Summary & Overview
HCPCS V2623: Prosthetic Eye, Plastic, Custom
HCPCS Level II code V2623 represents a custom plastic prosthetic eye used for cosmetic restoration after loss of an eye. This code matters nationally as prosthetic ocular rehabilitation affects quality of life, drives durable medical device coverage decisions, and intersects with specialty outpatient care and ocularist services. Coverage and billing practices for custom ocular prostheses influence patient access and out-of-pocket costs across public and commercial plans.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose of the code, common sites of service, and payer coverage context. The publication also summarizes typical billing considerations, common modifiers used with durable medical device and outpatient prosthetic services, and related administrative issues that affect claims processing. Where available, benchmarks and policy updates about prosthetic device coverage are highlighted to inform billing and compliance workflows. Clinical context explains the role of custom prosthetic eyes in rehabilitation after enucleation or severe ocular injury. Data not available in the input.
Billing Code Overview
HCPCS Level II code V2623 describes a prosthetic eye, plastic, custom. This service involves fabrication and fitting of a custom, patient-specific ocular prosthesis made from plastic materials to replace a missing eye for cosmetic restoration and facial symmetry. The service type is prosthetic device provision and fitting. The typical site of service for this code is an outpatient specialty clinic or ocular prosthetics/prosthetist office, often involving collaboration between ocularists and ophthalmology or prosthetics services.
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Clinical & Coding Specifications
Clinical Context
A patient who has undergone enucleation or evisceration secondary to trauma, chronic infection, painful blind eye, or ocular malignancy presents to an ocularist or ophthalmology clinic for fabrication and fitting of a custom, implantable-appearing prosthetic eye. The clinical workflow begins with a consult visit where history, prior operative reports, and external orbital anatomy are reviewed. Measurements and molds of the anophthalmic socket are obtained; high-resolution impressions or digital scans may be used to capture eyelid contours, fornices, and conjunctival cuff. Color matching and iris/pupil positioning are coordinated with the patient for a custom-painted ocular prosthesis. A trial scleral conformer or shell may be used to check motility and lid interactions. Final delivery includes insertion, adjustment, patient education on removal and cleaning, and documentation of patient tolerance and cosmetic outcome. Follow-up visits assess socket health, lubrication needs, and any required polishing or refitting of the prosthesis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the prosthetic is for the left ocular socket |
RT | Right side |