`V2756` Eye glass case

Eye glass case

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 0 units per day (clinical), rationale: Published Contractor Policy

Medicare pricing for V2756

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for V2756

Payer coverage policies that name V2756

V2756 appears in 5 coverage policies from Aetna, Capital Blue Cross, Premera Blue Cross, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Contact Lenses and Eyeglasses (0126)	not covered	Mar 26, 2026	payer document
Aetna	Orthoptic Vision Therapy (0489)	listed, no stance (range V2700-V2799)	Jul 28, 2025	payer document
Capital Blue Cross	Intraocular Lenses, Spectacle Correction, and Iris Prosthesis (MP 6.058) Procedure codes	unproven / investigational	Mar 1, 2026	payer document
Premera Blue Cross	Non-covered Services and Procedures Page \| 23 of 30 \| ∞	not covered	Jun 1, 2026	payer document
UnitedHealthcare	Vision Services Not Routinely Covered (for Ohio Only) (CS359OH.E)	listed, no stance	Jul 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, OH.

NE: $1.23 (vision), effective Jul 1, 2026
VT: $1.50 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

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.

V2756 Eye glass case