Scleral Shell

Scleral shells are covered when they function as prosthetic devices — specifically for eyes rendered sightless and shrunken by inflammatory disease where they act as artificial eyes, and in rare cases as a prosthetic substitute for lacrimal gland failure in severe dry eye. Coverage is limited to prosthetic use under §1861(s)(8) and is not described for routine vision correction or cosmetic purposes; clinical documentation demonstrating the prosthetic role is required.

"Coverage allowed when an eye has been rendered sightless and shrunken by inflammatory disease and the scleral shell serves essentially as an artificial eye, potentially obviating enucleation or pro..."

Sign up to see full coverage criteria, indications, and limitations.