Clinic: Medicare Billing Codes

Question 1

10910

Answer 1

Adults <65yo. Full consult > 15 min

Question 2

10911

Answer 2

Adults >65yo. Full consult >15 min

Question 3

10912

Answer 3

Any age. If significant change of visual function requiring comprehensive reassessment (1st course of attn). >15 min

significant change includes:

• vision or visual acuity of 2 lines (0.2 10gMAR) or more (corrected or uncorrected)
• visual fields or previously undetected field loss
• binocular vision
• contrast sensitivity or previously undetected contrast sensitivity loss

Changes must be documented on the patient’s record card.

Question 4

10913

Answer 4

New signs or symptoms unrelated to earlier course of attn, requiring comprehensive reassessment. (1st course of attn). >15min

Question 5

10914

Answer 5

Progressive disorder requiring comprehensive reassessment. 1st attn. Must give evidence of condition with copy or excerpt of px’s file. >15min

Question 6

10915

Answer 6

Diabetes px (confirmed dx). 1st attn. >15 min

Question 7

10916

Answer 7

Adult < 15 min.

Question 8

10917

Answer 8

Professional attendance of > 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 or age-within the previous 12 months

Question 9

10918

Answer 9

2nd attn/subsequent consult [NOT related to CLs fitting/paediatric]

Cannot be billed with any digital imaging or to discuss imaging results

Question 10

10943

Answer 10

Paeds for BV dysfunction (b/w 3-14yo)

Question 11

10944

Answer 11

Removal of FB (complete including removal of rust ring. If incomplete, charge 10916)

Question 12

10945/46

Answer 12

Telehealth <15 min > 15 min

Question 13

10947/48

Answer 13

Aged care telehealth <15 min > 15 min

Question 14

10905

Answer 14

1st attn. Px was referred here from another optom not associated with the optom patient is referred to

Question 15

10921

Answer 15

Contact lens prescription/fitting consult for patients with Myopia >/=5D SPE in at least one eye

Question 16

10922

Answer 16

Contact lens prescription/fitting consult for patients with manifest hyperopia >/=5D SPE in at least one eye

Question 17

10923

Answer 17

Contact lens prescription/fitting consult for patients with astigmatism >/= 3D

Question 18

10924

Answer 18

Contact lens prescription/fitting consult for patients with keratometry confirmed irregular astigmatism in either eye, if max VA with specs is worse than 6/12 and if CL acuity improves on that by at least one line/0.1 logMAR

Question 19

10925

Answer 19

Contact lens prescription/fitting consult for patients with anisometropia of >/= 3D (difference between spherical equivalents)

Question 20

10926

Answer 20

Contact lens prescription/fitting consult for patients with VA <6/30 in both eyes, where CL prescribing is part of a telescopic system

Question 21

10927

Answer 21

patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia
caused by:
(i) pathologjcal mydriasis; or
(ii) aniridia; or
(iii) coloboma of the iris; or
(iv) pupillary malformation or distortion; or
(v) significant ocular deformity or corneal opacity

Question 22

10928

Answer 22

CLs for patients who, by reason of physical deformity, are unable to wear spectacles

Question 23

10929

Answer 23

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, where the condition is
specified on the patient’s account

Question 24

10930

Answer 24

All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of
contact lenses where the patient meets the requirements of an item in the range 10921-10929 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 ofthe fitting of a contact lens covered by item 10921 to 10929