MEDICINE Page 1

Unit Fee
Code Value ZIM USD

CONSULTATIONS AND VISITS

CONSULTATIONS AND VISITS

Medical Specialities - Paediatricians; Physicians; Neurology

90000 Initial consultation at rooms ............................................................ 23.43 18 242.00 80.00

90001 Subsequent consultation at rooms for same illness............................8.60 6 696.00 45.00
90002 Initial consultation at hospital, nursing home or residence...............24.81 19 316.00 90.00
90003 Subsequent consultation at hospital per day .....................................8.60 6 696.00 55.00
90004 Subsequent consultation at hospital or nursing home - maximum per
week............................................................................................. ....60.20 46 870.00 250.00

Dermatologists

90015 Initial consultation at rooms.............................................................14.43 11 235.00 60.00

90016 Subsequent consultation at rooms for same illness............................8.08 6 291.00 33.00
90017 Initial consultation at hospital or nursing home...............................14.43 11 235.00 60.00
90018 Subsequent consultation at hospital per day...................................... 8.08 6 291.00 41.00
90019 Subsequent consultation at hospital or nursing home - maximum per
week..................................................................................................56.56 44 036.00 187.00

Pathologists, Haematologists, Clinical Immunologists

90020 Consultation by specialist pathologist, at rooms, hospital, nursing home

or residence.......................................................................................23.43 18 242.00 25.00
90021 Professional fee. BR..........................................................................8.08 6 291.00 33.00
Note: Only applicable where a specialist pathologist’s additional
Input is required under specific instructions. Not applicable to
Tariff codes 89247,89248 and 892512.
90023 Consultation by a specialist pathologist registered in the sub-specialty
haematology, on referral by a medical practitioner, rooms, initial...23.43 18 242.00 80.00
90024 - subsequent, for same illness ............................................................ 8.60 6 696.00 45.00
90025 Consultation by a specialist pathologist registered in the sub-specialty

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Unit Fee
Code Value ZIM USD

haematology, on referral by a medical practitioner, at hospital, nursing

home or residence, initial..................................................................24.81 19 316.00 90.00
90026 - subsequent........................................................................................6.84 6 696.00 55.00
90027 - maximum per week........................................................................60.20 46 870.00 250.00

Surgery - General surgery; Urology; Vascular; Gynaecology; Obstetrics; Orthopaedics;

Otorhinolaryngology; Plastic and Thoracic Surgery; Ophthalmology; Radiotherapy.

For Maternity Consultation Fees see items 59475 to 59490

90030 Initial consultation at rooms.............................................................12.08 9 405.00 50.00

90031 Subsequent consultation at rooms for same illness ........................... 8.08 6 291.00 30.00
90032 Initial consultation at hospital or residence ..................................... 13.47 10 487.00 60.00
90033 Subsequent consultation at hospital or nursing home ....................... 8.08 6 696.00 35.00
90035 Subsequent consultation at hospital or nursing home - maximum per
week................................................................................................. 56.56 44 036.00 173.00

Neurosurgery

90040 Initial consultation at rooms ............................................................ 17.50 13 6245.00 60.00

90041 Subsequent consultation at rooms for same illness ........................... 8.08 6 291.00 38.00
90042 Initial consultation at hospital or nursing home .............................. 18.97 14 769.00 70.00
90043 Subsequent consultation at hospital or nursing home, per day ......... 8.08 6 291.00 34.00
90044 Subsequent consultation at hospital or nursing home - maximum per
week................................................................................................. 56.56 44 036.00 235.00

Obstetrics - Specialist and General Practice

Note: This section, as a duplication of relevant information and items listed under Maternity Care and
Delivery in the Female Genital Section of the Schedule, is included here for the convenience of
practitioners.

Medical aid awards for normal follow-up ante-natal and post-natal care, normal vaginal delivery
and "on call" delivery (i.e. 59438, 59439, 59477, 59479, 59489 and 59490) shall be 70% of the fee

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Unit Fee
Code Value ZIM USD

applicable. Shortfalls arising from medical aid "grant-in-aid" awards may be collected from the
patient by the practitioner.
This "grant-in-aid" principle does not apply to initial specialist or general practitioner ante-natal
consultations either in rooms, home or hospital (i.e. 59475, 59476 and 59478).

All fees to be charged on a fee-for-service basis, up to any stipulated maximum. All delivery fees
listed (i.e. item 59438, 59439, 59440, 59441, 59444, 59445 and 59446) are inclusive of routine
attendance by the practitioner during the period of labour.

Where normal conditions unrelated to the pregnancy and requiring consultations or hospital visits
arise during ante-natal and post-natal care, these should be charged under the Medical Section of
the Tariff and not as obstetrics.

Where abnormal conditions associated with the pregnancy but requiring consultations or hospital
visits in excess of those relevant to normal obstetric care arise during the ante-natal and post-natal
care, these may be charged under the Medical Section of the Tariff and not as obstetrics, but shall
be by report (BR.).

