CommercialCoverageMedium impact
05.00.83, Eye Prostheses and Scleral Cover Shell
Independence Blue Cross·Ophthalmology, Optometry·Medical Policy
Effective date
Feb 24, 2025
We identified it
Jun 19, 2026
Summary
This is a new medical policy (05.00.83) establishing coverage guidelines for eye prostheses and scleral cover shells, effective February 24, 2025. The billing team must review the full policy text to understand specific coverage criteria, prior authorization requirements, and applicable billing codes for these devices.
Action Required
By February 24, 2025: Billing team must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=02&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-05-00-83 to identify specific CPT/HCPCS codes, prior authorization requirements, and medical necessity criteria. Update billing software, encounter forms, and provider education materials accordingly. Communicate coverage guidelines to providers and clinical staff. Beginning February 24, 2025, ensure all claims for eye prostheses and scleral cover shells comply with this new policy or they may be denied.