Billing and medical-aid claims for psychology practices

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 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. Psychology is discipline 86:

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.

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.