For occupational therapy
Billing and medical-aid claims for occupational therapy practices
NetPractice submits occupational therapy claims to South African medical schemes in real time, using the 66-prefixed five-digit tariff codes occupational therapy actually bills — so a procedure printed as 303 on your schedule goes out as 66303, not 0303. 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
Occupational therapy carries more assessment and report work than most allied disciplines, and those are billed differently from treatment sessions. Getting the distinction right on the claim matters as much as getting the code form right.
South African tariff codes come in two billed forms, and which one applies depends on your discipline. Medical specialists bill the bare four-digit code — a GP bills 0190 as 0190. Allied and paramedical disciplines bill their BHF discipline number followed by the three-digit procedure. Occupational therapy is discipline 66:
| Discipline | BHF number | Billed code form |
|---|---|---|
| Occupational therapy | 66 | 66nnn |
| Podiatry | 68 | 68nnn |
| Physiotherapy | 72 | 72nnn |
| Audiology | 82 | 82nnn |
| Dietetics | 84 | 84nnn |
| Psychology | 86 | 86nnn |
| Nursing and home-based care | 88 | 88nnn |
| 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, and 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 occupational therapy practice gets
- Assessments, treatment sessions and report writing captured as the distinct items they are.
- Longer treatment arcs, where a patient may run across benefit years.
- Reports and referral letters that schemes and schools frequently ask for.
- Cash and scheme patients billed side by side.
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 occupational therapy lines usually show up first.
Occupational therapy billing questions
Can I bill for an occupational therapy report?
Report and assessment items exist separately from treatment codes, but whether a given scheme and plan reimburses them varies. Check the scheme’s own schedule before you rely on it, and get authorisation in writing where the scheme offers one.
Does occupational therapy use the same code form as physiotherapy?
The same convention, a different number. Occupational therapy is discipline 66, so the billed code is 66 followed by the three-digit procedure, in the same way physiotherapy uses 72.
Do occupational therapy 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 occupational therapy 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.
Start with 10 free claims
R9.50 a claim after your first 10 each month, no monthly fee and no contract. Set up within 24 hours.