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MINOR ASSESSMENTS AND AUTOMATED VISUAL FIELD TESTS PROVIDED BY OPTOMETRISTS

In the unusual circumstance where a patient does present for a second minor assessment as described above, a claim for payment is to be submitted through the manual review process (Claims Flagged for Manual Review – form 2404-84). The form is available from the ministry’s online forms catalogue at:
http://www.health.gov.on.ca/english/public/forms/form_menus/ohip_fm.html

Minor assessments (V408), provided to individuals 20-64 years of age, to re-assess an ocular condition(s) following an insured major eye examination (V409 or A115) are also limited as above. A V408 service provided for a purpose unrelated to the re-assessment of an ocular condition for which they are eligible for the major eye examination is not an insured service.

B. Automated Visual Field Testing (“AVF”)

The phrase “visual field examination” contained in the mandatory elements of a periodic-oculo visual assessment (POVA) and major eye exam (MEE) does not refer to and, therefore, does not include AVF testing. However, medically necessary AVF testing remains as an insured service. Claims for the provision of medically necessary AVF tests are to be submitted as minor assessments (V402 or V408) with a unique identifier. This identifier will assist in ensuring that claims submitted for AVF can be identified and billing patterns monitored. Where an AVF test is rendered, the diagnostic code 918 must be added to the claim for V402 minor assessment (under 19 and over 65) and to the V408 (20-64 minor assessment following a major eye exam).

An AVF test can be billed in conjunction with a POVA, MEE, or minor assessment where the POVA, MEE or minor assessment is therapeutically necessary in addition to the AVF test, and the requirements of the respective assessment have been satisfied. Where the AVF test is being provided solely as a diagnostic service (e.g. on referral by the primary eye care provider – optometrist/ophthalmologist), a minor assessment cannot be billed in conjunction with a POVA, MEE or minor assessment.

Note: Charges to patients for insured services (as clarified above) will be subject of Ministry recovery and reimbursement of patients whether the charge is an instance of inappropriate billing or “extra-billing”.


Ontario Ministry of Health and Long-Term Care
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