Bulletin 240506 — Update: Health Card Validation for Optometry Time Limited Codes
Health Card Validation to check eligibility for oculo-visual minor assessments (V408, V415) and paediatric cycloplegic refraction complexity premium (V412)
To: Optometrists
Category: Optometrist Services
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: May 28, 2024
Bulletin Number: 240506
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 described in INFOBulletin 230311 and INFOBulletin 230804, adjustments to the affected fee schedule codes and their eligibility period came into effect September 1, 2023.
The following services are time limited. This can now be validated through the ministry’s Health Card Validation web and Interactive Voice Response (IVR) system:
- V408: Oculo-visual minor assessment for patients aged 20 to 64 years
- V415: Oculo-visual minor assessment for patients aged 65 years or older
- V412: Paediatric cycloplegic refraction complexity premium
Oculo-visual minor assessments
When validating an oculo-visual minor assessment V408 or V415, one of the following response codes will be returned:
- ‘206 - Eligible major oculo-visual examination performed and oculo-visual minor assessment limit has not been reached’ if the patient is eligible.
- ‘207 - Limit of oculo-visual minor assessments reached’ if the patient is not eligible due to the reaching the limit of V408 or V415.
- ‘205 - Oculo-visual minor assessment not eligible, check major oculo-visual examination eligibility’ if the patient is not eligible as they have not received a major oculo-visual examination (V406, V407, or V409) within the preceding 12 or 18 months.
Note: These codes do not return a service date.
Major oculo-visual examinations
Additionally, changes have been made to the validation of major oculo-visual examinations for adults (V409) and seniors (V406 or V407).
One of the following response codes will be returned, in lieu of the ‘201’ response code:
- ‘101 – No information available’ if the patient is eligible. (Reminder: this response code may also be returned if validating an incorrect code for the patient’s age. Please ensure you validate the correct code based on patient eligibility for that code, to obtain complete information and ensure correct payment).
- ‘209 - Physician eye exam on history, major oculo-visual examination not eligible’ if the patient is not eligible as a physician eye exam has been rendered to the patient within the preceding 12 or 18 months.
- ‘210 - A major oculo-visual examination has been performed on this patient within the permitted time frame’ if the patient is not eligible as another major oculo-visual exam has been rendered to the patient within the preceding 12 or 18 months.
Paediatric cycloplegic refraction complexity premium
When validating if the complexity modifier V412 is eligible for a patient, one of the following response codes will be returned:
- ‘101 – No information available’ if a complexity modifier has not been rendered to the patient within the preceding 12 months. (Reminder: this response code may also be returned if validating an incorrect code for the patient’s age. Please ensure you validate the correct code based on patient eligibility for that code, to obtain complete information and ensure correct payment).
- ‘208 - Limit of complexity modifier reached’ if the patient has already received their annual limit.
Note: These codes do not return a service date.
New time limited service response codes
The following new response codes and responses were added to the ministry’s Health Card Validation system:
| Response Code | Response |
|---|---|
205 | Oculo-visual minor assessment not eligible, check major oculo-visual examination eligibility |
206 | Eligible major oculo-visual examination performed and oculo-visual minor assessment limit has not been reached |
207 | Limit of oculo-visual minor assessments reached |
208 | Limit of complexity modifier reached |
209 | Physician eye exam on history, major oculo-visual examination not eligible |
210 | A major oculo-visual examination has been performed on this patient within the permitted time frame |
Keywords/Tags
Oculo-visual minor assessment; V408; V415; Optometry Services Agreement; optometrists; Paediatric cycloplegic refraction complexity premium; V412; V406; V407; V409; response codes; HCV
Contact information
Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.