Should the patient transfer from one practitioner to another during normal confinement, and the laid
down maximum fee be exceeded, the practitioner may charge on a fee-for-service basis, which
shall be for the patient's account.

59475 Initial ante-natal consultation by specialist obstetrician at rooms..... 12.08(m) 9 405.00 50.00
59476 Initial ante-natal consultation by specialist obstetrician at hospital ...13.47(m) 10 487.00 30.00
59477 Subsequent ante-natal consultation by specialist obstetrician at rooms
or hospital, per consultation to a maximum of nine consultations.......8.08(m) 6 291.00 25.00
59478 Initial ante-natal consultation by general practitioner........................13.26(m) 7 382.00 20.00
59479 Subsequent ante-natal consultation by general practitioner, per
consultation, to a maximum of nine consultations.............................11.27(m) 6 274.00 15.00
59483 Where the full obstetrical care is undertaken by a specialist obstetrician
resulting in a normal delivery without complications, post-natal care
may not be charged by the referring practitioner. Where the infant is
referred back to a general practitioner for a post-natal consultation the
maximum charge shall be...................................................................13.26(m) 7 382.00 13.00
59484 Post-natal assessment of infant (independent procedure) where total
obstetrical care is undertaken and the infant is not referred to
another practitioner for post-natal consultation. Maximum charge...13.26(m) 7 382.00 13.00
59489 Post-natal consultation by specialist obstetrician at hospital or rooms,

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Unit Fee
Code Value ZIM USD

per consultations to a maximum of five consultations..........................8.08(m) 6 291.00 40.00

59490 Post-natal consultation by general practitioner, per consultation, to a

maximum of five consultations........................................................11.27(m) 6 274.00 15.00

GENERAL PRACTICE

The general practitioner initial consultation fee is 70% of the average of the fees for a physician’s initial and
two subsequent consultations. The general practitioner subsequent consultation fee is 85% of the general
practitioner initial consultation fee.

Office and Hospital Visits

The fees and medical aid awards for hospital visits shall be as listed.

For Psychiatric consultations and therapy see under Psychiatric Services.

For Maternity Consultation Fees See Items 59478 to 59490.

90050 Initial consultation at rooms.............................................................13.26 7 382.00 25.00

90051 Subsequent consultation at rooms for same illness .........................11.27 6 274.00 18.00
90052 Subsequent consultation at hospital or nursing home per day……..11.27 6 274.00 18.00
90053 Subsequent consultation at hospital or nursing .. home - maximum per
week..................................................................................................78.89 43 918.00 61.00
90054 Routine visit to nursing homes for the aged .- maximum of 1 per week
- first patient.....................................................................................16.49 9 180.00 30.00
90055 - each additional patient...................................................................11.27 6 274.00 15.00
90056 Emergency visits to hospital - as per the appropriate home visiting
fee for the first patient plus appropriate consultation room fee for each
additional patient...................................................................................... 0
90057 Initial consultation at hospital or nursing home................................13.26 7 382.00
90058 Where a practitioner has to especially open his rooms outside of his
normal consulting hours to consult with a specific patient on an
emergency basis, then such consultation fee is chargeable in
accordance with the appropriate home visits fee......................................... 0
90059 If having opened his rooms in accordance with the provisions under tariff
90058, he consults with other patients (on an emergency or routine basis),
then consultation fees in respect of such other patients are only chargeable

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Unit Fee
Code Value ZIM USD

in accordance with tariffs 90050 or 90051 as appropriate............................ 0

Note: When a patient is seen and treated in accordance with tariffs

90057 and 90059 and additional fee equal to the difference between that
fee and the appropriate fee otherwise chargeable under tariff 90058 may
be raised on a cash basis, but is not refundable by medical aid and the
patient/member to be advised accordingly.

Home Visits: Visits to the patient’s home or place of residence. For appropriate situations only.

The full fee for a home visit by a general practitioner shall be as presented under tariff codes 90060 to 90068.
The medical aid award for a home visit by a general practitioner shall be the full fee, as presented under tariff
codes 90060 to 90068, less the cash co-payment specified under “Office Visits”, the amount of which shall be
subject to independent agreement between ZiMA and NAMAS and subsequent amendment from time to time,
and is not refundable by medical aid societies. The patient/member to be so advised.

The full fee charged, namely that part payable by medical aid societies and the part payable by the
patient/member must be stated on the medical claim form. Any practitioner who does not charge the full fee
shall be deemed to have opted out.

