Summary & Overview
HCPCS V2113: Spherocylinder Single-Vision High-Power Lens
HCPCS Level II code V2113 denotes a high-prescription spherocylinder single-vision lens (sphere ±7.25 to ±12.00d; cylinder 4.25 to 6.00d), billed per lens. This code is nationally relevant because it documents provision of specialty ophthalmic lenses for patients with severe refractive errors who require custom single-vision correction. Accurate coding affects coverage determinations, supply claims, and reporting for vision benefit management across public and commercial payers.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of how V2113 is used in clinical supply settings, typical sites of service (optical dispensaries and outpatient ophthalmology clinics), and the clinical context for prescribing high-power single-vision lenses. The publication provides benchmarks and comparisons for payer coverage approaches, notes on billing practice considerations, and summaries of policy language where available. It also outlines operational implications for claims submission, including unit-of-service (per lens) reporting and common modifier use for vision supplies.
Where input data is missing, the report indicates limited or unavailable fields. The focus is national in scope and intended for billing managers, revenue cycle teams, and vision care clinicians involved in eyewear procurement and reimbursement.
Billing Code Overview
HCPCS Level II code V2113 describes a spherocylinder, single vision lens with high refractive power: sphere range ±7.25 to ±12.00 diopters and cylinder range 4.25 to 6.00 diopters, billed per lens. This code represents a specialty ophthalmic lens intended to correct significant refractive errors combining high myopia or hyperopia with substantial astigmatism.
Service Type: Ophthalmic lens fabrication and supply
Typical Site of Service: Optical dispensary, ophthalmology clinic, or outpatient vision center
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A patient with a high refractive error presents to an optometry or ophthalmology practice seeking single-vision corrective lenses. The ordering provider (optometrist or ophthalmologist) documents a manifest or cycloplegic refraction showing a spherical power between ±7.25 and ±12.00 diopters and a cylindrical power between 4.25 and 6.00 diopters. The office issues a spectacle prescription and submits a claim for custom single-vision spherocylindrical lenses coded as V2113 per lens. Typical workflow: patient examination and refraction → documentation of prescription in the medical record → selection of lens options and measurements (vertex distance, pupillary distance, lens material) → laboratory order placed for high-power spherocylindrical single-vision lenses → fitting and delivery visit with final verification and adjustment. Typical sites of service are outpatient ophthalmology or optometry clinics, optical shops affiliated with those clinics, and retail optical dispensaries where prescriptions are filled under the supervising provider’s order. A typical patient scenario is a young adult with high myopic astigmatism or a post-refractive-surgery patient requiring strong residual correction, requiring a custom high-power single-vision lens in each eye billed per lens with V2113.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |