{"id":"F2020L00741","name":"Health Insurance (Section 3C General Medical Services - Optometric Services) Determination 2020","slug":"health-insurance-section-3c-general-medical-services-optometric-services-determination-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":145343,"registerId":"commonwealth-F2020L00741-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1. Name","sectionType":"division","heading":"1. Name","content":"### 1. Name\n\nThis instrument is the Health Insurance (Section 3C General Medical Services ‑ Optometric Services) Determination 2020.","sortOrder":0},{"sectionNumber":"3. Authority","sectionType":"division","heading":"3. Authority","content":"### 3. Authority\n\nThis instrument is made under the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"5. Definitions","sectionType":"division","heading":"5. Definitions","content":"### 5. Definitions\n\n(1) In this instrument:\n\nAct means the Health Insurance Act 1973.\n\nbulk‑billed for a relevant service, means:\n\n(a) a medicare benefit is payable to a person in relation to the service; and\n\n(b) under an agreement entered into under section 20A of the Act:\n\n(i) the person assigns, to the person by whom the service is provided, his or her right to the payment of the medicare benefit; and\n\n(ii) the second‑mentioned person accepts the assignment in full payment of his or her fee for the service provided.\n\nold item 10900 means item 10900 of the general medical services table as in force at any time before the repeal of the item by Part 1 of Schedule 1 to the Health Insurance Legislation Amendment (Optometric Services and Other Measures) Regulation 2014.\n\nrelevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act, relating to medical services, professional services or items.\n\nrelevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.\n\nresidential aged care facility has the same meaning given by the Health Insurance (General Medical Services Table) Regulations 2021.\n\nSchedule means the Schedule to this instrument.\n\ntelehealth eligible area has the same meaning as in the general medical services table.\n\nNote: The following terms are defined in subsection 3(1) of the Act:\n\n clinically relevant\n\n general medical services table\n\n optometrist\n\n(2) In this instrument, Group A10 refers to the group of all the relevant services specified in items the Schedule, Subgroup 1 of Group A10 refers to the group of relevant services specified in items 10905 to 10944 of the Schedule and Subgroup 2 of Group A10 refers to the group of relevant services specified in items 10945 to 10948 of the Schedule.\n\n(3) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.","sortOrder":2},{"sectionNumber":"6. Treatment of relevant services","sectionType":"division","heading":"6. Treatment of relevant services","content":"### 6. Treatment of relevant services\n\nFor subsection 3C(1) of the Act:\n\n(a) a relevant service, other than the service described in item 10944, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:\n\n(i) it were both a professional service and a medical service; and\n\n(ii) there were an item in the general medical services table that:\n\n(A) related to the service; and\n\n(B) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.\n\n(b) the relevant service described in item 10944, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions of the Act other than subsection 3(5), as if:\n\n(i) it were both a professional service and a medical service; and\n\n(ii) there were an item in the general medical services table that:\n\n(A) related to the service; and\n\n(B) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.","sortOrder":3},{"sectionNumber":"7. Application of item 10929","sectionType":"division","heading":"7. Application of item 10929","content":"### 7. Application of item 10929\n\nItem 10929 does not apply to a service if the patient’s requirement for contact lenses is only for any of the following reasons:\n\n(a) because the patient does not want to wear spectacles for reasons of appearance;\n\n(b) because the patient wants contact lenses for work or sporting purposes;\n\n(c) because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.","sortOrder":4},{"sectionNumber":"8. Application of item 10931","sectionType":"division","heading":"8. Application of item 10931","content":"### 8. Application of item 10931\n\nIf item 10931 applies to a service, the fee mentioned in the item applies in addition to the fee mentioned in another item in Subgroup 1 of Group A10 that applies to the service.","sortOrder":5},{"sectionNumber":"9. Application of items 10938, 10939, 10","sectionType":"division","heading":"9. Application of items 10938, 10939, 10940 and 10941","content":"### 9. Application of items 10938, 10939, 10940 and 10941\n\n(1) For this section, the following are perimetry services:\n\n(a) a service described in item 10938;\n\n(b) a service described in item 10939;\n\n(c) a service described in item 10940;\n\n(d) a service described in item 10941.\n\n(2) It is acceptable for an optometrist rendering perimetry services to utilise an assistant to operate the perimeter to ensure a patient is properly positioned for the service to be completed.","sortOrder":6},{"sectionNumber":"11. Limitation on items","sectionType":"division","heading":"11. Limitation on items","content":"### 11. Limitation on items\n\n(3) Items 10921 to 10929 may only apply to a service in respect of a particular patient once in a 36 month period.","sortOrder":7},{"sectionNumber":"12. Limitation on item 10944","sectionType":"division","heading":"12. Limitation on item 10944","content":"### 12. Limitation on item 10944\n\nItem 10944 does not apply to a service on the same occasion as a service mentioned in any of items 10905, 10907, 10910, 10911, 10913, 10914, 10915, 10916 and 10918.","sortOrder":8},{"sectionNumber":"14. Application of items 10945 and 10946","sectionType":"division","heading":"14. Application of items 10945 and 10946","content":"### 14. Application of items 10945 and 10946\n\nItems 10945 and 10946 only apply to a service if the video conferencing consultation in which the patient is participating is a service for which there is an item in the general medical services table, or treated as being in the table because of subsection 3C(1) of the Act.","sortOrder":9},{"sectionNumber":"15. Professional attendance items and se","sectionType":"division","heading":"15. Professional attendance items and services provided with non‑medicare services","content":"### 15. Professional attendance items and services provided with non‑medicare services\n\n(1) Clause 1.2.5 of the general medical services table has effect as if items 10905 to 10929 were also specified in subclause 1.2.5(1).\n\n(2) Clauses 1.2.8 and 1.2.9 of the general medical services table have effect as if items 10905 to 10948 were also specified in those clauses.","sortOrder":10},{"sectionNumber":"16. Indexation","sectionType":"division","heading":"16. Indexation","content":"### 16. Indexation\n\n (1) At the start of 1 July 2025 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:\n ![1.024 multiplied by the amount immediately before the indexation time](image.002.png)\n\nNote: The indexed fees could in 2025 be viewed on the Department of Health and Aged Care’s MBS Online website (https://www.mbsonline.gov.au).\n\n(2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.\n\n(3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).","sortOrder":11},{"sectionNumber":"Schedule — Relevant services","sectionType":"division","heading":"Schedule — Relevant services","content":"### Schedule – Relevant services\n\n```html\n

