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, Disability and Ageing. 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, Disability and Ageing and Services Australia are located at the end of these Notes.

Related Items: 10921 10924 10926 10927 10928 10929

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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

Fee: $193.45 Benefit: 85% = $164.45

(See para AN.0.2, AN.10.1 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, 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

Fee: $244.05 Benefit: 85% = $207.45

(See para AN.0.2, AN.10.1 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, 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

Fee: $193.45 Benefit: 85% = $164.45

(See para AN.0.2, AN.10.1 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, 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

Fee: $244.05 Benefit: 85% = $207.45

(See para AN.0.2, AN.10.1 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, 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

Fee: $193.45 Benefit: 85% = $164.45

(See para AN.0.2, AN.10.1 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, 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

Fee: $244.05 Benefit: 85% = $207.45

(See para AN.0.2, AN.10.1 of explanatory notes to this Category)