Health Service Code 09.13E
Optical coherence tomography (OCT), for the diagnosis and management of ocular pathology, interpretation
NOTE:
May not be claimed for routine examinations or routine screening.
| Category: | T Test |
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| Base rate: | $26.35 |
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Fee modifiers:
No modifiers.
Governing Rules:
2.5.2
Unless otherwise specified in this Schedule, HSCs designated with a T category code may be claimed with visits and consultations on the same day.
4.4.8 CLAIMS REQUIRING REFERRING PRACTITIONER NUMBER
When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.
HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.
HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.
6.5 NON-INVASIVE DIAGNOSTIC PROCEDURES IN HOSPITAL, AACC OR UCC
Benefits for non-invasive diagnostic procedures including HSCs in Section E (Laboratory and Pathology) and X (Diagnostic Radiology) performed for a hospital inpatient, registered outpatient or AACC or UCC patient are not payable under the Schedule. Payment for these services is the responsibility of the hospital/Regional Health Authority. This applies to both the technical and professional components. Such procedures include but are not limited to the following list.
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
- 09.13I Yearly bilateral biometry for myopic progression in children under
- 18 years of age, technical
- 09.13J Yearly bilateral biometry for myopic progression in children under
- 18 years of age, interpretation
- 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
9.1.3
Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.02A, 03.03A, 03.03AZ, 03.07A, 03.07AZ, and 03.07B:
- 03.12A Intraocular pressure measurement
- 09.01A Biomicroscopy (slit lamp examination)
- 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
- 09.13I Yearly bilateral biometry for myopic progression in children under
- 18 years of age, technical
- 09.13J Yearly bilateral biometry for myopic progression in children under
- 18 years of age, interpretation
- 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
9.1.4
When done independently on a separate day or as a repeat, not more than three interpretations and three technical services from the list in GR 9.1.3 may be claimed.
