CLAIMING

Purpose:  

This service aims to provide access to Long Term Contraception options, including administration of Depo Provera, and the insertion of contraceptive implants and IUDs to target populations. Removal of these devices as necessary is also funded.

Eligibility Criteria: 

All patients who; 

• live in quintile 5 areas 
• or hold a CSC 
• or are at high risk of poor health and social outcomes 

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment (standard clinic charge) or appointment fee for this service.

Services Funded: 

• Contraceptive consultation relating to long acting reversible contraception or oral contraception $30.50 (VLCA clinic)
• Contraceptive consultation relating to long acting reversible contraception or oral contraception $65.00 (Non VLCA clinic) 
• IUD or Jadelle insertion $180.00
• Jadelle removal $180.00
• IUD Removal $90.00
• Jadelle or IUD Removal AND Insertion during same consultation $270.00
• Depo Provera $27.50 Maximum of 4 per annum
• Vasectomy $600.00

Note: 1 failed attempt is funded

Funding Stream: 

Health New Zealand contract

Purpose:  

Alcohol screening and brief interventions in primary care settings are effective in reducing total alcohol consumption and excessive drinking among hazardous drinkers.   

Eligibility Criteria:  

• Enrolled patients 12 years and over whose alcohol consumption is above screening guidelines. 
• Please ensure Alcohol Consumption level is recorded in Screening as this will be used to audit eligibility of claims.  

Services Funded:

• Brief advice (only) $5.75
• Comprehensive Assessment $37.49

Funding Stream: 

Health New Zealand

Purpose:

• Assess the child to check that they are meeting the developmental, psychological and behavioural milestones. 
• To identify any issues that might stop a child learning when they get to school. 
• To refer the child and/or family on to the appropriate secondary service for support. 

The B4 School check is provided by a trained and accredited Registered Nurse, either in the practice, a public health nurse or outreach nurse. 

All information is recorded on the B4 School Check website. 

Eligibility Criteria: 

• HPHO enrolled patients aged 4 years.

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment (standard clinic charge) or appointment fee for this service.

Services Funded: 

• B4School Check completion $150.00 
• Hauraki PHO covers the cost of B4 School lunchboxes directly with the expectation that the orders reflect the number of B4 School Checks completed.  

Funding Stream: 

Health New Zealand Contract

Purpose:

The National Bowel Screening Programme has two objectives; reduce mortality rates from bowel cancer and to identify and remove pre-cancerous advanced adenoma from the bowel before they become cancerous.  

Eligibility Criteria:

• HPHO Enrolled Patients who have received a positive FIT result via the National Bowel Screening Service

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment (standard clinic charge) or appointment fee for this service.

Services Funded: 

A free consultation (virtual or face to face) with eligible patients to inform them of their result and advise of the next steps in the pathway (including completion of BPAC Bowel Screening referral)

• $74.62

Funding Stream: 

Health New Zealand

Purpose:  

The purpose of funding CVRA for never-screened or overdue high-risk patients in primary care is to support early identification and management of cardiovascular risk, particularly among those most at risk of adverse outcomes. This funding enables proactive outreach and equitable access to preventive care for underserved populations.  

Eligibility Criteria: 

Enrolled patients who are recommended for Screening as per the Ministry of Health CVD guidelines: https://www.heartfoundation.org.nz/professionals/health-professionals/cvd-consensus-summary 

AND

• Have never previously had a CVRA
• OR are overdue and previous CVD Risk above 10%

Note: Claims will be audited to ensure appropriate use of funding

No Co-Payment:

Providers claiming for this service agree not to charge the patient a co-payment.

Services Funded: 

CVDRA Completed: $32.50

Funding Stream: 

Health New Zealand Contract

Hauraki PHO's approach to Diabetes Support Funding is multi pronged to ensure we are targeting the limited funded we receive to where it will have the biggest impact. This includes those with pre-Diabetes, newly diagnosed and those with poorly controlled diabetes. 

We anticipate this consultation will take at least 30mins.

Eligibility Criteria:

Prevention (HbA1c 40-47 for the first time within past 3 months).

Consider discussing the risk of diabetes, encouraging a balanced diet and regular physical activity, referring to a dietitian, supporting weight management, promoting smoking cessation and alcohol moderation, providing resources for self-management.

Newly Diagnosed (HbA1c 48+ for the first time within the past 3 months)

Consider diabetes education and self-management support, treatment goals with the patient, lifestyle modification support (nutrition, exercise, smoking/alcohol), starting pharmacological therapy as appropriate,  consider referral to multidisciplinary care team, or other relevant provider, arrange follow-up and regular HbA1c monitoring

At Most Risk (Latest HbA1c >= 80)

Consider the following, review patient history, comprehensive physical exam, medication review, review lifestyle factors,

review monitoring and self-management, consider referral to multidisciplinary care team, or other relevant provider.

No Co-Payment: 

Providers claiming for this service agree not to charge the patient a co-payment.

Services Funded:

Initial consultation $115.00

Note: a 30 minute follow up consult will only be funded for High Risk patients only (within 6 months) $115.00

Note: Regular audits will be undertaken to ensure appropriate use of funding

Purpose:

• This service is important for providing access to a low-income predominantly Māori client base. 
• It relieves pressure on WDHB hospital services as preventative intervention reduces the need for major surgical procedures. 
• It can be better managed where community based dental services are available.  

This service may not utilise more than 15% of your SIA funding allocation. 

