FAQ 19: Lens costs and insurance
How much do scleral lenses cost? Does insurance cover the cost of scleral lenses if they are medically necessary?
The costs of scleral lenses vary widely. In the US, the cost of a pair of lenses range anywhere from $1K to as much as $15K per pair with the majority of lenses costing approximately $2K to $3K per pair on average according to a 2023 survey conducted by the Dry Eye Shop. The more customized lenses are more expensive but not everyone needs the highest level of customization. There are ongoing costs for wearing scleral lenses for the PF saline, disinfection solutions, replacement tools, etc. There were 214 scleral lens users who completed a Dry Eye Shop survey in 2023 and reported their annual recurring expenses for wearing scleral lenses ranged from $250 to over $1K with the majority of users reporting between $250 and $500 per year.
Group vision insurance plans sometimes cover the cost of scleral lenses if there is an appropriate diagnosis and/or if there are two or more lines of vision improvement with scleral lenses compared to glasses. Some medical insurance plans cover scleral lenses for ocular surface disease/dry eye disease. CPT (HCPCS) codes for the lenses are V2531 and V2627. V2627 is only used for a limited number of diagnoses. There are also other procedure codes such as 92313 (designated for the fitting of a lens for treatment of ocular surface disease/dry eye disease) or 92072 (designated for the fitting of a lens for the management of keratoconus). The diagnosis code is the condition for which the lenses are being fit. Scleral lenses deemed medically necessary may or may not be covered by insurance and it depends on whether the insurance policy provides coverage for the lenses based on diagnosis.
Medicare coverage for scleral lenses is for very limited diagnoses. To bill Medicare, the practitioner must be a durable medical equipment (DME) provider and most scleral lens practitioners are not DME providers. A practitioner who is not a DME provider cannot bill Medicare for the scleral lenses even though they can bill Medicare for other office visits and exams. Scleral lens coverage with Medicare is covered under NCD 80.5.
https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=235