Procedure Code

Description

Rand

11001

Optometric Examination

Note: Relevant for replacement of spectacles or contact lenses.

561,00

11046

Ocular Pathology Examination

Note: When IOD has caused ocular Injury.

631,00

11061

Low Vision Examination

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

778,00

11356

Gonioscopy

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

270,20

11366

Dilated fundus examination with Fundus lens

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

268,00

11423

Visual field-Non threshold Testing

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

172,90

11443

Visual Field -Threshold Testing

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

302,60

11246

Colour Vision Evaluation

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

198,80

11265

Contrast Sensitivity Evaluation

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

122,30

11604

Photography of Anterior Segment

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

86,40

11624

Photography of Fundus

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

138,30

11702

Pachymetry

Rule: can be billed in addition o 11001 or 11046 when necessary

121,00

11802

Optical Coherence Tomography (OCT) Health screening

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

250,70

11803

Optical Coherence Tomography (OCT) Anterior

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

181,50

11804

Optical Coherence Tomography (OCT) Posterior

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

216,10

11906

Lacrimal Drainage System Patency

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

319,80

15000

Removal of corneal foreign body

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

207,50

15002

Removal of corneal foreign body

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

303,00

15004

Removal of corneal foreign body

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

393,40

15025

Management of ocular pathology

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

760,70

15030

Management of ocular pathology - follow up

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

544,60

11141

Refractive Status evaluation

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

216,10

11183

Keratometry

Note: Appropriate for fitting of contact lens or monitoring of corneal recovery after 100 to the eye

108,10

11202

Tonometry without anaesthetic

Note: After ocular IOD cases only

129,70

11212

Tonometry with anaesthetic

Note: After ocular IOD cases only

172,90

11402

Visual field - screening

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

138,30

11838

Glaucoma investigation

Note: Relevant in cases of ocular injury

224,80

Lens Code

Description

Rand

11501

Dispensing fee - single vision basic

Rule: Only with replacement of spectacle lenses code 81BS001

77,80

11521

Dispensing fee - Bifocals

Rule: Only with replacement of spectacle lenses code 84BS001

103,70

11541

Dispensing fee -Varifocal distance to near

Rule: Only with replacement of spectacle lenses code 86BS001

129,70

11503

Dispensing fee - Single Vision Surfaced

Rule: Only with replacement of spectacle lenses code 82BS001

103,70

11531

Dispensing Fee - Accommodative Support

Rule: only with replacement of spectacle lenses code 83BS001

103,70

11540

Dispensing fee - Intermediate to near

Rule: Only with replacement of spectacle lenses code 85BS001

103,70

Note

For Single vision, Bifocal, Varifocal the below applies

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

Rule: A claim is limited to a maximum of 2. Occasionally there maybe 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

216,60

82BS001

Single Vision (surfaced) CR39

487,90

83BS001

Accommodative support lens

487,90

84BS001

Bifocals CR39

544,80

85BS001

Varifocal Intermediate to near

945,70

86BS001

Varifocal Distance to near

945,70

71BS001

Single Vision (standard) Glass

216,60

72BS001

Single Vision (surfaced) Glass

487,90

74BS001

Bifocal Glass

544,80

76BS001

Varifocal Distance to Near Glass

945,70

40501

Spectacle frame

Rule: Replacement frame if damaged or lost in IOD incident

891,01

Note

For Unbranded HRI the below applies:

LENS ENHANCEMENTS CODES: Where lenses are replaced as result of IOD, and Rx is greater than +4.00D (sphere) or -6.00D (sphere+ cyl, or cyl Is greater than -2.00)

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

81UB003

Unbranded HRI single vision stock

2462,30

83UB002

Unbranded HRI Accommodative Support

1822,30

86UB006

Unbranded HRI Varifocal Distance/Near

2157,30

Contact Lenses

Description

Rand

Note and Rule

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.

Rule: 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.

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

Rule: 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

24024

Rigid scleral contact lens

93800

Contact lens material benefit

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

61114

LVA - Multiple Elements Fixed Focus

61215

LVA - Multiple Element Variable focus

61318

LVA - Electronic

61320

Software aided vision program

ENDED CODES

DESCRIPTION

RAND

70081

Optometric examination and visual field screening consultation

556,78

70021

Optometric re-examination within six months of 70081 followup

318,21

70503

Walking Stick/Cane for the blind

347,00