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HCPCS V2628 · Level II · V code

V2628: Fabrication and fitting of ocular conformer, 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 V2628

Medicare payment
$372.48 to $496.63
DMEPOS non-rural state fees
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
2
MAI 3
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
1 / 0

TL;DR

V2628 is a Level II code from the V section (vision, hearing and speech-language pathology services), in use since 1993: "Fabrication and fitting of ocular conformer". DMEPOS fees for V2628, a PO (prosthetics and orthotics) item, run $372.48 in AZ, CA, CT and 18 more to $496.63 in CO, IA, ID and 10 more (floor $372.48, ceiling $496.63) in the October 2026 file. Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Service/Procedure); DME supplier 2 (MAI 3, Nature of Service/Procedure). 1 active LCD lists V2628: L33737 (Eye 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). Nearby codes: V2627, V2630, V2631, V2624.

V2628 descriptor and code status

The October 2026 HCPCS Level II file describes V2628 as “Fabrication and fitting of ocular conformer”. It sits in the V section (vision, hearing and speech-language pathology services), listed with the other V codes.

HCPCS file attributes of V2628
FieldValue
Short descriptorFabrication & fitting
Added to HCPCS1993-01-01
Last actionN (no maintenance), effective 2003-10-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
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 V2628

DMEPOS fees for V2628, a PO (prosthetics and orthotics) item, run $372.48 in AZ, CA, CT and 18 more to $496.63 in CO, IA, ID and 10 more (floor $372.48, ceiling $496.63) in the October 2026 file. 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 V2628 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$372.48 / $496.63$372.48 (AZ, CA, CT…) to $496.63 (CO, IA, ID…)—AK $351.50, HI $375.88, PR $962.64, VI $378.33

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 V2628

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Service/Procedure); DME supplier 2 (MAI 3, Nature of Service/Procedure). The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for V2628 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital23 Date of Service Edit: ClinicalNature of Service/Procedure
DME supplier23 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for V2628 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists V2628 in v323r0.

V2628 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 V2628 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for V2628

1 active Local Coverage Determination and 0 billing and coding articles list V2628. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on V2628

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists V2628

CARC 151 · N362

units of V2628 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 V2628 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for V2628 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 V2628

What does HCPCS code V2628 describe?

"Fabrication and fitting of ocular conformer" (short descriptor "Fabrication & fitting"), in the V section (vision, hearing and speech-language pathology services). Added 1993-01-01; last action N (no maintenance) effective 2003-10-01.

Is V2628 a CPT code?

No. V2628 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for V2628?

DMEPOS fees for V2628, a PO (prosthetics and orthotics) item, run $372.48 in AZ, CA, CT and 18 more to $496.63 in CO, IA, ID and 10 more (floor $372.48, ceiling $496.63) in the October 2026 file.

How many units of V2628 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Service/Procedure); DME supplier 2 (MAI 3, Nature of Service/Procedure). For the DME supplier MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover V2628?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD lists V2628: L33737 (Eye 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.