NHS Coding & Payment
The NHS payment scheme, like the National Tariff before it, sets out the prices, and rules for determining prices, payable by NHS commissioners to providers for providing services as part of the health service.
The HFMA’s introductory guide to NHS finance is a comprehensive guide of how the NHS finance regime works, as well as the wider landscape in which it operates.
NHS 2023/2025 Payment Scheme
The 2022 Health and Care Act replaces the National Tariff Payment System with the NHS Payment Scheme (NHSPS). The NHSPS contains rules to establish the amount payable for NHS-funded secondary healthcare.
The 2023/25 NHSPS has been set for two years (2023/24 and 2024/25). It contains rules for four payment mechanisms:
- Aligned payment and incentive (API) – covers almost all NHS provider activity and comprises fixed and variable elements. Almost all elective activity, and all activity which form part of the ERF, is included in the variable element and paid for using 100% of NHSPS unit prices.
- Low volume activity (LVA) block payments – applies to almost all NHS provider/commissioner relationships with an annual value below £0.5m. Commissioners should pay providers the nationally set LVA value, based on a three-year rolling average, with no other transactions in-year.
- Activity-based payment – applies to all services with NHSPS unit prices delivered by non-NHS providers. Activity is paid for using 100% of NHSPS unit prices for each unit of activity delivered.
- Local payment arrangements – providers and commissioners locally agree an appropriate payment approach.
2023-25 NHS Payment Scheme (england.nhs.uk)
This workbook contains the NHS Payment Scheme unit and guide prices, and related information, for 2023/24. The workbook will be reissued for 2024/25, reflecting revised cost uplift and efficiency factors.
Annex A – 2023/24 prices workbook
For outpatient attendances, the currency used is based on attendance type and clinic type, defined by a treatment function code (TFC) for the majority of specialties. Admitted patients relies largely on two standard classifications, (ICD-10) for diagnoses and (OPCS-4) for operations, procedures and interventions to be recorded.
The healthcare resource group HRG4+ system uses clinical information collected from these services to classify patients to case mix groups. This grouping is done using grouper software produced by NHS HRG4+ 2023/24 Consultation Grouper – NHS Digital
HRGs are identified by a five-character code structure with the first alphabetical character (J) representing the HRG Chapter. The first two alphabetical characters together (JC) represent the HRG Subchapter. The next two numeric characters (NN) represent the HRG Number within the chapter (JC 46). The final alphabetical character (Z) signifies the Split applicable to the episode.
HRG subchapter JD covers all skin disorders in adults. It includes activity undertaken in an inpatient and day case setting. All diagnosis-driven activity relating to the treatment of children (aged 18 years and under) groups to an HRG in Subchapter PA, Paediatric Medicine, in line with the requirements of the Casemix Design Framework.
Other HRG subchapters may also provide a higher tariff for site specific operations, procedures and interventions. The HRG4+Code to Group spreadsheet contains a list of the chapters and subchapters relevant to an individual Casemix grouper. It includes a list of all ICD10 an OPCS codes mapped to the relevant HRG subchapter.
The main OPCS codes for dermatology services are associated with OPCS Chapter S – Skin, Breast and Burns and subchapter Skin Surgery (S01 – S70) and Chapter U – Diagnostic Imaging, Testing and Rehabilitation and subchapter diagnostic application tests on skin (U01-U54). Chapter Z – Subsidiary Classification Sites of Operation (Z01-Z99) provides site codes to be used alongside the primary chapter code where the procedure site is not specific. However other OPCS Chapters such as ‘D – Ear and subchapter Extirpation of lesion of external ear (D01-D08) should also be used when a site-specific procedure is relevant. Please note: repatriation costs back to dermatology budgets are necessary when using other site-specific specialty codes.
For a glossary of terms relating to NHS Tariffs, please refer to the NHS Improvement website
For updates on the development of the NHS payment system, including news on payment systems in development, the current national tariff payment system and supporting information, and access to past tariffs please visit NHS England » NHS Payment Scheme
A Simple Guide to Recording Specialised Service Activity for Dermatology has been written by the BAD to help services comply with the Implementation Rules.
Also in this section
Specialised Service Tariff and Payments
Market Forces Factor and its use in the NHS Payment Scheme
High Cost Drugs
Transition from SUS to SUS+
Payment Scheme for Dermatology and Coding Standards
Patient Level Information and Costing Systems (PLICS)
NHS Excluded Care
Not all dermatological issues are covered by the NHS. Most regions across the UK have had some form of ‘cosmetic policy’ for a number of years, but what has been lacking is consistency. The Evidence Based Intervention (EBI) programme is an opportunity to reduce variation in policy between regions and to ensure that those patients who need treatment are not denied it.
The EBI policy is about benign cosmetic lesions, it does not include benign lesions which are troublesome, which may be painful, bleed or become regularly infected, these are still able to be treated.
Please see below a link to information on Specials recommended by the BAD.
