MedicaidPrior AuthMedium impact
Alaska Medicaid Policy Clarification: Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Devices
Alaska Medicaid·AK · Ophthalmology, Optometry·Policy Update
Effective date
Sep 7, 2022
We identified it
Jun 21, 2026
Summary
Alaska Medicaid has clarified coverage and billing requirements for PROSE (Prosthetic Replacement of the Ocular Surface Ecosystem) devices. The policy establishes different coding requirements for scleral cover shells (V2627) versus scleral contact lenses (V2531), with prior authorization required for cover shells and medical documentation required for contact lenses.
Action Required
Immediately: Billing team must update Alaska Medicaid billing procedures for PROSE devices. For scleral cover shells (V2627), obtain prior authorization before providing services. For scleral contact lenses (V2531), ensure medical records justifying medical need and invoice are submitted with all claims. Update billing system to require RT/LT modifiers for all PROSE device codes and bill bilateral services on separate claim lines. Claims without proper documentation or prior authorization will be denied.