Eligibility Criteria: 

HPHO enrolled patients where there is no other subsidy or MSD funding available (see the link for more info: https://www.workandincome.govt.nz/eligibility/health-and-disability/dental-treatment.html), focusing on;

• Māori or Pasifika 
• and/or Community Service Card or High User Health Card Holders
• and/or those living within an area of high deprivation (Quintile 5) 
• and/or those who cannot afford to pay

Services Funded:

• Extraction $300.00
• Filling $300.00 
• Screening/Assessment $180.00  

Funding Stream: 

Services to Improve Access (SIA) allocation

Purpose:

Eligible patients may receive a funded ECG when clinically indicated by a GP or Nurse Practitioner to support diagnosis and early detection of heart disease (excluding acute chest pain already covered by POAC)

Eligibility Criteria:

HPHO enrolled patients focussing on; 

• Māori or Pasifika 
• and/or Community Service Card or High User Health Card Holders
• and/or those living within an area of high deprivation (Quintile 5) 
• and/or those who cannot afford to pay

Services Funded:

• Non Chest Pain ECG only  $63.00

Consultation fee still chargable

Includes eligible patients on long term psychotropic medication

Funding Stream: 

Services to Improve Access (SIA) allocation

Purpose:  

The aim of this service is to fund the additional consultation time needed for eligible enrolled patients who face higher and more complex needs.

Eligibility Criteria:

HPHO enrolled patients focusing on;

• Māori or Pasifika 
• and/or Community Service Card or High User Health Card Holders
• and/or those living within an area of high deprivation (Quintile 5) 
• and/or those who cannot afford to pay
• suffering from -

• complex medical conditions

• multiple chronic conditions

• mental health condition

• poverty

• acute conditions (not already covered by POAC)

Co-Payment Applies:

• Providers claiming for this service are able to charge the patient a co-payment (standard clinic charge) or appointment fee for the first 15mins of this service.

Services Funded:

• GP/NP Time $30.00 - per extra consult 10 mins
• Travel Time $30.00 - per 10 mins travel time
• $1.06 per km travel

Funding Stream: 

Services to Improve Access (SIA) allocation

Purpose:

Cervical cancer is one of the most preventable cancers. Early detection of persistent HPV infections through HPV Primary Screening is intended to help the country meet its goal of eliminating cervical cancer.

Eligibility:

• Priority Group (Māori, Pacific, CSC holders-) -aged 25-69 years OR 
• Unscreened - Never had screening - aged 30-74 years OR 
• Under screened - 5+ years since last cytology | 7+ years since last HPV test - aged 30-74 years OR 
• Follow-up Testing  including: 

-Repeat screening after an invalid HPV test result, or an unsatisfactory cytology sample 

-All follow-up testing after ‘HPV Other’ detected (until returned to routine screening) 

-Not yet been returned to routine interval screening after a previous low-grade cytology result 

-Test of Cure or recommended follow-up after colposcopy 

-Annual co-testing 

Note: Patients who are immune deficient are considered ‘under-screened’ when it has been 3 years or more since their last cytology, OR 5 years or more since their last HPV test. 

No Co-Payment:

Providers claiming for this service agree not to charge the patient a co-payment.

Services Funded:

Routine Priority Screening $59.22

Unscreened | Underscreened $59.22

Unscreened | Underscreened - Priority Group - $71.07

Follow up $85.28

Funding Stream: 

Health New Zealand

Purpose:

• This service aims to provide practices with adequate funding to enable insulin initiation and follow up to support improved outcomes for patients with diabetes. 

Eligibility Criteria: 

• HPHO enrolled patients who have been classified with Type 2 Diabetes required insulin initiation 

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment

Services Funded: 

• Insulin initiation $90.00
• Insulin follow-up $50.00

Funding Stream: 

Health New Zealand Contract

Purpose:

This service aims to provide specified IV procedures within the practice to reduce the need for patients to travel to Outpatient Clinics.

Eligibility Criteria:  

HPHO enrolled patients focussing on; 

• Māori or Pasifika 
• and/or Community Service Card or High User Health Card Holders
• and/or those living within an area of high deprivation (Quintile 5) 
• and/or those who cannot afford to pay

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment

Services Funded:

• Zoledronic Acid Infusion $172.50 
• Cortisone Injection $82.50
• Other Injections $27.50

NOTE Iron Infusions to be claimed either via Primary Options (low ferritin) or Secondary Referred Iron Infusion Form (Pre-Op Infusion)

Funding Stream: Services to Improve Access (SIA) allocation

Purpose:

This funding is to support the transition or transfer of care for eligible people with long term mental illness from specialist to primary services and/or improve the provision of physical health care for people who have not been engaged with a primary care provider. 

Eligibility Criteria: 

• A person who has been a long term client of specialist services (more than 2 years)
• Referred by secondary services for transistion into primary care

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment (standard clinic charge) or appointment fee for this service. 

Services Funded:

• Extended GP/NP Consult $157.65
• Standard GP/NP Consult $103.50
• Nurse Extended Consult $51.80
• IM Injection $25.59
• Did Not Attend GP/NP Consult $87.11

Funding Stream: 

Health New Zealand

Purpose:  

The service is intended to facilitate the care of terminally ill patients in their home or the practice environment by increasing access to primary care by:

• relieving the patient’s financial burden in the terminal phase of their illness
• allowing the general practice to receive reimbursement for the loss of income whilst caring for the terminal patient.

Eligibility Criteria:

• receiving palliative care AND assessed as being within their expected last year of life
• Focusing on but not limited to patients of Māori or Pasifika ethnicity and/or with CSC/HUHC 

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment (standard clinic charge) or appointment fee for this service.

Services Funded:

• GP/NP time (ie. consultations, medication management, liaison with other health providers etc) $30.00 per 10 mins
• Travel Time $30.00 per 10 mins 
• $1.06c per km

Funding Stream: 

Service to Improve Access (SIA) allocation

Purpose:  

This service aims to achieve a reduction in the incidence of unplanned hospital admissions and/or amputations for diabetes related foot complications.  

