Billing and medical-aid claims for physiotherapy practices

Physiotherapy bills a course of treatment rather than one-off procedures, so the same handful of codes goes out many times a month. That makes the code form the single most expensive thing to get wrong: an error does not cost you one claim, it repeats across every session until somebody notices.

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. Physiotherapy is discipline 72:

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.

Why are my physiotherapy codes rejected as unknown or priced at zero?

Almost always the code form rather than the code itself. If claims are being rejected across the board rather than case by case, check that you are submitting the 72-prefixed five-digit form and not the bare four-digit one used by medical specialists.

What happens when a patient runs out of physiotherapy benefits mid-course?

The remaining sessions become the patient’s to pay. The practical problem is finding out early enough to tell them, which is why seeing the scheme’s response per session matters more in physiotherapy than in most disciplines.

Do physiotherapy 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 physiotherapy 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.