Summary of Covid-Related Claims & Processes
28/01/2022
To support recent updates around claiming for Covid-related activity in general practice recently, please see the below summary of the various claiming types and processes for these:
Swab-based Activity Claims Claim Type
Amount (inc. GST)
Eligibility
Virtual Consultation
$69 $69 $138 $138 $287.50
For guidance and flowchart on these claims click here.
Amount (inc. GST)
Eligibility
Claim Via
Māori, Pasifika, CSC Holder (or ‘Other’ as per clinical discretion)
Claim as: ‘PreVaccination Consult’ ‘Nurse’ ‘Quick Call/Virtual’
Simple Assessment (No Swab) Asymptomatic Consult + Swab Simple Assessments (+ Swab) Full Assessments + Swab
Claim Via Halcyon As activity occurs. Payments made on monthly cycle.
Vaccination Support Claims Claim Type
Halcyon
‘Quick Call’ by Nurse (For Vaccine Hesitant Pts & to Encouraging uptake of eligible vaccination doses & boosters)
$23
Pre-Vaccination Consultation (Pfizer) (All consults prior to Pfizer 1st, 2nd primary dose + booster vaccine - to encourage uptake & discuss patient concerns)
3rd Primary Dose (Immunocompromised) (inc. Virtual/In-person consult + Prescription, Consult, no prescription/patient declined)
Halcyon $69
Simple Consult + Prescription: $69 Complex Consult + Prescription = $138 Patient Declines Vaccine or Deemed Not Eligible: $69
AstraZeneca Consultation (All consults prior to AstraZeneca 1st, 2nd primary dose + booster vaccine. Prescription sometimes required - see clinical guide).
Post–Vaccine Consult: Adverse Event (inc. Virtual/in person limited assessment + in-person full assessment)
Temporary Vaccine Exemption Consult (inc. Standard (no exam) and Complex (with exam)
$69
Māori, Pasifika, CSC Holder (or ‘Other’ as per clinical discretion)
Claim as: ‘PreVaccination Consult’ & Select appropriate Vaccine Dose Number & Type
Age 12+ severely immunocompromised patients.
Claim as: ‘PreVaccination Consult’ “3rd Dose” – Simple/Complex Consult + Outcome (e.g. Prescription Given)
For clinical guidance document click here.
Halcyon
All Patients
Halcyon
AsraZeneca Clinical Guidance Document here.
Claim as: ‘PreVaccination Consult’ & Select appropriate Vaccine Dose Number & Type
Prescription required only for ‘off label’ use as per clinical guidelines.
Halcyon Virtual/In Person Limited Assessment: $69 In-Person Full Assessment: $138
Standard (no Pt exam): $69 Complex (Full Pt exam): $138
All patients Claim must be within 14 days of Vaccination Event
Specified exemption criteria. For Clinical Guidance (including application form) click here.
Claim as: ‘Post-Vaccine (Adverse Event)’ – Limited/Full Assessment. You can add ‘Additional Costs (such as ECG) in the form.
Halcyon Claim as: ‘Vaccine Exemption’ + Patient Examination/ No Examination’