Medicare Benefits Schedule - Note AN.0.2

All Australian residents and certain categories of visitors to Australia can claim Medicare benefits for services by optometrists. The Health Insurance Act 1973 contains legislation covering the major elements of the Medicare program. 

Responsibility for regulating the Medicare program lies with the Australian Government through the Department of Health and Aged Care. Services Australia is responsible for consideration of applications and for the day to day operation of Medicare and the payment of benefits. Contact details of the Department of Health and Aged Care and Services Australia are located at the end of these Notes.

Related Items: 10921 10922 10923 10924 10925 10926 10927 10928 10929

• Previous - Note AN.0.1
• Next - Note AN.0.3

CONTACT LENSES FOR SPECIFIED CLASSES OF PATIENTS - BULK ITEMS FOR ALL SUBSEQUENT CONSULTATIONS

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

Payable once in a period of 36 months for

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

Fee: $182.50 Benefit: 85% = $155.15

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months for

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

Fee: $182.50 Benefit: 85% = $155.15

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months for

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

Fee: $182.50 Benefit: 85% = $155.15

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months 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

Fee: $230.30 Benefit: 85% = $195.80

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months for

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

Fee: $182.50 Benefit: 85% = $155.15

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months 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

Fee: $182.50 Benefit: 85% = $155.15

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months for

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

    i.    pathological mydriasis; or

    ii.    aniridia; or

    iii.    coloboma of the iris; or

    iv.    pupillary malformation or distortion; or

    v.    significant ocular deformity or corneal opacity

-whether congenital, traumatic or surgical in origin

Fee: $230.30 Benefit: 85% = $195.80

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months for

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

Fee: $182.50 Benefit: 85% = $155.15

(See para AN.0.2 of explanatory notes to this Category)

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

Payable once in a period of 36 months 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

Note: Benefits may not be claimed under Item 10929 where the patient wants the contact lenses for appearance, sporting, work or psychological reasons - see paragraph O6 of explanatory notes to this category.

Fee: $230.30 Benefit: 85% = $195.80

(See para AN.0.2 of explanatory notes to this Category)