Preventative screening

Procedure

Tariff Codes

Tariff description

Eligible beneficiaries and Frequency

Healthcare Providers allowed

Cholesterol Screening

4027

Blood Cholesterol (finger prick)

Once per Benefit year for all beneficiaries who are 20 years and older

General Medical Practice, Specialist Family Medicine

0013

Blood cholesterol and/or triglycerides

Pharmacy

99384

Cholesterol screening

Registered Nurses

Glucose Screening

4050

Blood glucose finger prick in rooms

(Glucose strip-test with photometric reading)

Once per benefit year for all beneficiaries 20 years and older.

General Medical Practice, Specialist Family Medicine

0012

Blood Glucose

Pharmacy

99370

Glucose Screening Test

Registered Nurses

Osteoporosis Screening:

Bone Densitometry scan

50120

X-ray bone densitometry

Once per benefit year for female beneficiaries who are 65 years and older.

Radiologist

3604

Bone densitometry (to be charged once only for one or more levels done at the same session)

Gynaecologist, Physician, Orthopaedics

Pap Smear screening

0190 - 0193

Consultation/visit

Once per benefit year for female beneficiaries who are 12 – 65years

General Medical Practice, Specialist Family Medicine, Gynaecologist

0201, 0202, 0210

Procedure codes: 0201- Cost of material

0202 – setting of sterile tray

0210 – collection of specimen

General Medical Practice, Specialist Family Medicine, Gynaecologist

99385

Procedure code: Sterile tray and specimen handling fee

General Medical Practice, Specialist Family Medicine, Gynaecologist, Registered Nurses

005,006,001,002

Consultation

Registered Nurses

020,301

Procedure codes: 020 Specimen code

301 Consumables used

Registered Nurses

4566

Vaginal or cervical smear

Pathologist, Medical Technology

4559

Cytology preparation using approved liquid-based cytology method: first unit

Pathologist, Medical Technology

CER1

HPV Polymerase chain reaction

Pathologist, Medical Technology

Blood Pressure Monitoring

0015

Blood Pressure Monitoring

Once per benefit year for beneficiaries 18 years and older

Pharmacy

99371

Blood Pressure Monitor

Registered Nurses

HIV and AIDS Pre-

test Counselling

(no test done)

7016

Pre-counselling

Once per benefit

year, per

beneficiary

General Medical Practice, Specialist Family Medicine

0016

Pre-counselling

(Without going

ahead with the HIV test)

Pharmacy

99376

HIV Pre-Test Counselling

Registered Nurses

HIV and AIDS testing (screening test, post-test counselling, confirmatory test, and condoms)

7017

Pre-counselling, Screen test, Post-test counselling, Confirmatory test (all-inclusive code)

Once per benefit year, per beneficiary

General Medical Practice, Specialist Family Medicine

0017

HIV and AIDS Testing and Post Counselling

Pharmacy

99377

HIV and AIDS testing and post counselling

Registered Nurses

Peak Flow measurement

0019

Peak Flow Measurement

Once per benefit year for beneficiaries 4 years and older

Pharmacy

99383

Peak Flow Measurement

Registered Nurses

Mammography Screening

39175

Mammography: Unilateral or bilateral

Once per benefit year for female beneficiaries who are 40 years and onwards.

Radiography

3934100

X-ray mammography including ultrasound

Radiologist

3605

Mammography: Unilateral or bilateral, including ultrasound and Doppler ultrasound examination, where necessary.

General Medical Practice, Specialist Family Medicine

Prostate Screening

4519

Prostate specific antigen

Once per benefit year for male beneficiaries who are 45 – 69 years.

Pathologist, Medical Technology

Faecal Occult blood test

4352

Occult blood: Monoclonal antibodies

Once per benefit year for all beneficiaries who are 50 – 75 years.

Pathologist, Medical Technology

Neonatal Hypothyroidism

4507

Thyrotropin (TSH)

Once per neonatal beneficiary up to 28 days of age

Pathologist

Glaucoma Screening

11202

Tonometry (non-contact)

Once per benefit year for all beneficiaries 40 years and older.

Optometrist, Optical dispensers

11212

Tonometry (Aplanation)

3014

Tonometry per test with maximum of 2 tests for provocative tonometry

(one or both eyes)

Ophthalmologist

3017

Retinal threshold test inclusive of computer disc storage for Delta of Statpak programs

3018

Retinal threshold trend evaluation (additional to Item 3017)

Pregnancy Screening

0018

Pregnancy Screening

Once per benefit year for a female beneficiary 12 years and older.

Pharmacy

99381

Pregnancy Screening

Registered Nurses

Urine Analysis

0014

Urine Analysis

Once per benefit year for beneficiaries of all ages.

Pharmacy

99382

Urine analysis

Registered Nurses

Childhood hearing screening for children

1010

Audiology consultation. Duration 5 - 15 mins

Once per beneficiary for the period from age one up to and including seven years.

