LCD/NCD Portal

NCD80.5

 

SCLERAL SHELL

 

Effective Date of this Version

• This is a longstanding national coverage determination.

• The effective date of this version has not been posted.

 

Benefit Category

• Prosthetic Devices.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• Scleral shell (or shield) is a catchall term for different types of hard scleral contact lenses.

 

Indications and Limitations of Coverage

• A scleral shell fits over the entire exposed surface of the eye as opposed to a corneal contact lens which covers only the central non-white area encompassing the pupil and iris.

o Where an eye has been rendered sightless and shrunken by inflammatory disease, a scleral shell may, among other things, obviate the need for surgical enucleation and prosthetic implant and act to support the surrounding orbital tissue.

• In such a case, the device serves essentially as an artificial eye. In this situation, payment may be made for a scleral shell under §1861(s) (8) of the Act.

• Scleral shells are occasionally used in combination with artificial tears in the treatment of "dry eye" of diverse etiology.

o Tears ordinarily dry at a rapid rate, and are continually replaced by the lacrimal gland.

o When the lacrimal gland fails, the half-life of artificial tears may be greatly prolonged by the use of the scleral contact lens as a protective barrier against the drying action of the atmosphere.

o Thus, the difficult and sometimes hazardous process of frequent installation of artificial tears may be avoided.

o The lens acts in this instance to substitute, in part, for the functioning of the diseased lacrimal gland and would be covered as a prosthetic device in the rare case when it is used in the treatment of "dry eye."

 

Cross Reference

See the Medicare Benefit Policy Manual, Chapter 1 §§40 and 120.1 and Chapter 15 §§120 and 130.

 

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