MyMedi-AI

V2627 — Scleral cover shell

HCPCS Level II V-code

Code system
HCPCS Level II
Family
V — Vision & hearing services
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Prosthetics & orthotics
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required 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.

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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

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

V2627 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $1258.82 to $2103.31 depending on state and rural status.

Former-CBA payment limits: ceiling $2103.31 · floor $1577.48

StateNon-ruralRural
AK$1584.61
AL$1753.44
AR$1772.96
AZ$1577.48
CA$1577.48
CO$2049.79
CT$1577.48
DC$1577.48
DE$1577.48
FL$1753.44
GA$1753.44
HI$1694.44
IA$1577.48
ID$2103.31
IL$1751.05
IN$1751.05
KS$1577.48
KY$1753.44
LA$1772.96
MA$1577.48
MD$1577.48
ME$1577.48
MI$1751.05
MN$1751.05
MO$1577.48
MS$1753.44
MT$2049.79
NC$1753.44
ND$2049.79
NE$1577.48
NH$1577.48
NJ$1935.48
NM$1772.96
NV$1577.48
NY$1935.48
OH$1751.05
OK$1772.96
OR$2103.31
PA$1577.48
PR$1258.82
RI$1577.48
SC$1753.44
SD$2049.79
TN$1753.44
TX$1772.96
UT$2049.79
VA$1577.48
VI$1935.48
VT$1577.48
WA$2103.31
WI$1751.05
WV$1577.48
WY$2049.79
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

Bill V2627 with confidence

MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.

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, V2627 included, and starter credits via POST /bot-marketplace/register.