Commonwealth legislation

Health Insurance (Section 3C General Medical Services - Optometric Services) Determination 2020

In ForceCTH

Jurisdiction

Commonwealth

Collection

legislative instrument

Plain English Summary

6/10 complexity

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.

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).

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Deep Dive

7,345 words · generated 21/06/2026

What it does

This instrument, the Health Insurance (Section 3C General Medical Services ‑ Optometric Services) Determination 2020, specifies a set of optometric services that are to be treated as both professional services and medical services for the purposes of the Health Insurance Act 1973 and related instruments. It is made under the Health Insurance Act 1973, see s 3 Authority and s 5(1) definition of Act. The instrument identifies a group labelled Group A10 and two subgroups of relevant services, sets the Medicare fee payable for each listed item in the Schedule, and prescribes detailed eligibility, frequency and situational rules that determine when each item can be claimed (see s 5(2), s 6 and the Schedule).

Mechanically, the determination does these main things. First, it declares that a "relevant service", when provided as a clinically relevant service in accordance with the instrument, is to be treated for the "relevant provisions" as if there were a corresponding item in the general medical services table with a fee for each State equal to the fee in the Schedule, see s 6(a)(i)‑(ii). For item 10944 there is a slightly different formulation: it is treated as a professional and medical service for the relevant provisions of the Act other than subsection 3(5) of the Act, see s 6(b)(i)‑(ii). Second, it sets out textual and numeric details of each item in Group A10 in the Schedule, including the fee for each item, clinical conditions that must be met and frequency caps for claims. Third, it creates rules about combinations and exceptions, for example restrictions on when item 10929 applies (s 7), an additive application rule for item 10931 (s 8), and cross item exclusivity for item 10944 (s 12). Fourth, it permits limited delegation in perimetry services, by allowing an assistant to operate a perimeter for positioning under specified items, s 9(2). Fifth, the instrument integrates the new items into certain operational clauses of the general medical services table, by making items 10905 to 10929 specified in clause 1.2.5, and items 10905 to 10948 specified in clauses 1.2.8 and 1.2.9, see s 15(1)‑(2). Finally, it sets an indexation operation to take effect 1 July 2025, increasing each Schedule fee by a factor of 1.024 and rounding to the nearest 5 cents, see s 16(1)‑(3).

Current sections

Direct links to the current provisions in Health Insurance (Section 3C General Medical Services - Optometric Services) Determination 2020.

1. Name

This instrument is the Health Insurance (Section 3C General Medical Services ‑ Optometric Services) Determination 2020.

3. Authority

This instrument is made under the Health Insurance Act 1973.

5. Definitions

(1) In this instrument:

Act means the Health Insurance Act 1973.

bulk‑billed for a relevant service, means:

(a) a medicare benefit is payable to a person in relation to the service; and

(b) under an agreement entered into under section 20A of the Act:

(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

(ii) the second‑mentioned person accepts the assignment in full payment of his or her fee for the service provided.

old 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.

relevant 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.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.

residential aged care facility has the same meaning given by the Health Insurance (General Medical Services Table) Regulations 2021.

Schedule means the Schedule to this instrument.

telehealth eligible area has the same meaning as in the general medical services table.

Note: The following terms are defined in subsection 3(1) of the Act:

 clinically relevant

 general medical services table

 optometrist

(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.

(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.

6. Treatment of relevant services

For subsection 3C(1) of the Act:

(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:

(i) it were both a professional service and a medical service; and

(ii) there were an item in the general medical services table that:

(A) related to the service; and

(B) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

(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:

(i) it were both a professional service and a medical service; and

(ii) there were an item in the general medical services table that:

(A) related to the service; and

(B) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

7. Application of item 10929

Item 10929 does not apply to a service if the patient’s requirement for contact lenses is only for any of the following reasons:

(a) because the patient does not want to wear spectacles for reasons of appearance;

(b) because the patient wants contact lenses for work or sporting purposes;

8. Application of item 10931

If 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.

9. Application of items 10938, 10939, 10

9. Application of items 10938, 10939, 10940 and 10941

(1) For this section, the following are perimetry services:

(a) a service described in item 10938;

(b) a service described in item 10939;

(d) a service described in item 10941.

