V2627 Scleral Cover Shell HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS V2627: Scleral Cover Shell

HCPCS Level II code V2627 identifies a scleral cover shell — a specialized prosthetic ocular device designed to cover the sclera for cosmetic restoration, protection of the ocular surface, or to support healing in complex surface disease. Nationally, this code is relevant for ophthalmology practices, ocularists, and durable medical equipment suppliers that manage patients with severe ocular surface disorders or post-surgical needs. Coverage and billing for V2627 affect access to prosthetic eye care and can influence care pathways for patients with disfiguring or functionally limiting ocular conditions.

Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code meaning, typical clinical uses, and where the device is commonly provided. The publication also highlights benchmarking and coverage patterns, recent policy considerations affecting durable medical devices and prosthetics, and clinical context that clarifies appropriate use cases for the scleral cover shell.

This piece is intended to inform billing professionals, provider administrators, and clinical leads about the role of V2627 in treatment pathways, payer coverage considerations, and the operational settings where the device is most often supplied. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareV2627HCPCS Level IIscleral cover shellocular prostheticsophthalmologydurable medical equipmentprosthetic deviceoutpatient specialty caremedical billingcoverage policy

Billing Code Overview

HCPCS Level II code V2627 denotes a scleral cover shell, a prosthetic ocular device used to cover and protect the scleral surface of the eye. This item is typically fabricated to fit over the sclera and can be used to address cosmetic concerns, protect compromised ocular surfaces, or support healing in severe ocular surface disease.

Service Type: Prosthetic ocular device

Typical Site of Service: Ophthalmology clinics, ocular prosthetics laboratories, or outpatient specialty clinics

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with severe irregular globe contour following ocular trauma, scleral thinning, enophthalmos after orbital fracture repair, or a disfiguring scleral defect from surgical resection. The ophthalmologist or oculoplastic surgeon evaluates the patient in an outpatient specialty clinic. Examination includes visual acuity, slit-lamp exam, assessment of ocular motility, and external scleral and orbital inspection. When a prosthetic alternative to an ocular prosthesis is indicated to provide cosmesis and globe protection without restoring vision, a custom or prefabricated V2627 scleral cover shell is ordered from an ocular prosthetics lab. The workflow includes measurement and impression, selection of material and tinting to match the contralateral eye, fitting in the clinic, adjustments for comfort and motility, and patient education on insertion, removal, and cleaning. Follow-up visits assess fit, surface integrity, and periocular health; revisions or replacement are scheduled as needed. Typical site of service is an ophthalmology or oculoplastic outpatient clinic or an ocular prosthetics laboratory visit coordinated with the clinic.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician's professional interpretation or fitting component provided separately from the device fabrication.

HCPCS V2500: Contact Lens, PMMA, Spherical, Per Lens

HCPCS-V2221-LENTICULAR-BIFOCAL-LENS

HCPCS V2221: Lenticular Lens, Bifocal

HCPCS-V2109-HIGH-POWER-SPHEROCYLINDER-SINGLE-VISION-LENS

HCPCS V2109: High-Power Spherocylinder Single-Vision Lens

HCPCS-V2101-SINGLE-VISION-SPHERICAL-LENS-HIGH-POWER

HCPCS V2101: Single-Vision Spherical Lens, High Power

HCPCS-V2624-OCULAR-PROSTHESIS-POLISHING-RESURFACING

HCPCS V2624: Polishing/Resurfacing of Ocular Prosthesis

HCPCS-V2121-LENTICULAR-LENS-SINGLE-IMPLANTABLE-OPHTHALMIC-DEVICE

HCPCS V2121: Lenticular Lens, Per Lens, Single

HCPCS-V2207-SPHEROCYLINDER-BIFOCAL-LENS

HCPCS V2207: Spherocylinder Bifocal Lens, Specific Diopter Range

HCPCS-V2305-TRIFOCAL-SPHEROCYLINDER-LENS

HCPCS V2305: Spherocylinder Trifocal Ophthalmic Lens, Per Lens

HCPCS-V2520-HYDROPHILIC-SPHERICAL-CONTACT-LENS-PER-LENS

HCPCS V2520: Hydrophilic Spherical Contact Lens, Per Lens

HCPCS-V2788-PRESBYOPIA-CORRECTING-INTRAOCULAR-LENS

HCPCS V2788: Presbyopia-Correcting Intraocular Lens

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Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Primary specialty performing evaluation, fitting, and follow-up for scleral cover shells.
206E00000X	Oculoplastics (Ophthalmic Plastic and Reconstructive Surgery)	Subspecialty managing complex orbital/scleral defects and surgical reconstruction alongside prosthetic fitting.
163WX0000X	Optometry	Optometrists may perform initial assessments, referrals, and routine follow-up in some jurisdictions; fitting limited by scope of practice.
334600000X	Orthoptist / Ocularist	Ocularists (prosthetic specialists) fabricate and custom color/tint scleral cover shells and coordinate with clinicians.
363L00000X	Physical Medicine & Rehabilitation	Occasionally involved when prosthetic use is part of broader facial rehabilitation and prosthetic coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H02.233`	Paralytic ectropion, bilateral	Ectropion with scleral exposure can require a scleral cover shell to improve cosmesis and protect the ocular surface.
`H02.233`	Paralytic ectropion, bilateral	Duplicate entry not allowed — see other common codes below.
`H02.103`	Unspecified entropion of unspecified eyelid	Entropion-related corneal surface irregularity may lead to use of protective shells when surgery is not feasible.
`H18.89`	Other corneal disorders	Corneal surface irregularities and scarring can be managed symptomatically with scleral shells to improve comfort and vision in select cases.
`S05.89XA`	Other injury of eye and orbit, initial encounter	Traumatic globe contour deformities and scleral defects after injury may be addressed with a scleral cover shell for protection and cosmesis.
`H44.9`	Disorder of globe, unspecified	General globe disorders that cause deformity or exposure may use a scleral cover shell as a noninvasive prosthetic alternative.
`Q11.0`	Congenital malformation of eyelid	Congenital scleral or eyelid anomalies causing exposure or disfigurement can be managed with prosthetic shells in some patients.
`Z98.890`	Other specified postprocedural states	Postoperative defects or reconstructions resulting in scleral irregularities may be managed with a scleral shell.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67850`	Fitting and supply of ocular prosthetic (orbital) shell; initial	Performed when a custom or prefabricated ocular/scleral prosthetic is fitted; may precede or accompany `V2627` billing for the device.
`92499`	Unlisted ophthalmological service or procedure	Used when a specific fitting or custom fabrication service related to the scleral cover shell does not have a dedicated CPT code.
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit	Billed for miscellaneous supplies or special materials used during fitting or adjustment of the scleral cover shell.
`99072`	Additional supplies, materials, and clinical staff time over and above those usually included	Use for enhanced infection control or extended clinic resources used during fitting visits (site-dependent billing policies).
`92340`	Prescription of optical and physical characteristics of ocular prosthetic shell; external ocular prosthesis	Documentation code for prescription and specifications sent to ocularist for fabrication of `V2627`.

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