Change to DVA Fee Schedule for Optical Coherence Tomography

Ophthalmologists are advised the Department of Veterans’ Affairs (DVA) Fee Schedule will change from 1 July 2021.

OCT services for DVA clients will only be claimable using the Medicare Benefits Schedule (MBS) item numbers 11219 or 11220.

The DVA-only item for OCT services, MT12, will be removed.

DVA will pay 140% of the MBS fee amount when an ophthalmologist claims MBS item 11219 or 11220 for a DVA client.

From 1 July 2021, the MBS fee for items 11219 and 11220 will be $41.60, and the amount paid for a DVA client will be $58.25. Providers are not entitled to charge a co-payment for services provided to DVA clients.

Ophthalmologists can continue to claim for DVA clients’ OCT services using the same channel as they currently use (for example, via Webclaim or their practice software system).

The only change to the process is that the providers will need to input the MBS item 11219 or 11220, rather than the DVA MT12 item.

It is the responsibility of the provider to determine which of the MBS items — 11219 or 11220 — is appropriate to claim for their DVA client. Providers should also familiarise themselves with the descriptor and explanatory notes for these items.

Providers can use MBS Online’s AskMBS Email Advice Service if they have any questions about MBS requirements.

Further information for providers claiming OCT services for DVA clients is available on DVA’s Fee notes for GPs and specialists page.