Does Ambetter require prior authorization for V2627?

Ambetter lists V2627 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for V2627?

AmeriHealth Caritas lists V2627 on AmeriHealth Caritas Louisiana Act 233 prior authorization service list for medicaid managed plans, with conditions. Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for V2627?

Arizona Complete Health lists V2627 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for V2627?

BCBS Michigan lists V2627 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for V2627?

CalViva Health lists V2627 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS V2627?

There are 17 tracked policy changes affecting HCPCS V2627, including updates from Utah Medicaid, Humana, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS V2627?

Payers that have issued tracked updates for HCPCS V2627 include: Utah Medicaid, Humana, Independence Blue Cross, Sentara Health Plans, Aetna, Alaska Medicaid.

How do I get notified when HCPCS V2627 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS V2627. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS V2627?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

PAYER POLICY CHANGES

V2627 Insurance Policy Changes

HCPCS V2627 is officially defined as "Scleral cover shell." HCPCS V2627 is referenced in 17 tracked payer policy changes from Utah Medicaid, Humana, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS V2627 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Utah Medicaid · Effective Jan 1, 2026High impact
January 2026 Medicaid Information Bulletin
Unless otherwise noted, the changes in this January 2026 Utah Medicaid bulletin took effect January 1, 2026. Dental providers must use the Utah Medicaid Index of Orthodontic Treatment Need (IOTN) form, and any orthodontic prior authorization request submitted on or after January 1, 2026 without the IOTN form will be denied. Physical therapy and occupational therapy services are limited to 20 therapy sessions per discipline per calendar year, and chiropractic spinal manipulation is limited to twelve visits per rolling year for EPSDT members ages 6 through 20 and pregnant members.
Humana · Effective May 13, 2026Medium impact
Prosthetics - MEDICAID - INDIANA (New)
Humana has released a new comprehensive Medicaid policy for prosthetics coverage in Indiana, establishing detailed criteria for various prosthetic devices including upper/lower limb prostheses, facial prostheses, and specialized devices like osseointegrated prostheses. This policy defines coverage determination criteria and includes specific billing codes for prosthetic services.
Independence Blue Cross · Effective Apr 20, 2026Medium impact
MA05.050c, Eye Prostheses and Scleral Cover Shell
Independence Blue Cross clarified medically necessary criteria for eye prostheses and scleral cover shells to align with CMS recommendations, effective April 20, 2026. The policy intent remains unchanged, but billing teams must ensure documentation meets updated standards for polishing/resurfacing (twice yearly), enlargements/reductions (first without documentation, additional requiring medical record support), and trial scleral cover shells (non-billable, included in final shell reimbursement).
Independence Blue Cross · Effective Apr 20, 2026Medium impact
05.00.83a, Eye Prostheses and Scleral Cover Shell
Independence Blue Cross updated Medical Policy 05.00.83a to clarify coverage criteria and benefits for eye prostheses and scleral cover shells, effective 04/20/2026. Key clarifications include: eye prosthesis coverage for absence/shrinkage due to birth defect, trauma, or surgical removal; polishing/resurfacing covered twice yearly; one enlargement or reduction covered without documentation, additional ones require medical necessity documentation; and scleral cover shells covered for sightless/shrunken eyes from inflammatory disease or severe dry eye. Documentation requirements remain consistent with Medicare standards, requiring timely provider orders and contemporaneous delivery confirmation.
Humana · Effective Feb 20, 2026Medium impact
Prosthetics - MEDICAID - FLORIDA (New)
This is a new comprehensive prosthetics coverage policy for Florida Medicaid that establishes coverage criteria for various prosthetic devices including upper/lower limb prostheses, facial prosthetics, artificial corneas, and specialized devices like OPRA systems. The policy defines specific eligibility requirements and covered codes for each type of prosthetic device.
Humana · Effective Feb 11, 2026Medium impact
Prosthetics - MEDICAID - VIRGINIA (Revised)
This is a comprehensive revised policy for prosthetics coverage under Virginia Medicaid, covering various prosthetic devices including upper limb prostheses, lower limb prostheses, facial prostheses, and artificial corneas. The policy establishes detailed coverage criteria and introduces new coverage for osseointegrated prostheses for rehabilitation of amputees (OPRA).
Humana · Effective Feb 11, 2026Medium impact
Prosthetics - MEDICAID - SOUTH CAROLINA (Revised)
Humana has issued a comprehensive revised policy for prosthetics coverage under South Carolina Medicaid, effective February 11, 2026. This policy establishes detailed coverage criteria for various prosthetic devices including upper and lower limb prostheses, osseointegrated devices, artificial corneas, and facial prostheses with specific eligibility requirements and contraindications.
Humana · Effective Feb 11, 2026Medium impact
Prosthetics - MEDICAID - MICHIGAN (Revised)
This is a revised Medicaid prosthetics policy for Michigan that establishes comprehensive coverage criteria for various prosthetic devices including upper/lower limb prostheses, eye prostheses, and specialized devices like osseointegrated prostheses. The policy provides detailed eligibility requirements and introduces coverage for newer technologies like enhanced dexterity prosthetic arms and multiarticulating myoelectric hands.
Sentara Health Plans · Effective Feb 1, 2026Medium impact
