Optometrists

On this page, you will find information on:

  • Enrolment in MSP
  • Changing your address
  • De-enrolment and opting out
  • Notifying patients of any costs they are required to pay
  • Billing codes and payment schedules   
  • RoadSafetyBC (formerly OSMV) Form Fee items
  • Refused  Fees from RoadSafetyBC

Enrolment

Optometrists who are licensed by the College of Optometrists of British Columbia (COBC) are eligible to enrol with MSP and obtain MSP billing numbers.

Enrolment status, and, therefore, the possession of an active billing number, is contingent upon the practitioner's continued licensure by the COBC. Any change in licensure, such as the renewal of a temporary license or specialty, must be reported to MSP to avoid refusal of claims.

Enrolment

Licensed optometrists who register with MSP are called "enroled" optometrists. Enroled optometrists may choose to be "opted-in" or "opted-out".

Opted-in optometrists must bill MSP directly for all required services provided to MSP beneficiaries. Opted-in optometrists are prohibited by legislation from charging MSP beneficiaries more than the amount paid by MSP for an MSP-insured service.

Opted-out optometrists have elected to bill patients directly for insured services. Although opted-out optometrists may choose to submit claims to MSP on behalf of patients who are MSP beneficiaries, MSP reimburses the beneficiaries directly for those insured services.

Optometrists Who Are Not Enroled

The services of a non-enroled or de-enroled optometrist are not benefits of MSP. These services can be billed directly to the patient for an amount more than that set in the optometry payment schedule, provided the patient is advised of the practitioner's payment protocol before the service is rendered.

Assignment of a Billing Number

Each practitioner enroled with MSP is assigned a billing number consisting of two numbers:

  • a practitioner number, which identifies the practitioner rendering the service, and
  • a payment number, which identifies the person or group (e.g. clinic, hospital) to which payment is to be made.

The practitioner and payment numbers are usually the same. However, they differ in cases where a practitioner designates another practitioner or a group, such as a clinic or hospital, to receive that practitioner's MSP fee-for-service payments. See Assignment of Payment.

All claims submitted to MSP must include the practitioner number of the practitioner who performed the service; therefore, a practitioner cannot bill under another practitioner's number. The practitioner whose number appears on the MSP claim assumes full responsibility for the service provided.

Applying for a Billing Number

Optometrists wishing to obtain a billing number from MSP must follow a clearly defined process.

  1. You must first request licensure from the College of Optometrists.
  2. You must complete and submit the following application form:

Change of Address or Licence

If you change your address or telephone number, or if there is a change in your specialty or licence status, you must advise MSP so that your records can be updated accordingly. Timely notification of changes enables MSP to provide practitioners with accurate and efficient service and helps prevent unnecessary refusal of claims.

De-enrolment and Opting Out

An optometrist may:

  • enrol with MSP (if licensed with the appropriate licensing body); or
  • once enroled, opt out of MSP; or
  • once enroled, de-enrol from MSP (cancel the enrolment); or
  • not enrol with MSP.

Notifying Patients

If an optometrist intends to require their patients to pay all or a portion of the costs of a service, he or she must inform the patient, prior to rendering the service:

  • that the patient will be required to pay part or all of the cost directly;
  • the amount the patient will be required to pay; and
  • the amount the patient can expect to be reimbursed by MSP.

Medically Required Eye Examinations

An eye examination, for patients between the ages of 19 and 64, is an insured benefit only if medically required. The diagnoses which meet the MSP definition of medically required are listed below by ICD9 code, and are payable at the frequency indicated. To support exceptions to these frequencies or for other special circumstances, please ensure this information is included with your referral.

In general, the criteria for medically required include:

  • Ocular disease, trauma or injury
  • Systemic diseases associated with significant ocular risk (e.g. diabetes)
  • Medications associated with significant ocular risk

A note record documenting the medical necessity must be included to support exceptions to these frequencies.

Please note, under each three digit diagnostic code – the four and five digit codes in the same category would be limited to the same frequency guidelines. The exceptions are listed in the linked file below.

List of Diagnostic Codes for Medically-Required Eye Examinations (PDF, 63KB)

Payment Schedule and Preamble

The Optometry Payment  Schedule (updated January 1, 2016) lists fees payable for optometry services insured under MSP.

A. GENERAL PROVISIONS

1. Eye Examination Benefits

Optometric benefits are services defined in Section 23 of the Medical and Health Care Services Regulations, B.C. Reg. 426/97, and for which payment is provided pursuant to the Optometry Payment Schedule.

Routine eye examinations are not a MSP benefit for individuals aged 19 to 64 years. MSP provides as an insured benefit routine eye examinations for children under the age of 19 years and over the age of 65.

