Funded Programmes Summary
WellSouth has a number of funded programmes for specific conditions and patient groups.
Service Schedule
The service schedule below gives a brief summary around eligibility and programme fees. For more information, click on the programme name which will take you to the programme information sheet.
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Programme |
Fee |
Eligibility |
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$148.35 (incl. GST) |
Eligibility • 16 years of age or older. • Able to provide informed consent for the referral (or this can be provided by the person who has the legal right to make decisions on the client's behalf). • Has an approved ACC claim no older than 6 months. • Has been assessed by a trained GP as meeting the clinical criteria for relevant pathways.
• Patients under Accredited Employers are NOT eligible for this programme. |
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$115.00 (incl. GST) |
Eligibility Patients must be enrolled, and meet one of the below |
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$92.00 (incl. GST)
$172.50 (incl. GST)
$172.50 (incl. GST) |
Eligibility • Patients aged 0-13 years. • Presenting to the clinic outside of normal business hours.
Exclusions • Practices cannot claim GMS if the patient is enrolled in a WellSouth Practice, if not enrolled with WellSouth then GMS can be claimed. |
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$81.10 (incl. GST) |
Eligibility • Patients ages 60—74 who have had a positive FIT (faecal immunochemical test) result, notified to their general practice, this must have been via the national screening programme.
Exclusions • Patients with historic or current bowel cancer. • Colonoscopy within last 5 years. • Already on surveillance programme (polyps, bowel cancer, family history, IBD). • Current treatment for IBD. • Those currently experiencing symptoms (see GP outside of screening programme). • Patients who have had a result via an over the counter iFOBT kit.
Key Information • Please advise the patient of their positive test results within 10 working days of the result being reported. Claims older than 10 working days will be rejected. |
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$81.10 (incl. GST) |
Eligibility • Any patient discharged from the hospital, following a COPD admission. • Appointment must have been made by the discharging team, or by the WellSouth call centre.
Key Information • Prior to discharge from hospital, the discharge nurse or discharge coordinator will contact the patients usual GP to arrange a follow-up appointment. This appointment is expected to occur with 14 days of discharge. • Appointment can be with RN, NP, or GP. • This is for one appointment only, further follow ups if deemed necessary are not covered under this programme. |
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$46.00 (incl. GST) |
Eligibility • Funding is available for eligible patients who had a funded CVD funded risk assessment with a risk of 15% or greater. • See CVD Risk Assessment programme information sheet for eligibility.
Exclusions • Patients who are not enrolled. • Patients who have had a non-funded CVD risk assessment. |
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$50.67 (incl. GST)
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Eligibility Funding is available for the following group of patients: • Maori, Pacific & South Asian* MEN aged 30-74. • Maori, Pacific & South Asian* WOMEN aged 40-74. • All other ethnicities MEN aged 45-74 (must have CSC or HUHC or be Quintile 5). • All other ethnicities WOMEN aged 55-74 (must have CSC or HUHC or Quintile 5). • Patients with severe mental illness (Schizophrenia, major depressive disorder, Bipolar disorder, Schizoaffective disorder from age 25).**
Extended Criteria Eligible patients previously risk assessed: • Previous risk < 15% last funded CVDRA must have been a minimum of 5 years ago. • Previous risk >= 15% last funded CVDRA must have been a minimum of 2 years ago.
Key Information • Patients who do not meet the eligibility criteria may still be assessed using the CVD Risk Calculator, without a claim for funding (New Non-Funded Risk Assessment).
**Patients with a severe mental illness - assessment must be commenced as a new Non-Funded Assessment, once severe mental illness is ticked, the claim will update to a funded Assessment. |
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$50.67 (incl. GST)
$57.50 (incl. GST) |
Eligibility • All patients with Diabetes, either Type 1 or Type 2.
