MyMedi-AI

V2626 — Reduction of ocular prosthesis

HCPCS Level II V-code · short descriptor: “Reduction 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 2026-10-26; 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 2026-10-26; 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.

V2626 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $222.15 to $357.61 depending on state and rural status.

Former-CBA payment limits: ceiling $325.67 · floor $244.25

StateNon-ruralRural
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—
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 V2626 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

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