The optometry services can qualify as MSP beenfit if the optometrist is

• licensed by the College of Optometrists of British Columbia (COBC) and
• enrolled with MSP.

MSP Enrolment status is contingent upon the practitioner’s continued licensure by the College of Optometrists of British Columbia.

Optometrists enrolled with MSP can opt out of MSP Fee Schedule and charge their patients more. Opted-out optometrists must advise their patients prior to the treatment being performed:

• that they have opted out
• how much is reimbursed by MSP and
• how much the patient will be paying in addition to the MSP fee.

Opted Out optometrists should charge the fee difference directly to the patients or to their extended insurance plans, if applicable. They cannot bill MSP for amounts that differ from the MSP Fee Schedule.

Non-enrolled optometrists are not allowed to bill MSP. They should bill their services directly to patients or their extended insurance plans. Non-enrolled optometrists must advise their patients that their services are not MSP benefits.

Not enrolling with MSP is different from being opted out of MSP. Opted Out optometrists can bill the amount set up in the MSP Fee Schedule to MSP for eligible patients. Non-enrolled optometrists cannot bill MSP at at all.

MSP covers the following optometry services

• medically required eye examinations for all MSP beneficiaries when there is a medical necessity (for example, eye disease, trauma or injury, or health conditions associated with significant risk to the eyes, such as diabetes),
• eye examination for routine refractive services for patients under 19 and over 64 years old.

MSP does not provide coverage for the following:

• routine eye examinations for beneficiaries between the ages of 19 and 64;
• medical examinations, certificates or tests required for life insurance, a driver’s licence, school, immigration, employment, etc.

Optometrists shall not bill MSP for those services. They should bill their patients directly.

• 02899: $46.17 – Full optometric diagnostic examination of the eyes (includes the determination of the refractive index of the eye, the presence of any abnormality in the visual system, and all necessary tests connected thereto and the provision of a written prescription, if lenses are required)
• 02889: $46.17 – Full optometric diagnostic examination of the eyes with TPA (includes the determination of the refractive index of the eye, the presence of any abnormality in the visual system, and all necessary tests connected thereto and the provision of a written prescription, if lenses are required)
• 02898: $29.35 – Re-examination or minor examination
• 02888: $29.35 – Re-examination or minor examination with TPA
• 02897: $10.40 – Repeat Tonometry

• 02892: $40.33 – Examination for low vision aid
• 02893: $31.78 – Computer assisted quantitative visual fields
• 02894: $213.95 – Unilateral
• 02895: $322.72 – Bilateral

Notes:

1. Fee item 02892 billable only by optometrist having appropriate equipment.
2. Fee item 02893 billable only by optometrists having the appropriate computerized equipment for quantitative perimetry examinations. Claim must specify reason for visual fields examination.
3. Fee items 02894 and 02895 are applicable only to patients with keratoconus who are unable to achieve 20/40 visual acuity with conventional glasses and the fees include all visits and services necessary for fitting and follow-up for three months.
4. Fee item 02899 not billable in addition to 02892 when patient referred for low vision assessment.

Claim Manager offers built-in, searchable, automatically updated catalogs of MSP billing codes for optometrists. If the optometrist charges more than permitted by the MSP Fee Schedule, the balance is carried over and billed to the extended insurance plan and/or the patient.

Effective June 1, 2006, the Office of the Superintendent of Motor Vehicles (OSMV) will pay for certain driver fitness assessments including Driver Medical Examination forms required for people with medical conditions.

VFT and EVF – 96223

• 96223: $102.00 – OSMV-Visual Field Test (VFT) and Examination of Visual Functions (EVF) conducted by an optometrist as part of the same examination/at the same time.

Notes:

1. Fee items 96224 or 96225 are not billable in addition.
2. Only optometrists registered and approved for visual fields testing with MSP may bill this fee code.
3. This fee may only be claimed when specifically requested by the Superintendent of Motor Vehicles.
4. Patient birth date is required on the claims submission.
5. Patient driver’s licence number is required on the claim submission.(Driver’s licence number must be entered in the first 7 spaces of the note or comment field).
6. MSP fee items 02899, 02898, 02897, and 02893 are not billable in addition.
7. Repeat VFT/EVF is not payable to any practitioner within 3 months.

EVF  – 96224

• 96224: 70.00 –  OSMV Examination of Visual Function (EVF) conducted by an optometrist (does not include visual fields).

