Bulletin 250201 — Optometry Diagnostic Code Changes
This bulletin outlines some changes to the diagnostic codes relevant to OHIP insured optometry services with an effective date of March 1, 2025.
To: Optometrists
Category: Optometrist Services
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: February 19, 2025
Bulletin Number: 250201
Background
The Ministry of Health (ministry) and the Ontario Association of Optometrists (OAO) have been working together to implement changes to the Ontario Health Insurance Plan (OHIP) Schedule of Benefits for Optometry Services in accordance with the new Optometry Services Agreement, as outlined in INFOBulletin 230804 and INFOBulletin 230311.
The optometry diagnostic code changes will impact the following fee schedule codes:
| Fee Schedule Code | Description |
|---|---|
| V406A | Major oculo-visual examination for patients aged 65 years or older with no eligible medical conditions |
| V407A | Major oculo-visual examination for patients aged 65 years or older with one or more eligible medical conditions |
| V409A | Major oculo-visual examination for patients aged 20 to 64 years with one or more eligible medical conditions |
| V410A | Automated Visual Field Assessment |
Claims processing
The following changes are effective for claims with a service date of March 1, 2025 and beyond.
Diagnostic code ‘364 - Eye: Iritis’ has been added to the list of eligible diagnostic codes for fee schedule codes V407A and V409A.
Diagnostic code ‘363 - Eye: Chorioretinitis’ has been removed from the list of eligible diagnostic codes for fee schedule codes V407A and V409A.
- If V407A or V409A is submitted with diagnostic code 363, it will reject with error code ‘V16 – Unacceptable Diagnostic Code.’
Diagnostic codes ‘248 - Diabetes: mellitus with ocular complications’, ‘250 - Diabetes: Diabetes mellitus, including complications’ and ‘363 - Eye: Chorioretinitis' have been removed from the list of eligible diagnostic codes for V410A.
- If V410A is submitted with one of these diagnostic codes, it will reject with error code ‘V16 - Unacceptable Diagnostic Code.’
Fee service code V406A will no longer convert to V407A if a claim for V406A is submitted with a diagnostic code for an eligible condition.
Keywords/Tags
Optometry Diagnostic Code Changes; Ontario Association of Optometrists (OAO); changes to OHIP-insured optometry coverage; Optometry Services Agreement; V406; V407A; V409A; V410A; Iritis; Chorioretinitis; Mellitus.
Contact information
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