Eligibility Criteria: 

• Enrolled patients diagnosed with type I or II diabetes and high risk foot disease as defined in the Diabetic Foot Screening and Risk Stratification Tool
• Please ensure Foot Risk is recorded in Screening as this will be used to assess eligibility of claims 

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment.

Services Funded: 

• Initial Consult $114.91 
• Follow-up Consult $76.61 

Maximum of 4 consults per year

Funding Stream: 

Health New Zealand Contract

Purpose:

Funding non-cancerous lesion removals and other minor operations in primary care improves patient access, reduces hospital waitlists, and supports efficient use of the health system by managing appropriate procedures closer to home

Eligibility Criteria:

HPHO enrolled patients focusing on;

• Māori or Pasifika 
• and/or Community Service Card or High User Health Card Holders
• and/or those living within an area of high deprivation (Quintile 5) 
• and/or those who cannot afford to pay

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment.

Services Funded:

• Liquid Nitrogen $34.50
• Biopsy $150.00 
• Wedge Resection $200.00
• Simple Operation $310.00
• Complex Operation $555.00

Includes one funded follow up GP/Nurse Practitioner consultation

Note: Regular audits will be undertaken to ensure appropriate use of funding.

Funding Stream: 

Services to Improve Access (SIA) allocation

Purpose:  

This service aims to prevent the development of acute rheumatic fever by providing free and open access to timely sore throat management

Eligibility Criteria: 

Patient presenting with sore throat who are:

Aged 4-19 

• Maori/Pacifika 
• and/or with CSC 
• and/or Quintile 5 

OR Household contact of an eligible patient who has had a positive swab result

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment (standard clinic charge) or appointment fee for this service. 

Services Funded: 

• Throat Swab and follow up $29.50

Funding Stream: 

Health New Zealand Contract

Purpose:

Funding skin cancer lesion removals in primary care enables timely, accessible treatment, reducing progression risk and demand on secondary care services.

Eligibility Criteria:

• Any patient identified with suspected skin cancer lesions

No Co-Payment:

Providers claiming for this service agree not to charge the patient a co-payment.

Services Funded:

Includes consumables and 1 post-op consultation

Basic level: $310.00

This would include:

• punch biopsy, shave biopsy 
• simple ellipse excision with direct closure
• excision of lesions requiring basic layered closure.

Exclusions to basic level:

• all head and neck lesions
• below knee lesions > 5mm
• excisions on digits, ears.

It is expected that NPs/GPs and suitable trained nurses with basic minor surgery skills and dermoscopy skills and should be able to undertake simple/basic excisions in primary care setting. 

Complex level: $555.00

This would include:

• curettage
• below the knee, simple ellipses if direct closure can be achieved <10mm
• flap closures.

Exclusions – to be referred:

• all head and neck lesions
• lesions involving the ear canal or inner conchal bowl
• gaiter lesion not suitable for primary closure
• melanoma stage 2 or higher (Breslow >0.75mm), these need sentinel nodes biopsy +/- CT etc.

Complex excisions to be provided by NPs/GPs who have undertaken further surgical training - they may have previously worked in hospital surgical departments, have completed specific postgraduate training or be experienced NPs/GPs with significant experience in minor surgery and targeted CME - and participate in regular minor surgical updates, peer review processes or regular audit of surgical practice.

These NPs/GPs would self-identify as having the skills to complete more complex surgery in primary care and have a suitable facility to provide this service.

For multiple excisions carried out together, one excision can be claimed at the full amount, the second at half the rate. A maximum of 2 excisions can be claimed together.

Funding Stream: 

Health New Zealand  

Purpose:  

This service is intended to improve access to primary health services for children under 14 years old.   

The goals are to: 

• Help improve access to services through reducing financial barriers  
• Reduce the numbers of young children presenting to Emergency Departments with conditions that might be better treated by primary care providers
• Enhance child health outcomes  

Eligibility Criteria: 

• Child under 14 years of age can access this service after hours focusing on CSC holders
• After hours primary health care is defined as meeting the needs of patients “who cannot be safely deferred until the general practice they are enrolled with is open for business”.  
• After-hours is defined as those hours between 6pm and 8am on weekdays and 24 hours on weekends and public holidays. 

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment

Services Funded:

After Hours Consult:

• Under 6 : $23.43
• Aged 6 to 13: $45.06

Funding Stream: 

Health New Zealand contract

Purpose:  

This is available designed to help improve access to services through reducing financial barriers for this age group. 

This claim is in leiu of charging the patient an appointment fee. Not to be claimed in conjunction with other funded services.

Eligibility Criteria:  

HPHO enrolled patients aged 14 to 17 years, focusing on

• Māori or Pasifika 
• and/or with CSC or HUHC 
• and cannot afford to pay for this service in Primary Care.

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment

Services Funded: 

• NP/GP consult or Repeat Prescription $13.50

Funding Stream: 

Services to Improve Access (SIA) allocation

Purpose:

This service is a free primary care based sexual health and contraception service for under 25-year olds living outside of Hamilton City

Eligibility Criteria: 

All patients aged under 25 years

Exclusions

• Practices located inside the Hamilton City boundaries are not able to claim for the service.
• services normally provided under the maternity services contract
• sexual abuse and assault services normally covered by ACC
• women who are eligible to claim via the priority women cervical screening project, or the long-acting reversible contraceptives (LARCs) programme.

