Health Insurance (Section 3C General Medical Services – Optometric Services) Amendment Determination 2025 I, Louise Riley, delegate of the Minister for Health and Aged Care, make the following Determination. Dated 3 February 2025 Louise Riley Assistant Secretary MBS Policy and Reviews Branch Medicare Benefits and Digital Health Division Health Resourcing Group Department of Health and Aged Care Contents 1 Name 2 Commencement 3 Authority 4 Schedules Schedule 1—Amendments Health Insurance (Section 3C General Medical Services ‑ Optometric Services) Determination 2020 1 Name This instrument is the Health Insurance (Section 3C General Medical Services – Optometric Services) Amendment Determination 2025. 2 Commencement 1. Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms. Commencement information Column 1 Column 2 Column 3 Provisions Commencement Date/Details 1. The whole of this instrument 1 March 2025. Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument. 1. Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument. 3 Authority This instrument is made under subsection 3C(1) of the Health Insurance Act 1973. 4 Schedules Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms. Schedule 1—Amendments Health Insurance (Section 3C General Medical Services ‑ Optometric Services) Determination 2020 1 Section 8 (title of section) Omit ", 10932 and 10933". 2 Section 8 Omit ", 10932 or 10933 applies to a service, the fee mentioned in that item", substitute "applies to a service, the fee mentioned in the item". 3 Section 9 Repeal the section, substitute: 9. Application of items 10938, 10939, 10940 and 10941 (1) For this section, the following are perimetry services: (a) a service described in item 10938; (b) a service described in item 10939; (c) a service described in item 10940; (d) a service described in item 10941. (2) 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. 4 Section 10 Repeal the section. 5 Subsections 11(1) and (2) Repeal the subsections. 6 Section 12 Omit "10912,". 7 Schedule (table, heading, row with "Item" in column 1, "Service" in column 2 and "Fee ($)" in column 3) Repeal the row, substitute: Column 1 Column 2 Column 3 Item Service Fee ($) 8 Schedule (item 10907, column 2) Omit "10912,". 9 Schedule (item 10907, column 2) Omit ", or to which old item 10900 applied". 10 Schedule (item 10910, column 2, paragraph (b)) Repeal the paragraph, substitute: (b) the patient has not, within the previous 36 months, received a service to which this item or item 10905, 10907, 10913, 10914 or 10915 applies 11 Schedule (item 10911, column 2, paragraph (b)) Repeal the paragraph, substitute: (b) the patient has not, within the previous 12 months, received a service to which this item or item 10905, 10907, 10910, 10913, 10914 or 10915 applies 12 Schedule (item 10912) Repeal the item. 13 Schedule (cell at item 10913, column 2) Repeal the cell, substitute: 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 14 Schedule (cell at item 10914, column 2) Repeal the cell, substitute: Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has a progressive disorder (excluding presbyopia) 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, 10913 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, 10913 or 10915 applies 15 Schedule (item 10916, column 2) Omit "10931, 10932, 10933", substitute "10938, 10939". 16 Schedule (item 10918, column 2) After "which item" insert " 10938, 10939,". 17 Schedule (cell at item 10921, column 2) Repeal the cell, substitute: 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 18 Schedule (item 10922) Repeal the item. 19 Schedule (item 10923) Repeal the item. 20 Schedule (cell at item 10924, column 2) Repeal the cell, substitute: 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 21 Schedule (item 10925) Repeal the item. 22 Schedule (cell at item 10926, column 2) Repeal the cell, substitute: 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 23 Schedule (cell at item 10927, column 2) Repeal the cell, substitute: 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 24 Schedule (cell at item 10928, column 2) Repeal the cell, substitute: 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 25 Schedule (cell at item 10929, column 2) Repeal the cell, substitute: 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 26 Schedule (cell at item 10931, column 2) Repeal the cell, substitute: 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 27 Schedule (cell at item 10931, column 3) Omit "24.20", substitute "43.75". 28 Schedule (item 10932) Repeal the item. 29 Schedule (item 10933) Repeal the item. 30 Schedule (after item 10931) Insert: 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: 72.55 (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: 43.80 (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 31 Schedule (cell at item 10940, column 2) Repeal the cell, substitute: Full quantitative computerised perimetry (automated absolute static threshold), with bilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that: (a) is not a service involving multifocal multichannel objective perimetry; and (b) is performed by an optometrist; (c) the patient has received fewer than two perimetry services to which this item or item 10941 applies in a 12-month period other than a service associated with a service to which item 10916 or 10918 applies 32 Schedule (cell at item 10941, column 2) Repeal the cell, substitute: Full quantitative computerised perimetry (automated absolute static threshold) with unilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that: (a) is not a service involving multifocal multichannel objective perimetry; and (b) is performed by an optometrist; (c) the patient has received fewer than two perimetry services to which this item or item 10940 applies in a 12-month period other than a service associated with a service to which item 10916 or 10918 applies 33 Schedule (cell at item 10942, column 2) Repeal the cell, substitute: 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 34 Schedule (cell at item 10943, column 2) Repeal the cell, substitute: Additional testing to confirm diagnosis of, or establish a treatment regime for, a significant binocular or accommodative dysfunction, in a patient aged 3 to 14 years, where the service: 1. includes assessment of one or more of the following: 1. accommodation; 2. ocular motility; 3. vergences; 4. fusional reserves; 5. cycloplegic refraction; and 2. is not performed for the assessment of learning difficulties or learning disabilities; other than a service to which item 10916, 10921, 10924, 10926, 10927, 10928, 10929 or 10930 applies Applicable once per patient in a 12-month period 35 Schedule (cell at item 10944, column 2) Repeal the cell, substitute: Complete removal of embedded foreign body (including a rust ring, if present) from the cornea—not more than once on the same day by the same optometrist (excluding after‑care). Only claimable when either fully removed, or if the patient is referred to an Ophthalmologist or other appropriately qualified practitioner for further assessment and management after second attendance results in partial removal Other than a service associated with a service to which items 10905, 10907, 10910, 10911, 10913, 10914, 10915, 10916 or 10918 applies