Does V2623 require prior authorization?

No, V2623 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for V2623?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`V2623`, Prosthetic eye, plastic, custom

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for items addressed in this policy.
For DMEPOS base items that require a WOPD, the supplier must have received a signed SWO/WOPD before delivering the DMEPOS item to the beneficiary.

Claims must be correctly coded per CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, and DME MAC articles; refer to the LCD-related Standard Documentation Requirements Article and LCD-related Policy Article for additional documentation rules.

Key Coverage Criteria

Eye prosthesis is covered for a beneficiary with absence (anophthalmia) or shrinkage (phthisis) of an eye due to birth defect, trauma, or surgical removal (enucleation/evisceration).
Polishing and resurfacing of an ocular prosthesis (HCPCS V2624) is covered up to twice per calendar year.
One enlargement (HCPCS V2625) or one reduction (HCPCS V2626) of an ocular prosthesis is covered without additional documentation.
Covered items must be within a defined Medicare benefit category and be reasonable and necessary for diagnosis/treatment or to improve functioning of a malformed body member per Social Security Act §1862(a)(1)(A).
Facial prosthesis is covered when there is loss or absence of facial tissue due to disease, trauma, surgery, or a congenital defect.
Any item is covered only if it is in a defined Medicare benefit category and is reasonable and necessary for diagnosis or treatment of illness or injury or to improve functioning of a malformed body member.

6 Active Policies

HUMANA-PROSTHETICS-OK-MEDICAID, Prosthetics

HUMANA-PROSTHETICS-KY-MEDICAID, Prosthetics

L33737, Eye Prostheses

L33738, Facial Prostheses

AETNA-CPB-0619, Eye Prosthesis

AETNA-CPB-0620, Facial Prostheses, External

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V2623, Prosthetic eye, plastic, custom