Exclusions • Patients with Pre Diabetes. • Patients who have had a DAR less than 11 months ago. |
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$450.00 (incl. GST) |
Eligibility Patient must be: • Enrolled in WellSouth • Enrolled in Careplus or had a CLIC CHA • Diagnosed Type 2 • Have had two HBA1C readings >64mmol/mol (8%) • On appropriate oral medication • Compliant with medications • 18 years and over
Exclusions • Patients under 18 years of age. • Patients non compliant with medication. |
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Diabetes Medication Transition
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$69.00 (incl. GST)
$46.00 (incl. GST) |
Eligibility · For the initial consultation, the patient must have Type 2 diabetes and be either: · Eligible to be transitioned onto one of: |
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Refer to summary sheet for detailed time/workforce payment schedule |
Eligibility General practices will be able to claim for providing package of care (POC): · To patients with an acute condition, who without support would otherwise be referred acutely to hospital (Acute Care). Available to all practices. · For rural practice providing prolonged clinical care and observation for patients waiting on a hospital transfer (Rural Stabilisation). · There is no age restriction. · See sheet for presenting concerns.
Exclusions · Unstable patients (except for rural stabilisation.) · ACC claimable services. · Patients not eligible for NZ healthcare funding. · Patients requiring non-urgent investigations. · Services already contracted for, e.g. maternity services.
Key Information · You may claim for patients who are not enrolled with your practice, at your discretion. You acknowledge in making a claim that no additional funding is available for this. · No additional amount will be paid for after-hours service delivery. · You can claim for the time spent actively treating or observing the patient. Not for the entire time the patient was in the practice. |
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(Formerly Quick CLIC)
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$115.00 (incl. GST)
$69.00 (incl. GST) |
Key Information · Focused Care—Hāpai Atu is best for patients who have a long term condition (LTC) OR are experiencing an episode of acute mental distress. · These patients are expected to return to their usual level of wellness, after a short period of increased support and intervention from their practice team. · A review can be completed for a patient at anytime within the ensuing 6 months. This review is there to identify what interventions and outcomes have occurred for the patient. Review can take place at anytime from a few weeks after initial assessment, through to the full 6 months. |
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$184.00 (incl. GST)
Up to a $92.00 (incl. GST) max |
Eligibility · Former Refugee patients enrolled in a WellSouth practice within Dunedin and Invercargill are eligible for funded GP and Nurse appointments for the first 3 years of their resettlement. · The patient must be registered on the programme by WellSouth at the time of arrival (ahead of first appointment). |
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Hepatitis C Treatment - Maviret
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$111.53 (incl. GST) |
Eligibility • Patient must be HCV positive with a positive HCV viral load. • Patients should not have been treated previously.
Exclusions • Patient with known cirrhosis. • Patient with co–infection with Hepatitis B or HIV. |
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$57.50 (incl. GST)
$57.50 (incl. GST)
$69.00 (incl. GST)
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Eligibility Patients who are eligible for funded screening are: a) Wāhine/women or person with a cervix aged 25 to b) All Wāhine/women and people with a cervix who c) Anyone requiring follow up. |
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$143.75 (incl. GST) |
Eligibility Presenting concerns: • Symptomatic Iron Deficiency, or • Maternity: Trimester 2 or 3 only, or • Chronic Heart Failure, or • Inflammatory Bowel Disease, or • Chronic Kidney Disease, or • Postpartum, or • Patients who have already had an IV Iron Infusion within the last 3 months and need to have a 2nd infusion because a dose of >1000mg is required or on consultant advice.*
Exclusions • Maternity: Trimester 1 • Any patient weighing less than 35kg. |
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Long Acting Reversible Contraception (LARC)
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$142.19 (incl. GST)
$184.00 (incl. GST)
$172.50 (incl. GST)
$69.00 (incl. GST) |
Eligibility LARC Insertions • High Needs women (Maori, Pacific, Q5) aged under 52, or CSC Holders aged under 52, or Termination of pregnancy.
LARC Removals • Any patient who is High needs (Maori, Pacific, Q5) or has a CSC. May be aged over 52, but please note they will not be eligible for a new insertion if over 52.
Exclusions • Women who require management of bleeding, but do not require contraception. |
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Long Term Conditions Support - Toitū Takata
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$345.00 (incl. GST)
$287.50 (incl. GST) |
Eligibility Eligible patients will meet one (or more) of the • Māori • Pacific • Former refugee (quota refugees) • Community Services Card (CSC) holders • High Use Health Card holders • Living in a Q5 area • Newly diagnosed with a LTC (last 6 months)
And have one (or more) of the following long term • Cardiovascular disease • Respiratory disease • Diabetes • Gout • Stroke • Any other long term condition; these patients must
Or • Patients with severe and enduring mental illness or
Exclusions • Patients under 14 |
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$230.00 (incl. GST)
$287.50 (incl. GST) |
Eligibility • Registration is for all Patients who have a terminal condition with end of life likely to be within 6 months. • Patient must be enrolled at the practice.