(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.

11. Limitation on items

(3) Items 10921 to 10929 may only apply to a service in respect of a particular patient once in a 36 month period.

12. Limitation on item 10944

Item 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.

14. Application of items 10945 and 10946

Items 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.

15. Professional attendance items and se

15. Professional attendance items and services provided with non‑medicare services

(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).

(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.

16. Indexation

(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: 1.024 multiplied by the amount immediately before the indexation time

Note: 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).

(2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.

(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).

Schedule — Relevant services

Schedule – Relevant services

<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:8.35pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Group A10 – Optometric services provided by optometrist</span></p></td></tr><tr><td style="width:14.36%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:8.35pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Column 1</span></p><p style="margin-top:3pt; margin-left:8.35pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Item</span></p></td><td style="width:70.68%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Column 2</span></p><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Service</span></p></td><td style="width:14.96%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Column 3</span></p><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Fee ($)</span></p></td></tr></thead><tbody><tr><td colspan="3" style="border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span style="font-weight:bold">Subgroup 1 – General</span><span style="font-weight:bold"></span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10905</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>69.45</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10907</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span><span> </span><span>10905, 10910, 10911, 10913, 10914 or 10915 applies:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) for a patient who is less than 65 years of age—within the previous 36 months; or</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) for a patient who is at least 65 years of age—within the previous 12 months</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>34.80</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10910</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) the patient is less than 65 years of age; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) the patient has not, within the previous 36 months, received a service to which this item or item</span><span> </span><span>10905, 10907, 10913, 10914 or 10915 applies</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span></span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>69.45</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10911</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Professional attendance of more than 15 minutes in duration,</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>being the first in a course of attention, if:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) the patient is at least 65 years of age; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) the patient has not, within the previous 12 months, received a service to which this item or item</span><span> </span><span>10905, 10907, 10910, 10913, 10914 or 10915 applies</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span></span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>69.45</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10913</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(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</span><span> </span><span>10905, 10907, 10910, 10914 or 10915 applies; or</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(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</span><span> </span><span>10905, 10907, 10910, 10911, 10914 or 10915 applies</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>69.45</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10914</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(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</span><span> </span><span>10905, 10907, 10910, 10913 or 10915 applies; or</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(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</span><span> </span><span>10905, 10907, 10910, 10911, 10913 or 10915 applies</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>69.45</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10915</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>69.45</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10916</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span><span> </span><span>10938, 10939, 10940, 10941, 10942 or 10943 applies)</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>34.80</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10918</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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,</span><span> </span><span>10940 or 10941 applies)</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>34.80</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10921</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span><span> </span><span>10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>For patients with any of the following:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><a id="_Hlk187871654"><span>(a) myopia of 5.0 dioptres or greater (spherical equivalent) in at least one eye;</span></a></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in at least one eye;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) astigmatism of 3.0 dioptres or greater in at least one eye;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(d) anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once for each condition in a period of 36 months</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>172.55</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10924</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12); and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>being a course of attention for which the first attendance is a service to which item</span><span> </span><span>10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once in a period of 36 months</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>217.70</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10926</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span><span> </span><span>10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once in a period of 36 months</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>172.55</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10927</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) pathological mydriasis;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) aniridia;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) coloboma of the iris;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(d) pupillary malformation or distortion;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(e) significant ocular deformity; or</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(f) corneal opacity;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>whether congenital, traumatic or surgical in origin being a course of attention for which the first attendance is a service to which item</span><span> </span><span>10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once in a period of 36 months</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>217.70</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10928</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span><span> </span><span>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</span><span> </span><span>10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once in a period of 36 months</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>172.55</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10929</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) item</span><span> </span><span>10905, 10907, 10910, 10911, 10913, 10914, 10915 or 10916 applies; and</span></p><p style="margin-top:6pt; margin-bottom:6pt"><span style="font-size:10pt">(b) the contact lenses are not required for appearance, sporting, work or psychological reasons.