Eye surgery (Ophthalmology) services in Medicare 011-20062640

External websites

Australian Health Practitioner Regulation Agency (Ahpra) website

MBS Online - Diagnostic Procedures and Investigations, Group D1, Subgroup 2 - Ophthalmology

MBS Online - Therapeutic Procedures, Group T8, Subgroup 9 - Ophthalmology

Medical terms for eye procedures

Table 1: This table lists terms and descriptions to support the assessment of claims.

Term	Description
Astigmatism	Someone who has an astigmatism is unable to focus on close or distant objects. The condition can be accompanied by myopia (short-sightedness) or hyperopia (long-sightedness).
Blepharitis	Inflammation of the eyelids.
Capsulotomy	A Yag capsulotomy is a special laser treatment used to improve vision after cataract surgery.
Cataract surgery	Eye surgery that involves removing all or part of the lens and replacing it with an intraocular lens implant.
Conjunctivitis	A condition where the conjunctiva has become inflamed.
Cornea	The transparent (clear) front part of the eye. The cornea covers the iris, pupil, and anterior chamber.
Cyclodestructive surgery	An eye operation that treats glaucoma by destroying the ciliary body with a laser.
Electroretinography (ERG) test	Measures the electrical response of the light-sensitive cells in eyes. This test looks at the back of the eye known as the retina (also known as an electroretinogram).
Filtration surgery	Eye surgery that opens a passage allowing excess aqueous humor to drain into surrounding tissues. This is generally a treatment for glaucoma.
Glaucoma	A disease in which the pressure of the fluid inside the eye is too high. This results in a loss of peripheral vision.
Hyperopia	Where people can see distant objects clearly but are unable to focus on close objects.
Iridectomy	Eye operation that treats closed-angle glaucoma by surgical removal of part of the iris of the eye.
Iridotomy	A surgical procedure that makes an incision in the iris of the eye in order to enlarge the pupil or to treat closed-angle glaucoma.
Keratotomy	A surgical incision into the cornea.
LASEK (Laser Epithelial Keratomileusis)	A laser eye surgery procedure.
Lasik laser eye surgery	A procedure used to correct vision. Lasik is used in a refractive surgery procedure that reshapes the cornea. Note: this is not the same as LASEK.
Myopia	Short-sightedness.
Ophthalm	Eye
Ophthalmology	The medical specialty studying eye disease and surgery of the eye.
Ophthalmologist	Physician who practices in the specialty of ophthalmology.
Ophthalmoscopy	The examination of the interior of the eye using an instrument.
Ophthalmoscope	The instrument used for eye examination in ophthalmoscopy.
Optical coherence tomography (OCT)	A non-invasive imaging test. OCT uses light waves to take cross-section pictures of your retina.
Optic nerve	The bundle of nerve fibres that connect the retina with the brain.
Pachymetry	An examination to measure the thickness of the cornea.
Presbyopia	The inability to focus on close objects.
Pupil	The black circular opening in the centre of the iris (the coloured part) of the eye.
Retina	The area of light sensitive nerve tissue that is located at the back of the eye. It converts the images that the eye sees into electrical impulses. These electrical impulses are sent along the optic nerve to the brain, which then interprets them as images.
Refractive errors	When light enters the eye it is refracted (bent) as it passes through the cornea and lens.
Strabismus (squint)	Is a condition which causes the eyes to be misaligned. They are not directed at the same point at the same time. It occurs when the eye muscles are not working together properly.
Trabeculoplasty (SLT)	A form of laser surgery that is used to lower intraocular pressure in glaucoma.
Ultrasonic echography	Ultrasound of the eye.
Vitrectomy	A surgical procedure that removes the vitreous humor and replace it with saline solution.

Diagnostic procedures and investigations

Table 2: This table is a guide to assist with the most frequently claimed items.

Item	Description	Helpful information	Useful facts	The text/notation required
11204	Electroretinography	Explanatory note DN. 1.5 Electroretinography.	Can be claimed for 1 or both eyes	Which eye(s) were assessed e.g. Left, right or left and right.
11220	Optical Coherence Tomography	Explanatory note DN. 1.5 Electroretinography.	Only 1 service can be claimed per eye per lifetime	Which eye(s) was assessed e.g. Left, right.
11221	Full Quantitative Computerised Perimetry	Explanatory note DN.1.6 Computerised Perimetry Printed Results. Explanatory note DN.1.7 Computerised Perimetry.	This a bilateral item a maximum of 3 services can be paid in 12 months	N/A
11224	Full quantitative computerised Perimetry	Explanatory note DN.1.6 Computerised Perimetry Printed Results. Explanatory note DN.1.7 Computerised Perimetry.	This a unilateral item maximum of 3 services can be paid in 12 months	Which eye(s) were assessed e.g. Left, right
11240	Ultrasonic Echography	Explanatory note DN.1.8 Orbital Contents.	Measurement of one eye prior to lens surgery on that eye	Which eye(s) were assessed e.g. Left, right
11241	Ultrasonic Echography measurement for both eyes	Explanatory note DN.1.8 Orbital Contents.	For a bilateral eye measurement prior to lens surgery on both eyes	N/A
11242	Ultrasonic Echography measurement for one after surgery	Explanatory note DN.1.8 Orbital Contents.	The measurement of an eye previously measured and on which lens surgery has been performed	Which eye(s) were assessed e.g. Left, right
11243	Ultrasonic Echography measurement for both eyes after surgery	Explanatory note DN.1.8 Orbital Contents.	For the measurement of a second eye where surgery for the first eye was more than 3 years ago	Which eye(s) were assessed e.g. Left or right

