Code

Code Description

Rand

11001

Optometric Examination

Note: Relevant for replacement of spectacles or contact lenses.

583.44

11046

Ocular Pathology Examination

Note: When IOD has caused ocular Injury.

656.24

11061

Low Vision Examination

Note: When IOD has caused deterioration of vision to sub-standard levels,or following IOD incident of low-vision patient.

809.12

11246

Colour Vision Evaluation

Rule: Can be billed In addition to 11001 or 11046 when necessary

206.75

11265

Contrast Sensitivity Evaluation

Rule: Can be billed in addition to 11001 or 11046 when necessary

127.19

11356

Gonioscopy

Rule: Can be billed in addition to 11001 or 11046 when necessary

281.01

11366

Dilated fundus examination with Fundus lens

Rule: Can be billed in addition to 11001 or 11046 when necessary

278.72

11423

Visual field - Non threshold testing

Rule: Can be billed in addition to 11001 or 11046 when necessary

179.82

11443

Visual field - Threshold testing

Rule: Can be billed in addition to 11001 or 11046 when necessary

314.70

11604

Photography of Anterior Segment

Rule: Can be billed In addition to 11001 or 11046 when necessary

89.86

11624

Photography of Fundus

Rule: Can be billed in addition to 11001 or 11046 when necessary

143.83

11702

Pachymetry

Rule: Can be billed in addition to 11001 or 11046 when necessary

125.84

11802

Optical Coherence Tomography (OCT) Health screening

Rule: Can be billed in addition to 11001 or 11046 when necessary

260.73

11803

Optical Coherence Tomography (OCT) Anterior

Rule: Can be billed in addition to 11001 or 11046 when necessary

188.76

11804

Optical Coherence Tomography (OCT) Posterior

Rule: Can be billed in addition to 11001 or 11046 when necessary

224.74

11906

Lacrimal Drainage System Patency

Rule: Can be billed in addition to 11001 or 11046 in cases such as chemical or vapour exposure

332.59

15000

Removal of non embedded foreign body

Rule: Can be billed in isolation or with 11001 or 11046 or 11061 or 15025 or 15030

215.80

15002

Removal of embedded; non-penetrating foreign body

Rule: Can be billed in isolation or with 11001 or 11046 or 11061 or 15025 or 15030

315.12

15004

Removal of corneal foreign body

Rule: Can be billed In isolation or with 11001 or 11046 or 11061 or 15025 or15030

409.14

15025

Management of ocular pathology

Rule: Cannot be billed with 15030 or 11001 or 11046 or 11061

791.13

15030

Management of ocular pathology - follow up

Rule: Cannot be billed with 15025 or 11001 or 11046 or 11061

566.38

11141

Refractive Status evaluation

Note: Appropriate after IOD incident to monitor recovery of the eye.

224.74

11183

Keratometry

Note: Appropriate for fitting of contact lens or monitoring of corneal recovery after IOD to the eye

112.42

11202

Tonometry without anaesthetic

Note: After ocular IOD cases only

134.89

11212

Tonometry with anaesthetic

Note: After ocular IOD cases only

179.82

11402

Visual field - screening

Note: Relevant in cases of head and/or ocular injury

143.83

11838

Glaucoma investigation

code Relevant in cases of ocular injury

233.79

Lens

Code

Code Description

Rand

11501

Dispensing fee - single vision basic

Rule: Only with replacement of spectacle lenses code 81BS001

80.91

11521

Dispensing fee - Bifocals

Rule: Only with replacement of spectacle lenses code 84BS001

107.85

11541

Dispensing fee -Varifocal distance to near

Rule: Only with replacement of spectacle lenses code 86BS001

134.89

11503

Dispensing fee - Single Vision Surfaced

Rule: Only with replacement of spectacle lenses code 82BS001

107.85

11531

Dispensing Fee - Accommodative Support

Rule: only with replacement of spectacle lenses code 83BS001

107.85

11540

Dispensing fee - Intermediate to near

Rule: Only with replacement of spectacle lenses code 85BS001

107.85

Note

For Single vision, Bifocal, Varifocal the below applies

LENS CODES: Replacement lenses after ocular injury if lenses were broken or if treatment changed due to IOD incident.

