For psychology
Billing and medical-aid claims for psychology practices
NetPractice submits psychology claims to South African medical schemes in real time, using the 86-prefixed five-digit tariff codes psychology actually bills — so a procedure printed as 303 on your schedule goes out as 86303, 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
Psychology billing is dominated by two things that have nothing to do with codes: session limits, and whether the presenting condition falls under Prescribed Minimum Benefits. Both determine who actually pays, and both are better established before the session than after it.
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. Psychology is discipline 86:
| 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 psychology practice gets
- Session-based billing where the number of covered sessions is often capped by plan.
- PMB conditions, which are funded differently from general mental-health benefits.
- A high proportion of patient-portion balances, so statements and follow-up matter.
- Clinical notes kept private to the practice, with only billing information going to the scheme.
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 psychology lines usually show up first.
Psychology billing questions
How many psychology sessions do medical schemes cover?
It depends on the scheme, the plan and whether the condition is a Prescribed Minimum Benefit. PMB conditions carry a statutory minimum level of cover; general mental-health benefits are usually capped per beneficiary per year. Confirm the member’s remaining sessions before booking a course.
What clinical information does a scheme see when I submit a claim?
A claim carries the diagnosis code and the billing detail, not your session notes. That is worth explaining to patients who ask, because the question comes up often in psychology and the honest answer is reassuring.
Do psychology 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 psychology 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.