MyMedi-AI

V2625 — Enlargement of ocular prosthesis

HCPCS Level II V-code · short descriptor: “Enlargemnt of eye prosthesis”

Code system
HCPCS Level II
Family
V — Vision & hearing services
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Prosthetics & orthotics
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

V2625 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $370.98 to $604.16 depending on state and rural status.

Former-CBA payment limits: ceiling $604.16 · floor $453.12

StateNon-ruralRural
AK$525.62—
AL$482.76—
AR$469.62—
AZ$528.40—
CA$528.40—
CO$597.47—
CT$453.12—
DC$453.12—
DE$453.12—
FL$482.76—
GA$482.76—
HI$562.04—
IA$604.16—
ID$604.16—
IL$590.24—
IN$590.24—
KS$604.16—
KY$482.76—
LA$469.62—
MA$453.12—
MD$453.12—
ME$453.12—
MI$590.24—
MN$590.24—
MO$604.16—
MS$482.76—
MT$597.47—
NC$482.76—
ND$597.47—
NE$604.16—
NH$453.12—
NJ$453.12—
NM$469.62—
NV$528.40—
NY$453.12—
OH$590.24—
OK$469.62—
OR$604.16—
PA$453.12—
PR$370.98—
RI$453.12—
SC$482.76—
SD$597.47—
TN$482.76—
TX$469.62—
UT$597.47—
VA$453.12—
VI$453.12—
VT$453.12—
WA$604.16—
WI$590.24—
WV$453.12—
WY$597.47—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps V2625 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related V-codes

Bill V2625 with confidence

Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, V2625 included, and starter credits via POST /bot-marketplace/register.