1:30min
Last year, we informed members that as part of the Federal Budget 2024-25, the Commonwealth Government would implement recommendations made by the MBS Review Taskforce relating to optometry items.
These changes have been confirmed and come into effect from 1 March 2025. Many of these changes pleasingly align with those we actively advocated for, though not all the changes we sought have been implemented. Whilst there has been an increase to the domiciliary item fee, this increase is insufficient and we will continue to advocate for a fee that better reflects the true cost of travelling and providing care outside of practice.
From 1 March 2025, the following changes will take effect:
- Comprehensive consultations: Items 10912 and 10913 will combine into one item number, 10913, and the previous ‘same practice’ restrictions will be removed.
- Visual fields: A third computerised perimetry test in a 12-month period where indicated by the presence of glaucoma with a high risk of clinically significant progression will be introduced. Explanatory notes will be reworded to emphasise the need for providers to clearly document the rationale underlying the need for the practitioner to perform a computerised perimetry test. The two new items that will be introduced are:
- 10938 (bilateral) – $72.55 scheduled fee.
- 10939 (monocular) – $43.80 scheduled fee.
- Domiciliary visits: Items 10931 to 10933 will be replaced with a single item number, 10931, which covers all domiciliary visits. The scheduled fee is $43.75. The co-claiming restrictions on domiciliary visits will be removed, enabling the billing of a short consultation (10916 or 10918) and computerised perimetry (10940 or 10941) at domiciliary visits.
- Contact lenses: Items 10921, 10922, 10923 and 10925 will combine into one item number, 10921, and the explanatory notes reworded to remove the requirement to deliver the lens.
- Foreign body removal: Item 10944 will be amended to clarify the requirement for complete removal of the rust ring with a ferrous embedded foreign body, and to provide more clarity around when this item can be claimed.
- Residual vision: Item 10942 will be amended to reflect current best practice for testing of residual vision.
25-02-25 update
The Department of Veterans Affairs (DVA) has confirmed that the DVA optometrist fee schedule will align with MBS items and follow the MBS rules. Amended item 10931 (fee increase) and new items 10938, 10938 will be payable from 1 March 2025. They have advised that Items 10912, 10922, 10923, 10925, 10932, 10933 will be removed from the schedule, noting that claims for these items up to 28 February 2025 can be made within 2 years from the date of service. DVA will endeavour to publish the updated fee schedule as soon as possible in the week beginning 3 March 2025.
A clause has been added to the Health Insurance Amendment Determination 2025 legislation to give the use of assistants in conducting visual fields legal effect: “It is acceptable for an optometrist rendering perimetry services to utilise an assistant to operate the perimeter to ensure a patient is properly positioned for the service to be completed”. Further clarification on the use of assistants with visual fields is expected in the new MBS explanatory notes to be published 1 March.
The full item descriptors and information on other changes to the MBS will be published on the MBS Online website.
New item numbers and their descriptors
| Item number | Descriptor |
|---|---|
| 10913 | Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has suffered a significant change of visual function or has new signs or symptoms, unrelated to the earlier course of attention, requiring comprehensive reassessment: (a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which this item, or item 10905, 10907, 10910, 10914 or 10915 applies; or (b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which this item, or item 10905, 10907, 10910, 10911, 10914 or 10915 applies |
| 10938 | Full quantitative computerised perimetry (automated absolute static threshold), with bilateral assessment and report, where indicated by the presence of glaucoma with a high risk of clinically significant progression that: (a) is not a service involving multifocal multichannel objective perimetry; (b) is performed by an optometrist; and (c) is performed on a patient who has received two perimetry services to which item 10940 or 10941 applies in the previous 12 months other than a service associated with a service to which item 10916 or 10918 applies Applicable once per patient (including any service to which item 10939 applies) in a 12-month period |
| 10939 | Full quantitative computerised perimetry (automated absolute static threshold) with unilateral assessment and report, where indicated by the presence of glaucoma with a high risk of clinically significant progression that: (a) is not a service involving multifocal multichannel objective perimetry; and (b) is performed by an optometrist (c) is performed on a patient who has received two perimetry services to which item 10940 or 10941 applies in the previous 12 months other than a service associated with a service to which item 10916 or 10918 applies Applicable once per patient (including any service to which item 10938 applies) in a 12-month period |
| 10931 | A flag fall service to which an item in Subgroup 1 of Group A10 applies (other than this item), if the service: (a) is provided: (i) during a home visit to a person; or (ii) in a residential aged care facility; or (iii) in an institution; and (b) is provided to one or more patients at a single location on a single occasion; and (c) is: (i) bulk billed for the fees for this item and another item applying to the service; or (ii) not bulk billed for the fees for this item and another item applying to the service Applicable once per occasion a service is provided under paragraph (a) for each distinct location |
| 10921 | 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 |
| 10942 | Testing of residual vision to provide optimum visual performance for a patient who has best corrected visual acuity of 6/15 or N12 or worse at 40cm in the better eye or a horizontal visual field of less than 110 degrees and within 10 degrees above and below the horizontal midline, involving one or more of the following: (a) spectacle correction; (b) determination of contrast sensitivity; (c) determination of glare sensitivity; (d) prescription of magnification aids;other than a service associated with a service to which item 10916, 10921, 10924, 10926, 10927, 10928, 10929 or 10930 applies Applicable twice per patient in a 12-month period |
We will continue to keep members informed about Medicare changes and advocate for improvements that better support optometrists and their patients.
Tagged as: Medicare-MBS-PBS