These guidelines should be read in conjunction with our General provider guidelines.
Who can provide orthoptic services?
You can provide services if you are eligible for registration with the Australian Orthoptic Board.
What we can pay for
We can pay the reasonable costs of orthoptic services when they are required as a result of a transport accident injury. We can pay for:
- Orthoptic consultations.
- Services that are part of a rehabilitation program.
- Provision of basic equipment. Our approval is required for specialised equipment. Please read our Medical and rehabilitation equipment guidelines and use the Equipment Prescription Form to submit written requests.
We will review our client’s services to ensure they're reasonable, clinically justified, outcome focused and in line with the Clinical Framework. We'll ask you and our client for information during these reviews and may temporarily stop funding treatment if we don’t receive it.
Reviews help us understand our client’s injuries, treatment needs and goals and how to best support them to get their life back on track. After a review we’ll let you and our client know the decision regarding further treatment.
Other things to note
For accidents that occurred prior to 14 February 2018 a medical excess may apply. Visit the medical excess page to see if it applies to your patient. If the medical excess applies you will need to invoice the client directly.
Gap in treatment
If our client has not received treatment in 6 months they will need to seek approval from us before we will pay for further treatment. Ask our client for a copy of their approval if you haven’t seen them in 6 months.
How much we can pay
We can pay for services in line with our Orthoptic services fees.
Fees for orthoptic services performed within a public hospital will be based on DHHS Schedule of Fees and Charges for acute health services in Victoria.
What we cannot pay for
We cannot pay for the cost of travel for an orthoptist, as this cost is covered in the out of rooms fee rates.