</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once in a period of 36 months</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>217.70</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10930</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span><span> </span><span>10921 to 10929</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>172.55</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10931</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>A flag fall service to which an item in Subgroup 1 of Group A10 applies (other than this item), if the service:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) is provided:</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(i) during a home visit to a person; or</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(ii) in a residential aged care facility; or</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(iii) in an institution; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) is provided to one or more patients at a single location on a single occasion; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) is:</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(i) bulk</span><span>‑</span><span>billed for the fees for this item and another item applying to the service; or</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(ii) not bulk</span><span>‑</span><span>billed for the fees for this item and another item applying to the service</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>Applicable once per occasion a service is provided under paragraph (a) for each distinct location</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>43.75</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10938</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) is not a service involving multifocal multichannel objective perimetry;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) is performed by an optometrist; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) is performed on a patient who has received two perimetry services to which item 10940 or 10941 applies in the previous 12 months</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>other than a service associated with a service to which item 10916 or 10918 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once per patient (including any service to which item 10939 applies) in a 12</span><span>‑</span><span>month period</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>72.55</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10939</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) is not a service involving multifocal multichannel objective perimetry; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) is performed by an optometrist</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) is performed on a patient who has received two perimetry services to which item 10940 or 10941 applies in the previous 12 months</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>other than a service associated with a service to which item 10916 or 10918 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once per patient (including any service to which item 10938 applies) in a 12</span><span>‑</span><span>month period</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>43.80</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10940</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) is not a service involving multifocal multichannel objective perimetry; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) is performed by an optometrist;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) the patient has received fewer than two perimetry services to which this item or item 10941 applies in a 12</span><span>‑</span><span>month period</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>other than a service associated with a service to which item</span><span> </span><span>10916 or 10918 applies</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>66.30</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10941</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) is not a service involving multifocal multichannel objective perimetry; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) is performed by an optometrist;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) the patient has received fewer than two perimetry services to which this item or item 10940 applies in a 12</span><span>‑</span><span>month period</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>other than a service associated with a service to which item</span><span> </span><span>10916 or 10918</span><span> </span><span>applies</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>40.00</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10942</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) spectacle correction;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) determination of contrast sensitivity;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(c) determination of glare sensitivity;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(d) prescription of magnification aids;</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>other than a service associated with a service to which item</span><span> </span><span>10916, 10921, 10924, 10926, 10927, 10928, 10929 or 10930 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable twice per patient in a 12</span><span>‑</span><span>month period</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>34.80</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10943</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) includes assessment of one or more of the following:</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(i) accommodation;</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(ii) ocular motility;</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(iii) vergences;</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(iv) fusional reserves;</span></p><p style="margin-top:3pt; margin-left:28.35pt; line-height:115%; font-size:10pt"><span>(v) cycloplegic refraction; and</span></p><p style="margin-top:3pt; margin-left:2.3pt; text-indent:-0.05pt; line-height:115%; font-size:10pt"><span>(b) is not performed for the assessment of learning difficulties or learning disabilities;</span></p><p style="margin-top:3pt; text-indent:2.3pt; line-height:115%; font-size:10pt"><span>other than a service to which item 10916, 10921, 10924, 10926, 10927, 10928, 10929 or 10930 applies</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Applicable once per patient in a 12</span><span>‑</span><span>month period</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>34.80</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10944</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>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</span><span>‑</span><span>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</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>Other than </span><a id="_Hlk187872870"><span>a service associated with a service to which items 10905, 10907, 10910, 10911, 10913, 10914, 10915, 10916 or 10918 applies</span></a></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>75.05</span></p></td></tr><tr><td colspan="3" style="border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span style="font-weight:bold">Subgroup 2 – Telehealth attendance</span></p></td></tr><tr><td style="width:14.36%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10945</span></p></td><td style="width:70.68%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>A professional attendance of less than 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) is not an admitted patient</span></p></td><td style="width:14.96%; border-bottom:1pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>34.80</span></p></td></tr><tr><td style="width:14.36%; border-top:1pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>10946</span></p></td><td style="width:70.68%; border-top:1pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>A professional attendance of at least 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and</span></p><p style="margin-top:3pt; line-height:115%; font-size:10pt"><span>(b) is not an admitted patient</span></p></td><td style="width:14.96%; border-top:1pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>69.45</span></p></td></tr></tbody></table>

Source text: opening excerpt

Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.

