Eye Prostheses - Policy Article

Eye prostheses are covered under the Medicare artificial limbs/eyes benefit when determined reasonable and necessary per the applicable LCD and when statutory payment rules are met; many associated services (evaluation, fabrication, materials, and routine modifications/repairs/follow-ups within 90 days) are included in the device allowance and are not separately billable. PROSE devices are payable as V2627 (scleral cover shell) only for two specific indications (sightless/shrunken eye from inflammatory disease or dry eye when substituting lacrimal gland function) and must meet face-to-face and WOPD requirements for specified HCPCS codes per Final Rule 1713; other uses of PROSE should be coded V2531 and may be excluded under the refractive lens statutory exclusion.

"Eye prostheses are covered under the Medicare Artificial Legs, Arms and Eyes benefit (Social Security Act §1861(s)(9)) when the item meets the Local Coverage Determination reasonable and necessary ..."