A medical claims adjustment for eligible claims submitted between April 1, 2021 and March 31, 2022 has been completed

To: Optometrists
Category: Optometrist Services
Written by: Claims Services Branch; OHIP , Pharmaceuticals and Devices Division
Date issued: May 30, 2022

Background

Further to INFOBulletin 220406 – Optometry Fee Code Increases, claims for V404 and V406 assessed prior to April 1, 2022 have been adjusted to pay at the increased rates below.

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

The fee schedule code increases became effective April 1, 2022, retroactive to April 1, 2021.

Claims processing

  1. Claims submitted between April 1, 2021 and March 31, 2022 for either V404 or V406 with a service date between April 1, 2021 and March 31, 2022 have been adjusted to pay in accordance with the new payment rate.
  2. These adjustments will begin to appear on the June 2022 Remittance Advice (RA).
  3. Reprocessed claims will appear on the RA with explanatory codes ‘55-This deduction is an adjustment on an earlier account’ and ’57-This payment is an adjustment on an earlier account’.

Keywords/tags

OHIP ; Optometry; V404; V406; Retroactive; Optometrist; POVA; Periodic oculo-visual assessment;

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.