1. Name 1. Name

1. Name

This instrument is the Health Insurance (Section 3C General Medical Services ‑ Optometric Services) Determination 2020.

3. Authority 3. Authority

3. Authority

This instrument is made under the Health Insurance Act 1973.

5. Definitions 5. Definitions

5. Definitions

(1) In this instrument:

Act means the Health Insurance Act 1973.

bulk‑billed for a relevant service, means:

(a) a medicare benefit is payable to a person in relation to the service; and

(b) under an agreement entered into under section 20A of the Act:

(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

(ii) the second‑mentioned person accepts the assignment in full payment of his or her fee for the service provided.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.

residential aged care facility has the same meaning given by the Health Insurance (General Medical Services Table) Regulations 2021.

Schedule means the Schedule to this instrument.

telehealth eligible area has the same meaning as in the general medical services table.

Note: The following terms are defined in subsection 3(1) of the Act:

 clinically relevant

 general medical services table

 optometrist

Step 1, align each claim with item text and conditions. Before claiming an item, confirm the relevant Schedule item’s textual conditions are met. This includes clinical prerequisites, patient age thresholds and timing windows for prior attendances. For example, check whether the patient is under or over 65 for items 10907, 10910 and 10911 and verify prior item dates to ensure the 12 or 36 month windows are respected, see Schedule entries for 10907, 10910 and 10911 and s 11(3) for items 10921 to 10929 applicability.

Step 2, document the clinical basis on the patient account where required. For item 10929 the instrument requires that the medical or optical condition be specified on the patient’s account and that the contact lenses are not required for appearance, sporting, work or psychological reasons, see s 7 and Schedule item 10929. Ensure clinical notes, diagnosis codes and account entries clearly support the claimed item.

Step 3, maintain bulk‑billing agreements and record assignments. If bulk billing, ensure there is an agreement entered under section 20A of the Health Insurance Act, obtain the patient’s assignment of the Medicare benefit to the provider and document acceptance of the assignment as full payment, since the instrument defines "bulk‑billed for a relevant service" by reference to these requirements, see s 5(1).

Step 4, observe frequency caps and keep prior claim history accessible. Implement practice management checks that prevent claims for items with a once per 36 month or per 12 month cap unless the prior service dates produce eligibility. The instrument makes frequency caps explicit, for example s 11(3) for items 10921 to 10929, and Schedule entries for perimetry and low vision items. Integrate prior claims data into eligibility checks before submission.

Step 5, follow delegation limits for perimetry. Where perimetry services are performed under items 10938 to 10941, an assistant may operate the perimeter to ensure proper positioning only, see s 9(2). The optometrist must ensure that the clinical duties reserved to the optometrist are personally undertaken, and maintain records that show the assistant’s involvement was limited to positioning.

Step 6, verify telehealth preconditions. For items 10945 and 10946 confirm that 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 under subsection 3C(1) of the Act, see s 14 and Schedule entries for 10945 and 10946. Establish and retain documentation that the specialist teleconsultation was claimable under the MBS table.

Step 7, apply flag fall rules correctly. When claiming item 10931 for home visits, residential aged care facility visits or institution visits, ensure the claim meets the location and occasion criteria, that the flag fall is charged only once per occasion for each distinct location, and that any associated item from Subgroup 1 is claimed in addition to the flag fall where appropriate, see Schedule item 10931 and s 8 which confirms item 10931 applies in addition to other Subgroup 1 fees where it applies.

Step 8, implement the indexation adjustment for 1 July 2025. Update claim and billing systems at the start of 1 July 2025 to replace each Schedule fee by the amount worked out by multiplying the pre‑indexation amount by 1.024 and rounding to the nearest 5 cents according to s 16(1)‑(3). Keep evidence of the calculation steps and the applied rounding rule for audit purposes.

Step 9, ensure integrated billing table clause compliance. Note that s 15 modifies the operation of clause 1.2.5 and clauses 1.2.8 and 1.2.9 of the general medical services table so that items 10905 to 10929 and 10905 to 10948 are treated as specified in those clauses. Ensure your practice’s interpretation of those table clauses reflects the instrument’s insertion of these items in those clauses.

