroclysis) | | 721.76 |
RD15 | Contrast enema | | 430.53 |
RD20 | Dynamic proctogram | | 430.53 |
RD30 | ERCP | | 430.53 |
RD40 | IVP, including plain film and tomography | | 249.03 |
RD44 | Cystogram: retrograde or antegrade | | 430.53 |
RD45 | Urethrogram | | 430.53 |
RD46 | Micturating cysto-urethrogram | | 430.53 |
RD47 | Ascending urethrogram | | 430.53 |
| Special procedures | | |
RS42 | Tube injection | | 249.03 |
RS43 | Dacrocystogram | | 249.03 |
RS44 | Sialogram | | 249.03 |
RS46 | Hysterosalpingogram | | 430.53 |
RS61 | Myelogram cervical | | 430.53 |
RS62 | Myelogram lumbar | | 430.53 |
RS63 | Myelogram multilevel | | 430.53 |
RS70 | Arthrogram | | 249.03 |
RS71 | Arthrogram—upper limb | | 249.03 |
RS73 | Arthrogram—lower limb | | 249.03 |
| Ultrasound | | |
| Abdomen and pelvis | | |
RU01 | US abdomen | | 130.85 |
RU02 | US abdomen and pelvis | | 164.61 |
RU03 | US renal tracts | | 122.40 |
RU04 | US abdominal aorta (without Doppler) | | 122.40 |
RU06 | US pelvis (transabdominal only) | | 122.40 |
| Infants | | |
RU10 | US infant head | | 122.40 |
RU11 | US infant pylorus | | 122.40 |
RU12 | US infant heart | | 232.15 |
RU13 | US infant hips | | 122.40 |
RU19 | US infant miscellaneous | | 122.40 |
| Various | | |
RU20 | US thyroid or neck | | 122.40 |
RU21 | US scrotum and testes | | 122.40 |
RU22 | US breast | | 122.40 |
RU23 | US veins | | 173.05 |
RU24 | US eye | | 122.40 |
RU25 | US chest | | 122.40 |
RU27 | US injection or aspiration | | 244.81 |
RU28 | US additional region | | 88.64 |
RU29 | US miscellaneous | | 122.40 |
| Skeletal | | |
RU30 | US shoulder | | 173.05 |
RU31 | US musculo-skeletal | | 130.85 |
RU32 | US foreign body localisation | | 97.08 |
RU39 | US skeletal miscellaneous | | 130.85 |
| Intracavitary | | |
RU40 | US prostate | | 151.95 |
RU41 | US anus or rectum | | 151.95 |
RU42 | US female pelvis (includes transvaginal and transabdominal, or transvaginal only) | | 151.95 |
RU43 | US trans-oesophageal | | 257.47 |
RU44 | US intraoperative | | 257.47 |
RU49 | US intracavitary (miscellaneous) | | 151.95 |
| Vascular | | |
RU51 | Duplex or Doppler of chest | | 206.82 |
RU56 | Duplex or Doppler of additional limb (arterial or venous) | | 164.61 |
| Pregnancy | | |
RU60 | US routine pregnancy less than 28 weeks | | 130.85 |
RU61 | US problem pregnancy | | 164.61 |
RU62 | US pregnancy exceeding 28 weeks | | 164.61 |
RU64 | US with amniocentesis | | 244.81 |
RU68 | US pregnancy (per extra foetus exceeding 1) | | 63.31 |
| Additional | | |
RX24 | X-ray additional region | | 46.43 |
RX25 | Domiciliary X-ray (in addition) | | 88.64 |
Specialists’ costs | | |
| Repair recent wound | | |
SR1 | Not exceeding 7 cm (superficial) | | 134.73 |
SR2 | Not exceeding 7 cm (deeper tissue) | | 179.63 |
SR3 | Exceeding 7 cm (superficial) | | 224.56 |
SR4 | Exceeding 7 cm (deeper tissue) | | 269.46 |
| Fractures (closed reduction) | | |
SF1 | Phalanges | | 89.83 |
SF2 | Metacarpals (excluding Bennetts) | | 161.68 |
SF3 | Metatarsals | | 125.76 |
SF4 | Bennetts | | 233.53 |
SF5 | Carpal bones | | 116.75 |
SF6 | Colles | | 215.55 |
SF7 | Radius and ulna—shafts | | 260.45 |
SF8 | Radius—head and neck | | 233.53 |
SF9 | Humerus | | 260.45 |
SF10 | Talus—neck | | 242.52 |
SF11 | Calcaneus | | 242.52 |
SF12 | Other tarsals | | 152.72 |
SF13 | Ankle—fracture dislocation, Potts | | 377.23 |
SF14 | Tibia and fibula—shaft | | 431.10 |
SF15 | Tibia and fibula—upper end | | 377.23 |
SF16 | Tibia and fibula—involving joint traction | | 440.07 |
SF17 | Femur, any site (with or without traction) | | 664.64 |
| Haematoma, abscess, or other infection | | |
SH1 | Small—aspiration | | 22.50 |
SH2 | Large—incision and drainage (local anaesthetic) | | 107.22 |
SH3 | Large—incision and drainage (general anaesthetic) | | 116.75 |
| Foreign body, removal of | | |
SB1 | Under local anaesthetic | | 85.38 |
SB2 | Under general anaesthetic | | 188.60 |
SB3 | From cornea or sclera | | 58.42 |
SB4 | From ear (other than by simple syringing) | | 89.83 |
SB5 | From muscle, tendon, or other deep tissue | | 269.46 |
SB6 | From nose (other than by simple probing) | | 107.78 |
SB7 | From throat (additional fee) | | 89.83 |
| Dislocations (closed reduction) | | |
SD1 | Elbow, wrist, thumb, and fingers with strapping or splint | | 179.63 |
SD2 | Shoulder | | 107.78 |
SD3 | Patella | | 152.72 |
SD4 | Hip | | 215.55 |
| Plaster | | |
SP1 | Upper limb—above elbow | | 134.73 |
SP2 | Upper limb—below elbow | | 116.75 |
SP3 | Lower limb—above knee | | 161.68 |
SP4 | Lower limb—below knee | | 134.73 |
| Other | | |
SM1 | Aspiration of joint | | 22.50 |
SM2 | Amputation of all or part of 1 digit | | 197.62 |
SM3 | Extensor tendon (primary repair) | | 314.36 |
SM4 | Nail (simple removal) | | 89.83 |
Specified treatment providers’ costs | | |
TMT | All treatment | | 23.42 |
POD3 | Podiatry: abscess or haematoma: drainage with incision (with or without local anaesthetic agent) | | 28.38 |
POD4 | Podiatry: nail, simple removal | | 22.72 |
POD5 | Podiatry: nail, removal or wedge resection requiring the use of digital anaesthesia | | 94.55 |
XRAY | X-ray services provided by chiropractor (maximum of 2 films per claimant per personal injury) | | 14.37 |