Group A10 – Optometric services provided by optometrist

Column 1

Item

Column 2

Service

Column 3

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

69.45

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, 10913, 10914 or 10915 applies:

(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

34.80

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 this item or item 10905, 10907, 10913, 10914 or 10915 applies

69.45

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 this item or item 10905, 10907, 10910, 10913, 10914 or 10915 applies

69.45

10913

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 or 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 this item, or item 10905, 10907, 10910, 10914 or 10915 applies; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which this item, or item 10905, 10907, 10910, 10911, 10914 or 10915 applies

69.45

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 this item or item 10905, 10907, 10910, 10913 or 10915 applies; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which this item or item 10905, 10907, 10910, 10911, 10913 or 10915 applies

69.45

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

69.45

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 10938, 10939, 10940, 10941, 10942 or 10943 applies)

34.80

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 10938, 10939, 10940 or 10941 applies)

34.80

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 for optical correction, being a course of attention for which the first attendance is a service to which item 10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies

For patients with any of the following:

(a) myopia of 5.0 dioptres or greater (spherical equivalent) in at least one eye;

(b) manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in at least one eye;

(c) astigmatism of 3.0 dioptres or greater in at least one eye;

(d) anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)

Applicable once for each condition in a period of 36 months

172.55

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, for patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, topographic or quantitative corneal morphology if:

(a) the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12); and

(b) if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens;

being a course of attention for which the first attendance is a service to which item 10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies

Applicable once in a period of 36 months

217.70

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, 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, being a course of attention for which the first attendance is a service to which item 10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies

Applicable once in a period of 36 months

172.55

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, for patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by any of the following:

(a) pathological mydriasis;

(b) aniridia;

(c) coloboma of the iris;

(d) pupillary malformation or distortion;

(e) significant ocular deformity; or

(f) corneal opacity;

whether congenital, traumatic or surgical in origin being a course of attention for which the first attendance is a service to which item 10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies

Applicable once in a period of 36 months

217.70

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, for patients who, because of physical deformity, are unable to wear spectacles, being a course of attention for which the first attendance is a service to which item 10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies

Applicable once in a period of 36 months

172.55

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, 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, being a course of attention for which the first attendance is a service to which:

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

(b) the contact lenses are not required for appearance, sporting, work or psychological reasons.

Applicable once in a period of 36 months

217.70

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

172.55

10931

A flag fall service to which an item in Subgroup 1 of Group A10 applies (other than this item), 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 one or more patients at a single location on a single occasion; and

(c) is:

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

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

Applicable once per occasion a service is provided under paragraph (a) for each distinct location

43.75

10938

Full quantitative computerised perimetry (automated absolute static threshold), with bilateral assessment and report, where indicated by the presence of glaucoma with a high risk of clinically significant progression that:

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

(b) is performed by an optometrist; and

(c) is performed on a patient who has received two perimetry services to which item 10940 or 10941 applies in the previous 12 months

other than a service associated with a service to which item 10916 or 10918 applies

Applicable once per patient (including any service to which item 10939 applies) in a 12‑month period

72.55

10939

Full quantitative computerised perimetry (automated absolute static threshold) with unilateral assessment and report, where indicated by the presence of glaucoma with a high risk of clinically significant progression that:

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

(b) is performed by an optometrist

(c) is performed on a patient who has received two perimetry services to which item 10940 or 10941 applies in the previous 12 months

other than a service associated with a service to which item 10916 or 10918 applies

Applicable once per patient (including any service to which item 10938 applies) in a 12‑month period

43.80

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;

(c) the patient has received fewer than two perimetry services to which this item or item 10941 applies in a 12‑month period

other than a service associated with a service to which item 10916 or 10918 applies

66.30

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;

(c) the patient has received fewer than two perimetry services to which this item or item 10940 applies in a 12‑month period

other than a service associated with a service to which item 10916 or 10918 applies

40.00

10942

Testing of residual vision to provide optimum visual performance for a patient who has best corrected visual acuity of 6/15 or N12 or worse at 40cm in the better eye or a horizontal visual field of less than 110 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, 10924, 10926, 10927, 10928, 10929 or 10930 applies

Applicable twice per patient in a 12‑month period

34.80

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, where the service:

(a) includes assessment of one or more of the following:

(i) accommodation;

(ii) ocular motility;

(iii) vergences;

(iv) fusional reserves;

(v) cycloplegic refraction; and

(b) is not performed for the assessment of learning difficulties or learning disabilities;

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

Applicable once per patient in a 12‑month period

34.80

10944

Complete removal of embedded foreign body (including a rust ring, if present) from the cornea—not more than once on the same day by the same optometrist (excluding after‑care). Only claimable when either fully removed, or if the patient is referred to an Ophthalmologist or other appropriately qualified practitioner for further assessment and management after second attendance results in partial removal

Other than a service associated with a service to which items 10905, 10907, 10910, 10911, 10913, 10914, 10915, 10916 or 10918 applies

