V2627 HCPCS code: Scleral cover shell
V2627 is the HCPCS Level II code for scleral cover shell. The 2026 Medicare DMEPOS fee schedule pays $1,258.82 to $2,103.31 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume rose 3% from 2022 to 2024 (2,722 to 2,804 services). In 2024, 182 suppliers billed Medicare for V2627 (purchases), serving 2,054 beneficiaries; California, Massachusetts, Illinois accounted for 40% of services. Its average fee ranks 9 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 | D — Special coverage instructions apply |
| 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 V2627
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,258.82 | $2,103.31 | $2,103.31 | $1,577.48 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,584.61 | — |
| AL | — | $1,753.44 | — |
| AR | — | $1,772.96 | — |
| AZ | — | $1,577.48 | — |
| CA | — | $1,577.48 | — |
| CO | — | $2,049.79 | — |
| CT | — | $1,577.48 | — |
| DC | — | $1,577.48 | — |
| DE | — | $1,577.48 | — |
| FL | — | $1,753.44 | — |
| GA | — | $1,753.44 | — |
| HI | — | $1,694.44 | — |
| IA | — | $1,577.48 | — |
| ID | — | $2,103.31 | — |
| IL | — | $1,751.05 | — |
| IN | — | $1,751.05 | — |
| KS | — | $1,577.48 | — |
| KY | — | $1,753.44 | — |
| LA | — | $1,772.96 | — |
| MA | — | $1,577.48 | — |
| MD | — | $1,577.48 | — |
| ME | — | $1,577.48 | — |
| MI | — | $1,751.05 | — |
| MN | — | $1,751.05 | — |
| MO | — | $1,577.48 | — |
| MS | — | $1,753.44 | — |
| MT | — | $2,049.79 | — |
| NC | — | $1,753.44 | — |
| ND | — | $2,049.79 | — |
| NE | — | $1,577.48 | — |
| NH | — | $1,577.48 | — |
| NJ | — | $1,935.48 | — |
| NM | — | $1,772.96 | — |
| NV | — | $1,577.48 | — |
| NY | — | $1,935.48 | — |
| OH | — | $1,751.05 | — |
| OK | — | $1,772.96 | — |
| OR | — | $2,103.31 | — |
| PA | — | $1,577.48 | — |
| PR | — | $1,258.82 | — |
| RI | — | $1,577.48 | — |
| SC | — | $1,753.44 | — |
| SD | — | $2,049.79 | — |
| TN | — | $1,753.44 | — |
| TX | — | $1,772.96 | — |
| UT | — | $2,049.79 | — |
| VA | — | $1,577.48 | — |
| VI | — | $1,935.48 | — |
| VT | — | $1,577.48 | — |
| WA | — | $2,103.31 | — |
| WI | — | $1,751.05 | — |
| WV | — | $1,577.48 | — |
| WY | — | $2,049.79 | — |
How the V2627 fee compares
| Measure | Value |
|---|---|
| Rank among 9 V26 codes (lowest = 1) | 9 |
| Family fee range (average of state fees) | $82.57–$1,741.96 |
| Rural fee uplift | — |
Who bills V2627 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 182 |
| Referring clinicians | 983 |
| Medicare beneficiaries | 2,054 |
| States with claims | 32 |
| Share of services in top 3 states (California, Massachusetts, Illinois) | 40% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 194 | 2,075 |
| 2023 | 196 | 2,040 |
| 2024 | 182 | 2,054 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for V2627, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,722 | 2,075 | $1,334.08 | $1,041.16 |
| 2023 | 2,706 | 2,040 | $1,430.97 | $1,112.52 |
| 2024 | 2,804 | 2,054 | $1,471.31 | $1,144.98 |
States with the most V2627 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 496 | $1,163.73 |
| Massachusetts | 430 | $1,007.74 |
| Illinois | 175 | $1,223.22 |
| Florida | 136 | $1,262.48 |
| New York | 131 | $1,393.74 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
Medicare policy articles for this code
- A52462: Eye Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52499: Refractive Lenses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (6 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| H27.00 | Aphakia, unspecified eye | 1 |
| H27.01 | Aphakia, right eye | 1 |
| H27.02 | Aphakia, left eye | 1 |
| H27.03 | Aphakia, bilateral | 1 |
| Q12.3 | Congenital aphakia | 1 |
| Z96.1 | Presence of intraocular lens | 1 |
What changed for V2627
- 2026-01-01: Average state fee rose 2.0%: $1,707.80 to $1,741.96
- 1993-01-01: V2627 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 V2627?
V2627 is the HCPCS Level II code for scleral cover shell. Short descriptor: "Scleral cover shell".
How much does Medicare pay for V2627?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,258.82–$2,103.31. Rural fees can be higher.
Does Medicare cover V2627?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for V2627?
Medicare policy articles that cite V2627 list 6 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include H27.00 (Aphakia, unspecified eye), H27.01 (Aphakia, right eye), H27.02 (Aphakia, left eye). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for V2627 change in 2026?
The average non-rural state fee moved from $1,707.80 in 2025 to $1,741.96 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of V2627 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)
- V2626 — Reduction of ocular prosthesis ($222.15–$357.61)
- 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 V2627
- Watch V2627 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for V2627
Sources: CMS HCPCS Level II release October 2025; 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.