Notes:

1. Not billable with fee items 96223 or 96225.
2. This fee may only be claimed when specifically requested by the Superintendent of Motor Vehicles.
3. Patient birth date is required on the claims submission.
4. Patient driver’s licence number is required on the claim submission. (Driver’s licence number must be entered in the first 7 spaces of the note or comment field).
5. MSP fee items 02899, 02898, and 02897are not billable in addition.
6. Repeat VFT/EVF is not payable to any practitioner within 3 months.

VFT – 96225

• 96225: $42.00 –  OSMV Visual Field Test (VFT) conducted by an optometrist as a stand-alone test $42.00.

Notes:

1. Not billable with fee item 96223 or 96224.
2. Only optometrists registered and approved for visual fields testing with MSP may bill for this fee code.
3. This fee may only be claimed when specifically requested by the Superintendent of Motor Vehicles.
4. Patient birth date is required on the claims submission.
5. Patient driver’s licence number is required on the claims submission. (Driver’s licence number must be entered in the first 7 spaces of the note or comment field).
6. MSP fee item 02893 is not billable in addition.
7. Repeat VFT/EVF is not payable to any practitioner within 3 months.

• HJ – A claim for one of these fee items has been paid to another practitioner on the same date of service.  – For fee items: 96223, 96224, 96225
• MW – There is a paid claim for 96224 or 96225 on the same date of service by the same practitioner. This OSMV form fee is not payable on the same date of service as another OSMV form fee you have billed. – For fee item: 96223.
• MW – There is a paid claim for 96223 or 96225 on the same date of service by the same practitioner. This OSMV form fee is not payable on the same date of service as another OSMV form fee you have billed. – For fee item: 96224
• MW – There is a paid claim for 96223 or 96224 on the same date of service by the same practitioner. This OSMV form fee is not payable on the same date of service as another OSMV form fee you have billed. – For fee item: 96225
• MY – There is a paid claim within 3 months prior for the same fee item by any practitioner. A repeat OSMV form fee is not payable to any practitioner within 3 months. – For fee item: 96223, 96224, 96225
• FV – There is a paid claim on the same date of service by the same practitioner or payee for fee items 02899, 02898 or 02897. – For fee items: 96223, 96224.
• FV – There is a paid claim on the same date of service by the same practitioner or payee for fee item 02893. – For fee items: 96223, 96225
• MX – The driver’s licence number is not numeric, is partially numeric, is missing or is not located in the first 7 spaces in the note or comment field. – For fee items: 96223, 96224, 96225
• MZ – The OSMV form fee was billed under the wrong insurer code – i.e. WCB or ICBC. Insurer is invalid for this service. – For fee items: 96223, 96224, 96225
• HA – A duplicate claim has been billed. This claim has been paid to you.- For fee items: 96223, 96224, 96225
• FG –  Patient age is less than 16 years old. Age of patient does not correspond with fee item billed. – For fee items: 96223, 96224, 96225
• CQ –  Wrong specialty for the fee item billed. Practitioner is not licensed to bill for this service. – For fee items: 96223, 96224, 96225
• WF – Practitioner not authorized to bill a visual fields test. Fee item billed and doctor’s specialty/practitioner number do not correspond. – For fee items: 96223, 96224, 96225.

If you have questions about the OSMV forms, please contact RoadSafetyBC:

RoadSafetyBC
PO Box 9254, Stn Prov Govt
Victoria, B.C.
V8W 9J2

Victoria: (250) 387-7747
Elsewhere in B.C.: 1-855-387-7747
Fax: (250) 387-4891
Email: osmv.mailbox@gov.bc.ca

MSP Enrollment for the Patients

Under the Medical Protection Act, eligible residents of B.C. must enrol themselves and their dependents with Medical Services Plan (MSP). If your patients have questions about MSP enrollment eligibility, please refer them to the MSP eligibility and enrollment web page.

BC Services Card

MSP enrollment is confirmed by issuing an applicant the BC Services Card (former BC CareCard). Being presented with the healthcare card is not enough to verify patient’s MSP enrollment because the card might expire prematurely. To verify the patient’s MSP eligibility on the date of service, practitioners need to make an eligibility inquiry to MSP.

MSP beneficiaries are eligible for routine refractive services under MSP if they are

• 18 years old and younger
• 65 years old and older

MSP beneficiaries in between those age groups are eligible for eye examinations only if it is medically required. The claim for medically required eye exam must contain a diagnostic code from the list of approved MSP ICD9 codes.

MSP Eligibility report  offers three important pieces of information for optometrists. It shows

• if the patient “Is Eligible for Medical Coverage Under MSP” on the date of service,
• the patient’s age,
• date of the last eye exam.