Step 10, retain robust records for audit. Because the instrument places the items under the "relevant provisions", claims will be subject to the same audit and recovery mechanisms as other Medicare items. Retain contemporaneous clinical notes, patient account entries, referral documentation, assignment and s 20A agreement records for bulk billed services, dates of prior attendances and evidence of telehealth consultation eligibility. Where a condition is required to be specified on the account, store that notation and supporting diagnostic evidence.

Step 11, train staff on item mapping and eligibility checks. Reception, billing and clinical staff should be trained to map clinical encounters to the correct item numbers, to check patient age and prior attendance windows, to determine whether the reason for contact lenses is allowable, and to apply flag fall, telehealth and perimetry delegation rules. Implement checklists for items with complex combinations or frequency rules.

Step 12, consult the Health Insurance Act and National Health Act definitions where required. The instrument cross‑references definitions and concepts in subsection 3(1) of the Health Insurance Act, for instance "clinically relevant" and "optometrist", see s 5(1) Note. Where the meaning of those terms is material to claimability, ensure the legal definitions from the Act are applied in clinical decision making and documentation.

Step 13, update practice management software. Configure billing systems to prevent submission of claims that contravene explicit prohibitions in the instrument, such as submitting item 10944 on the same occasion as the listed first attendance items, and to apply the indexation factor and rounding on 1 July 2025. Keep logs of software configuration changes and applied calculations.

Step 14, communicate with patients about out‑of‑pocket liability. Some items specify that services can be bulk billed or not, and others have limited eligibility. Where a claim is not bulk billed or eligibility is unclear, inform the patient, document consent for out‑of‑pocket charges and ensure account entries reflect the patient’s understanding. For item 10929 note that lenses cannot be claimed where they are for appearance, sporting, work or psychological reasons, so discuss the medical basis for the contact lens prescription with the patient and document that basis on the account.

Following these steps aligns operational practice with the instrument’s textual requirements. Because the instrument incorporates these items into the wider "relevant provisions", compliance with this determination also requires respect for the broader statutory and regulatory compliance obligations under the Health Insurance Act 1973 and the National Health Act 1953 as they apply to medical and professional services.

Deep Dive

What it does

Current sections

1. Name

1. Name

3. Authority

3. Authority

5. Definitions

5. Definitions

6. Treatment of relevant services

6. Treatment of relevant services

7. Application of item 10929

7. Application of item 10929

8. Application of item 10931

8. Application of item 10931

9. Application of items 10938, 10939, 10940 and 10941

9. Application of items 10938, 10939, 10940 and 10941

11. Limitation on items

11. Limitation on items

12. Limitation on item 10944

12. Limitation on item 10944

14. Application of items 10945 and 10946

14. Application of items 10945 and 10946

15. Professional attendance items and services provided with non‑medicare services

15. Professional attendance items and services provided with non‑medicare services

16. Indexation

16. Indexation

Schedule — Relevant services

Schedule – Relevant services

Source text: opening excerpt

1. Name 1. Name

1. Name

3. Authority 3. Authority

3. Authority

5. Definitions 5. Definitions

5. Definitions

Main concepts

Who it affects

Key duties and rights

Penalties and enforcement

How it interacts with other laws

Amendment history

Litigation history

Gotchas

How to comply

6. Treatment of relevant services 6. Treatment of relevant services

6. Treatment of relevant services

7. Application of item 10929 7. Application of item 10929

7. Application of item 10929

8. Application of item 10931 8. Application of item 10931

8. Application of item 10931

9. Application of items 10938, 10939, 10 9. Application of items 10938, 10939, 10940 and 10941

9. Application of items 10938, 10939, 10940 and 10941

11. Limitation on items 11. Limitation on items

11. Limitation on items

12. Limitation on item 10944 12. Limitation on item 10944

12. Limitation on item 10944

14. Application of items 10945 and 10946 14. Application of items 10945 and 10946

14. Application of items 10945 and 10946

15. Professional attendance items and se 15. Professional attendance items and services provided with non‑medicare services

15. Professional attendance items and services provided with non‑medicare services

16. Indexation 16. Indexation

16. Indexation

Schedule — Relevant services Schedule — Relevant services

Schedule – Relevant services