Optical coherence tomography

This page 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.

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Who is eligible to receive DVA funded OCT?

If the entitled person has a Veteran Gold Card, they may be eligible to receive OCT, if they meet the DVA criteria noted below. 

If the entitled person has a Veteran White Card, under DVA arrangements they are eligible for treatment that is required for an accepted war or service caused injury or disease. 

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 Commonwealth and Other Allied Veterans Living in Australia for information on the services available.

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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).

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When will DVA fund OCT?

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

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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. 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 critieria.

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.

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Where do I lodge requests for prior approval?

Requests for prior approval should be emailed to Health.Approval [at] dva.gov.au (Health[dot]Approval[at]dva[dot]gov[dot]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 page.

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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.

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:

• How to claim page of the DVA website
• How to do business with DVA page of the DVA website 

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More Information