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

67.85

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, 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 of age—within the previous 12 months

34.00

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:

(i) this item or item 10905, 10907, 10912, 10913, 10914 or 10915 applies; or

(ii) old item 10900 applied

67.85

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:

(i) this item, or item 10905, 10907, 10910, 10912,

10913, 10914 or 10915 applies; or

(ii) old item 10900 applied

67.85

10912

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 requiring comprehensive reassessment:

(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10913, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10913, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied

67.85

10913

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient 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:

(i) this item, or item 10905, 10907, 10910, 10912, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied

67.85

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:

(i) this item, or item 10905, 10907, 10910, 10912, 10913 or 10915 applies; or

(ii) old item 10900 applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10913 or 10915 applies; or

(ii) old item 10900 applied

67.85

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

67.85

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 10931, 10932, 10933, 10940, 10941, 10942 or 10943 applies)

34.00

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 10940 or 10941 applies)

34.00

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with myopia of 5.0 dioptres or greater (spherical equivalent) in one eye

168.45

10922

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in one eye

168.45

10923

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with astigmatism of 3.0 dioptres or greater in one eye

168.45

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens

212.55

10925

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)

168.45

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

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

168.45

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity—whether congenital, traumatic or surgical in origin

212.55

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients who, because of physical deformity, are unable to wear spectacles

168.45

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

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

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

212.55

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

168.45

10931

A service to which an item in Subgroup 1 of Group A10 applies (other than this item or item 10916, 10932, 10933, 10940 or 10941), 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 a single patient at a single location on a single occasion; and

(c) is:

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

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

23.65

10932

A service to which an item in Subgroup 1 of Group A10 applies (other than this item or item 10916, 10931, 10933, 10940 or 10941), 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 each of 2 patients at a single location on a single occasion; and

(c) is:

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

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

11.80

10933

A service to which an item in Subgroup 1 of Group A10 applies (other than this item or item 10916, 10931, 10932, 10940 or 10941), 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 each of 3 patients at a single location on a single occasion; and

(c) is:

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

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

7.80

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;

other than a service associated with a service to which item 10916, 10918, 10931, 10932 or 10933 applies

64.75

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;

other than a service associated with a service to which item 10916, 10918 10931, 10932 or 10933 applies

39.05

10942

Testing of residual vision to provide optimum visual performance for a patient who has best corrected visual acuity of 6/15 or N.12 or worse in the better eye or a horizontal visual field of less than 120 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, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

34.00

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, including assessment of one or more of the following:

(a) accommodation;

(b) ocular motility;

(c) vergences;

(d) fusional reserves;

(e) cycloplegic refraction;

other than a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

34.00

10944

Cornea, complete removal of embedded foreign body from—not more than once on the same day by the same optometrist (excluding after-care)

Note: If the embedded foreign body is not completely removed, this item does not apply but item 10916 may apply.

73.30

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; and

(c) either:

(i) is located within a telehealth eligible area and, at the time of the attendance, is at least 15 kilometres by road from the specialist mentioned in paragraph (a); or

(ii) is a patient of an Aboriginal Medical Service, or an Aboriginal Community Controlled Health Service, for which a direction under subsection 19(2) of the Act applies

34.00

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; and

(c) either:

(i) is located within a telehealth eligible area and, at the time of the attendance, is at least 15 kilometres by road from the specialist mentioned in paragraph (a); or

(ii) is a patient of an Aboriginal Medical Service, or an Aboriginal Community Controlled Health Service, for which a direction under subsection 19(2) of the Act applies

67.85

10947

A professional attendance (not being a service to which any other item applies) 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) at the time of the attendance, is located at a residential aged care facility (whether or not at consulting rooms situated within the facility); and

(c) is a care recipient in the facility; and

(d) is not a resident of a self-contained unit;

for an attendance on one occasion—each patient

34.00

10948

A professional attendance (not being a service to which any other item applies) 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) at the time of the attendance, is located at a residential aged care facility (whether or not at consulting rooms situated within the facility); and

(c) is a care recipient in the facility; and

(d) is not a resident of a self-contained unit;

for an attendance on one occasion—each patient

67.85

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

    /sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

    effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

    effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

    cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

    commenced or to be commenced

Health Insurance (Optometric services) Determination 2016

9 March 2016 (see F2016L00285)

1 April 2016

Health Insurance (Section 3C – Cataract and Optometric Services) Amendment Determination 2018

13 June 2018 (F2018L00767)

1 July 2018 (s 2)

—

Health Insurance (Section 3C – Optometric Services) Amendment Determination 2019

9 Apr 2019 (F2019L00583)

1 July 2019 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020

29Apr 2020 (F2020L00518)

Sch 1 (items 6–8): 1 May 2020 (s 2(1) item 1)

—

Part 1

s 2.............................................

rep LA s 48D

s 4.............................................

am F2020L00518

s 14...........................................

am F2018L00767; F2020L00518

Schedule

Schedule...................................

am F2019L00583