75.05

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

34.80

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

69.45

\n```","sortOrder":12}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This Determination brings a defined set of optometric services within the operation of subsection 3C(1) by treating each listed 'relevant service' as both a professional and a medical service and by prescribing specific Medicare item fees and rules (see s6 and Schedule). It therefore narrows operational discretion by fixing item definitions, eligibility limits and fees for those services (see s5 definitions and s6 treatment)."},"complexity_factors":["Extensive, itemised Schedule specifying many discrete services and fees (Group A10; Schedule)","Multiple cross‑references to the Health Insurance Act, general medical services table and other regulations (see s5(3), s6)","Item‑specific eligibility and exclusion rules (e.g. contact‑lens exclusions for item 10929 — s7; telehealth eligibility — s14)","Temporal frequency limits and per‑patient caps (e.g. items 10921–10929 once per 36 months — s11(3); perimetry and vision testing periodicity in Schedule items 10938–10942)","Mixed billing modalities and assignment/bulk‑billing mechanics defined (definition of bulk‑billed in s5(1)) creating administrative checks","Operational delegations (use of assistants for perimetry — s9(2)) introducing scope‑of‑practice and supervision considerations","Indexation formula and rounding rule for all Schedule fees effective 1 July 2025 (s16) requiring future fee adjustment calculations"],"plain_english_summary":"**What it does:** This Determination creates a detailed list of optometric services (Group A10) and treats each listed \"relevant service\" as both a professional and a medical service under section 3C of the Health Insurance Act, attaching specific Medicare item fees and billing rules. It sets eligibility, frequency limits, telehealth conditions and a small scheduled indexation.\n\n**Who pays and who decides:** Medicare pays benefits to claimants; optometrists provide services and claim fees (including bulk‑billing where assigned under section 5). The instrument fixes fees, limits re‑claims and adds operational conditions (e.g. perimetry, telehealth, contact‑lens rules)."},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"The instrument appears consistent with its original purpose of specifying Medicare benefits for optometric services under section 3C of the Health Insurance Act 1973. While it includes modern additions like telehealth items (10945-10946) and indexation mechanisms, these represent natural evolution within the established framework rather than scope creep. The structure remains focused on the core function of defining which optometric services attract Medicare rebates and under what conditions."},"complexity_factors":["44 separate service items with intricate eligibility conditions","Multiple overlapping time-based restrictions (12-month and 36-month limits depending on patient age and service type)","Extensive cross-referencing between items (e.g., item 10907 references items 10905, 10910, 10911, 10913, 10914, 10915)","Age-dependent eligibility (different rules for under-65 vs 65+ patients in items 10907, 10910, 10911, 10913, 10914)","Nested conditional logic (e.g., item 10924 requires keratometric confirmation, specific visual acuity thresholds, AND improvement thresholds)","Incorporation by reference of external instruments (General Medical Services Table, National Health Act provisions) with 'as in force from time to time' drafting","Specific exclusion rules (e.g., item 10944 cannot be claimed with 9 other specific items)","Mathematical indexation formula with rounding rules to nearest 5 cents","Telehealth provisions requiring parallel Medicare-billable specialist consultations"],"plain_english_summary":"This instrument sets Medicare rebates for 44 optometrist eye‑care services (fees ~$35–$218), defining who can claim what and when. It affects patients’ out‑of‑pocket costs and optometrists’ billing, with rules on eligibility, frequency limits (e.g. most comprehensive exams once every 3 years for <65, yearly for 65+), exclusions for cosmetic contact lens fittings, some same‑day claim limits, and a 2.4% fee rise from 1 July 2025."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-general-medical-services-optometric-services-determination-2020","history":"/api/acts/health-insurance-section-3c-general-medical-services-optometric-services-determination-2020/history","analysis":"/api/acts/health-insurance-section-3c-general-medical-services-optometric-services-determination-2020/analysis","conflicts":"/api/acts/health-insurance-section-3c-general-medical-services-optometric-services-determination-2020/conflicts","importantCases":"/api/acts/health-insurance-section-3c-general-medical-services-optometric-services-determination-2020/important-cases","documents":"/api/acts/health-insurance-section-3c-general-medical-services-optometric-services-determination-2020/documents"}}