Here is the latest from OHIP to us. Please feel free to reach out to us to book your eye exams or for more clarification in your case.
Ontario Health Insurance Plan INFOBulletin Implementing the New Optometry Services Agreement Changes to OHIP-insured services for the period of April 1, 2021 to March 31, 2025 To: Optometrists Category: Optometrist Services Written by: Provider Services Branch, Physician and Provider Services Division and Claims Services Branch, Health Programs and Delivery Division Date issued: March 30, 2023 Bulletin Number: 230311 The Ministry of Health (ministry) has been working with the Ontario Association of Optometrists (OAO) to implement the new Optometry Services Agreement (Agreement) for the period of April 1, 2021 to March 31, 2025. Background The Ministry of Health (ministry) and the Ontario Association of Optometrists (OAO) reached early consensus to implement some changes to optometry services under the Ontario Health Insurance Plan (OHIP) prior to finalizing the new Optometry Services Agreement:
In order to implement the remaining elements of the Agreement, amendments have been made to the Schedule of Benefits for Optometry Services as described below. Fee Schedule Code increases effective April 1, 2023 Starting April 1, 2023, the following Fee Schedule Codes will have their fee rates increased in the Fee Schedule Master (FSM): Fee Schedule CodeDescriptionNew FeeV404Periodic oculo-visual assessment for patients age 19 years or less$51.00V406Periodic oculo-visual assessment for patients age 65 years or older$80.00V409Major eye examination for patients age 20 to 64 years$55.00V450Periodic oculo-visual assessment-Ontario Disability Support Program$48.00V451Periodic oculo-visual assessment-Ontario Works$48.00Please ensure that your billing software is updated to reflect the new Fee Schedule Code values for any services submitted on or after April 1, 2023. The updated Fee Schedule Master can be found on the Ministry of Health website. The Schedule has been updated to reflect the new fees. The Schedule of Benefits for Optometry Services can also be found on the Ministry of Health website. Overview of specific Schedule changes effective September 1, 2023 Please Note: Additional information regarding implementation of these changes will be communicated closer to the effective date. This bulletin outlines the changes to the Schedule of Benefits for Optometry Services that involve the creation of new fee codes, and revised fee codes/descriptions. The online version of the Schedule of Benefits for Optometry Services reflects changes that take effect on September 1, 2023 to facilitate the transition to the changes to coverage. The following changes are not applicable to optometry services rendered prior to September 1, 2023. Optometrists should continue to follow existing payment rules for any services rendered before September 1, 2023. New Complexity Modifiers Three new codes have been added to the Schedule effective September 1, 2023:
Revised Fee Codes / Descriptions The Ministry of Health (ministry) and the Ontario Association of Optometrists (OAO) formed the Optometry Appropriateness Modernization Working Group (OAMWG) to use evidence, best practices or expert opinion to identify and update payment for the delivery of OHIP insured optometry services to help ensure the most effective care for Ontario patients. Revisions to descriptions and/or payment requirements have been made to the following services effective September 1, 2023. Major Oculo-Visual Examination for patients aged 20 to 64 years
Automated Visual Fields Assessment Revisions to the Automated Visual Fields Assessment (V410) have been added. The service is insured when clinically necessary to determine the extent and sensitivity of a patient’s visual fields for patients with the following conditions:
Clarification changes The Schedule of Benefits for Optometry Services has been amended to clarify that the following services are not common or elements of an insured major oculo-visual examination or a minor assessment:
These clarification changes will be reflected in Schedule of Benefits for Optometry Services effective September 1, 2023. However, they are currently not part of, and have never been considered part of, a routine eye exam insured under OHIP. Keywords/Tags Optometry Services Agreement; optometrists; payments; changes to OHIP-insured optometry coverage Contact information Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.
For More Information Call ServiceOntario, INFOline at: 1–866–532–3161 (Toll–free) In Toronto, (416) 314–5518 TTY 1–800–387–5559. In Toronto, TTY (416)327–4282 Hours of operation: Monday to Friday, 8:30 a.m. – 5:00 p.m.
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