V2626 HCPCS code: Reduction of ocular prosthesis
V2626 is the HCPCS Level II code for reduction of ocular prosthesis. The 2026 Medicare DMEPOS fee schedule pays $222.15 to $357.61 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 6% from 2022 to 2024 (1,123 to 1,054 services). In 2024, 86 suppliers billed Medicare for V2626 (purchases), serving 889 beneficiaries; California, Florida, Georgia accounted for 69% of services. Its average fee ranks 5 of 9 V26 codes (family range $82.57–$1,741.96).
Code details
| Field | Value |
|---|---|
| Section | V codes — Vision, hearing and speech-language pathology services |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1993-01-01 |
| Last action effective | 2003-10-01 |
2026 Medicare DMEPOS fee schedule for V2626
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $222.15 | $357.61 | $325.67 | $244.25 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $334.41 | — |
| AL | — | $306.28 | — |
| AR | — | $325.67 | — |
| AZ | — | $325.67 | — |
| CA | — | $325.67 | — |
| CO | — | $244.25 | — |
| CT | — | $244.25 | — |
| DC | — | $244.25 | — |
| DE | — | $244.25 | — |
| FL | — | $306.28 | — |
| GA | — | $306.28 | — |
| HI | — | $357.61 | — |
| IA | — | $325.67 | — |
| ID | — | $325.67 | — |
| IL | — | $244.25 | — |
| IN | — | $244.25 | — |
| KS | — | $325.67 | — |
| KY | — | $306.28 | — |
| LA | — | $325.67 | — |
| MA | — | $244.25 | — |
| MD | — | $244.25 | — |
| ME | — | $244.25 | — |
| MI | — | $244.25 | — |
| MN | — | $244.25 | — |
| MO | — | $325.67 | — |
| MS | — | $306.28 | — |
| MT | — | $244.25 | — |
| NC | — | $306.28 | — |
| ND | — | $244.25 | — |
| NE | — | $325.67 | — |
| NH | — | $244.25 | — |
| NJ | — | $244.25 | — |
| NM | — | $325.67 | — |
| NV | — | $325.67 | — |
| NY | — | $244.25 | — |
| OH | — | $244.25 | — |
| OK | — | $325.67 | — |
| OR | — | $325.67 | — |
| PA | — | $244.25 | — |
| PR | — | $222.15 | — |
| RI | — | $244.25 | — |
| SC | — | $306.28 | — |
| SD | — | $244.25 | — |
| TN | — | $306.28 | — |
| TX | — | $325.67 | — |
| UT | — | $244.25 | — |
| VA | — | $244.25 | — |
| VI | — | $244.25 | — |
| VT | — | $244.25 | — |
| WA | — | $325.67 | — |
| WI | — | $244.25 | — |
| WV | — | $244.25 | — |
| WY | — | $244.25 | — |
How the V2626 fee compares
| Measure | Value |
|---|---|
| Rank among 9 V26 codes (lowest = 1) | 5 |
| Family fee range (average of state fees) | $82.57–$1,741.96 |
| Rural fee uplift | — |
Who bills V2626 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 86 |
| Referring clinicians | 701 |
| Medicare beneficiaries | 889 |
| States with claims | 14 |
| Share of services in top 3 states (California, Florida, Georgia) | 69% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 103 | 975 |
| 2023 | 90 | 880 |
| 2024 | 86 | 889 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for V2626, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,123 | 975 | $260.39 | $191.35 |
| 2023 | 1,037 | 880 | $280.86 | $207.09 |
| 2024 | 1,054 | 889 | $287.85 | $213.94 |
States with the most V2626 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 275 | $227.57 |
| Florida | 235 | $213.15 |
| Georgia | 125 | $221.11 |
| Arkansas | 52 | $237.93 |
| Illinois | 46 | $175.35 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
What changed for V2626
- 2026-01-01: Average state fee rose 2.0%: $274.59 to $280.08
- 1993-01-01: V2626 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code V2626?
V2626 is the HCPCS Level II code for reduction of ocular prosthesis. Short descriptor: "Reduction of eye prosthesis".
How much does Medicare pay for V2626?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $222.15–$357.61. Rural fees can be higher.
Does Medicare cover V2626?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for V2626 change in 2026?
The average non-rural state fee moved from $274.59 in 2025 to $280.08 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of V2626 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related V26 codes
- V2600 — Hand held low vision aids and other nonspectacle mounted aids
- V2610 — Single lens spectacle mounted low vision aids
- V2615 — Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system
- V2623 — Prosthetic eye, plastic, custom ($904.18–$1,984.14)
- V2624 — Polishing/resurfacing of ocular prosthesis ($44.45–$99.38)
- V2625 — Enlargement of ocular prosthesis ($370.98–$604.16)
- V2627 — Scleral cover shell ($1,258.82–$2,103.31)
- V2628 — Fabrication and fitting of ocular conformer ($351.50–$962.64)
- V2629 — Prosthetic eye, other type
- V2630 — Anterior chamber intraocular lens ($145.73–$145.73)
- V2631 — Iris supported intraocular lens ($145.73–$145.73)
- V2632 — Posterior chamber intraocular lens ($145.73–$145.73)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under V2626
- Watch V2626 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for V2626
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.