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See a sample rate comparisonHCPCS V2626 Fee Schedule
Last Verified: September 2026
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.
Reduction of ocular prosthesis
| Key Fact | Detail |
|---|---|
| Service Type | Vision Services Eye Prosthetics and Services |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for V2626 |
National average reimbursement for HCPCS V2626 by major payers:
$260.53
$146.41
$221.38
$197.48
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HCPCS V2626
5 of 25 sample ratesHigher to lower in this preview
Sng Labs-Sng Prosthetic Eye Institute, Inc.
Sng Labssng Prosthetic Eye Institute Inc
$227.91Published rateShavone Bellamy
Bella Monique LLC
$149.80Published rateCordano Eye Care Center PA
$135.25Published rateM. Quirantes Orthopedic Appliances, Inc.
M Quirantes Orthopedic Appliances Inc
$113.68Published rateMedcare Services Of Orlando, Inc., Medcare Services
Medcare Services Of Orlando Inc
$55.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS 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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