No Co-Payment:

• Providers claiming for this service agree not to charge the patient a co-payment

Services Funded: 

Sexual health related consults including but not limited to:

• Assessment, diagnosis and treatment of sexual transmitted infections (STI)
• Sexual and reproductive health education and disease prevention advice.
• Contraceptive advice and prescribing
• Contact tracing 
• GP / NP / Nurse Consult $35.00

Funding Stream: 

Health New Zealand Contract

Purpose:  

To reduce financial barriers to service access for those who cannot afford to pay in primary care. It includes assistance for: 

• Transport  
• Ambulance  
• Ultrasound 
• X-ray 
• Blister packs 
• Prescription support

Eligibility Criteria:

HPHO enrolled patients focussing on;

• Māori or Pasifika 
• and/or Community Service Card or High User Health Card Holders
• and/or those living within an area of high deprivation (Quintile 5) 
• and/or those who cannot afford to pay

Services Funded:

• $5.00 - RX assistance per item
• $5.00 - Per blister pack
• $65.00 - $120.00 Xray assistance
• $180.00 - $285.00 Ultrasound assist
• $125.00 - Ambulance assistance
• $20.00 - Transport assistance

Funding Stream: Service to Increase Access allocation 

Purpose:  

This initiative now includes dual therapies that acknowledge both the hinengaro (mind) and tinana (body). It enables patients to access a broader range of culturally and clinically informed supports, including counselling, mirimiri, rongoā, and physiotherapy. This fund also supports clients who may need additional sessions beyond what is covered under the Primary Mental Health (PMH) contract.

Eligibility Criteria:

HPHO enrolled patients focussing on;

• Māori or Pasifika 
• and/or with CSC or HUHC 
• and cannot afford to pay for this service in Primary Care.
• Patient is not eligible for ACC funded services relating to this claim
• GP Referral required
• Providers claiming for this service agree not to charge the patient a co-paymet (standard clinic charge) or appointment fee for this service.

Services Funded:

• $97.75 - Counselling
• $97.75 - Mirimiri
• $97.75 - Rongoā Māori
• $90.00 - Physio (Initial)
• $60.00 - Physio (Follow up) 

• Treatment providers are contracted with and paid directly by the practice.

• A maximum of 4 sessions per patient, per annum

Funding Stream: Services to Improve Access Allocation

Eligibility criteria:

• Patients with abdominal pain, who are haemodynamically stable

Services Funded:

- IV Medication, includes consult time and any consumables

- Rehydration, includes consult time and any consumables

- Abdominal Ultrasound if required

- Funded follow-up consultation with a registered health care professional post Ultrasound

Co-Payment:

• Co-payment chargable for initial consultation. Follow-up is fully funded.

Service codes:

• Abdominal Pain - GP/NP Follow Up Consult $81.37
• Abdominal Pain - Rehydration $162.74
• Abdominal Pain - IV Medication $81.37

Funded via third party providers

An abdominal ultrasound is funded under this service to support management and avoid acute admission.  

Patients who are not acutely unwell and do not require a same day ultrasound are not funded under POAC and should be referred to primary referred radiology. Radiology is only funded for same-day investigations (within a 24-hour period).

Eligibility criteria:

• Patients with abnormal uterine bleeding who would benefit from further investigation and/or treatment. 

Services Funded:

• Pipelle biopsy:  includes consultation time and any consumables
• Iron infusion: as per PHARMAC Special Authority Criteria if required
• Mirena insertion and/or removal
• Pelvic Ultrasound if required
• One Funded follow-up consultation with a registered health care professional

No Co-Payment: 

Providers claiming for this service agree not to charge the patient a co-payment.

Service codes:

• Abnormal Uterine Bleeding - Pipelle biopsy $210.12
• Abnormal Uterine Bleeding - Iron Infusion $162.74
• Abnormal Uterine Bleeding - Mirena Insertion $177.68
• Abnormal Uterine Bleeding - Pipelle biopsy+mirena insertion $298.95
• Abnormal Uterine Bleeding - Mirena insertion and removal $231.75
• Abnormal Uterine Bleeding - Education release for PoP and/or Pipelle biospy $500.00
• Abnormal Uterine Bleeding -  GP/NP Follow up Consult $81.37

Funded via third party providers

An Pelvic ultrasound is funded under this service

Purpose:

This programme allows for the management of patients with low-risk chest pain (an EDAC score lower than 16).

Practices are required to have iSTAT equipment, and their staff have had appropriate training. (See equipment and supplies below.) iSTAT point of care (POC) testing equipment and consumables can be purchased from Abbott Pharmaceuticals.

Please make contact with them and set up an account to place your orders directly

Eligibility criteria:

Patients presenting to general practice with an episode of chest pain with onset within the last 72 hours.

Patients with an EDAC score lower than 16. 

Patients who receive a clinical assessment and meet the eligibility criteria in accordance with the suggested management.

Exclusions:

Patients with:

• ST segment elevation myocardial infarction present on ECG
• an EDAC score 16 or above
• haemodynamic instability
• active chest pain that is suspected to be of cardiac origin
• chest pain clearly due to non-coronary pathology
• suspected PE, pancreatitis, AAA or STEMI.
• Any patient who requires transfer to hospital regardless of a negative troponin, due to other medical conditions, or need for other investigations.

No Co-Payment:

• No Co-payment chargable

Service Funded:

Accelerated Chest Pain Pathway - Package of Care: $342

This package of care is for a low-risk patient who has completed the RACPP over a 2-hour period regardless of outcome.

This invoice includes an allocation for staff time as well as consumables, it cannot be claimed along with any other claims.

This allows for follow-up of patient’s 2-hour results and up to 115 mins of practice observation time.

Eligibility criteria:

• Where an acute admission has been considered by a GP/NP and after discussion with the relevant Senior Medical Officer (excluding Emergency Department) a management plan has been instigated to manage the patient in the community and to avoid an acute admission to the Hospital. 

