Tariffs 2017 - Optimum

1 Tariffs 2017 . SERIES 1000 - PROFESSIONAL FEES Per Eye Indicates that the fee is "Per Eye". If performed on both eyes, charge 2 x Can charge in isolation Indicates that the procedure can be charged without Effective Date: 1st January 2017 Version: 2017_1_1. doing an Eye Examination (11001/11081). Legend used in CHANGE* Column: Additional to 11001/11081. Indicates that the procedure can be charged in addition to a regular Eye N = NEW X = DELETED Examination (11001/11081). OPTOMETRIC EXAMINATIONS. The purpose of the Optometric Examination is to determine the status of a patient's visual system or to refer to the appropriate health care professional where necessary. Code Change Description RVU Tariff 11001 1 Optometric Examination 11081 1 Optometric Examination and Visual Field Screening 11021 1 Optometric Re-Examination within six months of 11001/11081 Consultation (15 minutes) without performing an Optometric 11041 1 Examination . DIAGNOSTIC PROCEDURES. Diagnostic procedures are done and charged in addition to an Optometric Examination (11001 to 11041).

2 These are therefore additional procedures based on findings arising out of the Optometric Examination. 11303 1 Cycloplegic Refraction 11323 1 Preferential Looking (Infants < Two Years) 11346 1 Corneal Topography 11356 1 Gonioscopy 11366 1 Dilated Fundus Examination / BIO 11423 1 Visual Field - Evaluation 11443 1 Visual Field - Threshold Testing 11246 1 Colour Vision Evaluation 11265 1 Contrast Sensitivity Evaluation 11283 1 Lacrimal System Evaluation 11604 1 Photography of Anterior Segment 11624 1 Photography of Fundus 11644 1 Diagnostic and Photographic Materials N/A. 11702 1 Pachymetry 11802 1 Optical Coherence Tomography (OCT) 11902 1 Visual Evoked Potentials (VEP) - Unilateral 11904 1 Visual Evoked Potentials (VEP) - Bilateral PROCEDURES DONE IN ISOLATION. These are generally follow-up procedures or specific requests by patients or medical practitioners. The clinical rule that applies is that these codes may be listed as a professional fee in isolation but may not be charged in conjunction with Optometric Examinations.

3 Please note that the sum total charged for such procedures done in isolation may not be more than an Optometric Examination (11001). 11141 1 Refractive Status Evaluation 11161 1 Ocular Pathology Screening 11183 1 Keratometry 11202 1 Tonometry (Non-contact) 11212 1 Tonometry (Aplanation) 11221 1 Colour Vision Screening 11402 1 Visual Field - Screening DISPENSING FEE (per pair). 11501 1 Dispensing Fee - Single Vision 11521 1 Dispensing Fee - Bifocals 11541 1 Dispensing Fee - Varifocals SERVICES OUTSIDE OF REGULAR OFFICE HOURS. 11707 1 After Hours or Away from Practice Visit . 11729 1 Broken Appointments OPTOMETRIC SCREENING SERVICES. 11809 1 Screening School (per hour) 11829 1 Screening Industrial (per hour) Professional fees - Page 1 of 146. Tariffs 2017 . CONTACT LENS PROFESSIONAL FEES. PLEASE NOTE THAT THE COMPLETE CONTACT LENS FITTING FEE (Includes Dispensing & 6 months aftercare) HAS BEEN DISCONTINUED. Contact lens fees are now specified and coded per visit. The terms Basic; Complex and Advanced are defined by factors such as time; skill; degree of difficulty and case type: Basic Up to 4 visits may apply for an initial (first time) fit.

4 Myopia < Hyperopia < + Low Astigmatism. Complex Up to 6 visits may apply for an initial (first time) fit. Myopia > Hyperopia > + Extended Wear & Toric Lenses Advanced Up to 8 visits may apply for an initial (first time) Bifocal / multifocal; Bitoric; Haptic; Post PKP; Post Lasik; Post RK; Reverse Geometry / Orthokeratology and Keratoconus. Therapeutic Therapeutic Contact lens procedures are used for conditions where functional vision cannot be obtained with spectacle lenses CONTACT LENS PROCEDURES. Code Description RVU. 12012 1 C Lens Consultation Basic - per 30 minutes 12032 1 C Lens Consultation Complex - per 30 minutes 12052 1 C Lens Consultation Advanced - per 30 minutes 12062 1 C Lens Consultation - Therapeutic - per 30 minutes 12112 1 C Lens follow-up Examination/Basic Case - per 30 minutes 12132 1 C Lens follow-up Examination/Complex Case - per 30 minutes 12152 1 C Lens follow-up Examination/Advanced Case - per 30 minutes 12162 1 C Lens Follow-up Therapeutic - per 30 minutes 12503 1 C Lens Related Problems Assessment - Monocular 12523 1 C Lens Related Problems Assessment- Binocular 12533 1 C Lens Instruction 12072 1 C Lens Dispensing and/or Assessment Note: Code 12072 refers to OTC dispensing of contact lenses; either re-ordered or from other practices BINOCULAR VISION/ORTHOPTICS.