90060 Weekday visits (between 7 am and 5 pm)..........................................18.99 10 575.00 40.00

90061 Weekend of holiday visit - weekend: a call received and a visit made
between Saturday 1 pm and 5 pm and Sunday am and 5 pm
- holiday: a call received and a visit made between 7 am and 6 pm..27.15 15 114.00 46.00
90062 Night visits........................................................................................ 29.88 16 634.00 52.00
90064 In the case of a home visit - where more than one patient is treated in the
same household, the fee shall be as listed in 90060, 90061, and 90062
for the first patient plus appropriate consultation room fee for each additional
patient. 11.00
90065 Subsequent visits - maximum per week.............................................79.89 43 918.00 61.00
90067 Routine visits for chronic disabling illness
- first three months - maximum per week...........................................57.66 32 099.00 210.00
90068 - thereafter, two routine visits per week - maximum per week.......... 22.54 12 548.00 126.00

SPECIFIC THERAPEUTIC PROCEDURES

90070 Injection (independent procedure) not requiring consultation.............2.40 672.00 5.00

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Unit Fee
Code Value ZIM USD

90071 Injection given during consultation ........................................................ 0

90072 Injection given by Registered General, Enrolled . or Certified Nurse (if
not immediately subsequent to a consultation)...................................1.19 333.00 3.00
90073 Dressing complex, requiring probing, irrigation, plugging or
debridement or a combination thereof and necessitating the medical
practitioner's personal skill. Per day to a maximum of seven days...2.38 666.00 5.00
(For materials used see 96932)
(For General Rules see 01073)
90075 Dressing - simple .................................................................................... 0
90076 Mantoux or Heaf test - to be included in consultation fee ..................... 0
90077 Urine chemical - by reagent stick, strip, tablet or similar....................... 100%

For use in ante-natal care only, to a maximum

of 7 tests in any one ante-natal period. 3.00
90078 Venepuncture or heel prick for pathological investigations...............0.66 185.00 3.00
90080 Urine culture, microstix......................................................................1.70 476.00 3.00
90081 Urine, pregnancy test..........................................................................1.75 490.00 3.00
90083 Blood glucose test...............................................................................4.76
Note: No charge for “finger prick” sampling
90084 Venepuncture, barrier conditions.......................................................0.69 193.00 3.00

PSYCHIATRIC SERVICES

All fees listed in this section are applicable to specialist psychiatrists.

Fees and awards for psychiatric services, including consultations and therapy, carried out by a medical
practitioner who is not a specialist psychiatrist shall be 70% of the listed value - add modifier 62.
Awards for psychiatric services, including consultation and therapy, but excluding convulsive therapy (tariffs
90836 and 90838) shall be to a maximum of 390, 41 units ($6 423 600.00) in any one year.

90790 Initial consultation at rooms...........................................................23.47 18 242.00 65.00

90791 Subsequent consultation at rooms for same illness..........................8.60 6 696.00 38.00
90792 Initial consultation at hospital, nursing home or residence............ 24.81 19 316.00 75.00
90793 Subsequent consultation at hospital, per day....................................6.84 5 325.00 38.00
90794 Subsequent consultation at hospital or nursing home - maximum per
week................................................................................................47.88 44 036.00 215.00

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Unit Fee
Code Value ZIM USD

Psychotherapy

Adult or child (verbal and/or play therapy, with or without drug management)

Not to be charged when a consultation fee is raised.

90803 Individual therapy, 25 to a maximum of 50

minutes office...................................................................................16.00 4 481.00 45.00
90804 - hospital or other facility.................................................................17.00 4 761.00 49.00
90806 - 15 - 25 minutes, office.....................................................................9.70 2 716.00 31.00
90807 - hospital or other facility...................................................................9.70 2 716.00 31.00
90811 - up to 15 minutes, office...................................................................6.40 1 792.00 21.00
90812 - hospital or other facility...................................................................7.30 2 044.00 24.00
90815 Group therapy (maximum 8 persons per group),
per person per session 45 - 50 minutes office....................................4.00 1 120.00 13.00
90816 - hospital or other facility...................................................................4.00 1 120.00 13.00
90817 - 90 minutes, office.............................................................................6.40 1 792.00 21.00
90818 - hospital or other facility...................................................................6.40 1 792.00 21.00
90836 Convulsive therapy - up to 35 treatments in one year, in-patient.....14.00 3 921.00 45.00
90838 - outpatient - up to 35 treatments in one year...................................14.00 3 921.00 45.00
90841 Psychologic testing, with written report given by or under supervision
of psychiatrist, per hour; psychometric test [identify test(s) used]..18.50 5 181.00 59.00
90842 - projective tests [identify test(s) used]............................................18.50 5 181.00 59.00
90875 Hypnotherapy 25 - 50 minutes.........................................................16.00 4 481.00 51.00
90876 - 15 - 25 minutes................................................................................9.70 2 716.00 31.00
90877 - up to 15 minutes..............................................................................6.40 1 792.00 31.00

DIALYSIS

The following descriptions apply only when these services are under the direct supervision of a physician and
reflect only the professional component. Supplies, materials, and services of other personnel should be
identified separately.
If haemodialysis for acute renal failure exceeds six weeks, a further report may be required.
Detention time may be allowed in addition for highly complicated or unusual or extended haemodialysis if
substantiated by report. If other significant, identifiable services are provided in addition to the appropriate
haemodialysis procedure, list the appropriate visit for that service.

