Better health and ageing for all Australians

MBS Primary Care Items

Claiming a Medicare Rebate

Medicare provides support to all Australians for a wide range of health services, including optometry services.

In this section:

Eligible Patients

Medicare provides support to all Australians for a wide range of health services, including optometry services. All Australian residents and certain categories of visitors to Australia can claim Medicare benefits for services by participating optometrists (optometrists who have signed an agreement to participate in arrangements with the Commonwealth Government). The Health Insurance Act 1973 establishes Medicare and contains legislation covering the major elements of the Medicare program. To be eligible for a Medicare rebate, a patient must not be an admitted public patient of a hospital.

Referral Arrangements

A General Practitioner (GP) referral is not required for a patient to make an appointment to see an optometrist (with the exception of the arrangement with the Better Start for Children with Disability initiative and Helping Children with Autism program). However, to register as an optometrist in Australia, applicants must meet certain requirements as detailed by the Optometry Board of Australia.

The Optometry Medicare Benefits Schedule

Information about the Optometry Medicare Benefits Schedule (OMBS) items includes the service length, type, minimum requirements, fees and explanatory notes. This information is located online at MBS Online under ‘Downloads’.

Optometry Items

Click on the item numbers below to view the current MBS descriptions and explanatory notes.

Claiming a Medicare Rebate

When visiting an optometrist, there are a variety of ways this service can be paid for:
  • a patient may have no out of pocket costs associated with the optometry service if the services are provided by an optometrist participating in Medicare and they are bulk billed. In this case, the optometrist will be paid for their services through Medicare;
  • a patient may be charged the Medicare fee and then can claim the Medicare rebate from Medicare Australia; and
  • a patient may be privately billed for the optometry service if the optometrist is not a participating optometrist or the service provided is not part of the optometric MBS.
In order for a patient to be able to claim a Medicare rebate, all of the following information must be included on an itemised account/receipt from the optometrist:
  • patient’s name;
  • date of service;
  • MBS item number;
  • name and provider number (or practice address) of the optometrist; and
  • amount charged, total amount paid, and any amount outstanding in relation to the service.
Patients can take the receipt to a Medicare Australia Office or lodge a claim online through Medicare Easyclaim. As well as the Medicare rebate, any additional out-of-pocket costs incurred by the patient with respect to the optometry service count toward the Medicare safety net.

Limitations on Claiming a Rebate

Medicare only pays benefits for services provided by ‘participating’ optometrists who have signed a Common Form of Undertaking for Participating Optometrists with the Australian Government in which they agree to several servicing arrangements, including an agreement to not charge more than the MBS fee for services covered by Medicare (see section 6.1 of the Undertaking). The two exceptions are for item 10907 (comprehensive initial consultation within 24 months of a previous comprehensive initial consultation by another optometrist) and for domiciliary visits.

‘Participating’ optometrists also agree that charges for appliances shall not include any amount related to consultation procedures for which benefits are payable.