A115

PDF page 138 / A10

Periodic oculo-visual assessment
     see General Preamble GP28 for definitions and conditions
 A110 aged 19 years and below .......................................................                 48.90
 A112 aged 65 years and above .......................................................                 48.90
   Identification of patient for a major eye examination
     Identification of patient for a major eye examination, is the service of determining that a patient
     aged 20 to 64 inclusive has a medical condition (other than diabetes mellitus, glaucoma,
     cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent
     uveitis or optic pathway disease) requiring a major eye examination and providing such a
     patient with a completed requisition.
 E077     - identification of patient for a major eye examination .. add                10.25
     Note:
     1.This service is limited to a maximum of one every four fiscal years by the same physician for
       the same patient unless the patient seeks a major eye examination from a physician other
       than the one to whom the original requisition was provided.
     2.This service is limited to a maximum of one per fiscal year by any physician to the same
       patient.
    Major eye examination
     A major eye examination is a complete evaluation of the eye and vision system for patients
     aged 20 to 64 inclusive. The examination must include the following elements:
    a. relevant history (ocular medical history, relevant past medical history, relevant family history)
    b. a comprehensive examination (visual acuity, gross visual field testing by confrontation,
       ocular mobility, slit lamp examination, ophthalmoscopy and, where indicated,
       ophthalmoscopy through dilated pupils and tonometry)
    c. visual field testing by the same physician where indicated
    d. refraction, and if needed, provision of a refractive prescription
    e. advice and instruction to the patient
    f. submission of the findings of the assessment in writing to the patient's primary care
       physician or nurse practitioner
    g. any other medically necessary components of the examination (including eye-related
       procedures) not specifically listed above.
 A115 Major eye examination............................................................ 53.60

PDF page 284 / A156

CONSULTATIONS AND VISITS
OPHTHALMOLOGY (23)
  Periodic oculo-visual assessment
A237 - aged 19 years and below ...................................................                 59.35
A239 - aged 65 years and above...................................................                  59.35
    Note:
    See General Preamble GP28 for definitions and conditions.
  Major eye examination
A115 Major eye examination (see page A10) ..................................                       53.60
  Orthoptic assessment
    Orthoptic assessment must include quantitative measurement of all cardinal positions of gaze
    (straight ahead, left, right, up, down, tilt right and tilt left), sensory testing for binocular vision
    suppression, cyclodeviation and retinal correspondence. An orthoptic assessment is eligible for
    payment in addition to an ophthalmology consultation or visit.
A230 Orthoptic assessment .............................................................       26.20
    Note:
    A230 is only eligible for payment when all tests described under orthoptic assessment are
    rendered personally and interpreted personally by the physician and results and measurements
    are documented in the patient’s permanent medical record.
     [Commentary:
     If a certified orthoptist is rendering the examination, G814 may be eligible for payment (page
     J94).]

Master, record 65. Record Layout PDF, page 1.

A11520260401999999990000053600000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.