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Unit Fee
Code Value ZIM USD

Peritoneal Dialysis

90955 Cannula insertion for peritoneal dialysis, including removal...........15.00 4 201.00 9.00
90958 - with limited omentectomy..............................................................44.00 12 322.00 26.00
90961 Tenchkoff shunt................................................................................55.99 15 679.00 33.00
90962 Removal of cannula or shunt, simple.................................................3.79 1 061.00 220.00
90963 Renal failure, institution of treatment programme, per dialysis.....120.00 33 605.00 72.00
90964 Removal of cannula or shunt in an operating theatre and G.A........28.70 8 037.00 17.00

Haemodialysis

Each of the following code numbers (90970 and 90981) is for a single therapeutic haemodialysis treatment.

90970 Acute renal failure and/or intoxication, initial haemodialysis.......220.30 61 693.00 132.00
90971 - second haemodialysis..................................................................135.80 38 030.00 81.00
90972 - third haemodialysis.....................................................................135.80 38 030.00 81.00
90973 - fourth haemodialysis through end of second week per treatment.67.85 19 001.00 40.00
90974 third through end of sixth week, per treatment...............................33.33 9 334.00 20.00
90980 Chronic renal failure, initial stabilisation through sixth treatment,
per treatment.................................................................................135.80 30 030.00 81.00
90981 - seventh stabilisation through end of first month of chronic
haemodialysis therapy, per treatment............................................51.19 14 335.00 30.00
90982 Haemodialysis in hospital by trained nursing staff under supervision
of a physician.................................................................................31.06 8 698.00 18.00

GASTROENTEROLOGY

91055 Gastric intubation by physician, washings, and preparing slides for

cytology (independent procedure).................................................12.00 3 360.00 7.00
(Naso-gastric intubation during an anaesthetic ................ is considered
an incidental procedure and an additional charge is not to be made)
91056 Gastric snip ring biopsy...................................................................3.60 1 008.00 2.00
91100 Insertion of Sengstaken tube for intestinal bleeding......................20.70 5 797.00 12.00
91110 Rectal biopsy with suction biopsy capsule.....................................16.00 4 481.00 9.00
91112 Anus, snip ring biopsy......................................................................3.60 1 008.00 2.00

SPECIFIC OPHTHALMOLOGICAL SERVICES

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Unit Fee
Code Value ZIM USD

92015 Determination of refractive state of eyes by general practitioner.

Comprehensive including consultation...........................................13.57 7 382.00 20.00
92020 Gonioscopy, in select cases only........................................................7.00 1 960.00 10.00
92021 Peripheral fundus examination with indirect ophthalmoscope. Only
applicable to initial consultation........................................................7.00 1 960.00 10.00
92022 Tonometry, per test to a maximum of two tests in any one year. Only
applicable to initial consultation and glucoma follow-up.................7.00 1 960.00 10.00
92023 Keratometry, per test to a maximum of two tests per year................7.00 1 960.00 10.00
92024 Charting of visual field, Bjerum Screen or automaric recording
perimeter, per test to a maximum of two tests per year....................7.00 1 960.00 10.00

Note: Any of the above procedures that are required to be undertaken in excess of the maximum
given shall be “by report” (B.R.)

SPECIAL OTORHINOLARYNGOLOGICAL SERVICES

92533 Labyrinthine caloric test...................................................................9.60 935.00 10.00

92535 Brain stem auditory evoked response, single bilateral run.............18.95 5 307.00 20.00
92536 - each additional bilateral run to a maximum of three, add ............. 9.97 2 792.00 10.00

Audiology Function Tests

The audiometric tests listed below imply the use of calibrated electronic equipment.
All descriptions refer to testing both ears.
92551 Screening test, pure tone, air only . ................................................34.48 9 656.00 20.00
92552 Pure tone audiometry (threshold); air only.....................................34.48 9 656.00 20.00
92553 - air and bone..................................................................................43.20 12 098.00 26.00
92555 Speech audiometry; threshold only................................................21.80 6 105.00 15.00
92556 - threshold and discrimination........................................................43.20 12 098.00 26.00
92557 Basic comprehensive audiometry (92553 and 92556 combined), (pure
tone, air and bone, and speech, threshold and discrimination). .....86.80 24 308.00 52.00
92560 Bekesy audiometry; screening........................................................32.50 9 101.00 20.00
92561 - diagnostic.....................................................................................65.00 18 203.00 40.00
92562 Loudness balance test, alternate binaural or monaural ..................13.01 3 643.00 7.00
92563 Tone decay test...............................................................................13.08 3 663.00 7.00
92564 Short increment sensitivity index (SISI).........................................13.01 3 643.00 7.00
92565 Stengers test, pure tone...................................................................19.42 5 438.00 11.00
92567 Tympanometry (impedance testing)...............................................38.84 10 877.00 23.00

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Unit Fee
Code Value ZIM USD

92568 Acoustic reflex testing....................................................................27.35 7 659.00 16.00

92569 Acoustic reflex delay test................................................................27.35 7 659.00 16.00
92577 Stenger test, speech........................................................................38.84 10 877.00 23.00
92582 Conditioning play audiometry........................................................19.42 5 438.00 11.00
92584 Electrocochleography......................................................................86.80 24 308.00 60.00
92585 Brainstem evoked response recording (evoked response (EEG)
audiometry).....................................................................................86.80 24 308.00 60.00

Other Procedures

92599 Unlisted otorhinolaryngological service or procedure ........................... BR.

Vestibular Function Test

92611 Electronystagmorgraph with caloric test.........................................64.30 18 007.00 38.00

CARDIOVASCULAR

For therapeutic services, see 96000 - 96020

Values for items 93000 - 93562 include laboratory procedure interpretation and physician's services (except
surgical and anaesthesia services as listed in section on Surgery), unless otherwise stated.

