POAC Claiming Schedule
Effective 1 July 2025
Item | Fee (incl GST |
|---|---|
$200 | |
After Hours Fee (claimable with Fixed Fees only) | $20 |
$1.20/minute | |
$65 | |
Catheterisation Male (fixed fee) * | $105 |
Catheterisation Female (fixed fee)* | $80 |
Clexane Delayed-Scan Injection (plus medication as consumables) | $25 |
Clexane Post-Scan (one off fee, plus medication as consumables) | $60 |
Consumables (not claimable for fixed fee services) | At price |
$65 | |
$185 | |
IV Fluids (1 Litre) for Moderate Dehydration* | $180 (1 Litre) |
IV Fluids (2 Litres) for Moderate Dehydration* | $240 (2 Litres) |
GP / NP Consultation (conditions apply) ** | At normal clinic rate |
Phone Review (review/result post radiology, or next day post treatment, where indicated) | $20 |
Cellulitis IV Cephazolin (ends August 2025). Max 3 doses. * | $110 per dose |
Cellulitis - High Dose Orals Review | TBC |
Nurse Time | $1.50/minute |
Observation Time (where does not relate to fixed fee) | $1.20/minute |
Point of Care Testing (POCT) Blood Draw (for eligible cases) * | $46 |
Pyelonephritis – Single Dose with Fluids * | $220 |
$20 | |
Wound Care/Dressings for Abscess post I&D - Simple | $30 |
Wound Care/Dressings for Abscess post I&D - Complex | $45 |
Important Claiming Rules
Clinical Documentation:
All claims must be supported with relevant clinical documentation.
Fixed Fees:
Items marked * are Fixed Fees — these cover all costs, including consumables, for treatment following the initial patient assessment. A GP/NP consult on the same day may only be claimed in addition if the patient requires referral to hospital.
GP/NP Consultations & Reviews:
The initial consult is payable by the patient unless referred by St John, a hospital, or another clinic — in which case the initial assessment can be claimed under POAC.
A same day consultation may be claimed post radiology where hospital admission/discussion, or additional acute management is required.
A next-day in person consult may be claimed where clinically indicated only (e.g. dehydration with ongoing symptoms).
This fee must not be claimed in addition to Fixed Fees for treatment provided.
Phone Review relates to a clinical (GP/NP/RN) review undertaken following a POAC-funded radiology investigation, or the following day, if clinically indicated, post treatment.
Consumables:
Consumables apply only to non-fixed fee services that are not supplied under MPSO (Medical Practice Service Order) and should be charged at the actual cost of each individual item. Consumables are not claimable for services that are included under a Fixed Fee.
Administration Fee:
The administration fee of $15.50 has been removed. The outcome / final diagnosis is no longer a separate requirement if no other claim is being made. For most referrals, however, it is expected a claim would be made for services provided.
General Claiming Conditions
POAC terms and conditions apply to all referrals and claims.
Submit the POAC referral at the time of the clinical decision to ensure eligibility.
No co-payment should be charged to any patient enrolled under POAC.
Observation between ECG/Troponin repeat tests is not claimable — if close monitoring is required, admission may be more appropriate.
GP review following initial treatment (e.g. initial IV fluids, asthma management) is not claimable prior to commencing further treatment on the same day.
The After Hours Fee is claimable only with Fixed Fees
No outcome/final diagnosis is required if no other claim is made for the referral. For most referrals, a claim would be expected for services provided.
Cellulitis Management Update
Funding for IV Cephazolin for cellulitis will end on 1 August 2025. National pathways will be updated to reflect best practice using high-dose oral therapy. A funding framework for reviewing high-risk patients is under development.
Claim Submission Timeline
Claims must be submitted by the 20th of the month following treatment.
All claims for referrals and activity up to 30th June 2025 must be finalised by the 31st August 2025 using the original fees.
Any claims submitted using the new rates for pre 1st July 2025 referrals will be adjusted accordingly.
More Information
For any queries related to how to claim, please email: claims@poac.co.nz