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.

care recipient means a person receiving residential care under section 21‑2 of the Aged Care Act 1997.

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 means a facility where residential care (within the meaning given by section 41‑3 of the Aged Care Act 1997) is provided.

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, 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 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 2024 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2024 be viewed on the Department of Health and Aged Care’s MBS Online website (http://www.health.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

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

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.

Endnote 2—Abbreviation key

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

Endnote 3—Legislation history

Name	Registration	Commencement	Application, saving and transitional provisions
Health Insurance (Section 3C General Medical Services ‑ Optometric Services) Determination 2020	17 June 2020 (F2020L00741)	1 July 2020 (s 2(1) item 1)
Health Insurance Legislation Amendment (Section 3C General Medical and Diagnostic Imaging Services – Medicare Indexation) Determination 2021	8 Apr 2021 (F2021L00426)	Sch 1 (items 80–111): 1 July 2021 (s 2(1) item 1)	—
Health Insurance Legislation Amendment (Telehealth Clinical Support Services) Determination 2021	17 Dec 2021 (F2021L01811)	Sch 1 (items 17–21): 1 Jan 2022 (s 2(1) item 1)	—
Health Insurance Legislation Amendment (Indexation) Determination 2022	7 Apr 2022 (F2022L00553)	Sch 1 (item 3): 1 July 2022 (s 2(1) item 1)	—
Health Insurance Legislation Amendment (Indexation) Determination 2023	24 Mar 2023 (F2023L00348)	Sch 1 (item 3): 1 July 2023 (s 2(1) item 1)	—
Health Insurance Legislation Amendment (2023 Measures No. 1) Determination 2023	11 May 2023 (F2023L00535)	Sch 1 (item 7): 1 July 2023 (s 2(1) item 1)	—
Health Insurance Legislation Amendment (Indexation No. 2) Determination 2023	4 Sept 2023 (F2023L01183)	Sch 1 (item 3): 1 Nov 2023 (s 2(1) item 1)	—
Health Insurance Legislation Amendment (Indexation) Determination 2024	21 May 2024 (F2024L00563)	Sch 1 (item 3): 1 July 2024 (s 2(1) item 1)	—
Health Insurance (Section 3C General Medical Services – Optometric Services) Amendment Determination 2025	4 Feb 2025 (F2025L00077)	1 Mar 2025 (s 2(1) item 1)	—

Endnote 4—Amendment history

Provision affected	How affected
s 2.....................	rep LA s 48D
s 4.....................	rep LA s 48C
s 5.....................	am F2023L00535
s 8.....................	am F2025L00077
	ed C7
s 9.....................	rs F2025L00077
s 10....................	rep F2025L00077
s 11....................	am F2025L00077
s 12....................	am F2025L00077
s 13....................	rep F2021L01811
s 14....................	am F2021L01811
s 16....................	ad F2022L00553
	am F2023L00348
	ed C4
	am F2023L01183; F2024L00563
Schedule
Schedule.................	am F2021L00426; F2021L01811; F2025L00077

Endnote 5—Editorial changes

In preparing this compilation for registration, the following kinds of editorial change(s) were made under the Legislation Act 2003.

Section 8 (heading)

Kind of editorial change

Correct a typographical error

Details of editorial change

Schedule 1 item 1 of the Health Insurance (Section 3C General Medical Services – Optometric Services) Amendment Determination 2025 provides as follows:

1 Section 8 (title of section)

Omit “, 10932 and 10933”.

This amendment results in the heading to section 8 appearing as “Application of items 10931”.

This compilation was editorially changed to omit “items” and substitute “item” in the heading to section 8 to correct the typographical error.