Health Insurance (Section 3C – Optometric Services) Amendment Determination 2019 (Cth)

Case

Health Insurance (Section 3C – Optometric Services) Amendment Determination 2019


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I, ELIZABETH DOWD, delegate of the Minister for Health, make the following determination. 

Dated         5 April 2019

Elizabeth Dowd

Assistant Secretary

MBS Policy and Specialist Services Branch

Medical Benefits Division

Health Financing Group

Department of Health

Contents

1.           Name

2.           Commencement

3.           Authority

4.           Schedules

Schedule 1 – Amendments

Health Insurance (Optometric services) Determination 2016

  1. Name

This Determination is the Health Insurance (Section 3C – Optometric Services) Amendment Determination 2019.

  1. Commencement

(1)        Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information
Column 1 Column 2 Column 3
Provisions Commencement Date/Details
1.  The whole of this instrument 1 July 2019

Note:          This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)        Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

  1. Authority      

This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.

  1. Schedules

Each instrument that is specified in a Schedule to this Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Determination has effect according to its terms.

Schedule 1 – Amendments

Health Insurance (Optometric services) Determination 2016

  1. Schedule (below the heading)

Repeal the table, substitute:

Group A10 – Optometric services provided by optometrist
Item Service Fee ($)
Subgroup 1 – General 
10905 Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has been referred by another optometrist who is not associated with the optometrist to whom the patient is referred 67.85
10907

Professional attendance of more than 15 minutes in duration, being the first in a course of attention if the patient has attended another optometrist for an attendance to which this item or item 10905, 10910, 10911, 10912, 10913, 10914 or 10915 applies, or to which old item 10900 applied:

(a) for a patient who is less than 65 years of age—within the previous 36 months; or

(b) for a patient who is at least 65 years of age—within the previous 12 months

 34.00
10910

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if:

(a) the patient is less than 65 years of age; and

(b) the patient has not, within the previous 36 months, received a service to which:

(i) this item or item 10905, 10907, 10912, 10913, 10914 or 10915 applies; or

(ii) old item 10900 applied

 67.85
10911

Professional attendance of more than 15 minutes in duration,

being the first in a course of attention, if:

(a) the patient is at least 65 years of age; and

(b) the patient has not, within the previous 12 months,

received a service to which:

(i) this item, or item 10905, 10907, 10910, 10912,

10913, 10914 or 10915 applies; or

(ii) old item 10900 applied

 67.85
10912

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has suffered a significant change of visual function requiring comprehensive reassessment:

(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10913, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10913, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied

 67.85
10913

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has new signs or symptoms, unrelated to the earlier course of attention, requiring comprehensive reassessment:

(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10912, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied

 67.85
10914

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has a progressive disorder (excluding presbyopia) requiring comprehensive reassessment:

(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10912, 10913 or 10915 applies; or

(ii) old item 10900 applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10913 or 10915 applies; or

(ii) old item 10900 applied

 67.85
10915 Professional attendance of more than 15 minutes in duration, being the first in a course of attention involving the examination of the eyes, with the instillation of a mydriatic, of a patient with diabetes mellitus, requiring comprehensive reassessment 67.85
10916 Professional attendance, being the first in a course of attention, of not more than 15 minutes in duration (other than a service associated with a service to which item 10931, 10932, 10933, 10940, 10941, 10942 or 10943 applies) 34.00
10918 Professional attendance, being the second or subsequent in a course of attention and being unrelated to the prescription and fitting of contact lenses (other than a service associated with a service to which item 10940 or 10941 applies) 34.00
10921

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with myopia of 5.0 dioptres or greater (spherical equivalent) in one eye

 168.45
10922

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in one eye

 168.45
10923

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with astigmatism of 3.0 dioptres or greater in one eye

 168.45
10924

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens

 212.55
10925

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)

 168.45
10926

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a contact lens is prescribed as part of a telescopic system

 168.45
10927

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity—whether congenital, traumatic or surgical in origin

 212.55
10928

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients who, because of physical deformity, are unable to wear spectacles

 168.45
10929

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10926, 10927 or 10928 applies) requiring the use of a contact lens for correction, if the condition is specified on the patient’s account

 212.55
10930 All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of contact lenses if the patient meets the requirements of an item in the series 10921 to 10929 and requires a change in contact lens material or basic lens parameters, other than a simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens covered by items 10921 to 10929 168.45
10931

A service to which an item in Subgroup 1 of Group A10 applies (other than this item or item 10916, 10932, 10933, 10940 or 10941), if the service:

(a) is provided:

(i) during a home visit to a person; or

(ii) in a residential aged care facility; or

(iii) in an institution; and

(b) is provided to a single patient at a single location on a single occasion; and

(c) is:

(i) bulk-billed for the fees for this item and another item in the table applying to the service; or

(ii) not bulk-billed for the fees for this item and another item in the table applying to the service

 23.65
10932

A service to which an item in Subgroup 1 of Group A10 applies (other than this item or item 10916, 10931, 10933, 10940 or 10941), if the service:

(a) is provided:

(i) during a home visit to a person; or

(ii) in a residential aged care facility; or

(iii) in an institution; and

(b) is provided to each of 2 patients at a single location on a single occasion; and

(c) is:

(i) bulk-billed for the fees for this item and another item in the table applying to the service; or

(ii) not bulk-billed for the fees for this item and another item in the table applying to the service

 11.80
10933

A service to which an item in Subgroup 1 of Group A10 applies (other than this item or item 10916, 10931, 10932, 10940 or 10941), if the service:

(a) is provided:

(i) during a home visit to a person; or

(ii) in a residential aged care facility; or

(iii) in an institution; and

(b) is provided to each of 3 patients at a single location on a single occasion; and

(c) is:

(i) bulk-billed for the fees for this item and another item in the table applying to the service; or

(ii) not bulk-billed for the fees for this item and another item in the table applying to the service

 7.80
10940

Full quantitative computerised perimetry (automated absolute static threshold), with bilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:

(a) is not a service involving multifocal multichannel objective perimetry; and

(b) is performed by an optometrist;

other than a service associated with a service to which item 10916, 10918, 10931, 10932 or 10933 applies

 64.75
10941

Full quantitative computerised perimetry (automated absolute static threshold) with unilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:

(a) is not a service involving multifocal multichannel objective perimetry; and

(b) is performed by an optometrist;

other than a service associated with a service to which item 10916, 10918 10931, 10932 or 10933 applies

 39.05
10942

Testing of residual vision to provide optimum visual performance for a patient who has best corrected visual acuity of 6/15 or N.12 or worse in the better eye or a horizontal visual field of less than 120 degrees and within 10 degrees above and below the horizontal midline, involving one or more of the following:

(a) spectacle correction;

(b) determination of contrast sensitivity;

(c) determination of glare sensitivity;

(d) prescription of magnification aids;

other than a service associated with a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

 34.00
10943

Additional testing to confirm diagnosis of, or establish a treatment regime for, a significant binocular or accommodative dysfunction, in a patient aged 3 to 14 years, including assessment of one or more of the following:

(a) accommodation;

(b) ocular motility;

(c) vergences;

(d) fusional reserves;

(e) cycloplegic refraction;

other than a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

 34.00
10944

Cornea, complete removal of embedded foreign body from—not more than once on the same day by the same optometrist (excluding after-care)

Note: If the embedded foreign body is not completely removed, this item does not apply but item 10916 may apply.

 73.30
Subgroup 2 – Telehealth attendance
10945

A professional attendance of less than 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and

(b) is not an admitted patient; and

(c) either:

(i) is located within a telehealth eligible area and, at the time of the attendance, is at least 15 kilometres by road from the specialist mentioned in paragraph (a); or

(ii) is a patient of an Aboriginal Medical Service, or an Aboriginal Community Controlled Health Service, for which a direction under subsection 19(2) of the Act applies

 34.00
10946

A professional attendance of at least 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and

(b) is not an admitted patient; and

(c) either:

(i) is located within a telehealth eligible area and, at the time of the attendance, is at least 15 kilometres by road from the specialist mentioned in paragraph (a); or

(ii) is a patient of an Aboriginal Medical Service, or an Aboriginal Community Controlled Health Service, for which a direction under subsection 19(2) of the Act applies

 67.85
10947

A professional attendance (not being a service to which any other item applies) of less than 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and

(b) at the time of the attendance, is located at a residential aged care facility (whether or not at consulting rooms situated within the facility); and

(c) is a care recipient in the facility; and

(d) is not a resident of a self-contained unit;

for an attendance on one occasion—each patient

 34.00
10948

A professional attendance (not being a service to which any other item applies) of at least 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and

(b) at the time of the attendance, is located at a residential aged care facility (whether or not at consulting rooms situated within the facility); and

(c) is a care recipient in the facility; and

(d) is not a resident of a self-contained unit;

for an attendance on one occasion—each patient

 67.85
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