93000 Electrocardiogram with interpretation and report (resting)...............8.33 2 333.00 27.00

93005 - tracing only, without interpretation and report...............................4.76 1 333.00 15.00
93010 - interpretation and report only..........................................................5.95 1 666.00 19.00
93015 Electrocardiogram with multi-stage treadmill test including
monitoring, interpretation and report..............................................30.00 8 401.00 97.00
93017 - monitoring and tracing only, without interpretation and report...,22.00 6 161.00 71.00
93018 - interpretation and report only..........................................................8.00 2 240.00 26.00
93019 - monitoring, tracing, interpretation and report by physician with use
of hospital equipment.....................................................................14.00 3 921.00 45.00

93021 Electrocardiogram with resting and limited exercise test, such as

step test...........................................................................................14.85 4 159.00 48.00
93022 - tracing only without interpretation and report...............................7.04 9 971.00 23.00
93023 - interpretation and report only.........................................................8.33 2 333.00 27.00
93024 Electrocardiogram, tracing and interpretation of report by physician

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Unit Fee
Code Value ZIM USD

with use of hospital equipment.........................................................8.33 2 333.00 27.00

This also applies to private practice where the specialist undertakes tracing and the practitioner
or radiologist merely provides the use of the equipment - fee to be shared on a 50 - 50% basis.

93025 Provision of electrocardiogram equipment and material by hospital

(only) where tracing is undertaken by physician personally...........2.40 672.00 8.00
93201 Phono cardiogram with ECG lead, with supervision during recording
with interpretation and report (When equipment is supplied by the
physician)......................................................................................12.50 3 501.00 41.00
93270 Electrocardiogram monitoring utilising a system such as magnetic tape,
for up to 12 hours, includes recording, scanning analysis, interpretation
and report.......................................................................................37.11 10 392.00 120.00
93274 - 12 through 24 hours recording....................................................51.76 14 495.00 168.00
93278 - 24 through 72 hours recording ....................................................62.35 17 461.00 202.00

CARDIAC CATHETERIZATIONS

Listed values are for the physician’s services only and include usual pre-assessment of cardiac problem.
Consultation services are separate and may be performed by the same or different individual doing the
catheterization. (For consultation services see 90000 - 90004).

Cardiac catheterization procedure includes placement of catheter(s), recording of intra-cardiac and intra-
vascular pressure, obtaining blood samples for measurement of blood gases and/or dye (or other) dilution
curves and cardiac output measurements (dye/dilution, Fick or other method with or without rest and exercise
and/or other studies) with or without electrode catheter placement, final evaluation and report.

93501 Right heart catheterization only...................................................107.30 30 048.00 51.00

93502 - His bundle recording only...........................................................71.43 20 003.00 34.00
93503 - placement of flow directed catheter (with or without balloon tip)
only, when placed for monitoring purposes or angiography..........57.14 16 002.00 27.00
93505 Endocardial biopsy.........................................................................98.80 27 668.00 47.00
93510 Left heart catheterization, retrograde, from the brachial artery,
axillary artery or femoral artery percutaneous...............................98.80 27 336.00 47.00
93511 - by cutdown.................................................................................113.09 31 670.00 54.00
93514 - by left ventricular puncture........................................................113.09 31 670.00 54.00
93515 - by trans-septal venous catheterization.......................................113.09 31 670.00 54.00
93524 Combined trans-septal and retrograde left heart catheterization.141.66 39 671.00 68.00

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Unit Fee
Code Value ZIM USD

93526 Combined right heart catheterization and retrograde left heart

catheterization.............................................................................198.80 55 672.00 95.00
93527 Combined right heart catheterization and trans-
septal left heart catheterization (with or without retrograde left
heart catheterization).....................................................................213.09 59 674.00 102.00
93528 Combined right heart catheterization with left ventricular puncture
(with or without retrograde left heart catheterization)..................213.09 59 674.00 102.00

Injection procedures performed in conjunction with cardiac catheterization

These include placement or repositioning of catheters and use of automatic power injectors. The technical
details of angiography, supervision of filming and processing, interpretation and report are not included. For
radiological services, see appropriate section.

