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POC 14 VISION (EYE) CARE - PDC 14 – SOINS DE LA VUE (YEUX) Rev 1.0

POC 14 VISION (EYE) CARE - PDC 14 – SOINS DE LA VUE (YEUX) Rev 1.0

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POC 14 VISION (EYE) CARE - PDC 14 – SOINS DE LA VUE (YEUX) Rev 1.0
POC 14 VISION (EYE) CARE - PDC 14 – SOINS DE LA VUE (YEUX) Rev 1.0

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Published by: Canadian_Veterans_Ad on Jan 31, 2012
Copyright:Attribution Non-commercial

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05/13/2014

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2 of 4
NEW
 
BENEFIT
 
CODES
 
 –
 
EFFECTIVE
 
FEBRUARY
 
1,
 
2012
 
(ALL
 
PROVINCES)C
ODE
D
ESCRIPTION
C
OMMENTS
 
600221 GDX Scanning Laser PolarimetryPre-authorization Required: YesFrequency: 1/1 CY600036Heidelberg Retinal Tomography (HRT) forGlaucomaPre-authorization Required: YesFrequency: 1/1 CY600301 PachymetryPre-authorization Required: YesFrequency: 1/2 CY600302 Retinal ImagingPre-authorization Required: YesFrequency: 1/2 CYDollar Limit: $35600303 Therapeutic Exam and Treatment Pre-authorization Required: Yes600034 Ocular Coherence Tomography (OCT) examPre-authorization Required: YesFrequency: 1/1 CY602561 Contact Lens ReplacementPre-authorization Required: YesPrescriber: O,OPFrequency: 4/1 CY600312 Lenses Progressive High IndexPre-authorization Required: YesPrescriber: O,OPFrequency: 1/2 CYDollar Limit: $108.99600313 Lenses Progressive Regular IndexPre-authorization Required: YesPrescriber: O,OPFrequency: 1/2 CYDollar Limit: $108.99630111 Exam Intraocular Lenses MasterPre-authorization Required: YesFrequency: 1/2 CY600310 Frames and Lenses (1 set) Special OversizedPre-authorization Required: YesPrescriber: O,OPFrequency: 1/2 CY630100 Exam Dilation Exam for DiabeticsPre-authorization Required: NoPrescriber: No602854Ophthalmic Dispensing Fee – Multifocal/Trifocal/ProgressivePrescriber: NoDollar Limit: $90602562Contact Lens Fitting Procedure/Evaluation – Multifocal/ToricPre-authorization Required: YesPrescriber: NoFrequency: 1/1 CY600212 Lens Coating PhotochromaticPrescriber: NoDollar Limit: $17
NEW
 
BENEFIT
 
CODES
 
 –
 
ALL
 
PROVINCES
 
EXCEPT
 
QUEBEC
 
WHERE
 
CODES
 
ALREADY
 
EXIST
 
FOR
 
THESE
 
BENEFITS
604128 Lenses Unifocal/Bifocal High IndexPre-authorization Required: YesPrescriber: O,OPFrequency: 2/2 CY604126 Lenses Unifocal/Bifocal Regular IndexPre-authorization Required: YesPrescriber: O,OPFrequency: 2/2 CY
NEW
 
BENEFIT
 
CODE
 
 –
 
ALL
 
PROVINCES
 
EXCEPT
 
THE
 
ATLANTIC
 
PROVINCES
 
WHERE
 
A
 
CODE
 
ALREADY
 
EXISTS
 
FOR
 
THIS
 
BENEFIT
600211Lens Coating – Anti-Reflective/Scratch ResistantCoatingFrequency: 2/2 CY
   O  n  e   V  e  t  e  r  a  n   O  n  e   S  t  a  n   d  a  r   d
 
