Our Schedule of Procedures and Fees
We base our Schedule of Procedures and Fees on work undertaken by the Clinical Coding & Schedule Development (CCSD) Group. The Schedule contains the codes for procedures where our policies provide benefit.
To understand our approach to fees, please read the introduction to the Schedule and our Billing Principles. If you wish to query our Billing Principles, you can contact us here.
We publish two versions of our Schedule, one for fee-approved specialists and one for fee-limited specialists. If you are unsure of your status please contact the specialist fees and contracting team via this link.
Fees outside our fee structure
Specialists recognised after 2008 accept our fees as full reimbursement. This reassures our members that their fees will be paid in full.
A very small number of specialists, recognised before 2008, charge fees higher than we will reimburse. This means members using these specialists may have to pay additional costs towards their treatment. We find that many patients decide to choose a different specialist if they think this is likely.
Updates on codes and fees
We will publish any changes we make to codes or fees on the ‘Important information’ section of the Schedule of Procedures and Fees.