Summary & Overview
HCPCS Level II V2211: Spherocylinder Bifocal Lens, High-Power
HCPCS Level II code V2211 identifies a high-power spherocylinder bifocal lens billed per lens. This code covers bifocal optical lenses with spherical power from ±7.25 to ±12.00 diopters and cylindrical correction from 0.25 to 2.25 diopters. The code matters nationally because it captures billing for specialty high-prescription bifocal lenses that are more complex to fabricate and often have different coverage and medical necessity considerations than standard lenses.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the payer landscape referenced above. The publication summarizes available benchmarks and policy-relevant considerations, highlights common billing modifiers in use, and provides guidance on where to locate additional coding and coverage details.
This summary is intended for a national audience of billing professionals, ophthalmic dispensers, and payers interested in understanding coding and reimbursement constructs for high-power bifocal lenses. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code V2211 describes a spherocylinder bifocal lens with high spherical power and a range of cylindrical correction, billed per lens. The full description is: Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens.
Service Type: Bifocal optical lens fabrication/dispensing
Typical Site of Service: Optical dispensary or outpatient vision care setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an ophthalmology or optometry clinic complaining of progressive difficulty with near and intermediate vision and blurred vision at distance. The patient has a manifest refraction showing high hyperopia or myopia within the spherical range of ±7.25 to ±12.00 diopters and an astigmatic component between 0.25 and 2.25 diopters, and requires bifocal lenses. The clinical workflow includes a comprehensive eye examination with visual acuity, refraction (objective and subjective), slit-lamp anterior segment exam, and binocular vision assessment. The licensed optometrist or ophthalmologist documents the final spectacle prescription specifying spherocylinder power and bifocal add. The optical dispensary or external ophthalmic laboratory fabricates per-lens bifocal spherocylinder lenses described by billing code V2211. Typical dispensing occurs in an optical shop within the clinic, an independent optical retailer, or a vision center. The patient receives frame fitting, verification of lens parameters, and instructions for adaptation to bifocal lenses. Follow-up visits address fit, visual complaints, and any necessary adjustments or remakes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Data not available in the input. | Data not available in the input. |