Understanding medical scheme codes

At Intercare we realise that understanding medical scheme codes and benefits can be quite daunting. In order to ensure a great healthcare experience, we would like to keep our patients informed by clarifying Code 0146 and 0148 billing procedures and regulations to you.

So what are these Codes and how does it affect billing for medical services?

CODE 0146

Code 0146 is an additional fee that is charged for an unscheduled emergency consultation/visit at the doctor's rooms. Payment for Code 0146 is covered by medical schemes as part of a patient's Prescribed Minimum Benefits (PMB). Medical schemes are only obliged to cover the costs for Code 0146 billing in the case of medical emergencies. Code 0146 may be charged for medical emergencies at any time of the day.

The Medical Schemes Act 131 of 1998 defines an "emergency medical condition" as "the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a body organ or part, or would place the person’s life in serious jeopardy".

It is important to note that a diagnosis alone is not sufficient to qualify as a medical emergency. It must be accompanied by immediate treatment of the condition.

CODE 0148

Illnesses and injuries are unpredictable and we understand that. To meet this need we offer extended operating hours. This allows the busy executive or mom an alternative to the hospital ER room for after-hours consultations.

An additional fee for non-emergency after-hours consultations may, by regulation, be charged under Code 0148 and this fee will not be paid by most medical schemes as it is the choice of the patient to consult the healthcare professional after hours. Patients should pay the additional fee billed under Code 0148 at the time of the consultation.

We trust that this information clarifies billing for after-hours consultations. We invite you to talk to the practice manager at your nearest Intercare medical centre should you have any enquiries or concerns regarding Code 0146 and Code 0148 billing.

Click here for a list of all the Intercare medical centres.

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