POAC Funding of Adult Community Acquired Pneumonia
Auckland | Waitemata | Counties Manukau
POAC Funded Chest X-Ray
Chest X-ray is not routinely required in mild CAP but may be considered when the result will change immediate management.
POAC funds CXR for mild or moderate CAP (CRB-65 score 0–1) when diagnosis is uncertain (e.g., pneumonia vs heart failure) and imaging will guide treatment to avoid unnecessary hospital referral.
Patients must be reviewed promptly by the requesting clinician after their X-ray.
POAC does not fund CXR for:
• Severe CAP (CRB-65 ≥ 2), unless endorsed by a hospital specialist.
• Cases where CAP is diagnosed clinically and treatment has already commenced (e.g., antibiotics started).
CRB-65 Severity Score Factor Criteria Score C – Confusion New disorientation in person, place, or time 1 R – Respiratory rate ≥ 30 breaths per minute 1 B – Blood pressure Systolic < 90 mmHg or Diastolic ≤ 60 mmHg 1 65 – Age ≥ 65 years 1
Total Score and Risk Stratification
0 → Low risk (<1% mortality). Suitable for community management.
1 → Moderate risk (1–10% mortality). Consider hospital assessment depending on co-morbidities and social support.
2 or more → High risk (>10% mortality). Recommend urgent hospital referral.
Refer Community Acquired Pneumonia HealthPathway
Other POAC-funded indications for CXR
Suspected pneumothorax (non-traumatic, where immediate admission is not required and the patient can safely attend radiology). Refer Chest Pain HealthPathway
Suspected heart failure when diagnosis is unclear (e.g., pneumonia vs heart failure) and treatment cannot be safely initiated without imaging. See Heart Failure HealthPathway
Management
Refer to Auckland HealthPathway – CAP in Adults for detailed assessment and antibiotic treatment guidance.
POAC does not fund IV antibiotics for CAP. If IV therapy is indicated, the patient should be referred to hospital.
If the patient is dehydrated and requires IV rehydration, refer to the POAC Dehydration Guideline.
POAC Referral and Funding
Submit a POAC referral via PMS (or online), provide the patient with the radiology request form (ensure the POAC case number is documented). The patient may attend any community radiology as a walk-in service.
It is expected CXR is performed within 24 hours of referral. Radiology results must be reviewed promptly by the requesting clinician.
POAC will fund:
Chest X-Ray (invoiced directly by radiology provider)
Telephone review of results (within 24 hours)
Same day GP/NP consultation may be claimed post radiology where hospital admission/discussion, or additional acute management is required.
See POAC Claiming Schedule for more information