Kaelo Tariff Structure
The Kaelo Tariff : The maximum amount we will pay for the cost of services by a non-Prime Cure Network provider. While we cover the cost of Treatment, payment will be limited to a maximum of 300% of the 2006 National Health Reference Price List (NHRPL). The 2006 NHRPL is available on the Council for Medical Schemes website at https://www.medicalschemes.com/files/NHRPLSchedules/MedicalPractitioners2006_v06.pdf.
In calculating the Kaelo Tariff , the following rounding method is used: Values R10 and below rounded to the nearest cent, R10+ rounded to the nearest 10cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed.
ALL Kaelo TARIFFS ARE VAT INCLUSIVE.
This list is subject to continuous review and may be updated or revised periodically to reflect changes in regulations, best practices, organisational needs, or other relevant factors. It is the responsibility of all stakeholders to stay informed of the latest version and comply accordingly.
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Kaelo Tariff Structure - 055 - Mental Health
| wdt_ID | wdt_created_by | wdt_created_at | wdt_last_edited_by | wdt_last_edited_at | Tariff Code | Description | Amount |
|---|---|---|---|---|---|---|---|
| 1 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0001 | Appointment not kept | - |
| 2 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0002 | Modifier 0002: Orthopaedic, Neurosurgical and Vascular: | - |
| 3 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0003 | 15% of the relevant rate to be deducted where equipment used is not owned by the practitioner | - |
| 4 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0004 | Procedures performed in own procedure rooms: a) Procedures performed in doctors' own procedure rooms instead of in a hospital theatre or unattached theatre unit: as per fee for procedure + 100% (the value of modifier 0004 equals 100% of the value of the p | - |
| 5 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0005 | Multiple therapeutic procedures/operations under the same anaesthetic: a) Unless otherwise identified in the tariff when multiple therapeutic procedures/operations add significant time and/or complexity, and when each procedure/operation is clearly identi | - |
| 6 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0007 | a) Use of own monitoring equipment in the rooms: Remuneration for the use of any type of own monitoring equipment in the rooms for procedures performed under intravenous sedation - 15,00 clinical procedure units irrespective of the number of items of equi | - |
| 7 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0008 | Specialist surgeon assistant: Where a procedure requires a registered specialist surgeon assistant, the fee is 33,33% (1/3) of the fee for the specialist surgeon | - |
| 8 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 0009 | Assistant: The fee for an assistant is 20% of the fee for the specialist surgeon, with a minimum of 36,00 clinical procedure units. The minimum fee payable may not be less than 36,00 clinical procedures units | - |
| 9 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 00090 | Consumables used in radiology procedures: cost price PLUS 26% (up to a maximum of R26,00). (Where applicable, VAT should be added to the above). | - |
| 10 | KirstyKF | 21/08/2025 04:24 PM | KirstyKF | 21/08/2025 04:24 PM | 001 | Unless timely steps (i.e. 24 hours prior to the appointment) are taken to cancel an appointment the relevant fee may be charged, but shall not be payable by medical schemes. Each case shall, however, be considered on merit and, if circumstances warrant, n | - |