Eye surgery items

Table 3: This table is a guide to assist with the most frequently claimed items.

Item	Description	Helpful information	Useful facts	The text/notation required
42644	Complete removal of embedded foreign body	Explanatory note TN.8.1 Surgical Operations Explanatory note TN.8.78 Imbedded Foreign Body	Where the imbedded foreign body is not completely removed, benefits are payable under the relevant attendance item.	Which eye(s) were assessed e.g. Left, right or left and right.
42672	Corneal Incisions	Explanatory note TN.8.79 Corneal Incisions	This is an Independent procedure to correct blurred vision.	Which eye(s) were assessed e.g. Left, right or left and right.
42698	Cataract surgery Explanatory note TN.8.80 Cataract surgery	Cataract surgery Explanatory note TN.8.80 Cataract surgery	This item is for removal of a cataract in the first eye.	Which eye(s) were assessed e.g. Left, right or left and right.
42701	Cataract surgery Explanatory note TN.8.80 Cataract surgery	Cataract surgery Explanatory note TN.8.80 Cataract surgery	This item is for the insertion of a lens, following the removal of cataract in the first eye.	Which eye(s) were assessed e.g. Left, right or left and right.
42738	Paracentesis of anterior chamber or vitreous cavity or both	Explanatory note TN.8.21 intravitreal injection	Item 42738 is cannot be claimed with other intraocular surgery.	Which eye(s) were assessed e.g. Left, right or left and right.
42740	Intravitreal Injection of therapeutic substances, or the removal of vitreous		Item 42740 as a procedure can be claimed with other intraocular surgery.	Which eye(s) were assessed e.g. Left, right or left and right.
42741	Posterior Juxtascleral Depot injection	Explanatory note TN.8.81 Posterior Juxtascleral Depot injection	This injection is to treat age-related macular degeneration.	Which eye(s) were assessed e.g. Left, right or left and right.
42770	Cyclodestructive Procedures	Explanatory note TN.8.82 Cyclodestructive Procedures	For the treatment of Intractable Glaucoma, can only be claimed twice in a 2 year period.	Which eye(s) were assessed e.g. Left, right or left and right.
42752	Insertion of drainage device for glaucoma	Explanatory note TN.8.83 Insertion of drainage device for glaucoma	Item 42752 is payable twice on the same day if the services are performed on separate eyes.	Which eye(s) were assessed e.g. Left, right or left and right.
42782	Laser Trabeculoplasty	Explanatory note TN.8.84 Laser Trabeculoplasty	A laser treatment for Glaucoma. Benefits under this item are restricted to a maximum of 4 treatments to 1 eye in a 2 year period.	Which eye(s) were assessed e.g. Left, right or left and right.
42785	Laser Iridotomy	Explanatory note TN.8.85 Laser Iridotomy	This item is for the treatment of glaucoma. This item can be claimed up to 3 times for each eye in a 2 year period.	Which eye(s) were assessed e.g. Left, right or left and right.
42788	Laser Capsulotomy	Explanatory note TN.8.86 Laser Capsulotomy	Item 42788 covers all laser capsulotomy treatment performed on 1 eye. A second item 42788 can be paid.	Which eye(s) were assessed e.g. Left, right or left and right.
42791	Laser Vitreolysis or Corticolysis of Lens Material or Fibrinolysis	Explanatory note TN.8.87 Laser Vitreolysis or Corticolysis of Lens Material or Fibrinolysis	Item 42791 covers all treatment performed on one eye. Item 42791 is claimable up to 3 times for each eye in a 2 year period.	Which eye(s) were assessed e.g. Left, right or left and right.
42794	Division of Suture by Laser	Explanatory note TN.8.88 Division of Suture by Laser	The treatment to one eye, a maximum of 2 treatments are claimable to that eye in a 2 year period.	Which eye(s) were assessed e.g. Left, right or left and right.
42845	Ophthalmic Sutures	Explanatory note TN.8.89 Ophthalmic Sutures	This item can be claimed for 1 or both eyes, as an independent procedure.	Which eye(s) were assessed e.g. Left, right or left and right.

Processing eye procedure items – indicating left or right

Table 4: This table includes abbreviations required for processing eye procedures.