A115 - Major eye examination

General Info

Billing Amount: $51.10


A major eye examination is a complete evaluation of the eye and vision system for patients aged 20 to 64 inclusive. The examination must include the following elements: a. relevant history (ocular medical history, relevant past medical history, relevant family history) b. a comprehensive examination (visual acuity, gross visual field testing by confrontation, ocular mobility, slit lamp examination, ophthalmoscopy and, where indicated, ophthalmoscopy through dilated pupils and tonometry) c. visual field testing by the same physician where indicated d. refraction, and if needed, provision of a refractive prescription e. advice and instruction to the patient f. submission of the findings of the assessment in writing to the patient's primary care physician or by a registered nurse holding an extended certificate of registration (RN(EC)) if requested g. any other medically necessary components of the examination (including eye-related procedures) not specifically listed above.


This service is only insured if the patient is described in (a) or (b) below:
a. A patient has one of the following medical conditions:
i. diabetes mellitus, type 1 or type 2
ii. glaucoma
iii. cataract
iv. retinal disease
v. amblyopia
vi. visual field defects
vii. corneal disease
viii. strabismus
ix. recurrent uveitis
x. optic pathway disease; or
b. The patient must have a valid "request for eye examination requisition" completed by another physician or by a registered nurse holding an extended certificate of registration (RN(EC)).

This service is limited to one per patient per consecutive 12 month period regardless of whether the first claim is or has been submitted for a major eye examination rendered by an optometrist or physician. Where the services described as comprising a major eye examination are rendered to the same patient more than once per 12 month period, the services remain insured and payable at a lesser assessment fee.

Any service rendered by the same physician to the same patient on the same day that the physician renders a major eye examination is not eligible for payment.

If all the elements of a major eye examination are not performed when a patient described in note 1 above attends for the service, the service remains insured but payable at a lesser assessment fee.

The requisition is not valid following the end of the fiscal year (March 31) of the 5th year following the year upon which the requisition was completed.