Medicare Benefits Schedule - Item 10806

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription-one service in any period of 36 months-patient with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes and for whom a contact lens is prescribed as part of a telescopic system

Fee: $135.95 Benefit: 75% = $102.00 85% = $115.60

(See para AN.0.34 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $407.85

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Benefits are paid for consultations concerned with the prescription and fitting of contact lenses only if patients fall into specified categories (ie patients with certain conditions). The classes of patients eligible for benefits for contact lens consultations are described in items 10801 to 10809. 

Benefits are not payable for item 10809 in circumstances where patients want contact lenses only for:

(a)              reasons of appearance (because they do not want to wear spectacles);

(b)              sporting purposes;

(c)              work purposes; or

(d)              psychological reasons (because they cannot cope with spectacles). 

Benefits are payable for an initial referred consultation rendered in association with the fitting and prescribing of the lenses.  Subsequent follow-up attendances attract benefits on a consultation basis.

Related Items: 10801 10802 10803 10804 10805 10806 10807 10808 10809