Summary & Overview

HCPCS Level II V2629: Prosthetic Eye, Other Type

HCPCS Level II code V2629 designates a prosthetic eye (other type), covering the supply and fitting of ocular prostheses used to replace an absent or removed eye. This code is relevant for ophthalmology practices, ocularists, prosthetics suppliers, and payers because it captures durable medical device and prosthetic provisioning outside of standard intraocular procedures. Nationally, accurate use of V2629 supports appropriate device reimbursement, claims adjudication, and inventory and quality tracking for ocular prostheses.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of coverage considerations, typical sites of service, and common billing practice context. The publication summarizes benchmark topics such as prevailing payer coverage patterns, claim submission elements, and coding nuances that affect payment and documentation workflows. It also situates V2629 within clinical care pathways for patients requiring ocular replacement, noting the intersection of prosthetic supply, fitting visits, and follow-up ocularist services.

What readers will learn: how V2629 is used to represent prosthetic eye services, the payer landscape for national plans, practical billing and documentation themes, and areas where policy or administrative attention commonly arises. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareV2629HCPCS Level IIprosthetic eyeocular prosthesisprosthetics billingophthalmologydurable medical equipmentmedical coding

Billing Code Overview

HCPCS Level II code V2629 denotes a prosthetic eye, other type. This code represents provision of a custom or prefabricated ocular prosthesis used to replace a natural eye lost to trauma, disease, or congenital absence. The service type is prosthetic device supply and fitting, and the typical site of service is outpatient prosthetics/ocularist clinics, ophthalmology offices, or specialty prosthetics facilities.

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Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a history of trauma to the orbit following a motor vehicle collision presents to an ocular prosthetics clinic for fitting of a custom prosthetic eye. The patient underwent enucleation of the right globe several weeks prior and after healing and orbital socket assessment, is scheduled for delivery and fitting of a prosthetic ocular conformer and definitive prosthetic eye. The clinical workflow includes a pre-fitting socket evaluation by an ocularist and ophthalmologist, measurement and impression of the anophthalmic socket, trial fitting and adjustments, polishing and customization of the prosthesis to match the fellow eye, and final delivery with patient education on insertion, removal, cleaning, and follow-up care.

The typical site of service for V2629 is an outpatient ophthalmology clinic, ocular prosthetics laboratory, or ambulatory surgery center when combined with other procedures. The service applies to fabrication and delivery of an external prosthetic eye (other type) supplied to an individual patient.

Coding Specifications

Modifier	Description	When to Use
`00`	(Default) No modifier	Use when no special circumstances apply.
`22`	Increased procedural services	Use when work required to fabricate or fit the prosthesis is substantially greater than typical.
`26`	Professional component	Use when billing only the professional component (interpretation, fitting) separate from the device supply.
`52`	Reduced services	Use when services provided are less than the full procedure (partial fitting or limited customization).
`53`	Discontinued procedure	Use if the fitting or fabrication is discontinued due to patient safety or medical complications.
`54`	Surgical care only	Use when a surgeon provides only the operative portion; applicable if paired with separate prosthesis supply billing.
`55`	Postoperative management only	Use when billing only for follow-up care related to the prosthesis after the primary service was billed by another provider.
`62`	Two surgeons	Use when two surgeons with different specialties collaborate on operative reconstruction of the orbit prior to prosthesis fitting.
`80`	Assistant surgeon	Use when an assistant surgeon participates in surgical preparation of the socket before prosthetic placement.
`82`	Assistant surgeon (when qualified resident unavailable)	Use when a qualified resident is unavailable and an assistant surgeon is documented.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when a PA/NP/CNS provides part of the fitting or follow-up services under appropriate supervision.
`NU`	New equipment/new item	Use to indicate supply of a new prosthetic device as opposed to a replacement or repair.
`QK`	Medical direction of two or three qualified individuals	Use when the billing physician medically directs multiple allied health professionals during prosthetic care.

Taxonomy Code	Specialty	Notes
`252S00000X`	Ocular Prosthetist / Ocularist	Primary clinician for fabrication, impression, and customization of prosthetic eyes.
`207W00000X`	Ophthalmology	Ophthalmologists evaluate the socket, perform enucleation/orbital surgery, and manage medical issues related to prosthesis.
`363L00000X`	Orthoptist / Ocular Technician	Assists with measurements, trials, and patient education; supportive clinical role.
`163W00000X`	Physician Assistant (Ophthalmology)	Provides peri-procedural care, fittings, and follow-up under supervising ophthalmologist.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H44.2`	Phthisis bulbi	Small, non-functional eye commonly leading to prosthetic eye placement after end-stage disease.
`H59.8`	Other intraocular and textural complications, not elsewhere classified	May reflect complications leading to loss of an eye and need for prosthesis.
`S05.1`	Injury of eyeball and orbital tissues	Traumatic injuries often result in enucleation or evisceration followed by prosthetic rehabilitation.
`H44.3`	Enucleation of eye (history) — note: use history code when applicable	Indicates prior enucleation; relevant to fitting and customization of prosthetic eye.
`Z98.89`	Other specified postprocedural states	Used to indicate prior orbital/ocular surgeries that necessitate prosthetic rehabilitation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92310`	Fitting of prosthetic device or scleral lens for prosthetic use; includes measurement, fabrication of impression and fitting	Commonly used for the fitting and measurement components prior to prosthetic eye delivery; often performed by ocularists.
`92311`	Fitting of prosthetic device; includes construction and insertion of final device	Used for final insertion and adjustment of a custom prosthetic ocular device; complements `V2629` supply billing.
`92002`	Ophthalmological services: new patient; intermediate, e.g., one or more diagnostic services	May be used for initial evaluation of the anophthalmic socket prior to impression and prosthesis fitting.
`99070`	Supplies and materials (except spectacles) provided by the physician over and above those usually included	Used when additional non-routine supplies or materials are provided during fabrication or fitting in conjunction with `V2629`.
`99000`	Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory	Occasionally used if impressions or laboratory specimens are transported to an external ocular prosthetics lab.