V2629 Prosthetic eye other typeProsthetic eye, other type
Status X: statutory exclusion, not paid under the PFS.
2 of 2 payer prior-auth lists that name V2629 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Neighborhood Health Partnership.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) | |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | Prior authorization required only for prosthetic codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
V2629 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Cosmetic Surgery and Procedures (0031) | covered if criteria are met (range V2623-V2629) | Jun 25, 2026 | payer document |
| Aetna | Eye Prosthesis (0619) | covered if criteria are met | Sep 24, 2026 | payer document |
| Aetna | Facial Prostheses, External (0620) | covered if criteria are met | Sep 3, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Prosthetics (L.1.04.401) | covered if criteria are met | payer document |
Prior authorization required or conditional in IL, KY, LA, MD, OH, VT, WA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.