5 These evaluations are done in addition to an Optometric Examination. Special examination techniques apply to this area of expertise. The differentiating factor regarding Simple and Complex cases is by default: Complex cases have to do with Eccentric Fixation and / or Anomalous Retinal Correspondence. 13003 1 Binocular Instability Evaluation - Simple Case 13023 1 Binocular Instability Evaluation - Complex Case VISUALLY RELATED DISORDERS. 13105 1 Visually Related Learning Disorders Evaluation 13125 1 Eye Movements Evaluation ( Visigraph) COLORIMETRY CODES. 13509 1 Reading Rate- screening 13529 1 Reading Ortho-Didactical skills evaluation 13549 1 Colorimetry Intuitive - evaluation VISUAL THERAPY/ ORTHOPTICS TRAINING. 13403 1 Vision Training - Home Therapy Instruction 13423 1 Vision Training - Individual (per 15 minutes) 13445 1 Vision Training - Individual (per 30 minutes) 13463 1 Vision Training - Group per Patient (per 15 minutes) 13489 1 Vision Training - Away From Practice (add to 13423 or 13463) N/A.

6 LOW VISION. The Low Vision Assessment examination is performed in addition to a visual examination where patients present with visual acuity that is worse than 6/18 or visual fields that are severely restricted. The reason being that such a visual examination is performed with a different approach to the conventional visual examination (both psychologically and clinically). In addition to the low vision assessment further Procedures done in isolation are necessary in order to determine what device and training is required as treatment. RVU. LOW VISION ASSESSMENT& TRAINING (per half hour). 16013 1 Low Vision Assessment per 30 mins 16073 1 Low Vision Training per 30 mins SPORTS VISION. SPORTS VISION - IN OFFICES PROCEDURES. RVU. 14008 1 Sports Vision Individual Screening 14218 1 Sports Vision Individual Evaluation 14238 1 Sports Vision Individual Training (per 15 minutes) 14268 1 Sports Vision Group Screening 14278 1 Sports Vision Group Evaluation 14288 1 Sports Vision Group Training (per 15 minutes) SPORTS VISION - PROCEDURES DONE IN THE FIELD.

7 14309 1 Sports Vision Individual Screening 14319 1 Sports Vision Individual Evaluation 14329 1 Sports Vision Individual Training (per 15 minutes) 14369 1 Sports Vision Group Screening 14379 1 Sports Vision Group Evaluation 14389 1 Sports Vision Group Training (per 15 minutes) REPORTS etc 19001 1 Report at request of Medical Aid. 19021 1 Professional fees - Page 2 of 146. Report at Patient's request (arising from Series 11001) Tariffs 2017 . SERIES 2000 - CONTACT LENS MATERIALS. Effective Date: 1st January 2017 Version: 2017_1_1. N = NEW X = DELETE. Code Change Description Pack Tariff CONTACT LENS SOLUTIONS. 23907 Contact Lens Solutions 23919 Contact Lens Accessories Note that pricing of contact lenses is no longer specified by the various categories, rather as a global fee without specifying type of material or design of lens and is marked up from the manufacturer price accordingly. HARD CONTACT LENS CODES (per lens). 24022 Hard Contact Lens 24024 Rigid Scleral Contact lens ADDITIONAL HARD CONTACT LENS CODES (per lens).

8 25412 Fenestration Hard Lens (per hole). 25512 Truncation Hard Lens 24202 Bifocal Hard Lens 26012 Laboratory Service / Modification / Polish 26115 Analysis of Hard Lens CONVENTIONAL SOFT CONTACT LENSES. Contact Lens Laboratory of SA. 27146 Kerasoft IC 77% 1 Vial 27147 Kerasoft 2 49% 1 Vial 27365 BIO-Colours 38% Conventional Custom-Colours (Sphere) 1 Vial 27368 BIO-Colours 38% Conventional Custom-Colours (Toric) 1 Vial 27327 CLL HEMA (up to 60%) 1 Vial 27329 CLL HWC (higher than 60%) 1 Vial 27145 CLL Contaflex 38% Prosthetic 1 Vial 27150 CLL Soft Haptic 38% Prosthetic 1 Vial 27155 CLL Dark Brown Iris Black Pupil Prosthetic 1 Vial 27165 CLL Field Eyes (sports tint) 1 Vial 27170 CLL Enhancing Iris Tint 1 Vial 27175 CLL Hand Painted Theatricals 1 Vial 27180 CLL Photo-phobic 1 Vial 27185 CLL Albino Iris 1 Vial 27341 Soflex Soft K 67% (Hydrogel) - For Keratoconus 1 Vial 27353 Soflex Soft K 67% RG (Hydrogel) - For Keratoconus 1 Vial 27343 Soflex Soft K 67% Toric (Hydrogel) - For Keratoconus 1 Vial 27345 Soflex Eye Q Multifocal 1 Vial 27347 Soflex Toric Eye Q Multifocal 1 Vial 27349 Soflex CDGM3 Spheric 1 Vial 27355 Soflex CDGM3 Toric 1 Vial 27351 Soflex Toric Lite (TLITE 58%)

