For Health Care Practitioners

What is considered medically necessary?

A medically necessary visit to an optometrist includes:

• Monitoring for diabetes and glaucoma issues

• Retinal detachment, defects and diseases

• Pre and Post-operative care for cataract patients

• Eye infections or injuries

• Inflammation of the eyelid

• Foreign objects in your eye

• Sudden changes in vision

Alberta Health and Wellness’ expansion of the coverage for medically necessary optometry services to include all Albertans creates more options for both the patients and health care providers.

Health care providers can now advise patients to see an optometrist without worrying about the out-of-pocket costs to the patient.  This allows the patients to take more control of their eye health, address eye injuries, illnesses and diseases quickly.

It will also make it easier for health care providers to maximize their time and resources, alleviating emergency room stress and waiting time for specialists.  Optometrists can play an important role in the ongoing care of these chronic conditions, allowing for increased collaboration between health care providers.

Physicians and other health care providers can refer patients to an Optometrist if they feel their condition is warranted.  A list of examples of conditions and services that fall under the Medically Necessary category (with ICD-9 codes in brackets) is available in the resources below.

This team approach benefits everyone – enhancing prevention, supporting early detection and providing effective treatment for eye health conditions.