The TAC Medical Excess may apply to these services
The TAC can fund the reasonable cost of optometry services for a client who has sustained an injury as a result of a transport accident. The service must be performed by an optometrist registered with the Optometry Board of Australia.
Transport Accident Act 1986 reference: s.3 'medical service' and s.60
What optometry services will the TAC consider funding?
The TAC will consider funding the reasonable cost of optometry services to:
- conduct an eye examination and an assessment of a client's vision
- prescribe spectacle glasses or contact lenses
- conduct computerised perimetry.
Fees for optometry services will be paid in accordance with the TAC optometry fee schedule.
What information does the TAC require in order to consider funding optometry services?
To consider funding optometry services the TAC requires a written request from a medical practitioner outlining a clinical need for this service and the way in which it relates to the client's transport accident injuries.
Who can provide optometry services?
Optometry services can only be provided by a registered optometrist.
What billing information does the TAC require from a provider in order to fund optometry services?
The TAC requires that the actual provider of the service be identified on each account for payment. It is the responsibility of the provider to ensure accounts submitted to the TAC are correct, regardless of who has completed the account.
What about funding spectacle glasses and contact lenses?
The TAC has a separate policy for spectacle glasses and contact lenses. Refer to Equipment policy.
What about funding orthoptist services?
The TAC has a separate policy for orthoptist services.
Can the TAC fund optometry services performed by a member of a client's immediate family?
What will the TAC not fund?
The TAC will not fund:
- treatment or services for a person other than the injured client
- treatment or services provided by an optician as the cost of these services is included in the cost of spectacle glasses and contact lenses
- treatment, services or equipment where there is no published evidence in a recent peer-reviewed journal article that the treatment, service or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services policy
- treatment or services where there is no clinical justification
- treatment or services for a condition that existed before the transport accident or that is not a direct result of a transport accident injury
- fees associated with non-attendance or telephone consultations
- treatment or services subcontracted to a non-registered provider
- treatment or services provided outside the Commonwealth of Australia
- treatment or services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit for the Application for Payment of Medical and Like Expenses policy.
Effective 1 July 2017
|Service Description||TAC Item Number||2017/18 Maximum Payment Rate||2016/17 Maximum Payment Rate|
|Comprehensive Initial Consultation||10910||$78.09||$76.76|
|Referred Comprehensive Initial Consultation||10905||$78.09||$76.76|
|Comprehensive initial consultation by another practitioner within 24 months of a previous comprehensive consultation.||10907||$39.09||$38.43|
|Other comprehensive consultations||10912||$78.09||$76.76|
|Professional attendance of more than 15 minutes duration, where patient has new signs or symptoms, unrelated to earlier course of attention, requiring comprehensive reassessment within 24 months of initial consultation.||10913||$78.09||$76.76|
|Professional attendance of more than 15 minutes duration being the first in a course of attention where the patient has a progressive disorder (excluding presbyopia) requiring comprehensive reassessment within 24 months of initial consultation.||10914||$78.09||$76.76|
|Professional attendance of more than 15 minutes 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.||10915||$78.09||$76.76|
|Brief initial consultation||10916||$39.09||$38.43|
|Contact lenses for specified classes of patients: patients with myopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye.||10921||$193.72||$190.43|
|Contact lenses for specified classes of patients: patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye.||10922||$193.72||$190.43|
|Contact lenses for specified classes of patients: patients with astigmatism of 3.0 manifest hyperopia of 3.0 dioptres or greater in 1 eye.||10923||$193.72||$190.43|
|Contact lenses for specified classes of patients: patients with irregular astigmatism in either eye.||10924||$244.49||$240.33|
|Contact lenses for specified classes of patients: patients with anisometropia of 3.0 dioptres or greater.||10925||$193.72||$190.43|
|Contact lenses for specified classes of patients: patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes.||10926||$193.72||$190.43|
|Contact lenses for specified classes of patients: patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by: pathological mydriasis; aniridia; coloboma of the iris; or pupillary malformation or distortion; or significant ocular deformity or corneal opacity.||10927||$244.49||$240.33|
|Contact lenses for specified classes of patients by reason of physical deformity cannot wear glasses.||10928||$193.72||$190.43|
|Contact lenses for specified classes of patients who have medical or optical condition.||10929||$244.49||$240.33|
|Professional attendance involving the prescription & fitting of contact lenses.||10930||$193.72||$190.43|
|Low Vision Assessment||10942||$39.09||$38.43|
|Children's Vision Assessment||10943||$39.09||$38.43|