V2623 - PROSTHETIC EYE, PLASTIC CUSTOM AFTER
An order for the initial eye
prosthesis which is signed and dated by the ordering physician
must be kept on file by the supplier. The physician's records
must contain information which supports the medical necessity of
the item ordered. The ocularist's documentation of the necessity
for a replacement prosthesis is appropriate documentation for
that claim if the replacement is necessitated by other than
medical reasons such as an accidental
Replacement eye prostheses are
covered every five (5) years with exceptions allowed when
documentation supports medical necessity for more frequent
V2624 - POLISHING/RESURFACING OF OCULAR
Polishing and resurfacing
is covered on a yearly basis. However, a recent change in region
"D" which includes San Diego county now allows polishing every
six months. If the patient requires more
frequent polishing, the expense will be the responsibility
of the patient.
V2625 - ENLARGEMENT OF OCULAR PROSTHESIS
V2626 - REDUCTION OF OCULAR PROSTHESIS
One enlargement (V2625)
reduction (V2626) of the prosthesis within five years of
the fitting date is covered without documentation.
Additional enlargements or
reductions are rarely medically necessary and are therefore
covered only when accompanied by documentation which supports
V2627 - SCLERAL COVER SHELL OVER SHRUNKEN
An eye prosthesis is covered for
a patient with absence or shrinkage of an eye due to birth
defect, trauma or surgical removal.
V2628 - FABRICATION AND
FITTING OF OCULAR CONFORMER
Custom conformers request by a physician
with a prescription are covered by Medicare under (V2628)
V2629 - PROSTHETIC EYE, OTHER TYPE
This code will be used for other ocular
prosthetic devices not covered by (V2623) through (V2628).
All claims under this code must be by report and requested by a physician.