Medically Necessary Conditions

Optometrists can play an increased role in the ongoing care of a patient’s eye health allowing for increased collaboration between health care providers.  

Health care providers can now advise patients to see an optometrist without worrying about out-of-pocket costs to the patients. 

Medically Necessary visits are covered by Alberta Health Care for all patients, regardless of age.   Examples of conditions and services that fall under this category (with the ICD-9 code in brackets) are:  

  • Cataract (366)
  • Chorioretinal Inflammations and Scars (363)
  • Conjuctival Disorders (includes all types of conjunctivitis) (372)
  • Corneal Opacity and Other Disorders of the Cornea (371)
  • Diabetes Mellitus (250)
  • Disorders of the Globe (360)
  • Disorders of the Iris and Ciliary Body (This includes all uveitis) (364)
  • Disorders of the Optic Nerve & Visual Pathways (377)
  • Disorder of the Orbit (376)
  • Foreign Body on External Eye (930)
  • Glaucoma (365)
  • Inflammation of the Eyelids (373)
  • Keratitis (370)
  • Lacrimal System Disorders (375)
  • Open Wound of Ocular Adnexa (870)
  • Open Wound of the Eyeball (871)
  • Other Disorders of the Eye (379.1 to 379.4)
  • Other Eyelid Disorders (374)
  • Other Retinal Disorder (362)
  • Retinal Detachments and Defects (361)
  • Superficial Injury of the Eye and Adnexa (918)
  • Visual Disturbances (368.2 to 368.4, 368.8)
  • Vitreal Disorders (379.2)