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
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
V2625 Medicare fee schedule (April 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
| State | Non-rural | Rural |
|---|---|---|
| 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 April 2026.
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.
Common denial codes to watch
Related V-codes
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