Authorization Updates - Effective February 1, 2026
Effective February 1, 2026, Sentara Health Plans stopped requiring prior authorization or precertification for a long list of procedures and services for Medicare products and for Medicaid products offered in Virginia. The lists include breast reconstruction codes 19357, 19361 and 19364, glenohumeral arthrodesis codes 23800 and 23802, cranial neurostimulation codes 61885 and 61886, and MR elastography code 76391. The notice also lists ocular, ENT, cardiac, genetic testing and home management codes among those no longer requiring authorization.
Humana · Effective Jan 7, 2026Medium impact
Prosthetics - MEDICAID - OKLAHOMA (Revised)
This is a comprehensive revision of Humana's Oklahoma Medicaid prosthetics coverage policy, establishing detailed coverage criteria for various prosthetic devices including upper/lower limb prostheses, eye/ear prostheses, and specialized devices like osseointegrated implants. The policy includes specific eligibility requirements and covered HCPCS codes for prosthetic services.
Aetna · Effective Dec 11, 2025Medium impact
Facial Prostheses, External (CPB 0620, reviewed 2025-12-11)
Aetna's Facial Prostheses, External policy (CPB 0620) establishes coverage criteria for superficial facial prostheses and related supplies when tissue loss occurs due to disease, trauma, surgery, or congenital defect. The policy covers specific prosthesis types (nasal, orbital, auricular, midfacial, hemi-facial, upper facial, partial facial) and associated adhesives/tape, but explicitly excludes cosmetic skin care products. Billing teams must ensure claims use correct CPT/HCPCS codes and understand the 90-day bundling rules for modifications and follow-up care.
Alaska Medicaid · Effective Nov 26, 2025Medium impact
Clarification for Vision Service Authorization
Alaska Medicaid has clarified vision service authorization requirements and provided specific guidance on how to properly complete authorization requests. The policy specifies which vision products require prior authorization and requires providers to indicate the reason for authorization in box 16 of the form.
Humana · Effective Oct 7, 2025Medium impact
Prosthetics - MEDICAID - KENTUCKY (New)
New Humana Medicaid policy for Kentucky establishes comprehensive coverage criteria for prosthetic devices including limbs, eyes, ears, and specialized systems. The policy defines covered prosthetics, specific eligibility requirements, and billing codes for various prosthetic components and services.
Humana · Effective Aug 1, 2025Medium impact
Ocular Surface Disease Diagnosis and Treatments - Medicare Advantage (Revised)
Humana Medicare Advantage has revised their policy for Ocular Surface Disease diagnosis and treatments, establishing new coverage criteria and procedures for dry eye disease and related conditions. The policy provides detailed guidance on diagnostic tests, treatment procedures, and medical necessity requirements for various ocular surface treatments.
Aetna · Identified Oct 4, 2026Medium impact
Facial Prostheses, External (CPB 0620, reviewed 2026-09-03)
Aetna's facial prostheses policy (CPB 0620) was reviewed on September 3, 2026, establishing coverage for superficial facial prostheses and related supplies (adhesives, tape, removers) when there is loss or absence of facial tissue due to disease, trauma, surgery, or congenital defect. The policy specifies 19 covered CPT/HCPCS codes, excludes cosmetic skin care products, and clarifies that modifications, repairs, and follow-up visits within 90 days of delivery are included in the prosthesis allowance and not separately reimbursed.
Aetna · Identified Oct 4, 2026Medium impact
Eye Prosthesis (CPB 0619, reviewed 2026-09-24)
Aetna's Eye Prosthesis policy (CPB 0619) was reviewed on September 24, 2026, clarifying coverage for eye prostheses, polishing/resurfacing, replacements every 5 years, and one modification (enlargement or reduction). The policy specifies covered HCPCS codes (V2623-V2629) and includes scleral cover shells under specific conditions. This is a policy clarification/reaffirmation with no substantive changes indicated from the previous version dated October 31, 2014.
Aetna · Identified Aug 15, 2026Medium impact
Contact Lenses and Eyeglasses (CPB 0126, reviewed 2026-03-26)
Aetna's Contact Lenses and Eyeglasses policy (CPB 0126) covers contact lenses and eyeglasses under medical plans only in a narrow set of therapeutic situations, because many Aetna medical plans exclude them. Covered situations include prosthetic lenses for aphakia after cataract surgery, therapeutic soft and scleral lenses used as corneal bandages, scleral shells, lenses for accidental injury, lenses for masking irregular astigmatism from keratoconus and other corneal disorders, Acuvue Abiliti Overnight and MiSight 1 Day lenses for myopia management, and contact lenses for aniridia. Echo Frames smart audio glasses, polarization, progressive lenses, mirror coating, scratch resistant coating and eyeglass cases are listed as not medically necessary.

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January 2026 Medicaid Information Bulletin

Prosthetics - MEDICAID - INDIANA (New)

MA05.050c, Eye Prostheses and Scleral Cover Shell

05.00.83a, Eye Prostheses and Scleral Cover Shell

Prosthetics - MEDICAID - FLORIDA (New)

Prosthetics - MEDICAID - VIRGINIA (Revised)

Prosthetics - MEDICAID - SOUTH CAROLINA (Revised)

Prosthetics - MEDICAID - MICHIGAN (Revised)

Authorization Updates - Effective February 1, 2026

Prosthetics - MEDICAID - OKLAHOMA (Revised)

Facial Prostheses, External (CPB 0620, reviewed 2025-12-11)

Clarification for Vision Service Authorization

Prosthetics - MEDICAID - KENTUCKY (New)

Ocular Surface Disease Diagnosis and Treatments - Medicare Advantage (Revised)

Facial Prostheses, External (CPB 0620, reviewed 2026-09-03)

Eye Prosthesis (CPB 0619, reviewed 2026-09-24)

Contact Lenses and Eyeglasses (CPB 0126, reviewed 2026-03-26)

Prior authorization required in some cases

Prior authorization required