Does UnitedHealthcare cover scleral lenses?

The policies this page is based on

UnitedHealthcare publishes medical policies that explain how it interprets its standard plans. We read two that address contact lenses used as treatment:

• Durable Medical Equipment, Orthotics, Medical Supplies, and Repairs/Replacements, Commercial and Individual Exchange Medical Policy MP.009.35, effective February 1, 2026. It applies to UnitedHealthcare commercial plans and Individual Exchange plans.^[1]
• Vision Care and Services, Benefit Interpretation Policy BIP191.P, effective May 1, 2026. It applies to UnitedHealthcare of California HMO plans and UnitedHealthcare Benefits Plan of California EPO/POS plans.^[2]

Both say the member’s own plan document governs if it conflicts with the policy.^[1][2]

What the commercial policy says

Many medical plans exclude contact lenses. UnitedHealthcare’s commercial policy carves out an exception in its benefit considerations section, under the heading “Contact Lenses & Scleral Bandages (Shells)”:^[1]

• Contact lenses or scleral shells used to treat an injury or disease, with corneal abrasion, keratoconus, or severe dry eye given as examples, are not considered durable medical equipment.
• They may be covered as a therapeutic service.
• In these situations, they are not subject to a plan’s contact lens exclusion.

That’s useful language to know if you have keratoconus or severe dry eye. If a representative tells you contact lenses are excluded, you can ask whether the therapeutic exception applies to your diagnosis.

Two cautions. First, “may be covered” is not a promise: your plan’s benefits, cost sharing, and any prior authorization rules still apply. Second, the policy doesn’t list diagnosis criteria, measurements, or billing codes for scleral lenses. Your fitter’s records are what show that the lenses are treating a disease rather than correcting ordinary vision.

What the California policy says

UnitedHealthcare’s California HMO and EPO/POS policy is more specific, and it shows how much plan type matters.^[2]

California small groups. The policy lists corrective lenses, contact lenses, and contact lens fitting and measurements as covered for the treatment of keratoconus, aphakia, aniridia, and use as a corneal bandage. It lists “special contact lenses” as including hard or rigid contact lenses for keratoconus, aphakia, and use as a corneal bandage. It says these contact lenses must be obtained through the network medical group, not the member’s supplemental vision benefit.^[2]

California large groups. The same policy lists contact lenses and fitting for keratoconus, aphakia, aniridia, or corneal bandage as not covered for large groups, unless the member’s Evidence of Coverage or supplemental vision benefit says otherwise.^[2]

The policy doesn’t use the word “scleral.” It also lists contact lens cleaning solution and normal saline as not covered.^[2]

Medicare Advantage and Medicaid

This page covers UnitedHealthcare’s commercial policies. Its Medicare Advantage and Medicaid plans have their own policies and plan documents, and they work within Medicare and state Medicaid rules. See our guides to Medicare and Medicaid, then ask your plan.

What to ask UnitedHealthcare

1. Does my plan exclude contact lenses? Does the exception for lenses that treat a disease apply to my diagnosis?
2. Are the scleral lens fitting and the lenses covered under my medical benefit?
3. Is prior authorization required? What records do you need?
4. Is the fitter I’m considering in network for my plan?
5. Do I also have a vision plan that should be billed for any part of this?

Write down the date, the representative’s name, and a reference number.

What to ask the practice

1. Do you bill UnitedHealthcare directly for my plan?
2. Will you request prior authorization and include a letter of medical necessity?
3. How will you code the fitting and lenses, and what do you expect me to owe?

If a request is denied, read the denial letter carefully and consider an appeal.