CommercialCoverageMedium impact
Gas Permeable Scleral Contact Lens
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology, Optometry·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a comprehensive policy defining medical necessity criteria for gas permeable scleral contact lenses. The policy establishes that these specialized lenses are covered for specific corneal conditions when standard treatments have failed, with clear CPT and HCPCS billing codes provided.
Action Required
Immediately: Billing team must ensure claims for scleral contact lenses use CPT codes 92313 or 92317 and HCPCS V2531. Verify patient has documented failure of topical medications or standard contact lens fitting before billing. Ensure diagnosis codes match covered conditions including corneal ectatic disorders, corneal scarring, irregular astigmatism, or ocular surface disease. Claims for other conditions will be denied as not medically necessary.