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Factsheet HIP90 - Providers - Optical Coherence Tomography

Purpose

This Factsheet describes the circumstances in which the Department of Veterans' Affairs (DVA) will accept financial responsibility for the provision of Optical Coherence Tomography (OCT) to entitled persons.

Who is eligible to receive DVA funded OCT?

If the entitled person has a DVA Health Card – All Conditions (Gold) or Totally & Permanently Incapacitated (Gold), they are eligible to receive OCT under DVA arrangements. For information about the Gold Card, please see Factsheets HSV59 - Eligibility for the DVA Health Card - All Conditions (Gold) or Totally & Permanently Incapacitated (Gold) and HSV60 - Using the DVA Health Card - All Conditions (Gold) or Totally & Permanently Incapacitated (Gold).

If the entitled person has a DVA Health Card – Specific Conditions (White), under DVA arrangements they are eligible for treatment that is required for an accepted war or service caused injury or disease. For more information about the White Card, please see Factsheet HSV61 - DVA Health Card - Specific Conditions (White).

If you or the entitled person are unsure of the entitled person's eligibility, you should contact DVA prior to commencing treatment.

Allied veterans may be eligible for treatment of war caused disabilities accepted by the entitled person’s country of enlistment. Please refer to Factsheet HSV62 - Commonwealth and Other Allied Veterans Living in Australia for information on the services available.

Who is eligible to provide DVA funded OCT?

OCT can only be provided to entitled persons by an ophthalmologist. DVA will not fund OCT if provided by an optometrist. To provide these services to entitled persons, ophthalmologists must be currently registered with the Department of Human Services (DHS).

When will DVA fund OCT?

DVA will fund clinically required OCT for eligible persons for the assessment and management of retinal diseases, excluding glaucoma. However DVA will not fund OCT as a screening tool. DVA will allow a one off OCT in circumstances where standard screening tests are inconclusive in the diagnosis of glaucoma. The frequency of OCT will be determined by the treating ophthalmologist following their clinical assessment of the health status of the eligible person.

Is prior approval required for OCT?

Prior approval is not required for the provision of OCT to eligible persons in circumstances where treatment is for the assessment and management of retinal diseases, excluding glaucoma. Prior approval is also not required for a one-off OCT in circumstances where standard screening tests are inconclusive in the diagnosis of glaucoma.

Prior approval is required when a provider wishes to provide OCT in circumstances outside the above circumstances.

Prior approval may be requested by the ophthalmologist in writing. The request should indicate the:

  • name and DVA file number of the entitled person who is to receive treatment
  • provider number of the health care provider
  • date of service, and
  • clinical justification for the requested service.

Where do I lodge requests for prior approval?

Requests for prior approval should be emailed to Health.Approval@dva.gov.au

Alternatively, they can be sent to:

Department of Veterans’ Affairs

GPO Box 9998

ADELAIDE  SA  5001

 

For enquires, please contact DVA Service Provider Enquiries via the contact details provided under Additional Information at the end of this Factsheet.

What is the DVA fee for OCT?

Providers should claim DVA item MT12 when submitting a claim for OCT. Only one MT12 item can be claimed and payable per day.

MT12 can be claimed on the same day as a consultation item. Consultation fees should be claimed in accordance with relevant items within the Repatriation Medical Fee Schedule (RMFS) section of the Fee Schedules for Medical Services, which is available on the Fee Schedules page of the DVA website at http://www.dva.gov.au/providers/fee-schedules

Claims for OCT (MT12 and the relevant consultation item) should be submitted directly to the Department of Human Services. For more information, please see the:

More Information

DVA General Enquiries

Phone: 1800 550 457 *

Email: GeneralEnquiries@dva.gov.au

DVA Website: www.dva.gov.au

Factsheet Website: www.dva.gov.au/factsheets

DVA Service Provider Enquiries

Service Provider Website: http://www.dva.gov.au/providers/becoming-dva-service-provider

Transport Bookings

Phone: 1800 550 455 *

Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC)

Providers Phone: 1800 552 580 *

Veterans Phone: 1800 500 869 *

* Calls from some mobile phones and pay phones may incur additional charges.

Related Factsheets

Disclaimer

The information contained in this Factsheet is general in nature and does not take into account individual circumstances. You should not make important decisions, such as those that affect your financial or lifestyle position on the basis of information contained in this Factsheet. Where you are required to lodge a written claim for a benefit, you must take full responsibility for your decisions prior to the written claim being determined. You should seek confirmation in writing of any oral advice you receive from DVA.

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1 June 2018