Governing Rules:

• 6.6.2

  If a procedure designated "+" is performed in a physician's office, both the procedural benefit and the appropriate office visit benefit for that day may be claimed, but if a consultation benefit pursuant to GR 6.6.4 has been claimed, a visit benefit will not be payable for the day on which the procedure is performed.

• 6.6.3

  If a procedure designated "+" is performed in a place other than a physician's office, either a procedural benefit or a visit benefit, but not both, may be claimed for that day.

• 6.6.4

  If a procedure designated "+" and a consultation are provided on the same day, both the procedural benefit and the appropriate consultation benefit are payable.

• 6.7.1

  If a minor procedure (M or M+) is provided with a hospital visit on the same day, only the greater benefit HSC may be claimed.

• 6.9.8

  Unless otherwise stated in the schedule, if a surgical procedure and related diagnostic procedure are performed by the same physician, utilizing the same anesthetic, only the greater benefit may be claimed.

• 9.1.1

  The following examinations are included in the complete examination (03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08H, 09.04) and may not be claimed in addition:

  • Measurement of vision
  • Refractive error
  • Extra-ocular muscle balance
  • 03.12A Intra-ocular pressure measurement
  • 09.01A Biomicroscopy (slit lamp examination)
  • Retinal examination
• 9.1.2

  Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08H and 09.04:

  • 09.01B Gonioscopy
  • 09.01C Orthoptic analysis, interpretation
  • 09.01E Orthoptic analysis, technical (may include Hess screen)
  • 09.02B Anterior chamber depth measurement
  • 09.02E Amblyopia evaluation for patients nine years of age or younger
  • 09.05A Full threshold perimetric examination, technical
  • 09.05B Full threshold perimetric examination, interpretation
  • 09.06A Color vision test, interpretation and technical
  • 09.11A Bilateral specular microscopy for corneal graft patients only - technical
  • 09.11B Bilateral specular microscopy for corneal graft patients only - interpretation
  • 09.11C Potential acuity measurement (PAM)
  • 09.12A Intravenous fluorescein angiography (IVFA), interpretation
  • 09.12B Intravenous fluorescein angiography (IVFA), technical

  09.13E Optical coherence tomography (OCT), interpretation 09.13F Optical coherence tomography (OCT), technical 09.26A Diurnal tension curve 09.26D Bilateral corneal pachymetry 21.31A Diagnostic irrigation of nasolacrimal duct, office procedure, per eye 24.89B Diagnostic conjunctival scraping 25.81A Diagnostic corneal scraping