Services Funded:

• Extended initial consultation either face-to-face or virtual for up to 30 minutes
• Up to two follow up consultations are funded to implement and evaluate the plan of care. 

Co-Payment:

• Co-payment chargable for initial consultation. Follow-up is fully funded.

Service codes:

• Acute Decline - GP/NP Extended consultation $81.37
• Acute Decline - GP/NP Follow-up consultation $81.37

Clinical Detail Required 

All claims must include reference to the discussion with the SMO and the management advice. 

Eligibility Criteria:

Adults and children with moderate asthma exacerbation that can be safely managed within the community (suspected bronchiolitis can also be accepted).

Services Funded:

Post consultation observations and management by relevant health care professional (up to 2 hours)

Follow-up consultation either face-to-face or virtual

Co-payment:

Co-payment chargable for initial consultation. Follow-up is fully funded.

Service codes:

• Asthma - Practice Observation - $1.00 per minute up to 120 minutes 
• Asthma - GP/NP Follow-up Consultation $81.37

Eligibility criteria

Oral antibiotic treatment for patients aged >= 15 years with moderate cellulitis.

Patients with a clear diagnosis of cellulitis who are haemodynamically stable. 

High risk patients

• Symptomatic peripheral vascular disease
• Symptomatic or clinically overt venous insufficiency
• Obesity BMI>40
• Recurrent cellulitis( 2 or more episodes within 12 months)
• CSC holders

Claims cover the time period within 7 days of the initial appointment.

Exclusions

• Cellulitis initiated by accident or injury (ACC) 
• Age <15 years old 
• Pregnancy
• Septic arthritis/prosthesis present/underlying fracture
• MRSA carrier

Services Funded

NON HIGH RISK PATIENTS

Initial consultation           Not funded

Patients pay a co-pay at the standard consultation rate as the initial consultation is considered a routine primary care appointment. 

First follow up                     Not funded

Patients pay a co-pay at the standard consultation rate as the first follow up is considered a routine primary care appointment for low-risk patients.           

Subsequent follow up       Funded

Subsequent GP/NP/Prescriber in-person follow up consult

HIGH RISK PATIENTS

Initial consultation          Not funded

Patients pay a co-pay at the standard consultation rate as the initial consultation is considered a routine primary care appointment.         

First follow up                     Funded

Patients will receive a phone or in person clinical follow up (usually nurse led) within 72 hours. Whether this is virtual or in person is up to clinician discretion.     

Subsequent follow up   Funded

Subsequent GP/NP in-person follow up consult.

Co-payment:

All patients 15 years and over make a co-payment for an initial GP consultation.

Service codes:

• Cellulitis - High Risk - First Follow up $44.85
• Cellulitis - Third Consult Onwards $109.25

Clinical Guidance

Available in HealthPathways

Discuss with relevant specialist as needed for further advice.

Eligibility criteria:

• The diagnosis is unclear, in a patient presenting with acute chest pain who would otherwise be sent acutely to hospital for ECG. 
• This funding does not cover the cost of a routine ECG.
• An urgent troponin will be ordered as well
• Clinical notes must demonstrate that a troponin has been ordered to qualify for POAC funded ECG.

Services Funded

• Acute ECG
• Follow-up consultation with a registered health care professional post ECG

Co-payment:

• Co-payment chargable for initial consultation. Follow-up is fully funded.

Service codes:

• Chest Pain - ECG $64.89
• Chest Pain - GP/NP Follow-up Consultation $81.37

Eligibility criteria:

• Patients with acute or sub-acute presentation of COPD requiring further management and/or support

Services Funded:

• Chest X-Ray where the cause of SOB is unclear and a CXR may help better management and avoid acute admission.
• GP/NP extended consultation (30 minutes max) at time of acute COPD presentation 
• Follow-up GP/NP consultation post Chest X-Ray

Co-Payment:

Co-payment chargable for initial consultation. Follow-up is fully funded.

Service codes:

• COPD - GP/NP Extended consultation $81.37
• COPD - GP/NP Follow-up consultation $81.37

Funded via third party providers

An chest x-ray is funded under this service to support management and avoid acute admission.  

Eligibility criteria:

• Children <5 years with acute croup that can be managed safely in primary care for observation after oral steroid administration.
• Excludes children requiring nebulised adrenaline as they should be admitted.

Services Funded:

• Practice observations to a maximum of two hours

No Co-Payment

• Zero co-payment fee for children ≤14 years and under

Service codes:

• Croup - Practice Observation - $1.00 per minute up to 120 minutes 

Clinical Guidance:

Available in HealthPathways.

Discuss with relevant specialist as needed for further advice.

Eligibility criteria:

• Suspected DVT (excluding pregnancy) with a Wells Score of >= 2 or a positive D-dimer

• DVT diagnosed in pregnancy must be discussed immediately with relevant hospital specialist; 
• No DVT treatment or follow up consultation claims will be allowed in pregnant patients unless instructed to do so by hospital specialist.
• Repeat scans funded in following circumstances:

1. Wells score >= 2, D-Dimer positive and 1st scan negative.
2. Below knee DVT on first scan with no initial anticoagulation given.
3. Persisting superficial venous thrombosis at 7-10 days with no risk factors in an  ambulatory patient.

Services Funded:

Based on treatment provided as documented in clinical notes:

• Oral Rivaroxaban is first choice for administration pre and post diagnosis
• Enoxaparin administration for prophylaxis or treatment – where patient is unsuitable to have Rivaroxaban
• Doppler ultrasound
• GP/NP follow-up consultation post ultrasound

Co-Payment:

Co-payment chargable for initial consultation. Follow-up is fully funded.