Medically required eye examinations are a benefit for all MSP beneficiaries. The diagnoses that meet the MSP definition of medically required are listed below by ICD9 code, and are payable at the frequency indicated. To support exceptions to these frequencies or for other special circumstances, practitioners should ensure this information is included with billing claims.

In general, the criteria for medically required include:

  • ocular disease, trauma or injury
  • systemic diseases associated with significant ocular risk (e.g. diabetes)
  • medications associated with significant ocular risk

Refractive change (needing glasses or contact lenses) with no other pathology does not meet the MSP medically required criterion for payment. Patients presenting with refractive change only should not be formally referred for an eye exam. These patients should contact their optometrist or ophthalmologist directly to request an eye exam and they should also be advised that payment for the eye examination will be their responsibility.

Formal referrals to ophthalmologists or direct requests to optometrists by a medical practitioner for an eye examination on behalf of patients are appropriate only if, in the practitioner’s judgment and based on clinical evidence, there is medical necessity for the examination.

MSP will accept claims and make payment for services provided by optometrists and ophthalmologists upon direct requests or referral from medical practitioners.

It is the responsibility of medical practitioners to exercise their judgment in referring those patients for whom an eye examination is medically required. This does not include visits for patients with refractive change (needing glasses or contact lenses) but with no other pathology. MSP will monitor referral patterns to ensure adherence to this policy.

For patients insured under the First Nations Health Authority (FNHA), prior approval is required for health benefits.

2. Medically Required Eye Examinations

The diagnoses which meet the MSP definition of medically required are listed below by ICD9 code, and are payable at the frequency indicated.

Practitioners must ensure that information necessary to support exceptions to these frequencies or for other special circumstances is included with referrals or billing claims.

Payment for services for conditions not listed below is the responsibility of the patient unless a referral is medically indicated and provided to the ophthalmologist or optometrist directly by the referring physician.

 

Complete Preamble and Payment Schedule:

MSP Payment Schedule: Optometry Services (PDF, 517KB)

RoadSafetyBC (formerly OSMV) Forms Payment Schedule

RoadSafetyBC will pay for certain driver fitness assessments including Driver Medical Examination forms required for people with medical conditions.

You may submit claims to MSP for payment of the following three OSMV RoadSafetyBC forms. The forms are identifiable by the inclusion of the MSP fee item and a box for the personal health number. Fees paid for RoadSafetyBC forms, such as the Visual Field test (VFT) and the Examination of Visual Function (EVF) are set by RoadSafetyBC. However, RoadSafetyBC has no authority to set the fees doctors charge. Doctors are entitled to set their own fee or any portion of the fee that exceeds the amount set by RoadSafetyBC.  

Further detailed information about assessment requirements and medical standards for driving can be found at RoadSafetyBC Driver Medical Fitness information for Medical Professionals

96223 RoadSafetyBC Visual Field Test (VFT) and Examination of Visual Functions (EVF) conducted by an optometrist as part of the same examination/at the same time. $102.00

Notes:

  1. Fee items 96224 or 96225 are not billable in addition.
  2. Only optometrists registered and approved for visual fields testing with MSP may bill this fee code.
  3. This fee may only be claimed when specifically requested by the Superintendent of Motor Vehicles.
  4. Patient birth date is required on the claims submission.
  5. Patient driver's licence number is required on the claim submission (Driver's licence number must be entered in the first 7 spaces of the note or comment field)
  6. MSP fee items 02899, 02898, 02897, and 02893 are not billable in addition.
  7. Repeat VFT/EVF is not payable to any practitioner within 3 months.
96224 RoadSafetyBC Examination of Visual Function (EVF) conducted by an optometrist (does not include visual fields) $70.00

Notes:

  1. Not billable with fee items 96223 or 96225.
  2. This fee may only be claimed when specifically requested by the Superintendent of Motor Vehicles.
  3. Patient birth date is required on the claims submission.
  4. Patient driver's licence number is required on the claim submission (Driver's licence number must be entered in the first 7 spaces of the note or comment field)
  5. MSP fee items 02899, 02898, and 02897are not billable in addition.
  6. Repeat VFT/EVF is not payable to any practitioner within 3 months.
96225 RoadSafetyBC Visual Field Test (VFT) conducted by an optometrist as a stand-alone test $42.00

Notes:

  1. Not billable with fee item 96223 or 96224.
  2. Only optometrists registered and approved for visual fields testing with MSP may bill for this fee code.
  3. This fee may only be claimed when specifically requested by the Superintendent of Motor Vehicles.
  4. Patient birth date is required on the claims submission.
  5. Patient driver’s licence number is required on the claims submission.  (Driver’s licence number must be entered in the first 7 spaces of the note or comment field)
  6. MSP fee item 02893 is not billable in addition.
  7. Repeat VFT/EVF is not payable to any practitioner within 3 months