9 1 Vial 27357 Soflex Expo Aspheric 1 Vial CooperVision 27195 X Proclear Sphere 1 Vial Delete 27200 Proclear Sphere Rx 1 Vial 27210 Zero 6 1 Vial 27215 Zero 6 Rx 1 Vial 27230 Proclear TMT 1 Vial 27235 Z6 Rx Toric 1 Vial Contact lens Materials - Page 3 of 146. Tariffs 2017 . 27245 X Hydrasoft Toric 1 Vial Delete 27255 X Omniflex Toric 1 Vial Delete Danker Lenses 27358 Alden Novakone Sphere 1 Vial 27359 Alden Novakone Toric 1 Vial 27360 Alden HP Sphere 59 1 Vial 27361 Alden HP Toric 59 1 Vial 27363 Alden VERSA Lens 1 Vial 27370 Ultravision 1 Vial 27371 Soft Spherical 1 Vial 27372 Soft Toric 1 Vial Eurotech 27290 Soleko SL 38 Standard I Vial 27295 Soleko SL 38 Color I Vial Hin Contact Lens Laboratory 27366 Biogel 60 percent I Vial 27367 Biogel 72 percent I Vial Lenscape 27265 Hydrowave Spher/Toric 1 Vial 27270 Kerasoft 2 1 Vial 27275 Kerasoft IC (KIC) 1 Vial 27280 Kerasoft 3 1 Vial Maxvue Vision 29018 HYDROSOFT Toric - Yearly 1 Vial COMBINATION HARD/SOFT (HYBRID) CONTACT LENSES. Danker Lenses 27800 Synergeyes A 1 Vial 27802 Synergeyes KC 1 Vial 27804 Synergeyes PS 1 Vial 27806 Synergeyes CK 1 Vial 27808 Duette 1 Vial 27810 Duette Multifocal 1 Vial 27812 Ultra Health - Kerataconus 1 Vial ADDITIONAL SOFT CONTACT LENS CODES (per lens).

10 28019 Cosmetic Tint 28115 Intensive Cleaning of Lens 28219 Analysis of Soft Lens SABLE/FREQUENT REPLACEMENT CONTACT LENS CODES. PRESCRIPTION (Per Multipack). Alcon 28470 AIR OPTIX AQUA 6 Pack TM. 28890 AIR OPTIX NIGHT & DAY AQUA 3 Pack TM. 28892 AIR OPTIX NIGHT & DAY AQUA 6 Pack . 28480 AIR OPTIX for ASTIGMATISM 6 Pack 28834 AIR OPTIX COLORS 2 Pack 28485 AIR OPTIX AQUA Multifocal 6 Pack 28490 DAILIES . AquaComfort Plus (Sphere) 30 Pack 28495 DAILIES . AquaComfort Plus (Sphere) 90 Pack 28952 DAILIES AquaComfort Plus TORIC 30 Pack 28954 DAILIES AquaComfort Plus MULTIFOCAL 30 Pack 28956 DAILIES TOTAL 1 30 Pack Contact lens Materials - Page 4 of 146. Tariffs 2017 . 28958 DAILIES TOTAL 1 90 Pack 28510 Freshlook One-Day 10 Pack 28894 Freshlook Illuminate 10 Pack 28520 Freshlook Colors 2 Pack 28525 Freshlook ColorBlends 2 Pack 28530 Freshlook Dimensions 2 Pack 28896 Freshlook Dimensions 6 Pack Bausch & Lomb 28400 SofLens 59 6 Pack 28405 Soflens 38 6 Pack 28410 Soflens Toric 6 Pack 28415 Soflens Natural Colours 2 Pack 28420 Soflens Multi-Focal 6 Pack 28425 PureVision 6 Pack 28465 PureVision 2HD 6 Pack 28467 PureVision 2HD for Astigmatism 6 Pack 28468 PureVision 2 For Presbyopia 6 Pack 28430 PureVision Toric 6 Pack 28435 PureVision Multi-Focal 6 Pack 28445 Soflens Daily Disposable 30 Pack 28450 Soflens Daily Disposable 90 Pack 28460 Soflens Daily Disposable for astigmatism 30 Pack 28557 Biotrue ONEday 30 Pack 28559 Biotrue ONEday 90 Pack 28564 Biotrue ONEday For Presbyopia 30 Pack 28633 Ultra 6 Pack Contact Lens Laboratory of SA.