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R 385
Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers - 2023Optometry Gazette 2023Optometry Tariff of Fees as from 1 April 2023 (Practice Type 70) |
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 |
[(Code 56010) substituted by correct pricing on Optometry Gazette by N1707, G48477, dated 28 April 2023]