For counselling
Billing and medical-aid claims for counselling practices
NetPractice submits counselling claims to South African medical schemes in real time, using the tariff-code form counselling actually bills. That is the 81-prefixed five-character code — so a procedure printed as 308 on your schedule goes out as 81308, not 0308. 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
Registered counsellors are their own HPCSA register and their own BHF discipline, and that is exactly where the billing goes wrong. Counselling is discipline 81; psychology is 86. The work can look similar in the room, but a counselling session billed under the psychology discipline is billed by a practitioner the scheme does not believe is registered to provide it, and it is refused on those grounds rather than on anything clinical.
South African tariff codes come in more than one billed form, and which one applies depends on your discipline. Medical specialties 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. Counselling is discipline 81:
| Discipline | BHF number | Billed code form |
|---|---|---|
| Psychiatry | 22 | nnnn |
| Occupational therapy | 66 | 66nnn |
| Podiatry | 68 | 68nnn |
| Physiotherapy | 72 | 72nnn |
| Counselling | 81 | 81nnn |
| Audiology | 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. It is the most common structural coding error in allied practices. 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 counselling practice gets
- Session billing under discipline 81, kept distinct from psychology’s 86.
- Codes that step with the length and format of the session, including group work.
- Benefit limits that run out mid-year, where knowing early is the whole game.
- Cash and scheme clients side by side, which is common in counselling.
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 counselling lines usually show up first.
Counselling billing questions
What tariff codes do registered counsellors bill?
Counselling is BHF discipline 81, so the billed code is 81 followed by the three-digit procedure - a session printed as 308 goes out as 81308. Your scheme’s schedule is the authority on which procedure number matches which session type.
Can a registered counsellor bill psychology codes?
No. Psychology is discipline 86 and is billed by registered psychologists. A registered counsellor billing under 86 is claiming for work under a registration they do not hold, and schemes reject it on that basis. Bill under 81 with your own practice number.
What happens when a client’s mental-health benefit runs out?
The remaining sessions become the client’s to pay. Because counselling is usually a course rather than a one-off, the useful thing is seeing the scheme’s response per session as it happens, so the conversation happens before the sessions rather than after them.
Do counselling 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 counselling 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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