Rule: A claim is limited to a maximum of 2 replacements. Occasionally there may be a combination of 2 different codes, but never a code starting with 8 together with a code starting with 7

81BS001

Single Vision (standard) CR39

225.26

82BS001

Single Vision (surfaced) CR39

507.42

83BS001

Accommodative support lens

507.42

84BS001

Bifocals CR39

566.59

85BS001

Varifocal Intermediate to near

983.53

86BS001

Varifocal Distance to near

983.53

71BS001

Single Vision (standard) Glass

225.26

72BS001

Single Vision (surfaced) Glass

507.42

74BS001

Bifocal Glass

566.59

76BS001

Varifocal Distance to Near Glass

983.53

40501

Spectacle frame

Note: Frame and lens will only be issued if the eye condition is IOD incident

926.65

Note

For Unbranded HRI the below applies:

LENS ENHANCEMENTS CODES: Where lenses are replaced as result of IOD, and treatment is greater than

+4.00D (sphere) or -6.00D (sphere + cyl, or cyl is greater than -2.00)

Note: First 2 digits must align with first 2 digits of lens codes

81UB003

Unbranded HRI single vision stock

2560.79

83UB002

Unbranded HRI Accommodative Support

1895.19

86UB006

Unbranded HRI Varifocal Distance/Near

2243.59

Note

Contact lenses can be either elective or clinically essential.

Elective lenses are selected as a convenience or cosmetic preference by the wearer. Clinically essential

contact lenses are necessary where adequate vision can only be achieved by the application of a contact lens.

Contact lenses are manufactured in a number of different materials and modalities.

On a high level there are rigid and soft lenses. Both fall into 2 major sub-categories:

Rigid: corneal and scleral. Rigid lenses can last for a number of years, if well cared.

Soft lenses: Disposable and Non-disposable. Non-disposable mostly have a lifespan of 12 months.

Disposable may be replaceable daily, weekly, or monthly.

Note: Where contact lenses were damaged in the IOD, they will only require replacement once. The employee would have been responsible for routine replacement prior to the IOD incident, and is therefore responsible thereafter.

Note: Where the IOD incident had made contact lenses clinically essential they will require ongoing replacement as per the replacement as per the replacement schedule.

Note: MOTIVATION IS REQUIRED FOR CONTACT LENSES AND WILL BE PAYABLE BASED ON THE REASONABILITY DETERMINED BY THE FUND.

24022

Rigid contact lens where rigid contact lens is damaged in IOD, or injury to eye requires rigid lens

3600.00

24024

Rigid scleral contact lens

7500.00

Note

Where IOD incident resulted in Low Vision status (normal visual function cannot be achieved with spectacles or contact lenses) one or more low vision devices are appropriate.

61013

LVA - Single Element

2500.00

61114

LVA - Multiple Elements Fixed Focus

2600.00

61215

LVA - Multiple Element Variable focus

15000.00

61318

LVA - Electronic

12000.00

61320

Software aided vision program

1300.00

Ocular Prosthetics

Note

Claims for Ocular Prostheses are for the fitting of a prosthesis after removal of the eye due to injury or pathology, and replacement of the prosthesis at the end of its life, and for the maintenance of the prosthesis in the interim.

Correctly manufactured and maintained prostheses should last approximately 5

years. They should be annually 'serviced' to maintain the surface of the prosthesis and thereby prevent deterioration and / or physiological issues from reducing the lifespan of the prostheses and / or resulting in the need for additional medical or surgical  intervention.

56000

Complete Eye

Note: Where IOD has resulted in the enucleation (removal) of the eye. The code covers all aspects of the fitting of a complete prosthesis, including 6 months of after care.

Note: Repeats are allowed without intervention after 48 months.

23780.22

56001

Polishing

407.39

56010

Complete Haptic Shell

Note: Where IOD has damaged and blinded the eye, but not necessitated enucleation. The code covers all aspects of the fitting of a complete prosthesis, including 6 months of after care

Note: Repeats are allowed without intervention after 48 months

4 029.66

59001

Annual Maintenance

Note: Not billable within 6 months of the fitting of code 56000 or 56010 prosthesis.

Code can be billed together with 53015.

2541.45

53015

Prosthetic Consultation

code Can be Billed together with 59001, or where annual visit codes 56000 or 56010

Can be billed  but does not necessitate maintenance 59001

797.99

70081

Optometric examination and visual field screening consultation

579.05

70021

Optometric re-examination within six months of 70081 followup

330.94

70503

Walking Stick/Cane for the blind

360.88