Speech therapy and Audiology

1011

Audiology consultation. Duration 16 - 30 mins

1115

Speech audiogram screening

1100

Pure Tone Audiogram (Air conduction) (3273)

1105

Bone conduction pure tone audiogram

1200

Tympanometry

Childhood hearing screening for infants

1505

Diagnostic Audiological Click ABR (Auditory Brainstem

Evoked Response) – Bilateral Air conduction threshold determination using click stimuli.

Once per beneficiary for the period up to and including age 1 (but excluding beneficiaries in the first three months of life)

Speech therapy and Audiology

1010

Audiology consultation. Duration 5-15 mins

1011

Audiology consultation. Duration 16 - 30mins

1580

Evoked otoacoustic emissions (OAE); limited

Childhood optometry screening

94000

Individual Child Screening

Once per beneficiary for the period up to and including age seven (but excluding beneficiaries in the first three months of life)

Optometrist

Syphilis screening

3951

Quantitative Kahn, VDRL or other flocculation

Once per benefit year per beneficiary

Pathologist, Medical Technology

3949

Qualitative Kahn, VDRL or other flocculation

Chlamydia/gonorrhoea screening

3946

IgM: specific antibody titre: ELISA/EMIT: per Ag

Once per benefit year per beneficiary

Pathologist, Medical Technology

3948

IgG: specific antibody titre: ELISA/EMIT: per Ag

3923

Biochemical identification ofbacterium: abridged

3925

Serological identification of bacterium: abridged

3960

Gonococcal, listeria or echinoccoccus agglutination

TB screening

0221

Allergy: Skin-prick tests: Delayed hypersensitivity testing (Type IV reaction): Per antigen

Once per benefit year, per beneficiary (no age restriction)

General Medical Practice, Specialist Family Medicine, Pathologist

Nappi 872938-027 Tuberculin PPD RT/23 Vial 1.5 ml)

Cost of material in treatment: This item provides for a charge for material used in treatment.

Procedure

Codes

Frequency

Eligible beneficiaries

Healthcare Providers allowed

Once per year

General Medical Practice, Specialist Family Medicine, Pharmacy, Pharmacotherapies,

Primary Care Drug Therapist, Registered Nurses,

Clinical Pharmacokinetics, Anaesthetists,

Dermatology,

Gynaecologist,

Pulmonology,

Physician,

Gastroenterology,

Neurology,

Cardiology,

Oncologist,

Neurosurgeon,

Nuclear Medicine, Ophthalmologist,

Clinical Haematology, Orthopaedics, Otorhinolaryngology (ENT),

Rheumatology,

Paediatrician,

Paediatric Cardiologist,

Physical Medicine,

Plastic and Reconstructive Surgery,

Radiation Oncology, Surgeon,

Cardio Thoracic Surgery,

Urology

Influenza vaccination

3000826 Vaxigrip Tetra single dose 0.5ml pre-fill

732826 Influvac

All beneficiaries ≥6 months of age

0190-0193 consultation

Pneumococcal vaccination

755826 ** Pneumovax 23 single dose vial 0.5ml

715858 Prevenar 13 pre-filled syringe 0.5ml

Once every 5 years

Once every 5 years for:

high- risk beneficiaries between the ages of 2 and 64 with the relevant chronic or hospital admission.

all beneficiaries 65 years and older irrespective of the chronic or hospital authorisation.

HPV vaccination

710020 Cervarix Pre-filled Syringe 0.5ml

710249 Gardasil Injection

One course per beneficiary per lifetime**

Females 9 - 45 years

COVID-19

vaccination

3002823 COVID-19 Vaccine Administration Fee

3003366 COVID-19Vaccine Janssen**

Three doses perbeneficiary

18 years and older

3003282 COVID-19Vaccine Pfizer**

Four doses per

beneficiary ***

Two doses per beneficiary ***

18 years and older

12 to 17 years

3006073 COVID-19Paediatric Vaccine Pfizer **

Two doses perbeneficiary***

5 to 11 years

700356 Engerix-b

700210 Engerix-b*

700767 Hiberix

700513 Avaxim**

700772 Priorix

701659 Heberbio hbv*

701658 Heberbio hbv

703442 Typherix**

892939 Varilrix**

703448 Havrix junior**

3000689 Boostrix

703846 Dukoral**

703994 Infanrix pre-filled

706829 Twinrix**

707285 Infanrix hexa

713048 Euvax b*

710935 Rotateq

714999 Synflorix

711258 Tetraxim

717194 Vivaxim**

713229 Adacel quadra

717466 Zostavax**

714133 Rotarix liquid oral

715349 Euvax b

716550 Priorix tetra**

720708 Menactra**

716655 Boostrix tetra

814970 Verorab**

719637 Hexaxim

814989 Stamaril**

3002554 Measles vaccine

822361 Havrix 1440**

722290 Measbio

822442 Typhim

723131 Onvara**

832693 Tetavax

724016 Omzyta

3002364 Tetanus Vaccine Cipla Ampoule 0.5ml

823678 OPV-merieux 10

848905 Avaxim**

823686 OPV-merieux 20

879460 Chirorab**

841307 OPV-merieux 10

3001925 Pneumovax 23**

872962 BCG

3002510 Adacel Vial 0.5ml

879452 Morupar

3004427 Tetanus toxoid