HCPCS V2626 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Vision Services • Eye Prosthetics and Services |
| Complexity Level | Moderate |
National average reimbursement for HCPCS V2626 by major payers:
$260.53
$146.41
$221.38
$197.48
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS V2626 | ||||||
United | V2626 | $116.97 | 1124404587 - ORTHOPARTNERS, INC., RESTORE POC | 330846785 | FL | Prosthetic/Orthotic Supplier (335E00000X) |
United | V2626 | $92.05 | 1528126141 - J. C. HOME CARE INC, JC HOME MEDICAL | 20682766 - (FL) J.C. HOME CARE, INC. | FL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | V2626 | $139.38 | 1508352204 - ORTHOTIC & PROSTHETIC CENTERS, INC., ORTHOTIC & PROSETHETIC CENTER OF SPRING HILL | 592139250 - ORTHOTIC PROSTHETIC CENTERS INC | FL | Prosthetic/Orthotic Supplier (335E00000X) |
United | V2626 | $161.05 | 1790758936 - DURA MEDICAL EQUIPMENT, INC., BAYSHORE DURA MEDICAL | 650389568 - (FL) DURA MEDICAL EQUIPMENT INC | FL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | V2626 | $142.10 | 1457803066 - THE DME BOUTIQUE LLC, HOPE MASTECTOMY BOUTIQUE | 814178823 - (FL) THE DME BOUTIQUE LLC | FL | Prosthetic/Orthotic Supplier (335E00000X) |
United | V2626 | $116.97 | 1538176169 - WESTCOAST BRACE & LIMB | 592066601 - WESTCOAST BRACE & LIMB, INC. | FL | Prosthetic/Orthotic Supplier (335E00000X) |
United | V2626 | $129.41 | 1053978601 - COMFORT MEDSOURCE CORP, LINCOLN HEALTH SUPPLY | 841769869 | FL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | V2626 | $167.00 | 1932325222 - EDARCH MEDICAL INC., MEDSTAR MEDICAL | 461322238 | FL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | V2626 | $116.97 | 1972510501 - WESTCOAST BRACE & LIMB | 592066601 - WESTCOAST BRACE & LIMB, INC. | FL | Prosthetic/Orthotic Supplier (335E00000X) |
United | V2626 | $80.98 | 1831126275 - FLORIDA BRACE & LIMB, INC. | 593330956 - FLORIDA BRACE LIMB INC | FL | Prosthetist (224P00000X) |
United | V2626 | $179.35 | 1578592309 - OPTIGEN INCORPORATED | 450510425 - OPTIGEN, INC. | FL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | V2626 | $139.38 | 1407318918 - HOPE 4 HEALING, INC. | 452601608 - HOPE 4 HEALING INC | FL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | V2626 | $119.66 | 1730364530 - TEAM POST-OP | 261588969 - (FL) TEAM POSTOP | FL | Prosthetic/Orthotic Supplier (335E00000X) |
United | V2626 | $227.91 | 1164835831 - SNG LABS-SNG PROSTHETIC EYE INSTITUTE, INC. | 650580048 - (FL) SNG LABSSNG PROSTHETIC EYE INSTITUTE INC | FL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | V2626 | $225.64 | 1851425037 - TALLAHASSEE ORTHOPEDIC CLINIC III PL, TALLAHASSEE ORTHOPEDIC CLINIC | 593598056 - TALLAHASSEE ORTHOPEDIC CLINIC III | FL | Prosthetic/Orthotic Supplier (335E00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS V2626 vs. Other Eye Prosthetics and Services Codes
The HCPCS V2626 code is part of the Vision Services services used for Eye Prosthetics and Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS V2626 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| V2625-HCPCS | Moderate | Enlargement of ocular prosthesis |
| V2626-HCPCS | Moderate | Reduction of ocular prosthesis |
| V2627-HCPCS | High | Scleral cover shell |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS V2626. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the V2626 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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