These report in combination with the patient’s diagnosis allows the optometrist to determine if the patient is eligible for MSP benefits.

There are four ways to check MSP eligibility of the patient.

1. Request an instant MSP eligibility report in Claim Manager.
2. Call the automated Practitioner Information Line:
   • Victoria: (250) 952-3102 or (250) 383-1226
   • Vancouver: (604) 669-6667
   • Toll-free: 1 800 742-6165
3. Use MSP Web Access.
4. Fax a request on a coverage research form if the PHN is unknown:
   • fax: (250) 952-3101.

Notes:

1. The services are listed in an order of convenience.
2. The patient’s personal health number (PHN) must be provided for steps 1, 2 and 3.
3. MSP Teleplan registration is required for steps 1 and 3.
4. Practitioner Information Line is an automated service that handles coverage inquiries using an interactive voice response (IVR) system.

Claim Manager conducts real time MSP coverage check on any date of service within the last six months. It shows the complete MSP coverage report.

Eye examinations billed with the following diagnostic codes are payable once every 24 months:

• 360 – Disorders of the globe
• 363 – Chorioretinal inflammations, scars and other disorders of choroid
• 368 – Visual disturbances
• 369 – Blindness and low vision
• 375 – Disorders of lacrimal system
• 379 – Other disorders of eye
• 4019 – Hypertensive disease not specified as malignant or benign
• 05440 – Herpes simplex – ophthalmic (acute onset)
• 05320 – Herpes zoster – ophthalmic (acute onset)
• 94010 – Burns of eyelids and periocular area
• 92190 – Unspecified contusion of eye
• 9182 – Superficial injury – conjunctiva
• 9301 – Foreign body in conjunctival sac
• 9181 – Superficial injury – cornea
• 9300 – Corneal foreign body
• 8026 – Fracture – orbital floor (blow out), closed
• 9502 – Injury to optic pathways
• 9503 – Injury to visual cortex
• 99520 – Unspecified adverse effect of drug, medicament and biological (allergic reaction to medication)

Include a note requiring medical necessity for claims submitted with exceptional frequencies.

Eye examinations billed with the following diagnostic codes are payable once every 12 months:

• 361 – Retinal detachments and defects
• 362 – Other retinal disorders
• 364 – Disorders of iris and ciliary body
• 365 – Glaucoma
• 366 – Cataract
• 370 – Keratitis
• 371 – Corneal opacity and other disorders of cornea
• 372 – Disorders of conjunctiva
• 373 – Inflammation of eyelids
• 374 – Other disorders of eyelids
• 376 – Disorders of the orbit
• 377 – Disorders of optic nerve and visual pathways
• 378 – Strabismus and other disorders of binocular eye movements
• 27910 – Deficiency of cell mediated immunity (AIDS (HIV))
• 7200 – Ankylosing Spondylitis
• 43600 – Cerebrovascular disease – acute but ill defined
• 17400 – Malignant neoplasm of breast
• 16200 – Malignant neoplasm of trachea, bronchus and lung
• 34000 – Multiple sclerosis
• 35800 – Myasthenia Gravis
• 23700 – Neoplasm – pituitary gland and craniopharyngeal duct
• 13500 – Sarcoidosis
• 24000 – Goitre, specified as simple
• 71020 – Sicca Syndrome (Sjogren’s Syndrome)
• 71000 – Systemic Lupus Erythematosus
• 44650 – Giant Cell Arteritis (Temporal Arteritis)
• 224 – Benign neoplasm of eye
• 8717 – Unspecified ocular penetration
• E07 – Intraocular surgery or injury with penetrating wound
• 9404 – Burn – Cornea / Conjunctiva
• V6751 – Following high risk medications (include a note stating type of medication).

Include a note requiring medical necessity for claims submitted with exceptional frequencies.

Eye examinations billed with the following diagnostic codes are payable once every 6 months:

• 250 – Diabetes Mellitus
• 3620 – Diabetic Retinopathy
• 36201 – Background diabetic retinopathy
• 36202 – Proliferative diabetic retinopathy

Include a note requiring medical necessity for claims submitted with exceptional frequencies.

Claim Manager offers a customized catalog of diagnostic codes for optometrists.

Ministry of Justice:  Driver Medical Fitness Information for Medical Professionals

Ministry of Public Safety and Solicitor General Office of the Superintendent of Motor Vehicles: 2010 BC Guide in Determining Fitness to Drive

Ministry of Social Development and Social Innovation: Healthy Kids Program

Ministry of Social Development and Social Innovation: Optical Program