bulletin

Ontario
Bulletin Number
        8075
Date
        March 11, 1998
Direct inquiries to
         Ministry of Health
         Processing Office

(address below)
Distribution
        Optometrists
Subject      CHANGES TO MINISTRY OF HEALTH SCHEDULE OF BENEFITS FOR OPTOMETRISTS’ SERVICES, EFFECTIVE APRIL 1, 1998
The Schedule of Benefits for optometrists’ services will be amended effective April 1, 1998, as follows:
  • New service definition for Periodic Oculo-Visual Assessment for the purpose of providing refractive prescriptions for simple refractive errors.

  • Age specific maximums as follows: under 20 years of age and over 65, one Periodic Oculo-Visual Assessment per person per year; between 20 and 64 years of age, one Periodic Oculo-Visual Assessment per person per 24-month period (regardless of who provides the service, optometrists or physicians).

  • One additional Periodic Oculo-Visual Assessment allowed in the second year for individuals between 20 and 64 years of age only for significant change in refractive error (defined as 0.5 diopters spherical equivalent) and due to disease or trauma and not progression of simple refractive error.

  • The previous one to two years of claim history will be used to determine if a claim is payable after April 1, 1998. For example, a 30 year-old patient with a previous eye exam (V401) on June 18, 1997, will be eligible for a Periodic Oculo-Visual Assessment (V405) after June 19, 1999.

  • Periodic Oculo-Visual Assessments in excess of the above are uninsured and may be billed to the patient. Optometrically necessary assessment for eye disorders other than above will continue to be claimed using V402, without the above limitations.

  • V401 is replaced by new age-specific fee codes (V404, V405, V406 and V407).

  • Service definition for Oculo-Visual Minor Assessment. Fee code remains as V402.

Claims for services performed up to and including March 31, 1998, may be submitted after April 1, 1998, and will be processed in the usual manner.

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