Coding & Tariff Determination

  1. Previously, the HPCSA determined the guidelines for reasonable professional fees, and the Council for Medical Schemes the “Reference Price List”. From 2005, the Competition board and Courts stopped all setting of prices (Competition Commission ruling 2006). At present, each Medical aid and Doctor set their own prices. The rates that medical aids pay depends on the individual funder and the plans they offer.
  2. The Practice determines the costs associated with the provision of anaesthetic services by using the coding rules as determined by the Health Professionals Council of South Africa (HPCSA), the South African Medical Association (SAMA) and South African Legislation (Health Act and Medical Schemes Act). The Practice will assume that the rules and guidelines as determined by SASA and SAMA as the correct and ethical interpretation. A specific Medical Aid may not recognise the validity of any or all of these codes as used by the Practice.
  3. The Practice’s anaesthetic fee is determined by the anaesthesiologist based on training, expertise, experience and practice costs and do not relate to any medical scheme rate. Each associate at the George Anaesthetic Group, sets their own rate annually, and there is no collusion between associates.
  4. The rates used to determine the fee is applicable to all patients, irrespective of circumstance or medical aid membership as required by the Consumer Protection Act.
  5. The cost of an anaesthetic is dependent on time and procedure complexity. As it is impossible to predict how long a procedure will take, it makes estimating the cost of an anaesthetic extremely difficult. A cost estimate may be requested before the procedure from AMS.
  6. The cost may increase according to the duration of the procedure, procedures performed, risk factors and/or complications in theatre.
  7. Your medical aid will reimburse you for your anaesthetic account at a rate based on the insurance plan you have selected and the rules of your medical aid, which may be vastly different to the rate determined by the anaesthesiologist. Be aware that your medical aid/funder may call this “the 100% rate” but this refers ONLY to their rates. The total amount may not be covered by your medical aid and you will be responsible for any shortfall.
  8. Additionally,  every anaesthetic account has to include VAT as the government has legislated that healthcare is a value added item and they have added 15% to each account.
  9. Some of the associates have a ‘direct payment arrangement’ with some of the medical funders with no co-payments on these plans, and others do not. The onus is therefore on the patient to find out who is going to be their Anaesthesiologist, and to obtain a cost estimate from them should they be worried that there may be a shortfall which they should pay themselves.

Anaesthetic Invoice

The anaesthetic invoice is calculated by adding various anaesthetic services. This will attempt to clarify how they are formulated.


  1. Preoperative risk assessment
  • The premedor pre-op assessment in your account.
  • This is a basic consultation of approximately 10 minutes and the preparation of the anaesthetic part of the theatre – this would include the creation of an anaesthetic plan, preparation of drugs, checking of equipment and monitors. This can take the anaesthesiologist up to 30 minutes and the fee covers this time.
  1. Procedure fee
  • This is a basic fee calculated according to the anaesthetic difficulty of the indicated surgical procedure.
  1. Time based anaesthetic fee
  • Depending on the duration of your procedure/operation, a time based anaesthetic fee is levied per 15 minutes or part thereof of your procedure.
  1. Additional Fees related to anaesthetic risk
  • An additional “emergency fee” may be charged if your procedure is either unbooked prior to the start of the list or an emergency, irrespective of the time of the day.
  • Emergency travel fee may be charged for the attending anaesthesiologist to make an unscheduled trip to the venue where your procedure takes place.
  • Epidurals, nerve blocks, postoperative drug infusions and ‘patient controlled analgesia’ (PCA) devices for pain relief.
  • Arterial and central venous lines for careful monitoring of your condition during and after the procedure.
  • Should you need specific or goal directed blood pressure control during your procedure.
  • The performance of ultrasound guided procedures.
  • Patients in non-typical positions during the procedure.
  • Patients less than a year old, or older than 70 years of age.
  • Body mass index(BMI) if greater than or equal to 35kg/m2.
  • Orthopaedic modifiers depending on the site of surgery.
  • Operations on the head/neck.
  • Insertion of a nasogastric tube.
  • Should the patient have systemic illnesses causing functional impairment.
  • Should the patient be ventilated or admitted to intensive care.

Account Administration & Terms of Payment

  1. The administration of an account remains the responsibility of the patient and/or guarantor.
  2. In cases where a funder’s administration is substandard or payments from the funder are payed directly to the patient, the Practice will NOT submit the account to the funder but directly to the patient/guarantor.
  3. The Practice may only accept payment from the patient and/or the patient’s guarantor and/or a medical funder registered as such with the Council of Medical Schemes.
  4. The patient and/or guarantor and/or employer (IOD cases) remains responsible for the full amount of the account.
  5. Terms of full payment is strictly 30 (thirty) days after service delivery. After which the account will be handed over for debt recovery and interest will be charged at 2% per month. All costs incurred to collect the arrears will be for your account on attorney and client scale.
  6. The Practice will NOT supply motivations to Medical Aids and/or Hospitals for the use of any medication and/or procedures and/or equipment that may be required during the course of the anaesthetic. In case the Medical Aid refuses to pay for clinically accepted treatments, you are advised to contact the Council of Medical Schemes (