For general practice
Billing and medical-aid claims for GP practices
NetPractice submits general practice claims to South African medical schemes in real time, using the tariff-code form general practice actually bills. GPs are medical practitioners, so they bill the bare four-digit code - a consultation printed as 0190 goes out as 0190, not 140190. The accepted or rejected outcome comes back in seconds, so a coding rejection is a two-minute fix on the day rather than a surprise at month-end.
The code-form trap
General practice bills the bare four-digit code with its leading zero, and for a dispensing practice the medicine goes on the same claim under its NAPPI product code. Most of what goes wrong is not the consultation: it is the medicine line, the chronic condition behind it, or the patient on the membership the claim was meant for.
South African tariff codes come in more than one billed form, and which one applies depends on your discipline. Medical practitioners, GPs and specialists alike, bill the bare four-digit code - a GP bills 0190 as 0190, and a psychiatrist bills 2974 as 2974. Allied and paramedical disciplines bill their BHF discipline number followed by the procedure number. That procedure part is three digits for most disciplines and four for speech therapy and audiology, which is the exception people miss. General practice is discipline 14:
| Discipline | BHF number | Billed code form |
|---|---|---|
| General practice | 14 | nnnn |
| Psychiatry | 22 | nnnn |
| Occupational therapy | 66 | 66nnn |
| Podiatry | 68 | 68nnn |
| Physiotherapy | 72 | 72nnn |
| Counselling | 81 | 81nnn |
| Audiology | 82 | 82nnnn |
| Speech therapy | 82 | 82nnnn |
| Dietetics | 84 | 84nnn |
| Psychology | 86 | 86nnn |
| Nursing and home-based care | 88 | 88nnn |
| Social work | 89 | 89nnn |
| Biokinetics | 91 | 91nnn |
This is invisible on a tariff schedule, because the schedule prints the short procedure number and leaves the form to you. For a medical practitioner the mistake runs the other way:following the allied convention and prefixing the discipline number produces a code the scheme has never heard of. It does not fail politely: codes come back unknown or priced at zero across the board rather than case by case. If that is what your rejections look like, check the form before you check anything else.
Each scheme’s own tariff schedule is the authority on its rates and codes. Where a scheme’s schedule disagrees with anything here, follow the schedule. Clinical technology is deliberately absent from the table above: its numbering is not consistent between schemes, so no single pattern would be correct.
What a GP practice gets
- Consultations on bare four-digit codes, keeping the leading zero that schemes expect.
- Dispensed medicine billed on its NAPPI code on the same claim as the consultation.
- Chronic patients, where the condition has to be registered with the scheme before the medicine pays.
- Cash and scheme patients side by side, with statements for what the patient owes.
Plus everything every practice gets: real-time claim submission with the scheme’s verdict in seconds, invoices and monthly statements, patients and visits, clinical notes, and reports on aged debtors, daily collections and turnover.
Two things worth reading next if claims are the problem: why medical aid claims get rejected and how to read a remittance advice, which is where short-paid general practice lines usually show up first.
General practice billing questions
Do GPs bill a 14-prefixed tariff code?
No. 14 identifies a general practice in its practice number, but GPs bill the bare four-digit code - a consultation printed as 0190 goes out as 0190. Prefixing the discipline number is an allied-health convention and produces a code the scheme does not recognise.
How does a dispensing GP bill medicine to a medical scheme?
Each medicine goes on the claim under the NAPPI code for that product and pack size, priced from the regulated single exit price plus a dispensing fee. Schemes may still pay less where the plan uses a formulary or a reference price, and the difference becomes the patient’s to pay.
Why was the medicine rejected when the consultation paid?
Most often because the chronic condition is not registered with the scheme, or the medicine is not on the plan’s formulary for it. The consultation and the medicine are assessed separately, so one line can pay while the other is refused.
Do general practice claims need an ICD-10 diagnosis code?
Yes. Every claim to a South African medical scheme needs a valid ICD-10 code, coded to the most specific level the record supports. For an injury the scheme also expects an external-cause code, and that cause code has to be a billable five-character code rather than a category heading.
What does billing software cost for a GP practice?
On NetPractice it is R9.50 per claim with the first 10 claims each month free, and no monthly fee or contract. A practice submitting 200 claims a month pays R1,805.
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