Exclusions • Any patient residing permanently in an aged residential care (ARC) facility at the time of registration. • Any patient transferred into an ARC facility. • Any patient who has previously been on palliative care.
Key Information • Exit from the programme is available on the patient's death or 6 months following registration (patients cannot be re-registered). • Complete the Exit claim before marking the patient as deceased in your PMS. |
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$235.75 (incl. GST)
$322.00 (incl. GST) |
Eligibility • Presenting concerns of heavy menstrual bleeding, or intermenstrual bleeding, or post menopausal bleeding, or endometrial cells on cervical smears. • The portal form will need to be parked when a successful sample has been obtained. Once results are available the form will be able to be completed and submitted. • For patients who have a negative result, any follow up appointments will be at the patient’s own expense.
Please Note: This procedure is only carried out by identified providers. |
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$40.00 (incl. GST) |
Eligibility • Patients diagnosed with Rheumatic Fever by a hospital specialist, paediatrician or physician, and currently requiring long term prophylactic antibiotics.
Exclusions • Patients who had childhood Rheumatic Fever, but no longer require long term antibiotics.
Key Information • Patient is registered onto the Rheumatic Fever programme in the WellSouth Portal. This is done before a claim can be made by the practice.
Please Note: There is no payment associated with registration. |
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$60.81 (incl. GST) |
Eligibility High Needs Patients: • Māori, Pacific, Quintile 5, CSC or HUHC holder • Patients must be enrolled with the practice • Maximum age limit of up to 50 years • No lower age limit • Available to both male and female patients
• Outside Dunedin and Invercargill • Patients must be enrolled with the Practice • Maximum age limit of up to 22 years • No lower age limit • Available to both male and female patients
Exclusions • Non-enrolled patients |
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$375.00 (incl. GST) Standard Excision
$580.00 (incl. GST) Complex Excision
$670.00 (incl. GST) Extremely Complex |
Referral Eligibility (All Practices) • Any patient with a suspected skin cancer, as per
Exclusions • Lesions where cancer is not suspected • Wide excision
Excision Eligibility (Only Approved GPSI) • All excisions must be approved via clinical triage • Retrospective requests for funding post excision will |
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Special Ukraine Policy Visa Holder
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$409.33 (incl. GST)
$265.44 (incl. GST)
$215.63 (incl. GST)
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Eligibility The funded health assessment is limited to the following: • Tuberculosis (TB) assessment and screening. • Assessment of eligibility for and provision of vaccination as per the National Immunisation Schedule. • Supporting enrolment in general practice for continuity of healthcare. |
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Up to: $58.00 (incl. GST) $64.50 (incl. GST) $13.00 (incl. GST) $19.50 (incl. GST) |
Eligibility • Available for anyone in urgent need of a GP/NP visit who cannot pay. • Vouchers must be used within 7 days of issue, however WellSouth can re-issue if not claimed. • Priority patients are eligible for one voucher every six months. The practice is encouraged to discuss payment plans or other options for reduced cost healthcare for future visits. |
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$143.75 (incl. GST) |
Eligibility • Must meet one of the following high needs criteria: Māori, Pacific, CSC (community services card) holder, or Q5. • Patient must be diagnosed with one of the following clinical qualification criteria: - Osteoporosis (10 year calculated hip fracture risk ≥ 3% or T score ≤ -2.5 or T score ≤ -1.5 on long-term gluco corticoid therapy) OR - Paget’s Disease
Exclusions • Patients who have had 3 infusions in the past 5 years. • Non high needs patients.
Key Information • The patient must have a GFR (calculated by Cockcroft-Gault Equation) > 35ml/min within the past 3 months. • Patients with a calculated GFR of between 25 and 35mml/min may qualify for subsidised infusion subject to Renal Specialist direction. • The patient must have a normal serum calcium level within the past 3 months. • Patient must be Vitamin D replete. |
