Health Insurance (Section 3C General Medical Services - Optometric Services) Determination 2020made under theHealth Insurance Act 1973Compilation No. 10Compilation date: 1 July 2026Includes amendments: F2026L00523About this compilationThis compilationThis is a compilation of the Health Insurance (Section 3C General Medical Services - Optometric Services) Determination 2020 that shows the text of the law as amended and in force on 1 July 2026 (the compilation date).The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.Uncommenced amendmentsThe effect of uncommenced amendments is not shown in the text of the compiled law. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au).Application, saving and transitional provisionsIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.Editorial changesFor more information about any editorial changes made in this compilation, see the endnotes.Presentational changesThe Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.ModificationsIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. Any modifications affecting the law are accessible on the Register.Self-repealing provisionsIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.Contents1. Name3. Authority5. Definitions6. Treatment of relevant services7. Application of item 109298. Application of item 109319. Application of items 10938, 10939, 10940 and 1094111. Limitation on items12. Limitation on item 1094414. Application of items 10945 and 1094615. Professional attendance items and services provided with non-medicare services16. IndexationSchedule – Relevant servicesEndnotesEndnote 1—About the endnotesEndnote 2—Abbreviation keyEndnote 3—Legislation historyEndnote 4—Amendment history1. NameThis instrument is the Health Insurance (Section 3C General Medical Services - Optometric Services) Determination 2020.3. AuthorityThis instrument is made under the Health Insurance Act 1973.5. Definitions(1) In this instrument:Act means the Health Insurance Act 1973.bulk-billed for a relevant service, means:(a) a medicare benefit is payable to a person in relation to the service; and(b) under an agreement entered into under section 20A of the Act:(i) the person assigns, to the person by whom the service is provided, his or her right to the payment of the medicare benefit; and(ii) the second-mentioned person accepts the assignment in full payment of his or her fee for the service provided.old item 10900 means item 10900 of the general medical services table as in force at any time before the repeal of the item by Part 1 of Schedule 1 to the Health Insurance Legislation Amendment (Optometric Services and Other Measures) Regulation 2014.relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act, relating to medical services, professional services or items.relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.residential aged care facility has the same meaning given by the Health Insurance (General Medical Services Table) Regulations 2021.Schedule means the Schedule to this instrument.telehealth eligible area has the same meaning as in the general medical services table.Note: The following terms are defined in subsection 3(1) of the Act: clinically relevant general medical services table optometrist(2) In this instrument, Group A10 refers to the group of all the relevant services specified in items the Schedule, Subgroup 1 of Group A10 refers to the group of relevant services specified in items 10905 to 10944 of the Schedule and Subgroup 2 of Group A10 refers to the group of relevant services specified in items 10945 to 10948 of the Schedule.(3) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.6. Treatment of relevant servicesFor subsection 3C(1) of the Act:(a) a relevant service, other than the service described in item 10944, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:(i) it were both a professional service and a medical service; and(ii) there were an item in the general medical services table that:(A) related to the service; and(B) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.(b) the relevant service described in item 10944, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions of the Act other than subsection 3(5), as if:(i) it were both a professional service and a medical service; and(ii) there were an item in the general medical services table that:(A) related to the service; and(B) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.7. Application of item 10929Item 10929 does not apply to a service if the patient’s requirement for contact lenses is only for any of the following reasons:(a) because the patient does not want to wear spectacles for reasons of appearance;(b) because the patient wants contact lenses for work or sporting purposes;(c) because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.8. Application of item 10931If item 10931 applies to a service, the fee mentioned in the item applies in addition to the fee mentioned in another item in Subgroup 1 of Group A10 that applies to the service.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.11. Limitation on items(3) Items 10921 to 10929 may only apply to a service in respect of a particular patient once in a 36 month period.12. Limitation on item 10944Item 10944 does not apply to a service on the same occasion as a service mentioned in any of items 10905, 10907, 10910, 10911, 10913, 10914, 10915, 10916 and 10918.14. Application of items 10945 and 10946Items 10945 and 10946 only apply to a service if the video conferencing consultation in which the patient is participating is a service for which there is an item in the general medical services table, or treated as being in the table because of subsection 3C(1) of the Act.15. Professional attendance items and services provided with non-medicare services(1) Clause 1.2.5 of the general medical services table has effect as if items 10905 to 10929 were also specified in subclause 1.2.5(1).