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) effective February 24, 2025, that establishes coverage guidelines for eye prostheses and scleral cover shells. The billing team must review the full policy text to identify specific codes, coverage criteria, prior authorization requirements, and documentation standards that will apply to these claims starting on the effective date.
Action Required
By February 24, 2025: Billing team must obtain and review the complete policy text at the provided URL (https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=01&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-05-00-83). Identify all applicable CPT and HCPCS codes for eye prostheses and scleral cover shells. Update billing software with any prior authorization requirements, coverage limitations, or documentation requirements. Train billing and clinical staff on new submission requirements. Notify providers of any changes to medical necessity documentation. Test system changes before effective date to prevent claim denials.