Eye Prosthesis

Aetna covers ocular prostheses for absence or shrinkage of an eye from trauma, surgical removal, or congenital defect (including twice-yearly polishing/resurfacing) but trial scleral cover shells are not separately payable and HCPCS V2627 is not covered for these indications. Replacements are allowed every 5 years (sooner only with supporting documentation), only one enlargement/reduction is considered medically necessary (additional changes rarely), and CPT 92002–92014 are covered only if selection criteria are met.

"HCPCS code V2627 (Scleral cover shells) is not covered for indications listed in the CPB."

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