Schedule of Procedures and Fees

Our Billing Principles underpin our fee structure

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.

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.

You can view our full Schedule of Procedures and Fees for Fee-Approved Specialists here.

You can view our full Schedule of Procedures and Fees for Fee-Limited Specialists here.

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.

If one of our members does want to find a different specialist, they can ask us to search for suitable alternatives using our Fast Track Appointment Service. In most cases, we will be able to suggest up to three suitable specialists from our list of fee-approved specialists.

In all cases, the key factors are the medical necessity and choosing the right specialist for the condition.


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.

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