93541 Injection procedure during cardiac catheterization for pulmonary

angiography....................................................................................42.85 12 000.00 20.00
93542 for selective right ventricular or right atrial angiography...............42.85 12 000.00 20.00
93543 - for selective left ventricular or left atrial angiography.................57.14 16 002.00 27.00
93544 - for aortography.............................................................................71.43 20 003.00 34.00
93545 - for selective coronary angiography (injection of radio-opaque
material may be by hand)...............................................................84.52 23 669.00 40.00
93546 Combined left heart catheterization and left ventricular...............127.38 35 672.00 61.00
angiography.
93547 Combined left heart catheterization, selective coronary angiography,
and selective left ventricular angiography (this code number is to be
used when procedure 93510 is combined with procedures 93543 and
93545)...........................................................................................198.80 55 672.00 95.00
93548 Combined left heart catheterization, selective coronary angiography,
selective left ventriculography and aortic root aortography.........226.19 63 342.00 108.00
93549 Combined right and left heart catheterization selective coronary
angiography and selective left ventricular angiography (this code
number is to be used when procedure 93547 is combined with right
heart catheterization).....................................................................283.33 79 344.00 136.00
93561 Indicator dilution studies such as dye or thermal dilution, including
arterial and venous catheterization, with cardiac output measurement
(independent procedure).................................................................84.52 23 699.00 40.00
93562 - subsequent measurement of cardiac output.................................20.23 5 665.00 10.00

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Unit Fee
Code Value ZIM USD

INTENSIVE CARE

Intensive Care is regarded as the critical care of an acutely ill patient and not the intensive care of a chronically
ill patient.
The fee and award will be for the actual total time spent with the patient within the appropriate period.

Only one practitioner may charge and be awarded for any one field of management which, except in
emergency where the relevant Specialist cannot be called, shall be within his particular Speciality.

No additional charge may be raised for the first 45 minutes in the Unit, this period being covered by the
relevant consultation or prior anaesthetic or surgical fee.

Where the attending practitioner is a Specialist Anaesthetist, the initial consultation fee shall be as for a
Specialist Physician (i.e. 90002) and be identified by adding modifier 16.

Thereafter, for any additional time spent with the patient the following tariff shall apply, with any fees raised
under 93573, 93574 and 93576 being “By Report”.

93570 First day - for each additional total 15 minutes actual Intensive Care attendance
with the patient to maximum of one hour, add..............................11.91 3 335.00 200.00
93571 - for each additional total 15 minutes actual attendance with the patient to a
maximum of two hours, add............................................................5.96 1 669.00 20.00
93572 Second and third days - for each additional total 15 minutes actual attendance
with the patient to a maximum of three hours per day, add............5.96 1 669.00 150.00
93573 Fourth to seventh days - for each additional total 15 minutes actual attendance
with the patient to a maximum of two hours per day, add (B.R.)...5.96 1 669.00 20.00
93574 Over seven days ...................................................................................... BR.
93575 Re-admission to Unit - for each additional total 15 minutes actual attendance
with the patient to a maximum of two hours per day for five...........5.96 1 669.00 20.00
days, add
93576 - over five days ....................................................................................... BR.

PARENTERAL NUTRITION

The fee and medical aid award for parenteral nutrition shall be on a strictly controlled basis and shall only
apply where it can be certified that the patient's condition is believed to be potentially reversible, and not
where an irreversible situation exists.

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Unit Fee
Code Value ZIM USD

All consultations and treatment administered shall be in a hospital environment and only one practitioner may
charge and be awarded, except in an emergency where the relevant specialist cannot be contacted and another
specialist is called.

Where a drug scheme exists and prior arrangements have been made with the medical aid scheme concerned a
percentage of drug material costs may be awarded to a predetermined maximum, provided that the drugs and
materials are prescribed and their administration is supervised by the attending specialist and the claims in
question give full details of all nutritional drugs and materials actually used.

Any fees for consultations in excess of the periods and maximum provided for, and drug costs in excess of
those agreed to by prior arrangement, shall only be considered for medical aid award where there has been
prior consultation and agreement between the attending specialist and an appropriate colleague of specialist
status and where prior representation and such additional arrangements have been made to and with the
Society concerned.

Where any drug and potential additional costs are rejected by a Society they may, following consultation and
with the member's expressed approval, be to the member's expense.

93580 Consultation, initial three days, per visit to a maximum of two visits
per day..............................................................................................6.37 1 784.00 20.00
93581 - subsequent, per day to a maximum of one visit per day for seven
days where no surgery is undertaken................................................6.37 1 784.00 20.00
93582 - subsequent, pre-operative, per day to a maximum one visit per day
for four days.....................................................................................6.37 1 784.00 20.00
93583 - subsequent, post-operative in the absence of irreversible disease,
per day to a maximum of one visit per day for seven days..............6.37 1 784.00 20.00

For insertion of Hickman line see 36491.

HEAD INJURIES

Appropriate initial consultation fee for first hour.

93590 - for the first forty-eight hours thereafter, per quarter of an hour.....5.95 1 666.00 19.00
93591 - fee for service basis thereafter.............................................................. F.F.S

PULMONARY

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Unit Fee
Code Value ZIM USD

Value for item 94001 includes laboratory procedures, interpretation and physician’s services (except surgical
and anaesthesia services as listed in the section on Surgery), unless otherwise stated.

