For speech therapy
Billing and medical-aid claims for speech therapy practices
NetPractice submits speech therapy claims to South African medical schemes in real time, using the tariff-code form speech therapy actually bills. That is the 82-prefixed six-character code — so a procedure printed as 1053 on your schedule goes out as 821053, not 1053. 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
Speech therapy shares discipline 82 with audiology, and with it the one code form on this list that is six characters long: the four-digit procedure goes out behind the 82. Add a caseload that is largely children on long courses of therapy, and most rejections come from the claim rather than the clinical work.
South African tariff codes come in more than one billed form, and which one applies depends on your discipline. Medical practitioners, GPs and specialists alike, 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. Speech therapy is discipline 82:
| Discipline | BHF number | Billed code form |
|---|---|---|
| General practice | 14 | nnnn |
| Psychiatry | 22 | nnnn |
| Occupational therapy | 66 | 66nnn |
| Podiatry | 68 | 68nnn |
| Physiotherapy | 72 | 72nnn |
| Counselling | 81 | 81nnn |
| Audiology | 82 | 82nnnn |
| Speech therapy | 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 speech therapy practice gets
- Assessments, therapy sessions and reports captured as the distinct items they are.
- Children as patients, where the dependant code on the claim has to match the scheme’s record of that child.
- Long courses of therapy that outlast a year’s benefits, so seeing each session’s response matters.
- Reports and letters for schools, doctors and schemes from the same record as the billing.
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 speech therapy lines usually show up first.
Speech therapy billing questions
What is the speech therapy discipline number for billing?
Speech therapy is BHF discipline 82, the same number as audiology. The procedure part is four digits, so the billed code is six characters - a procedure printed as 1053 goes out as 821053. The scheme’s own schedule is the authority on which procedure applies.
Why is a claim for a child rejected when the medical-aid number is right?
The membership number identifies the main member; the dependant code identifies which person on that membership the claim is for. A wrong dependant code, or a date of birth that does not match the scheme’s record, is rejected even though the membership is valid. Check the dependant details against the member’s card.
Do medical schemes pay for speech therapy?
Usually from day-to-day benefits or savings, with limits that vary by plan, and some conditions are covered as Prescribed Minimum Benefits. Because therapy often runs for months, confirm the remaining benefit before planning a course rather than finding out from a rejection.
Do speech 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 speech 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.
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