Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

Tariff Codes

Code

Code Description

Rand

11001

Optometric Examination

Note: Relevant for replacement of spectacles or contact lenses.

614.95

11046

Ocular Pathology Examination

Note: When occupational injury/disease related

691.68

11061

Low Vision Examination

Note: When occupational injury/disease has caused deterioration of vision to sub-standard levels, or following occupational injury/disease incident of low-vision patient.

852.81

11141

Refractive Status evaluation

Note: Appropriate after occupational injury/disease incident to monitor recovery of the eye.

236.88

11183

Keratometry

Note: Appropriate for fitting of contact lens or monitoring of corneal recovery after occupational injury/disease to the eye

118.49

11202

Tonometry without anaesthetic

Note: After ocular occupational injury/disease cases only

142.17

11212

Tonometry with anaesthetic

Note: After ocular occupational injury/disease cases only

189.53

11246

Colour Vision Evaluation

Rule: Can be billed In addition to 11001 or 11046 when necessary

217.92

11265

Contrast Sensitivity Evaluation

Rule: Can be billed in addition to 11001 or 11046 when necessary

134.06

11356

Gonioscopy

Rule: Can be billed in addition to 11001 or 11046 when necessary

296.18

11366

Dilated fundus examination with Fundus lens

Rule: Can be billed in addition to 11001 or 11046 when necessary

293.77

11402

Visual field - screening

Note: Relevant in cases of head and/or ocular injury

151.60

11423

Visual field - Non threshold testing

Rule: Can be billed in addition to 11001 or 11046 when necessary

189.53

11443

Visual field - Threshold testing

Rule: Can be billed in addition to 11001 or 11046 when necessary

331.70

11604

Photography of Anterior Segment

Rule: Can be billed In addition to 11001 or 11046 when necessary

94.71

11624

Photography of Fundus

Rule: Can be billed in addition to 11001 or 11046 when necessary

151.60

11702

Pachymetry

Rule: Can be billed in addition to 11001 or 11046 when necessary

132.64

11802

Optical Coherence Tomography (OCT) Health screening

Rule: Can be billed in addition to 11001 or 11046 when necessary

274.81

11803

Optical Coherence Tomography (OCT) Anterior

Rule: Can be billed in addition to 11001 or 11046 when necessary

198.95

11804

Optical Coherence Tomography (OCT) Posterior

Rule: Can be billed in addition to 11001 or 11046 when necessary

236.88

11838

Glaucoma investigation

Relevant in cases of ocular injury

246.42

11906

Lacrimal Drainage System Patency

Rule: Can be billed in addition to 11001 or 11046 in cases such as chemical or vapour exposure

350.55

15000

Removal of non embedded foreign body

Rule: Can be billed in isolation or with 11001 or 11046 or 11061 or 15025 or 15030

227.45

15002

Removal of embedded; non-penetrating foreign body

Rule: Can be billed in isolation or with 11001 or 11046 or 11061 or 15025 or 15030

332.14

15004

Removal of corneal foreign body

Rule: Can be billed In isolation or with 11001 or 11046 or 11061 or 15025 or15030

431.23

15025

Management of ocular pathology

Rule: Cannot be billed with 15030 or 11001 or 11046 or 11061

833.85

15030

Management of ocular pathology - follow up

Rule: Cannot be billed with 15025 or 11001 or 11046 or 11061

596.97

Lens

Code

Code Description

Rand

11501

Dispensing fee - single vision basic

Rule: Only with replacement of spectacle lenses code 81BS001

85.28

11521

Dispensing fee - Bifocals

Rule: Only with replacement of spectacle lenses code 84BS001

113.67

11541

Dispensing fee -Varifocal distance to near

Rule: Only with replacement of spectacle lenses code 86BS001

142.17

11503

Dispensing fee - Single Vision Surfaced

Rule: Only with replacement of spectacle lenses code 82BS001

113.67

11531

Dispensing Fee - Accommodative Support

Rule: only with replacement of spectacle lenses code 83BS001

113.67

11540

Dispensing fee - Intermediate to near

Rule: Only with replacement of spectacle lenses code 85BS001

113.67

Note

For Single vision, Bifocal, Varifocal the below applies

LENS CODES: Replacement lenses after ocular injury if lenses were broken or if treatment changed due to occupational injury/disease incident.

Rule: A claimis limited to a maximum of 2 replacements. Occasionally there may be a combination of 2 different codes, but never a code starting with 8 together with a code starting with 7

81BS001

Single Vision (standard) CR39

237.43

82BS001

Single Vision (surfaced) CR39

534.82

83BS001

Accommodative support lens

534.82

84BS001

Bifocals CR39

597.19

85BS001

Varifocal Intermediate to near

1036.64

86BS001

Varifocal Distance to near

1036.64

71BS001

Single Vision (standard) Glass

237.43

72BS001

Single Vision (surfaced) Glass

534.82

74BS001

Bifocal Glass

597.19

76BS001

Varifocal Distance to Near Glass

1036.64

40501

Spectacle frame

Note: Frame and lens will only be issued if the eye condition is due to occupational injury/disease.

976.69

Note

For Unbranded HRI the below applies:

LENS ENHANCEMENTS CODES:Where lenses are replaced as result of occupational injury/disease, and treatment is greater than

+4.00D (sphere) or -6.00D (sphere + cyl,or cyl is greater than -2.00)

Note: First 2 digits must align with first 2 digits of lens codes

81UB003

Unbranded HRI single vision stock

2699.07

83UB002

Unbranded HRI Accommodative Support

1997.53

86UB006

Unbranded HRI Varifocal Distance/Near

2364.75

Note

Where occupational injury/disease resulted in Low Vision status (normal visual function cannot be achieved with spectacles) one or more low vision devices are appropriate.

61013

LVA - Single Element

2635.00

61114

LVA - Multiple Elements Fixed Focus

2740.40

61215

LVA - Multiple Element Variable focus

15810.00

61318

LVA - Electronic

12648.00

61320

Software aided vision program

1370.20

Ocular Prosthetics

Note

Claims for Ocular Prostheses are for the fitting of a prosthesis after removal of the eye due to injury or pathology, and replacement of the prosthesis at the end of its life, and for the maintenance of the prosthesis in the interim.

Correctly manufactured and maintained prostheses should last approximately 5 years. They should be annually 'serviced' to maintain the surface of the prosthesis and thereby prevent deterioration and / or physiological issues from reducing the lifespan of the prostheses and / or resulting in the need for additional medical or surgical  intervention.

56000

Complete Eye

Note: Where occupational injury/disease has resulted in the enucleation (removal) of the eye. The code covers all aspects of the fitting of a complete prosthesis, including 6 months of after care.

Note: Repeats are allowed without intervention after 60 months.

25064.35

56001

Polishing

429.40

56010

Complete Haptic Shell

Note: Where occupational injury/disease has damaged and blinded the eye, but not necessitated enucleation. The code covers all aspects of the fitting of a complete prosthesis, including 6 months of after care.

Note: Repeats are allowed without intervention after 60 months.

4029.66

59001

Annual Maintenance

Note: Not billable within 6 months of the fitting of code 56000 or 56010 prosthesis.

Code can be billed together with 53015.

2678.69

53015

Prosthetic Consultation

Rule: Billed together with 59001, or where annual visit codes 56000 or 56010 Can be billed but does not necessitate maintenance 59001

841.08

70081

Optometric examination and visual field screening consultation

610.32

70021

Optometric re-examination within six months of 70081 followup

348.81

70503

Walking Stick/Cane for the blind

380.37