Volume Flow Studies

94000 Peak flow - maximum per day.........................................................2.39 669.00 1.00

94001 Vital capacity, with expiratory flow determination and/or flow volume
loop with interpretation and report (Spirogram)............................10.00 2 800.00 5.00
94002 - tracing only, without interpretation and report..............................6.02 1 686.00 3.00
94003 - interpretation and report only........................................................3.99 1 117.00 15.00
94010 Pulmonary function test with vitallometer.....................................23.80 6 665.00 28.00
94011 Forced expiratory volumes (F.E.V.O.5.F.E.V.I.O, etc)...................4.76 1 333.00 6.00
94012 Gas distribution. Closed circuit method (lung clearance method or
single breath oxygen curve)...........................................................10.70 2 996.00 13.00
94013 Lung volumes. Closed circuit method or body plythyssograph.....23.80 6 665.00 28.00
94014 Air-way resistance and conductance using body plythyssograph 23.80 6 665.00 28.00
94015 Compliance and resistance using oesophageal balloon..................23.80 6 665.00 28.00
94016 Exercise testing with a combination of the following measurements;
pulse, oxygen uptake, ventilation, respiratory quotient, blood
gases, compliance and resistance ...................................................23.80 6 665.00 28.00
94017 For complete pulmonary function battery, including the above.....88.00 24 644.00 52.00
94019 Diffusion tests or equivalents.........................................................23.80 6 665.00 28.00
94020 When using hospital equipment a 25% reduction will be granted on
the above pulmonary function test.

ALLERGY TESTING

The following values are based on allergy testing performed under the direct supervision of a Physician, and
must include Physician's observation and interpretation of their significance in relation to the history and
physical examination. Listed values may be added to other significant services rendered at the same visit.
Items 95005 - 95050 inclusive, carry follow-up days of 7.

95005 Scratch or puncture test, unit charge per test...................................0.45 126.00

95006 - minimum unit charge...................................................................23.80 6 665.00 14.00
95019 Intradermal test, unit charge per test................................................0.70 196.00 28.00
95021 - minimum unit charge...................................................................17.85 4 999.00 11.00
95039 Patch test, unit charge per test..........................................................0.70 196.00 20.00

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Unit Fee
Code Value ZIM USD

95041 - minimum unit charge...................................................................17.85 4 999.00 11.00

95045 Prick test, unit charge per test..........................................................0.45 126.00 0.00
95046 - minimum unit charge...................................................................23.80 6 665.00 14.00
95047 Punch biopsy....................................................................................3.60 1 008.00 29.00
95050 Bilharzia skin test.............................................................................2.40 672.00 1.00

NEUROLOGY AND NEUROMUSCULAR

95819 Electro-encephalogram (EEG), standard or

portable same facility.....................................................................20.00 5 601.00 14.00
95821 - portable, to an alternate facility...................................................30.00 8 401.00 18.00
95822 - sleep.............................................................................................30.00 8 401.00 18.00
95823 - physical or pharmacological, activation ......................................30.00 8 401.00 18.00
95824 - cerebral death evaluation recording.............................................30.00 8 401.00 18.00
95826 - intra-cerebral (depth) EEG...........................................................30.00 8 401.00 18.00
95828 - extended monitoring, greater than 1 hour....................................56.87 15 926.00 34.00
95829 - extended monitoring, 8 hours continuous....................................87.74 24 571.00 52.00
95831 - sphenoidal recording, including insertion of electrode................30.00 8 401.00 18.00
95833 - interpretation of record................................................................20.00 5 601.00 12.00
95836 Polysomnography; overnight cleep staging (digital) including interpretation
of record.........................................................................................95.50 26 744.00 57.00
95837 Multiple sleep latency testing, including recording, analysis and inter-
pretation of record..........................................................................80.66 22 588.00 48.00
95842 Nerve conduction studies...............................................................16.78 4 699.00 10.00
95845 Somatosensory evoked potentials..................................................30.96 8 670.00 19.00
95848 Visual evoked potentials; unilateral...............................................32.27 9 037.00 11.00
95849 - bilateral........................................................................................56.79 15 904.00 19.00
95851 Auditory evoked potentials and/or testing of the central nervous
system.............................................................................................25.81 7 228.00 15.00
95860 Electromyography, one extremity and related
paraspinal areas..............................................................................20.00 5 601.00 12.00
95861 - two extremities and related paraspinal areas...............................36.00 10 081.00 22.00
95863 - three extremities and related paraspinal
areas...............................................................................................44.00 12 322.00 26.00
95864 - four extremities and related paraspinal
areas.............................................................................................52.00 14 562.00 31.00
95867 Cranial nerve supplied muscles, unilateral.............................................. BR 0.00
95868 - bilateral................................................................................................. BR 0.00

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Unit Fee
Code Value ZIM USD

95869 - limited study of specific muscles, eg. external anal sphincter,

thoracic spinal muscles, etc..................................................................... BR 0.00
95870 - interpretation of record.................................................................20.00 5 601.00 12.00
95880 Tensilon test for Myasthenia Gravis.................................................5.14 1 439.00 3.00

SPECIFIC THERAPEUTIC PROCEDURES

Cardiology

For diagnostic services, see 93000 - 93562

For pericardiocentesis, see 33010
For thoracentesis, see 32000
For phlebotomy, therapeutic see 96450
For insertion or replacement of permanent transvenous electrode and pacemaker, see 33200
For venipuncture see 36410.

