What are the Medicare guidelines for prostheses?
HCPCS CODE: BENEFIT CATEGORY: Ocular Prosthetic Device V2623 – PROSTHETIC EYE, PLASTIC CUSTOM AFTER REMOVAL: An order for the initial eye prosthesis which is signed and dated by the ordering physician must be kept on file by the supplier. The physician’s records must contain information which supports the medical necessity of the item ordered. The ocularist’s documentation of the necessity for a replacement prosthesis is appropriate documentation for that claim if the replacement is necessitated by other than medical reasons such as an accidental loss. REPLACEMENT PROSTHESES: Replacement eye prostheses are covered every five (5) years with exceptions allowed when documentation supports medical necessity for more frequent replacement. V2624 – POLISHING/RESURFACING OF OCULAR PROSTHESIS: Polishing and resurfacing (V2624) is covered on a bi-yearly basis. If the patient requires more frequent polishing, the expense will be the responsibility of the patient. V2625 – ENLARGEMENT OF OCULAR PRO
