National Coverage Determination (NCD)

Scleral Shell


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Tracking Information

Publication Number
Manual Section Number
Manual Section Title
Scleral Shell
Version Number
Effective Date of this Version
This is a longstanding national coverage determination. The effective date of this version has not been posted.

Description Information

Benefit Category
Prosthetic Devices

Please 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. 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. Tears ordinarily dry at a rapid rate, and are continually replaced by the lacrimal gland. 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. Thus, the difficult and sometimes hazardous process of frequent installation of artificial tears may be avoided. 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.

Additional Information

Other Versions
Title Version Effective Between
Scleral Shell 1 01/01/1966 - N/A You are here