96000 Cardio-pulmonary resuscitation, e.g. cardiac arrest.......................88.10 24 672.00 200.00

96010 Nebulisation 15-30 minutes 5.00
96011 Nebulisation 30-45 minutes 10.00
96012 Nebulisation 45-60 minutes 15.00
96020 Electrical conversion of arrhythmia, external (independent, elective
or semi-elective procedure)............................................................34.00 9 521.00 20.00
96021 Chemical conversion of arrhythmia requiring intravenous bolus of
anti-arrhythmia agent (to a maximum of three) per bolus...............5.95 1 666.00 4.00

Cancer Chemotherapy

96030 Therapy prepared and administered parenterally by the medical

practitioner. Per day to a maximum of six days per week.
Including venepuncture and not applicable to an intensive care
situation. Appropriate consultation fee plus...................................5.30 1 484.00 3.00

For intro-arterial chemotherapy requiring arterial catheterization, see 36100 - 36299, and 36000.

For monitoring of an intra-arterial chemotherapy, drip or forced infusion, per hour or part of additional hour,
see 36620 - 36625.

96055 Injection of intrathecal chemotherapeutic agent, administered by

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Unit Fee
Code Value ZIM USD

physician........................................................................................14.28 3 999.00 7.00

For thoracentesis, see 32000

For paracentesis, see 62289.

96090 Gastric lavage, therapeutic - detention time plus .................................... F.F.S

Miscellaneous

96100 Desensitisation injection..................................................................2.00 560.00 1.00

96250 Hypothermia, regional....................................................................50.00 14 002.00 24.00
96450 Phlebotomy, therapeutic (independent procedure)...........................6.00 1 680.00 3.00
96451 Bone marrow - aspiration...............................................................12.00 3 360.00 6.00
96452 Radioscopy of chest..........................................................................8.72 2 442.00 4.00
96460 Morphine saturation test - morphine injection (plus intravenous
infusion as per item 36410)..............................................................5.96 1 669.00 3.00
96461 For each 15 minutes in attendance up to a maximum of 45 minutes5.96 1 669.00 3.00
96462 Pentothal saturation test - pentothal injection (plus intravenous
infusion as per item 36410)...............................................................5.96 1 669.00 3.00
96463 For each 15 minutes in attendance up to a maximum of 30 minutes5.96 1 669.00 3.00
96465 Cost of material, excluding local anaesthetic (see 96470), for minor
procedures under local anaesthetic undertaken in rooms..................3.13 100%
Note: Invoices to be attached.
96470 Local anaesthetic, including anaesthetic agent..................................1.33 877.00 3.00
96475 Venesection pack for therapeutic phlebotomy........................................ 100%

96480 Abstract from clinical records or report supplied at the request of

a medical aid society and with the patient's prior agreement.
Not applicable to BR items..............................................................9.57 2 680.00 5.00

Special Dermatological Procedures

List in addition to office visit.

96900 Actinotherapy (Ultraviolet light), local............................................4.80 1 344.00 2.00

96905 - general..........................................................................................10.80 3 024.00 5.00
96906 - to part or whole of body, administered by a trained nurse.............3.60 1 008.00 2.00
Dressings

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Unit Fee
Code Value ZIM USD

Only applicable to the consulting room situation and where the materials
used are supplied by the medical practitioner.
96932 Dressing materials used, or a combination thereof, including therapeutic
bandages, etc............................................................................................ 100%

To a maximum of seven dressings per lesion.

Surface X-ray Therapy

96940 Superficial or orthovoltage (under 600 KVP) dermatoses, 3 fields or

less, per treatment...........................................................................10.70 2 996.00 5.00
96941 - more than 3 fields, per treatment..................................................12.50 3 501.00 6.00
96942 Other benign lesions, 3 fields or less, per treatment.......................12.50 3 501.00 6.00
96944 - super voltage (600 KVP-2MeV) malignant lesion per course of
treatment.........................................................................................66.70 18 679.00 32.00

Mileage

96991 General Practitioners. Per km travelled. Applicable to all domiciliary

visits and emergency visits to hospitals and nursing homes.
Emergency visits to consulting rooms, by report. If second visit made
en route, no additional charge may be raised.......................................... 84.00 40.00

96993 Specialists. Per km travelled. Applicable to all emergency hospital

visits outside normal working hours (weekdays 5pm - am, weekends
Saturday 1pm - Monday am, public holidays am - 5pm). Time to be
specified. If second patient seen, no additional charge may be raised.... 84.0 0.31perkm/Visit

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