HCPCS V2628: Fabrication and Fitting of Ocular Conformer

HCPCS Level II code V2628 denotes the fabrication and fitting of an ocular conformer, a prosthetic device used to preserve orbital structure and protect the ocular surface after eye removal or severe ocular injury. Nationally, services tied to V2628 are important for post-enucleation care, cosmesis, and prevention of socket contracture, affecting outcomes in ocular rehabilitation and reconstructive care. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what V2628 covers clinically, typical sites of service, and the payer landscape addressed in the publication. The report summarizes available benchmarks where present, highlights policy and coverage considerations relevant to ocular prosthetic services, and provides clinical context for when fabrication and fitting of an ocular conformer is performed. If specific payer policies, coding edits, or utilization benchmarks are not provided in the input, those fields are noted as not available. The content is presented to support billing, administrative planning, and stakeholder understanding of prosthetic ocular services at a national level.

Billing Code Overview

HCPCS Level II code V2628 represents the fabrication and fitting of an ocular conformer, a custom prosthetic device used to maintain orbital volume, support eyelid anatomy, and protect the ocular surface following enucleation, evisceration, or in severe ocular surface disease. The service type is prosthetic/device fabrication and fitting. The typical site of service is an outpatient ocular prosthetics or ophthalmology clinic, or a specialized prosthetics lab within an ambulatory surgical center or hospital outpatient department.

Data not available in the input.

Clinical Context

An adult patient presents after orbital exenteration (surgical removal of the globe and surrounding orbital contents) due to malignancy or severe trauma. After the operative site has healed and inflammation subsided, the ocularist is consulted to fabricate and fit an ocular conformer to maintain the fornices, support eyelid position, and preserve socket shape in preparation for future prosthetic eye placement or continued socket management. The clinical workflow includes: initial socket assessment by an oculoplastic surgeon or ocularist; measurement and impression of the anophthalmic socket; fabrication of a custom ocular conformer in the laboratory; in‑office fitting and adjustment for comfort and retention; patient education on insertion, removal, and cleaning; and scheduled follow‑up visits to monitor healing and plan definitive prosthesis placement. Typical sites of service include outpatient ophthalmology clinics, ocular prosthetics laboratories, ambulatory surgical centers for related procedures, and specialty ocularist offices.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	Use when the conformer is for the left orbit
`RT`	Right side

Taxonomy Code	Specialty	Notes
`252W00000X`	Ocularist / Ocular Prosthetics	Specialist who fabricates and fits ocular conformers and prostheses
`207P00000X`	Ophthalmology	Oculoplastic surgeons perform socket assessment and surgical management
`207L00000X`	Optometry	May participate in post‑operative ocular surface management and prosthetic coordination
`363A00000X`	Anaplastologist	May assist with custom prosthetic design and complex aesthetic considerations

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H02.3`	Excision of lesion of eyelid	Socket changes after surgical procedures may necessitate conformer use to maintain anatomy
`C69.9`	Malignant neoplasm of eye, unspecified	Orbital exenteration for ocular malignancy often requires interim conformer management
`S05.89`	Other injury of eyeball and orbital tissues	Traumatic loss of the globe with resultant anophthalmic socket managed with conformer
`H16.23`	Exposure keratoconjunctivitis, bilateral	Severe surface disease leading to globe loss or need for socket shaping may involve conformer use
`T85.898`	Other complications of internal prosthetic devices, implants and grafts	Complications after orbital implants or prostheses that require conformer fitting during revision

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`21210`	Reconstruction, mandible or maxilla; for prosthetic rehabilitation (this code is illustrative of prosthetic‑related reconstruction)	Occasionally used in complex maxillofacial cases where orbital reconstruction interfaces with prosthetic planning (not specific to ocular conformers)
`67950`	Repair of eyelid laceration, extensive or complicated	Performed before or at time of socket surgery when eyelid repair is required to achieve adequate retention of a conformer
`68320`	Insertion of prosthesis, orbital (e.g., ocular prosthesis)	Represents later definitive prosthesis insertion after conformer use and socket maturation
`92399`	Unlisted ophthalmological service or procedure	Used for ocular prosthetic services not otherwise classified when specific CPT is unavailable for custom conformer fabrication

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Summary & Overview