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HCPCS V2623 · Level II · V code

V2623: Prosthetic eye, plastic, custom, HCPCS Level II V code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for V2623

Medicare payment
$1,098.93 to $1,465.24
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
2
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
2 / 0

TL;DR

HCPCS Level II V2623 reads "Prosthetic eye, plastic, custom" in the October 2026 file; it dates from 1985. V2623 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $1,098.93 in AL, DC, DE and 11 more to $1,465.24 in AR, AZ, CA and 5 more (floor $1,098.93, ceiling $1,465.24), October 2026. MUE limits for V2623: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 2, Anatomic Consideration); DME supplier 2 (MAI 2, Anatomic Consideration). 2 active LCDs list V2623: L33737 (Eye Prostheses), L33738 (Facial Prostheses). OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 1 other active code opens with "Prosthetic eye"; related codes: V2629, V2624, V2627, V2628.

V2623 descriptor and code status

The October 2026 HCPCS Level II file describes V2623 as “Prosthetic eye, plastic, custom”. It sits in the V section (vision, hearing and speech-language pathology services), listed with the other V codes.

HCPCS file attributes of V2623
FieldValue
Short descriptorPlastic eye prosth custom
Added to HCPCS1985-01-01
Last actionN (no maintenance), effective 2003-10-01
Coverage codeD: special coverage instructions apply
Pricing indicator38: DMEPOS orthotics, prosthetics, prosthetic devices and vision services (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for V2623

V2623 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $1,098.93 in AL, DC, DE and 11 more to $1,465.24 in AR, AZ, CA and 5 more (floor $1,098.93, ceiling $1,465.24), October 2026. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category PO (prosthetics and orthotics). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for V2623 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$1,098.93 / $1,465.24$1,098.93 (AL, DC, DE…) to $1,465.24 (AR, AZ, CA…)—AK $1,855.60, HI $1,984.14, PR $904.18, VI $1,418.85

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for V2623

MUE limits for V2623: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 2, Anatomic Consideration); DME supplier 2 (MAI 2, Anatomic Consideration). The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for V2623 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital22 Date of Service Edit: PolicyAnatomic Consideration
DME supplier22 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for V2623 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists V2623 in v323r0.

V2623 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check V2623 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for V2623

2 active Local Coverage Determinations and 0 billing and coding articles list V2623. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

  • Eye Prostheses (L33737) · CGS Administrators, LLC; Noridian Healthcare Solutions, LLC
  • L33738 Facial Prostheses · CGS Administrators, LLC; Noridian Healthcare Solutions, LLC

Denials to expect on V2623

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists V2623

CARC 151 · N362

units of V2623 exceed the DME supplier MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for V2623 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for V2623 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS V2623

What does HCPCS code V2623 describe?

"Prosthetic eye, plastic, custom" (short descriptor "Plastic eye prosth custom"), in the V section (vision, hearing and speech-language pathology services). Added 1985-01-01; last action N (no maintenance) effective 2003-10-01.

Is V2623 a CPT code?

No: CMS maintains V2623 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for V2623?

V2623 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $1,098.93 in AL, DC, DE and 11 more to $1,465.24 in AR, AZ, CA and 5 more (floor $1,098.93, ceiling $1,465.24), October 2026.

How many units of V2623 can be billed per day?

MUE limits for V2623: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 2, Anatomic Consideration); DME supplier 2 (MAI 2, Anatomic Consideration). For the DME supplier MUE (MAI 2), units above 2 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover V2623?

Coverage code D (special coverage instructions apply). 2 active LCDs list V2623: L33737 (Eye Prostheses), L33738 (Facial Prostheses).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.