Service codes:

DVT - Enoxaparin administration $81.37

DVT - GP/NP Follow up consultation $81.37

Funded via third party providers

An ultrasound is funded under this service to support management and avoid acute admission. 

Clinical Guidance:

• Available in HealthPathways.
• Discuss with relevant specialist as needed for further advice.

Eligibility criteria:

• Adults with moderate dehydration not responsive to oral fluids +/- antiemetic that can be safely managed in the community e.g. gastroenteritis, hyperemesis gravis, migraine
• Children with moderate dehydration or at risk of getting severely dehydrated due to gastroenteritis that can be managed safely in the community. Please note age 6 months to 15 years can usually be managed with oral rehydration.

Services Funded:

• Rehydration management including practice observations, consumables including IV fluids if required, and clinician time
• IV fluids to treat Hyperemesis are included only where maternity funding is not available

Co-Payment:

Co-payment chargable for initial consultation.

Service codes:

Dehydration - Rehydration $162.74

Clinical Guidance:

Available in HealthPathways.

Discuss with relevant specialist as needed for further advice.

See 1st trimester maternity funding rules

This programme is a collaboration between Te Runanga o Kirikiriroa (Facilitation Service) and general practices.

Funding is specifically targeted to people who are in emergency or transitional housing or homeless within inner city Hamilton and are engaged with Te Runanga o Kirikiriroa. The aim is to re/engage these people with general practice when they are unwell rather than them presenting to the emergency department. The secondary aim is for this population to then enrol with a practice.

Te Runanga o Kirikiriroa will employ a facilitator to work with social agencies and their clients. If the client needs a GP appointment, the facilitator works with the client and the practice to arrange an appointment.

Any practice in the Hamilton City area that has agreed to partner with Te Runanga o Kirikiriroa (Facilitation Service), can offer and claim for this service.

Practices wishing to participate in this programme can contact the practice support team.

Eligibility criteria:

Patients engaged with Te Runanga o Kirikiriroa facilitator who have had an appointment pre-arranged

No Co-payment:

Providers claiming for this service agree not to charge the patient a co-payment.

Services Funded:

Emergency Housing Programme: Initial GP/NP consultation (unenrolled) (one only): $152.80

Emergency Housing Programme: Initial GP/NP consultation (enrolled) (one only): $106.62

Emergency Housing Programme: Follow-up (unenrolled) (two only): $76.99

Emergency Housing Programme: Follow-up (enrolled) (two only): $59.23

Emergency Housing Programme: Renewal of prescription $26.45

Eligibility criteria:

• Epistaxis that can be safely managed in the community

Services Funded:

• Practice observations for management up to one hour

Co-Payment:

Co-payment chargable for initial consultation.

Service codes:

• Epistaxis - Practice Observations $1.00 per minute up to 60 minutes

Clinical Guidance:

Available in HealthPathways.

Discuss with relevant specialist as needed for further advice.

Eligibility criteria:

• Febrile (>38 C) children with moderate/amber symptoms or signs that can be safely managed in the community but would otherwise need to be sent to hospital.

Services Funded:

• Cost of practice observations and management up to two hours

No Co-Payment

Zero co-payment fee for children 14 years and under

Service codes:

Fever Unknown Origin - Observation Time $1.00 per minute up to 120 mins

The acute Frailty Admission Avoidance Service is a service meant to support GPs and their vulnerable elderly patients by providing alternatives to Emergency Department referral. 

Target patients are:

“individuals with increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is compromised”.

The service aims support GP’s to link patients into the most appropriate short-term community service: 

• Acute Home Based Support – in home
• Respite - in a rest home facility 
• START – in own home but provides a rehab service

Referrals can be made by phoning the triage coordinator.  

Triage coordinator: Phone 027 552 0187 or 07 839 8669.  

Hours of service: 8am - 4pm, Monday to Friday. 

Eligibility Criteria:

• 65 years and over.
• Acute event causing a borderline level of function with a reduction in personal activities of daily living or extended activities of daily living meaning it is not safe to send them home.
• Able to stand, transfer and toilet independently or with assistance.
• Patients consents and agrees to be seen by an inter-disciplinary team.

Exclusion Criteria:

• Acutely unwell requiring hospital admission.
• Progressive or deteriorating condition where partial or full recovery cannot be reasonably expected within 6 weeks (e.g. palliative care). 
• Home environment not safe for patient/staff or appropriate for rehabilitation. 

Services Funded

• ONE extended consult for initial assessment at surgery or patient’s residence. ONLY, if the patient is referred via pathway.
• ONE follow-up visit to patient’s home or residential care facility following completion of supports

Co-payment:

Patients’ make a co-payment for an initial GP consultation.

Service codes:

• Frailty Admission Avoidance Service -Initial Assessment $81.37
• Frailty Admission Avoidance Service - Home Visit $129.78 

Eligibility criteria:

• Secondary care will identify these patients and liaise with the GP.

Aim is to reduce rate of acute attendances at ED for “repeat attenders” where these presentations are considered inappropriate.

Inclusions:

• Initial consultation with the patient to assess and discuss the management plan to avoid the patient attending ED acutely. Duration of appointment up to 60 minutes, fee $120.00.
• Cost of GP attendance (in person or by telephone or video) at a multi-disciplinary hospital meeting to develop a management plan for those identified as frequent attendees by Emergency Department clinicians. Duration of meeting up to 60 minutes, fee $225.00.
• Follow-up GP visits for the events identified in the management plan where the GP has agreed with the patient that they will return to General Practice rather than presenting to ED. Maximum 4 extended consultations up to 30minutes each in one year, fee $75.00 per extended consultation.
• Zero co-payment for the initial and extended consultations.

