Summary & Overview
HCPCS V2104: Spherocylinder Single-Vision Corrective Lens
HCPCS Level II code V2104 denotes the supply of a single-vision spherocylinder lens with spherical power from plano to ±4.00 diopters and cylindrical power from 2.12 to 4.00 diopters, billed per lens. The code is used by vision care providers, ophthalmology clinics, and optical dispensaries to document and bill for specific corrective lenses that address combined spherical and astigmatic refractive errors. Nationally, accurate use of V2104 matters for claims consistency, benefit design clarity, and proper capture of lens-specific utilization and costs.
This publication includes analysis for major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for spherocylinder single-vision lenses, typical sites of service, and the billing context for per-lens supply codes. The content outlines what to expect in benchmarking and coverage language across major payers, highlights common modifiers encountered in claims, and summarizes areas where policy clarifications or coding consistency can affect adjudication. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code V2104 describes a spherocylinder single-vision lens intended for optical correction with a spherical power from plano to ±4.00 diopters and a cylindrical power between 2.12 and 4.00 diopters, billed per lens. This code covers the supply of a single-vision corrective lens with specified sphere and cylinder powers.
Service type: Corrective ophthalmic lens supply
Typical site of service: Optical dispensary, ophthalmology clinic, or vision center
Clinical & Coding Specifications
Clinical Context
A patient presents to an optometry or ophthalmology clinic requesting or requiring single-vision corrective lenses due to refractive error. Typical patients include adults or adolescents with simple myopia, hyperopia, or astigmatism whose prescriptions fall within the spherical range plano to ±4.00 diopters and cylindrical range 2.12 to 4.00 diopters. The clinical workflow includes: refraction (objective and subjective), slit-lamp anterior exam as indicated, verification of the prescription, lens selection (single-vision spherocylindrical lens), measurements for lens centration and pupillary distance, lens fabrication or ordering from an optical lab, and dispensing with patient education on lens care. Typical site of service is an outpatient eye clinic, optometry office, or optical dispensary within an ambulatory surgery center or hospital outpatient setting when provided as part of an outpatient encounter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component of service (e.g., physician's interpretation separate from lens fabrication) |
50 | Bilateral procedure | Use when lenses for both eyes are billed and payer requires bilateral modifier documentation |