Summary & Overview
HCPCS V2106: Single-Vision Spherocylinder Lens, High Astigmatism
HCPCS Level II code V2106 identifies a single-vision spherocylindrical eyeglass lens for patients requiring substantial astigmatic correction (cylinder over 6.00 diopters) with spherical power from plano to ±4.00 diopters. This code is used in billing for the fabrication and dispensation of corrective lenses tailored to high-cylinder prescriptions and informs coverage, pricing, and benefit design across payers. Nationally, V2106 matters because it captures higher-complexity lens fabrication that can affect benefit limits, retail optical allowances, and prior-authorization requirements for vision benefits.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical and service context for V2106, what sites typically bill the code, and which payers commonly appear in coverage policies. The publication outlines expected benchmarks and comparisons where available, summarizes relevant policy considerations for vision benefits (such as lens allowances and prior-authorization triggers), and provides clinical context on when a high-cylinder single-vision lens is indicated. Data not available in the input is noted where applicable. The content is intended for national audiences including billing managers, compliance officers, optical vendors, and clinician offices seeking a clear reference on V2106.
Billing Code Overview
HCPCS Level II code V2106 describes a spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens. This entry covers a single-vision ophthalmic lens with significant astigmatic correction (cylinder greater than 6.00 diopters) and spherical power within the plano to ±4.00 diopter range.
Service Type: Eyeglass lens fabrication and dispensation (single-vision spherocylindrical lens)
Typical Site of Service: Optical dispensary, ophthalmology clinic, optometry office, or retail optical shop
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents to an ophthalmology or optometry clinic with a history of high astigmatism and refractive error after a comprehensive eye examination. Manifest refraction reveals a single-vision prescription requiring a spherocylindrical lens with a spherical power within plano to ±4.00 diopters and a cylindrical power greater than 6.00 diopters in at least one eye. The clinician documents the prescription and orders custom single-vision spectacle lenses. The laboratory receives the order and fabricates one or two lenses invoiced per lens using V2106 for each lens manufactured. Typical clinical workflow steps include: visual acuity testing, manifest or cycloplegic refraction, slit-lamp anterior segment exam to ensure ocular surface suitability for glasses, documentation of the finalized prescription, transmission of the order to an optical lab, and delivery/fitting of the completed spectacles to the patient.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component of an associated service (e.g., refraction professional interpretation) separate from lens fabrication costs. |
52 |