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SBSCS | SAUDI BILLING SYSTEM - CODING STANDARDS

The Saudi Billing System Coding Standards (SBSCS): Driving Digital Health Transformation.

The Kingdom of Saudi Arabia's healthcare sector is undergoing a rapid digital transformation, with the Saudi Billing System Coding Standards (SBSCS) standing as a cornerstone of this evolution. Developed and regulated by the Council of Health Insurance (CHI), the SBSCS constitute a crucial national framework for standardizing the clinical coding and billing of healthcare services in the private health insurance market.

The primary goal of the SBSCS is to ensure transparency, efficiency, and accuracy in insurance claims processing, while simultaneously supporting national health reporting and morbidity analysis. By mandating a unified language for all private sector encounters, the system lays the groundwork for a truly connected and digitally empowered healthcare ecosystem.

Key Features and Foundational Structure

The SBSCS are not built from scratch but leverage globally recognized coding principles, adapting them to meet Saudi Arabia's unique clinical and regulatory requirements.

1. Basis in International Standards

The standards are firmly rooted in the internationally recognized Australian Coding Standards (ACS) for both the International Classification of Diseases, 10th Revision, Australian Modification (ICD-10-AM) and the Australian Classification of Health Interventions (ACHI), utilizing the 10th Edition. This foundation provides a robust, globally consistent framework for classifying diagnoses and procedures.

2. Adaptation for Saudi Arabia

While based on the Australian model, the SBSCS have been meticulously modified and extended to accommodate specific Saudi healthcare services. This includes the integration of unique national codes for:

• Specialized Services: Laboratory, ambulance, emergency, and mortuary services.
• Procedural Details: More granular codes to distinguish between unilateral and bilateral procedures.
• Care Setting: Specific codes for non-admitted care (outpatient services).

3. Code Structure

The core of the SBS billing code is a 7-digit code derived from ACHI. This is extended by two additional digits to form the complete SBS code:

• 8th Digit: Indicates a modification specific to the SBS.
• 9th Digit: Used to specify laterality (e.g., left, right) when relevant to the procedure.
• Regulatory Mandate and Scope
• The implementation of the SBSCS is mandatory and central to the Kingdom's goal of a centralized digital health infrastructure.
• Mandatory Use via NPHIES

Healthcare providers operating within the private health insurance sector are required to use SBSCS for every patient encounter. Crucially, all claims must be submitted through the National Platform for Health and Insurance Exchange Services (NPHIES). This centralized digital platform ensures that all billing data is standardized and instantly available for insurance processing and national monitoring.

Broad Scope of Services Covered

The standards apply across the continuum of care, encompassing virtually all services provided by a clinic or hospital:

• Outpatient and Admitted Care
• Consultations and Dental Services
• Laboratory and Radiology
• Ambulance and Mortuary Services
• Emergency Department services
• Room & Board
• Commitment to Modernization

SBSCS Essential Service Categories Guide

The SBSCS provides a comprehensive coding solution that must be applied across the entire continuum of care within Saudi Arabia's private health insurance sector.

1. Foundational Coding Systems (Diagnosis & Procedures)

The core of the SBSCS is based on international classifications, adapted for local use.

2. Scope of Services Covered by SBSCS

The standards apply to both inpatient and outpatient settings, ensuring a unified approach to claims.

3. Structural Compliance Feature

The standard uses an extended code format to ensure high data granularity:

To ensure the system remains relevant with evolving medical practices, the SBSCS undergoes regular updates. For instance, Version 3.0 became the active standard effective January 1st, 2026, requiring providers to continuously update their coding and billing practices.

The SBSCS is more than just a coding manual; it is a critical regulatory tool that guarantees consistent data quality, streamlines payment processes, reduces fraud, and ultimately allows the CHI and the Ministry of Health to accurately assess healthcare utilization and outcomes across the private sector.