(2) Clauses 1.2.8 and 1.2.9 of the general medical services table have effect as if items 10905 to 10948 were also specified in those clauses.16. Indexation(1) At the start of 1 July 2026 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:Note: The indexed fees could in 2026 be viewed on the Department of Health, Disability and Ageing’s MBS Online website (www.mbsonline.gov.au).(2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.(3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).Schedule – Relevant servicesGroup A10 – Optometric services provided by optometristColumn 1ItemColumn 2ServiceColumn 3Fee ($)Subgroup 1 – General10905 | Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has been referred by another optometrist who is not associated with the optometrist to whom the patient is referred | 69.4510907Professional attendance of more than 15 minutes in duration, being the first in a course of attention if the patient has attended another optometrist for an attendance to which this item or item 10905, 10910, 10911, 10913, 10914 or 10915 applies:(a) for a patient who is less than 65 years of age—within the previous 36 months; or(b) for a patient who is at least 65 years of age—within the previous 12 months34.8010910Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if:(a) the patient is less than 65 years of age; and(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 applies69.4510911Professional attendance of more than 15 minutes in duration,being the first in a course of attention, if:(a) the patient is at least 65 years of age; and(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 applies69.4510913Professional 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 applies69.4510914Professional 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 applies69.4510915 | Professional attendance of more than 15 minutes in duration, being the first in a course of attention involving the examination of the eyes, with the instillation of a mydriatic, of a patient with diabetes mellitus, requiring comprehensive reassessment | 69.4510916 | Professional attendance, being the first in a course of attention, of not more than 15 minutes in duration (other than a service associated with a service to which item 10938, 10939, 10940, 10941, 10942 or 10943 applies) | 34.8010918 | Professional attendance, being the second or subsequent in a course of attention and being unrelated to the prescription and fitting of contact lenses (other than a service associated with a service to which item 10938, 10939, 10940 or 10941 applies) | 34.8010921All 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 appliesFor 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 months172.5510924All 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 appliesApplicable once in a period of 36 months217.7010926All 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 appliesApplicable once in a period of 36 months172.5510927All 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 appliesApplicable once in a period of 36 months217.7010928All 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 appliesApplicable once in a period of 36 months172.5510929All 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 months217.7010930 | All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of contact lenses if the patient meets the requirements of an item in the series 10921 to 10929 and requires a change in contact lens material or basic lens parameters, other than a simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens covered by items 10921 to 10929 | 172.5510931A 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 serviceApplicable once per occasion a service is provided under paragraph (a) for each distinct location43.7510938Full 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 monthsother than a service associated with a service to which item 10916 or 10918 appliesApplicable once per patient (including any service to which item 10939 applies) in a 12-month period72.5510939Full 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 monthsother than a service associated with a service to which item 10916 or 10918 appliesApplicable once per patient (including any service to which item 10938 applies) in a 12-month period43.8010940Full 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 periodother than a service associated with a service to which item 10916 or 10918 applies66.3010941Full 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 periodother than a service associated with a service to which item 10916 or 10918 applies40.0010942Testing 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 appliesApplicable twice per patient in a 12-month period34.8010943Additional 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:(a) includes assessment of one or more of the following:(i) accommodation;(ii) ocular motility;(iii) vergences;(iv) fusional reserves;(v) cycloplegic refraction; and(b) 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 appliesApplicable once per patient in a 12-month period34.8010944Complete 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 removalOther than a service associated with a service to which items 10905, 10907, 10910, 10911, 10913, 10914, 10915, 10916 or 10918 applies75.05Subgroup 2 – Telehealth attendance10945A professional attendance of less than 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and(b) is not an admitted patient34.8010946A professional attendance of at least 15 minutes (whether or not continuous) by an optometrist providing clinical support to a patient who:(a) is participating in a video conferencing consultation with a specialist practising in the speciality of ophthalmology; and(b) is not an admitted patient69.45