By Helen Carter
Two new health insurance optical item codes for disposable multifocal contact lenses will be introduced on 1 April 2016.
- Item number 863 (abbreviated description DISPOSBL MULTI1) will be for a disposable contact lens supply (multifocal) of three months or less (single).
- Item number 864 (DISPOSBL MULTI2) will be for a disposable contact lens supply (multifocal) of three months or less (pair).
If worn on a daily basis, these supplies would last three months.
All health funds will provide these items for claimable rebates through HICAPS and CSC. If a practitioner does not have a HICAPS EFTPOS terminal, they can issue a receipt with items 863 or 864 and if the patient has paid in full, they will be reimbursed through their health fund.
Optometry Western Australia president Darrell Baker announced the news to delegates at WAVE in August.
Optometry WA CEO Tony Martella said the new item codes resulted from close co-operation between Optometry WA and Optometry Australia.
Optometry WA initially suggested to Optometry Australia that specific rebates were required for disposable contact lenses, which Optometry Australia then proposed to Private Healthcare Australia at its general treatment provider relations committee meeting in April 2015.
Optometry Australia CEO Genevieve Quilty said that historically item code 861/862 (or 871/872) had been used by many health funds to provide a rebate for disposable multifocal contact lenses (single or pair) even though the item descriptor referred to non-disposable bifocal contact lenses.
‘Not only does this not provide a true picture of the type of contact lenses being prescribed, it also means the wearer may not be receiving the correct level of benefit from their health fund,’ Ms Quilty wrote in a letter to Private Healthcare Australia.
She said the number of disposable multifocal contact lens products on the market had increased dramatically over the past few years and it was anticipated that with the ageing population, use of these products would continue to rise.
‘Many of our members and at least one health fund had raised concerns regarding this and requested assistance in finding a solution,’ she said.
Optometry Australia recommended that the new item codes be developed to ensure policyholders received the benefits they were entitled to and to stop confusion about which item code should be used by optometrists.
She said listing the new items as multifocal contact lenses most accurately captured the optical principles in their design and few true bifocal-style contact lenses remained on the market.
Ms Quilty said that despite the current HICAPS reference guide for optical services referring to item 861/862 as being for non-disposable contact lenses, excluding plano lenses, current reference guides such as Eyetalk were now referring to this item as multifocal, and updating this terminology in the item description for 861/862 should be considered in the future.
Health fund optical code items which already exist for disposable contact lenses include item 851 for disposable spherical contact lenses (single), supply of three months or less, and item 852 (spherical, pair) with the same criteria.
Item 853 is for toric (single) and 854 (toric, pair) with the same criteria.