CMS Pub. 100-03, ch. 1, § 80.5

CIM 65.3

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

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-references:

The Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health

Services,” §120 and §130

The Medicare Benefit Policy Manual, Chapter 1, “Inpatient Hospital Services,” §40 and

§120.1.