Scleral Shell

This policy covers scleral shells (scleral contact lenses/prosthetic scleral shells) and associated services for patients with anophthalmia/microphthalmia, craniofacial anomalies, eyes rendered sightless or shrunken by disease, trauma, or surgery, and for severe dry eye when used in combination with artificial tears, including pediatric use. Coverage is limited to medically necessary services to improve functional impairment, is subject to member benefit plan terms and frequency limits (e.g., scleral lenses annually; hearing aids/molds for craniofacial patients every two years), and plan/contract exclusions, caps, or ASO status govern benefit determinations.

"Reconstructive surgery and related medical care for any age diagnosed with a craniofacial anomaly when medically necessary to improve a functional impairment resulting from the anomaly"

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