Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesVision ServicesHCPCS hcpcs-v2203-spherocylinder-bifocal-lens-per-lens
    Ask Trek AI about this page

    HCPCS Level II V2203: Spherocylinder Bifocal Lens, per Lens

    HCPCS Level II code V2203 describes a single spherocylinder bifocal ophthalmic lens with plano to ±4.00 diopter sphere and 0.12 to 2.00 diopter cylinder per lens; service type is bifocal eyeglass lens provision/fitting, and typical site of service is optical dispensary/vision clinic or ophthalmology/optometry practice where corrective lenses are measured, fabricated, and dispensed.

    For related coverage guidance, see recent payer policy updates: Evaluation of Dry Eyes, Evaluation of Dry Eyes, Ophthalmic Prostaglandin Analog Prior Authorization Criteria.

    Customize your policy alerts

    Sign up for hcpcs V2203 policy alerts

    Get alerted when payer policies referencing V2203 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient presents to an optometry or ophthalmology clinic with progressive presbyopia and a pre-existing refractive error that includes both spherical and cylindrical components. The provider performs a refraction and determines the patient requires bifocal spectacle lenses with spherocylinder power within the range described by V2203 (plano to ±4.00 diopter sphere with 0.12 to 2.00 diopter cylinder). The clinical workflow includes: an evaluation by a licensed optometrist or ophthalmologist, measurement of the refractive error (objective and subjective refraction), selection of lens parameters (bifocal segment, sphere and cylinder power), order entry to an optical dispenser or lab, and verification of final lenses on dispensing. Typical site of service is an outpatient eye clinic, optical dispensary within a medical office, or retail optical shop affiliated with an eye care practice. The patient scenario commonly includes refraction for functional vision correction, follow-up to confirm comfort and acuity with the new bifocal lenses, and documentation of the prescription, medical necessity (if applicable), and dispensing details in the medical record.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    92015Determination of refractive state (refraction), separate procedurePerformed immediately before ordering bifocal spectacle lenses to document refractive error and prescription.
    92060Sensorimotor examination with multiple measurements of ocular alignment and fixation for strabismus; extended evaluationUsed when strabismus or binocular vision issues influence lens design (bifocals may be prescribed for accommodative issues).
    92310Prescription of optical and physical characteristics of and fitting of contact lens for aphakia; corneal lens, spherical (except hard contact)Related dispensing code for contact lenses when alternative correction is considered; included as part of optical services context.
    99070Supplies and materials (except spectacles) provided by the physician over and above those usually included with the office visitUsed if the provider supplies special materials or upgraded lens options at time of dispensing.
    92004Ophthalmological service; medical examination and evaluation, new patient, comprehensive, with initiation of diagnostic and treatment programPerformed when a new patient presents and a comprehensive exam leads to a prescription for bifocal lenses.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207W00000XOphthalmology PhysicianAn ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically train…
    2088F0040XUrogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianA subspecialist in Urogynecology and Reconstructive Pelvic Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education …
    344600000XTaxiA land commercial vehicle used for the transporting of persons in non-emergency situations. The vehicle meets local, county or state regulations set f…
    2083P0901XPublic Health & General Preventive Medicine PhysicianPublic health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined popu…
    313M00000XNursing Facility/Intermediate Care FacilityAn institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related …
    364SP0813XGeropsychiatric Psychiatric/Mental Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    163WX0601XOtorhinolaryngology & Head-Neck Registered NurseNursing Service Providers · Registered Nurse
    163WX0800XOrthopedic Registered NurseNursing Service Providers · Registered Nurse

    Related ICD-10-CM Codes

    20 rows

    ICD-10-CM CodeDescription
    E10.39Type 1 diabetes mellitus with other diabetic ophthalmic complication
    E11.39Type 2 diabetes mellitus with other diabetic ophthalmic complication
    G47.9Sleep disorder, unspecified
    H11.30Conjunctival hemorrhage, unspecified eye
    H26.9Unspecified cataract
    H43.9Unspecified disorder of vitreous body
    H50.9Unspecified strabismus
    H52.11Myopia, right eye
    H52.12Myopia, left eye
    H52.13Myopia, bilateral

    Showing 1–10 of 20

    Related Payer Policy Updates

    Specialty: Ophthalmology/Optometry1 / 2

    10 rows

    PolicyPayerEffective Date
    Evaluation of Dry EyesOscar Health2026-10-01
    Evaluation of Dry EyesBlue Cross Blue Shield - New Mexico2026-09-04
    Ophthalmic Prostaglandin Analog Prior Authorization Criteriamedimpact2026-09-01
    revakinagene taroretcel-lwey (Encelto) coverage for idiopathic macular telangiectasia (MacTel) type 2blue cross blue shield - louisiana2026-09-01
    Glaucoma ProstaglandinsCigna2026-08-15
    Corneal Cross‑linking (CXL) Procedurehusky_health2026-08-01
    Corneal surgical procedures (excluding corneal collagen cross-linking)husky_health2026-08-01
    Intracanalicular and Intravitreal Corticosteroid ImplantsUnitedHealthcare2026-08-01
    Eye Optical Coherence TomographyPremera Bluecross2026-08-01
    Susvimo (ranibizumab) intravitreal implant — Medical Benefit Drug PolicyUnitedHealthcare2026-08-01

    Related Codes

    HCPCS-LEVEL-II-V2211-SPHEROCYLINDER-BIFOCAL-HIGH-SPHERE

    HCPCS Level II V2211: Spherocylinder Bifocal Lens, High Sphere Range

    HCPCS-LEVEL-II-V2700-BALANCE-LENS-PER-LENS

    HCPCS Level II V2700: Balance Lens, Per Lens

    HCPCS-V2020-FRAMES-PURCHASES

    HCPCS Level II V2020: Frames, Purchases

    HCPCS-V2025-DELUXE-FRAME-VISION-APPLIANCE

    HCPCS V2025: Deluxe Frame

    HCPCS-V2100-SINGLE-VISION-SPHERE-LENS-PLANO-TO-PLUS-MINUS-4

    HCPCS V2100: Single Vision Sphere Lens, Plano to ±4.00 per Lens

    HCPCS-V2101-SINGLE-VISION-SPHERICAL-LENS-HIGH-POWER

    HCPCS Level II V2101: Sphere Single Vision High-Power Lens

    HCPCS-V2102-HIGH-POWER-SINGLE-VISION-SPHERICAL-LENS

    HCPCS V2102: Single-Vision High-Power Spherical Lens

    HCPCS-V2103-SPHEROCYLINDER-SINGLE-VISION-LENS

    HCPCS Level II V2103: Single-Vision Spherocylinder Lens, Per Lens

    HCPCS-V2104-SPHEROCYLINDER-SINGLE-VISION-LENS-PLANO-TO-4D-SPHERE-2-12-TO-4D-CYLINDER

    HCPCS V2104: Spherocylinder Single-Vision Lens, Per Lens

    HCPCS-V2105-SPHEROCYLINDER-SINGLE-VISION-LENS

    HCPCS Level II V2105: Spherocylinder Single-Vision Lens

    Showing 1–10 of 123

    • More pages

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.