3 of 4
MODIFICATIONS
 
TO
 
EXISTING
 
BENEFITS
 
 –
 
EFFECTIVE
 
FEBRUARY
 
1,
 
2012C
ODE
D
ESCRIPTION
C
OMMENTS
 T
HE FOLLOWING MODIFICATIONS APPLY TO ALL PROVINCES
:
600624 Fees (Vision) Ophthalmoscopy Pre-authorization Required: Yes (added)603070Sunglasses (not-corrective) Including Clip-Ons/ Wrap-AroundsPreauthorization Required: Yes (added)Prescriber: No (removed)Frequency: 1/2 CY (revised)
T
HE FOLLOWING MODIFICATION APPLIES TO
O
NTARIO ONLY
:
600624 Fees (Vision) OphthalmoscopyPre-authorization Required: Yes (added)Dollar Limit: $24.74 (added)
 T
HE FOLLOWING MODIFICATION APPLIES TO ALL PROVINCES EXCEPT THE
A
TLANTIC PROVINCES
(W
HERETHIS IS ALREADY A REQUIREMENT
):
600638 Fees (Vision) Biomicroscopy Pre-authorization Required: Yes (added)
 T
HE FOLLOWING MODIFICATION APPLIES TO ALL PROVINCES EXCEPT THE
A
TLANTIC PROVINCESAND
Q
UEBEC
(
AGREEMENTS IN PLACE
):
604120Lens Coating – Hardened/Impact Resistant -New Frames or LensesDollar Limit: $15 (added)
T
HE FOLLOWING MODIFICATION APPLIES TO ALL PROVINCES EXCEPT THE
A
TLANTIC PROVINCES
(
WHERE THIS IS ALREADY A REQUIREMENT
)
AND
B
RITISH
C
OLUMBIA
:
600427 Fees (Vision) TonometryPre-authorization Required: Yes (added)Dollar Limit: $21.70 (added)
 THE
 
FOLLOWING
 
CODES
 
ARE
 
TERMINATED
 
AS
 
OF
 
JANUARY
 
31,
 
2012
 
IN
 
ALL
 
PROVINCES:C
ODE
D
ESCRIPTION
 
600220 Lens Benefit - Other Lens Benefits - Oversized Lens600332 Fees Vision - Contact Lens Evaluation600777 Dispensing Fees - Special Frames for Cataracts601756 Lens Benefit - Other Lens Benefits - Progressive Lenses601991 Ophthalmic Dispensing Fees - Progressive602250 Contact lens replacement - Left602255 Contact lens replacement - Right603321 Glass Lens Coating
 – 
Photochromatic604015 Contact Lens Solution604118 Eyeglass Cases605006 Frames - Special Oversized Lens604136 Lens Benefit - Other Lens Benefits - Executive Lens604139 Lens Benefit - Other Lens Benefits - Plastic Lens602177 Contact Lens Fitting Procedures Including Initial Issue - Multifocal601300 Therapeutic Exam
   O  n  e   V  e  t  e  r  a  n   O  n  e   S  t  a  n   d  a  r   d
 
4 of 4
THE
 
FOLLOWING
 
CODES
 
ARE
 
TERMINATED
 
AS
 
OF
 
JANUARY
 
31,
 
2012
 
IN
 
ALL
 
PROVINCES
 
EXCEPT
 
THE
 
ATLANTIC
 
PROVINCES
 
(WHERE
 
THERE
 
IS
 
AN
 
AGREEMENT
 
IN
 
PLACE):
600230 Lens Coating - Ultraviolet Coating - Glass Lens
 
603324 Lens Coating - Scratch Resistant603802 Glass Lens Benefit - Oversize Lens600218 Lens Coatings - Anti-Reflecting Coating
 
601945 Ophthalmic Dispensing Fees - Multifocal/Trifocal
602156
 
Lens Fitting Procedure Including Initial Issue - Toric
 
THE
 
FOLLOWING
 
CODE
 
IS
 
TERMINATED
 
AS
 
OF
 
JANUARY
 
31,
 
2012
 
IN
 
THE
 
ATLANTIC
 
PROVINCES
 
ONLY:
 
603322 Plastic Lens Coating Photochromatic
 
THE
 
FOLLOWING
 
CODE
 
IS
 
TERMINATED
 
AS
 
OF
 
JANUARY
 
31,
 
2012
 
IN
 
SASKATCHEWAN
 
ONLY:
 
602505 High Index Lenses
Abbreviations
CY = Calendar YearO = OphthalmologistOP = Optometrist
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