Amended arrangements for DVA funded Optical Coherence Tomography

DVA’s new streamlined prior approval process will make it easier for ophthalmologists to seek Optical Coherence Tomography (OCT) services for DVA clients with a diagnosed degenerative macular disease.

As previously advised, the DVA-only fee item for optical coherence tomography (OCT) was removed on 1 July 2021 because OCT diagnostic services were added to the Medicare Benefits Schedule (MBS).

Acknowledging the role of OCT in the ongoing treatment of certain retinal conditions, DVA has streamlined the process for claiming these OCT services, as follows:

1. The ophthalmology provider submits a Treatment Prior Financial Approval Request to DVA for OCT services clinically required in the ongoing treatment of a degenerative macular disease.
2. If the request is approved, DVA will send a Decision Letter to the provider which will outline claiming instructions and include a new prior approved item.
3. The provider can use this item number to claim OCT services for the approved client up to six times within any 12 month period. The provider will not need to make further prior approval requests for OCT services for that client, unless the clinical circumstances for that client change.

If a DVA client has a clinical need for more than six OCT services in a 12 month period, providers will be able to request consideration of further OCT services under standard prior approval arrangements. Further information about making a Treatment Prior Financial Approval Request is available on the DVA website.

Providers are reminded that MBS items 112129 and 11220 can only be claimed for the purposes outlined in their item descriptors which are available from MBS Online. Under current MBS arrangements these items can only be claimed for diagnostic purposes.