Eligible advanced form service codes:

• Initial consultation with GP to discuss management plan to avoid the patient attending ED acutely, fee $120.00
• General Practitioner attendance at a multi-disciplinary hospital meeting and development of a management plan, fee $225.00
• Extended consultations up to 4 per annum, fee $75.00 each consultation (Maximum $300 in a year).

Eligibility criteria:

• Chest X-Ray where the cause of SOB/acute respiratory symptoms is unclear and a CXR may help better management and avoid acute admission.
• Slipped Upper Femoral Epiphysis - X-ray AP Pelvis and lateral of the hip for children aged 8-16 years with suspected Slipped Upper Femoral Epiphysis, unexplained hip, or knee pain, especially if the hip is internally rotated and flexed. A frog lateral is useful for comparison with the other side if the slip is subtle.
• RPOC - Ultrasound for investigation of retained products of conception in women post-partum >6 weeks or TOP/miscarriage >14 days (where patient no longer qualifies for maternity funding). 

Services Funded:

GP/NP follow-up consultation post imaging

Co-payment

• Co-payment chargable for initial consultation. Follow-up is fully funded.

Service codes:

• Imaging - GP/NP Follow-up Consultation $81.37

Please ensure POAC claim number is included on the referral form

Clinical Guidance:

• Available in HealthPathways

Eligibility Criteria

• Patients who meet the PHARMAC special authority criteria for prescribing subsidised ferric carboxymaltose (Ferinject) in the community

Services Funded:

• Infusion medication package of care including clinician time and consumables

No Co-Payment: 

• Providers claiming for this service agree not to charge the patient a co-payment.

Service codes:

• Iron Infusion - Iron Infusion $162.74 

Eligibility criteria:

• Patients with rapid palpitations and a systolic BP >100, where an ECG performed shows a regular narrow complex (QRS<= 120msec) tachycardia in whom vagal manoeuvres have been unsuccessful.
• This can only be claimed by those GP’s who are appropriately trained.

Services Funded:

• IV Adenosine including GP/nurse time, consumables and invoicing

Co-Payment:

• Co-payment chargable for initial consultation.

Service codes:

• IV Adenosine - IV Adenosine: $113.30 

Clinical Guidance:

• Available in HealthPathways.
• Discuss with relevant specialist as needed for further advice.

Purpose:

This funding has been established to support general practices and urgent care clinics to provide timely, equitable, and accessible care during the 2025–26 measles outbreak. It enables funded consultations, testing, and vaccination services for people identified by Public Health as measles cases, suspected cases, or close contacts, particularly those from priority and at-risk populations. The aim is to strengthen outbreak response and reduce barriers to care for those most at risk.

Eligibility

Funded services apply only to people identified and referred by Public Health as a measles case, suspected case, or close contact, who are also in one of the following groups:

· Māori, Pacific, disabled people

· People with severe mental health/addiction issues

· People living in quintile 4-5 areas

· Migrant or refugee communities, rough sleepers, people in transitional housing

· Those not enrolled in primary care

· Others as identified by Public Health

Co-Payment

No co payment to be charged to patient

Services Funded

Consultation + PCR swab 

Standard Hours $90 

After Hours $135

MMR vaccination (PEP) 

Standard Hours $90

After Hours $135

Measles serology (if not referred to lab) Standard Hours $30

After Hours $45

PCR swab only (no consultation) 

Standard Hours $30 

After Hours $45

Vaccination record retrieval (if cost incurred) 

Standard Hours $30 

After Hours $45

Notes:

· One claim type per patient, per day, per practice.

· Consultations can be in-person, phone, video, text, or patient portal.

· Services should generally be delivered during business hours (8am–5pm, Mon–Fri), with after-hours claims permitted if clinically required.

Eligibility criteria:

• Patients with suspected renal colic OR acute urological problems that can be managed safely in primary care, including:
• Acute indwelling catheter insertion for patient in acute urinary retention in the absence of red flags i.e. acute trauma – straddle injury/fractured pelvis, perineal haematoma. After 3 insertions over a period of 6 months, evidence of urology referral is required prior to funding further insertions.
• Blocked catheter, which cannot be unblocked by flushing, who would otherwise have to go to hospital to have this done. After 3 insertions over a period of 6 months, evidence of urology referral is required prior to funding further insertions.
• Uncomplicated pyelonephritis – this would fund the administration of a single dose of iv antibiotics, with observation in clinic for 2 hours

Uncomplicated pyelonephritis

- Female, aged 15 to 54 years

- Clinically stable

- Normal kidney function

- Normal renal structure

- Not pregnant

- No complicating disease e.g., diabetes

Complicated infection

- Aged > 55 years

- Male

- Evidence of sepsis

- Known or suspected renal impairment

- Abnormality of renal tract

- Known or suspected renal stones

- Bilateral pyelonephritis

- Pregnancy 

- Immunosuppression e.g., diabetes, steroids, renal transplant

- Spinal cord impairment

- History of UTI with resistant organisms e.g., ESBL (extended-spectrum beta-lactamase)

- Recent admission to hospital with UTI, or hospital acquired UTI

- UTI following instrumentation

- Catheter in situ

- Recent travel to India (resistant organisms)

- Failure to respond to a single dose of IV antibiotics in the community

Services Funded:

• Acute indwelling catheter insertion
• Rehydration
• IV antibiotics (once for pyelonephritis)
• Practice observation post analgesia administration for renal colic (Max 60 mins)
• Practice observation time following IV antibiotic dose for pyelonephritis (Max 120 mins)
• Renal Colic – CTU
• Renal Ultrasound if required
• GP/NP Follow up Consult

Co-payment:

• Co-Payment Applies for Initial Consult
• No Co-Payment for Follow up

Service codes:

• Renal Colic and Urology - IV medication $89.61 
• Renal Colic and Urology - GP/NP Follow-up Consultation $81.37
• Renal Colic - Acute Urinary Catheter procedure $151.41
• Renal Colic & Urology - IV Pyelonephritis Practice Obs $1.00 per min max 120mins
• Renal Colic and Urology - Observation Time $1.00 per min max 60 mins
• Renal Colic and Urology - Rehydration $162.74

Guidance:

• Available in HealthPathways.
• Discuss with relevant specialist as needed for further advice.

