DigitrustClaimable codes by facility level
Computed from the August 2026 schedule, Version 7 (25 September 2026). Within a level, every ownership is priced for the same list of codes; only the amounts differ. “Claimable” leaves out investigation codes that are priced but bundled into the tariff when done in-house (see investigations by level).
| Facility level | Ownerships priced | G-DRGs priced | Claimable | Investigation codes priced | General OPD ≥12 (OPDC06A) |
|---|---|---|---|---|---|
| Tertiary hospital | Public, Mission, Quasi-government | 729 | 729 | 197 | GH¢94.18 – GH¢100.16 |
| Secondary hospital | Public, Mission, Quasi-government | 711 | 528 | 197 | GH¢82.05 – GH¢83.64 |
| Primary hospital | Public, Mission, Quasi-government, Private | 647 | 464 | 183 | GH¢37.22 – GH¢81.31 |
| Clinic | Mission, Quasi-government, Private | 24 | 24 | — | GH¢31.28 – GH¢46.81 |
| Health centre | Public, Mission, Quasi-government, Private | 22 | 22 | — | GH¢24.90 – GH¢31.53 |
| Maternity home | Private | 22 | 22 | — | GH¢30.71 |
| CHPS compound | Public, Mission, Quasi-government | 20 | 20 | — | — |
| Stand-alone diagnostic centre | Private | 197 | 197 | 197 | — |
| Stand-alone eye centre | Mission, Quasi-government, Private | 27 | 27 | — | — |
| Stand-alone dental centre | Private | 37 | 37 | — | — |
CHPS compounds cannot claim General OPD
CHPS compounds have no General OPD code (OPDC06A or OPDC06C). A general attendance at a CHPS is claimed as unbundled consultation (OPDC11), GH¢11.05 for an adult at a public CHPS. Health centres, by contrast, do have General OPD, at GH¢24.90 for an adult at a public health centre. A CHPS that submits OPDC06 will see it deducted every time.
Investigations: priced is not the same as claimable
The current schedule prices investigation codes (INVE) at 197 codes for tertiary and secondary hospitals, 183 for primary hospitals and 197 for stand-alone diagnostic centres. Under the 2026 bundling rules, though, an investigation done in-house is part of the all-inclusive OPD or IPD tariff unless your level is allowed to claim it separately:
- Tertiary hospitals and stand-alone diagnostic centres: investigations are claimed separately.
- Secondary hospitals: only the 14 CT and MRI codes are claimed separately, with prior authorisation. Everything else is bundled.
- Primary hospitals and below: every in-house investigation is bundled, CT and MRI included. It is listed on the claim without an amount, not charged on top.
Claiming a bundled investigation as a separate line is one of the commonest deductions. Check the current NHIA Tariffs Operation Manual if your facility is unsure where it stands.
Specialist and stand-alone facilities
- Oncology (
ONNU, 14 codes) is claimable at secondary and tertiary hospitals only. - Neurosurgery (
NSUR) narrows by level: 20 codes at tertiary, 8 at secondary, 4 at primary hospitals. - Stand-alone diagnostic centres claim investigations only.
- Stand-alone eye centres claim ophthalmology codes plus outpatient codes; stand-alone dental centres claim dental codes plus outpatient codes.
Catering status at primary hospitals
Primary hospitals are priced in two blocks: catering inclusive, for facilities that feed their inpatients, and catering exclusive. For most ownerships the inclusive block pays more; at a private primary hospital, adult General OPD pays GH¢81.31 inclusive against GH¢81.01 exclusive. Set catering status once on your facility profile: claiming exclusive when you cater leaves money on the table, and claiming inclusive when you do not is an overclaim.
Check any code
Use our free NHIS tariff lookup to see whether a code is claimable at your level and what it pays, or read how G-DRG codes are built.