Physiotherapy Coding in South Africa

Physiotherapists are recognised by the Health Professional Council of South Africa (HPCSA) as ‘first line practitioners’. Physiotherapists may therefore assess, evaluate, diagnose, counsel and treat patients, within their scope of practice and competency levels, without the patient having been referred to them by another health care practitioner.

There is currently no coordinated system to maintain, update and modify coding. This has resulted in the stagnation of the current coding structure, which impacts on the physiotherapy profession.

Following the Competition Commissioner’s ruling in 2003, there has been limited interaction between stakeholders regarding the maintenance and development of billing codes and manuals.

The National Health Reference Price list (NHRPL) published by the Council for Medical Schemes (CMS) 2004 – 2006 was, in essence, the same as the 2003 BHF recommended guide to physiotherapy fees. There have been no to little updates or changes since. The 2006 RPL, which most medical schemes still use as a reference price, is incomplete and inadequate.

The lack of an officially regulated process for the determination of billing codes and tariffs has resulted in a hiatus, whereby the industry has been unable to address changing needs and incorporate new developments in technology and the latest research. This situation highlights the need for an updated physiotherapy coding and billing schedule relevant to current physiotherapy practice. At present ambiguities exist between the different physiotherapy coding schedules.

There are currently multiple physiotherapy coding schedules:

1. 2006 RPL Coding schedule

2. SASP Physiotherapy Coding Structure

3. COID Physiotherapy schedule

4. RAF Physiotherapy schedule

Each of the above coding structures have their own unique set of rules in their application and it is important for Physiotherapists in South Africa to familiarise themselves with all these rules and regulations when billing funders as incorrect coding can result in possible investigation for fraudulent practice.

2006 RPL Coding schedule

As mentioned before the RPL schedule is outdated and in dire need of updating. The RPL structure is divided into groups:

• Modality codes including codes for radiation therapy / moist heat / cryotherapy, low frequency currents, high frequency currents, physical modalities, manipulation / mobilisation of joints or immobilisation.

• Rehabilitation codes including but not limited to codes for 30min rehab, additional rehab, group rehabilitation and a 60min neurological rehab code.

• Evaluation codes for first and follow up visits

• Visiting codes for visits at healthcare facilities and for domiciliary visits i.e. home visits

• Other codes including but not limited to costing of material and appliances

SASP Physiotherapy Coding Structure

The SASP Physiotherapy Coding Structure started with the South African Society of Physiotherapy (SASP) submission to the Department of Health for the 2010 RPL. The SASP opted to submit a document that addressed the re-defining of the descriptors of specific codes, and the terminology and nomenclature of some rules. The structure was rolled out in phases with phase three released in 2017.

The main differences between SASP structure and the original RPL structure are:

• Addition of afterhours and emergency tariff codes

• Unbundling of the current evaluation/counselling codes into separate codes

• Redefining the definition, descriptors and application of the evaluation codes and counselling codes.

• Redefining of the current rehabilitation codes by:

  • Removing rehabilitation codes causing ambiguity

  • Introducing new rehabilitation codes

  • Introducing Group Physiotherapy Counselling codes

• Introducing a new modality code for extracorpeal shockwave therapy

• Introducing a new modifier code for additional same day treatments

• Rule 008 wording change, also allow additional modalities

  
  

COID Physiotherapy schedule

This schedule applies to patients with an injury on duty and must be claimed from the applicable funder related to the patient’s occupation. Various funders exist for IOD claims i.e. Compensation fund, RMA, FEM, local municipalities and SAPS. The COID Physiotherapy tariffs are released yearly in the Government gazette and includes codes for:

• Rehabilitation

• Evaluation

• Visiting

• Chest treatment (bundled codes for different levels of care)

• Spinal treatment (bundled codes for simple and complex treatments)

• Soft  tissue / peripheral joint treatment (bundled codes for simple and complex treatments)

An amendment to the 2025 Physiotherapy schedule was released in March 2025 introducing changes to the rules of application of some codes and additional group rehabilitation codes were added. It is vital that these changes are understood and applied correctly.

RAF Physiotherapy schedule

This schedule applies to patients involved in a motor vehicle accident with successful claims to the Road Accident Fund (RAF). The schedule is similar to the RPL schedule and has set fees per code applicable. The RAF Physiotherapy tariffs are released yearly in the Government gazette by the department of Transport.

Conclusion

Multiple Physiotherapy schedules exist in South Africa and there are specific rules to the application of the tariff codes for claims to be accepted by the funders. The amount of codes allowed to be charged per session and in what allowed combination is important to understand to ensure successful claiming for Physiotherapy treatment rendered. Repeated incorrect claiming can lead to a forensic investigation into the claiming practice and if found to be claiming fraudulently a clawback of the incorrectly claimed amounts paid out can be enforced. A claw back like this can be devastating to the Physiotherapist and ultimately detrimental to a practice.

It is therefore advised that Physiotherapists in South Africa stay updated with the latest updates in the physiotherapy coding world by attending relevant courses. Izandla Consulting is presenting a full day coding course in Johannesburg on 2 August 2025 that will cover all the latest updates on physiotherapy coding. Should you wish to find out more, please send an email to info@izandla.org.za