CTU Booking Information:

0800-1600 hours: Phone CT Inpatient Booking Clerk on 07 839 8726 ext 98492 and fax referral to 858 0972 and give referral to patient to bring to Waikato Hospital. 

1600-2200 hours & weekends: Phone on-call Radiology Registrar, fax referral to 07 858 0972 and give referral to patient to bring to Waikato Hospital front entrance where the Radiology Clinical Assistant will be contacted to take the patient to the 4th floor for the CT scan. 

2200-0800 hours: Manage pain overnight. Admit to Emergency Department if pain uncontrollable or significant sepsis.

Purpose:

This programme is designed to support proactive management for people with chronic respiratory conditions to optimise patients’ chances of staying well during winter months. Funding is available for comprehensive reviews and care planning for patients who are at high risk of respiratory exacerbation during the winter months.

Eligibility Criteria:

• Patients diagnosed with a chronic respiratory condition who have been identified by the practice at being at high risk of respiratory exacerbation. 

This includes but is not limited to

• Māori, Pacific, Q5 and CSC holders 
• Patients who have a respiratory related hospital admission in the last year
• Patients who have had a respiratory related after-hours presentation to either ED or urgent care in the last 12 months
• Patients with frequent acute on chronic exacerbations of their respiratory condition
• Patients who make frequent requests for reliever inhaler prescriptions

Hauraki PHO can support general practices to identify eligible patients.

Services Funded: 

• RN Respiratory review (once only)

Full review of the patient’s respiratory condition, spirometry testing as appropriate, review of medications, development of a management plan, inhaler and condition education, referrals as appropriate

• GP/NP or Clinical Pharmacist Respiratory review (once only)

To include Medication review, authorization of a management plan, prescriptions for medications to treat exacerbations

• RN Respiratory follow-up - can be virtual (once only)

Follow up consultation to ensure the patient is comfortable managing their respiratory condition, including appropriate inhaler use and provision of further education.

No Co-Payment: 

Providers claiming for this service agree not to charge the patient a co-payment.

Service codes:

• Proactive Respiratory Care - RN Review $40.17
• Proactive Respiratory Care - GP/NP/CP Review $81.37
• Proactive Respiratory Care - RN Follow-up $40.17

Eligibility Criteria:

• Patients who have documented symptomatic uterovaginal prolapse POP Stage 1-3
• Patient must have had a gynaecology assessment to exclude pelvic masses.
• Contributing lifestyle factors have been addressed.
• Referral for physiotherapy pelvic floor training considered.

Exclusions:

• Asymptomatic women.
• POP-Q Stage 4 where specialist assessment is indicated.
• Prolapse with voiding dysfunction causing urinary retention.

Services Funded:

• Insertion and/or change of pessary.
• Grant towards education attendance at Ring Pessary Clinic Waikato Hospital for GP/Nurse Practitioner or Practice Nurse 

To arrange education, phone Gynaecology Clinic Waikato Hospital 07 8398899 ext 96733

To obtain pessaries use bpac referral form under Enhanced Primary Care –Ring Pessary Order.

No Co-Payment: 

Providers claiming for this service agree not to charge the patient a co-payment.

Service codes:

Pelvic Organ Prolapse - Pessary Insertion/Change $81.37

• Pelvic Organ Prolapse - Education Release $500

Eligibility Criteria:

• Moderate allergic reaction requiring observation in general practice.
• Patients with a severe allergic reaction, who are haemodynamically stable and can be safely managed in the community.
• Patients with anaphylaxis who have received a single injection of adrenaline and have normal observations within 30 minutes and the practice are able to observe safely for four (4) hours.

Services Funded:

• Practice observations up to 4 hours to cover GP/nurse management.

Exclusions:

• Any patient with anaphylaxis who does not have normal observations within 30 minutes of administering a single dose of adrenaline.
• Any allergic reaction covered by ACC, see ACC cover for allergic reactions as personal injury cause by accident (PICBA).

Co-Payment:

Co-payment chargable for initial consultation.

Service Codes:

Severe Acute Allergic Reaction - Observation Time $1.00 per min up to 240 minutes

Clinical Guidance:

• Available in HealthPathways.
• Discuss with relevant specialist as needed for further advice

Eligibility Criteria: 

• Patient who has called 111.
• Voucher has been issued by St John Ambulance Service to a patient who met the clinical criteria.
• Voucher includes valid date and time of issue.
• Voucher is presented to a General Practice or an Urgent Care Clinic within 48 hours from the time of issue.

Services Funded:

• ONE INITIAL patient consultation for assessment and treatment with a General Practitioner.

Co-payment:

• ZERO CO-PAYMENT for patients presenting with a St John Ambulance Service VOUCHER. This voucher includes both the co-payment and initial consultation fees, including for ACC cases. 

Service codes:

• St John Redirection - GP/NP Consultation $81.37

Note: In addition to initial assessment, if a patient meets the criteria for treatment of a condition included in the POAC Service Manual, practice to follow the appropriate POAC pathway both for providing treatment and claiming.