Bulletin 220406 — Optometry Fee Code Increases
Optometrists will receive fee code increases effective April 1, 2021.
To: Optometrists
Category: Optometrist Services
Written by: Claims Services Branch, Ministry of Health
Date issued: April 1, 2022
Background
The Ministry of Health (ministry) and the Ontario Association of Optometrists (OAO) have been holding meaningful bilateral discussions that are progressing at the bargaining table. Through our collaborative efforts, there is early consensus on some changes to optometry services under the Ontario Health Insurance Plan (OHIP) while negotiations continue.
There will be a Fee Schedule Code (FSC) increase to two OHIP-insured optometry services, annual eye exams for children and seniors. These FSC increases are retroactive to April 1, 2021. These changes do not raise the costs to patients.
Fee Code increases
Starting April 1, 2022, the following FSCs will have their fee rates increased effective April 1, 2021 in the Fee Schedule Master (FSM):
| FSC | Description | New Fee |
|---|---|---|
| V404 | Periodic oculo-visual assessment for patients aged 19 years or less | $48.60 |
| V406 | Periodic oculo-visual assessment for patients aged 65 years or older | $60.00 |
Please ensure that your billing software is updated to reflect the new FSC values for any services submitted on or after April 1, 2022.
The updated Fee Schedule Master can be found on the Ministry of Health website.
This file will be available for download by April 7, 2022.
The Schedule of Benefits for Optometry Services (Schedule) has also been updated to reflect the new fees. The Schedule can be found on the Ministry of Health website.
This file will be available for download by April 7, 2022.
Due to the retroactive payment increase, a Medical Claims Adjustment (MADJ) will be used for eligible services that have already been submitted up to March 31, 2022. Further details will be communicated in a future INFOBulletin.
Keywords/tags
Ontario; OHIP; Optometrist; Optometry; V404; V406; Retroactive; FSM; Fee Schedule Master
Contact information
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