Summary & Overview
HCPCS V2204: Spherocylinder Bifocal Lens, Plano to ±4.00D
HCPCS Level II code V2204 identifies a spherocylinder bifocal lens—a prescription corrective lens with spherical power from plano to ±4.00 diopters and cylindrical power from 2.12 to 4.00 diopters—billed on a per-lens basis. This supply code is relevant to vision benefit administration, optical dispensing, and claims processing for patients requiring combined spherical and astigmatic correction with a bifocal segment. Nationally, accurate coding of such lens supplies affects benefit eligibility determinations, claims adjudication, and reporting of durable medical equipment and optical supplies within vision and medical plans.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical and billing context for V2204, an outline of typical sites of service, and guidance on what information is available versus missing. The piece summarizes expected use cases for dispensing and billing, common administrative considerations, and the scope of available metadata. Data elements not provided in the input—such as associated taxonomies, ICD-10 diagnoses, and payer-specific coverage rules—are noted as not available in the input. The content is intended for coding specialists, billing managers, and policy analysts seeking a national-level reference on this HCPCS Level II supply code.
Billing Code Overview
HCPCS Level II code V2204 describes a spherocylinder bifocal lens specified as plano to ±4.00 diopter sphere with 2.12 to 4.00 diopter cylinder, billed per lens. This code represents the supply of a corrective ophthalmic lens designed to address both spherical and astigmatic refractive errors with a bifocal segment.
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Service type: Ophthalmic optical device (bifocal corrective lens)
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Typical site of service: Optical dispensary, ophthalmology or optometry office, retail optical shop, or other outpatient settings where prescription lenses are fabricated or dispensed
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an optometry or ophthalmology clinic with progressive presbyopia and distance visual acuity corrected with astigmatic refractive error. The clinician documents a manifest refraction that includes spherical correction within the plano to ±4.00 diopter range and a cylindrical component between 2.12 and 4.00 diopters. The patient requests spectacle correction for both distance and near and the provider prescribes a bifocal, spherocylindrical lens to address both spherical and significant astigmatic refractive error.
The typical clinical workflow includes: initial visual acuity testing, autorefractor/keratometry measurements, manifest refraction, binocular vision assessment for bifocal fitting, lens order entry with lens parameters (spherical, cylindrical, axis, bifocal segment), verification of patient identification and insurance, and remittance of the ordered lens to an optical lab. The ordering provider is commonly an optometrist or ophthalmologist; optical dispensing staff or a licensed optician complete measurements for frame fit and finalize the order. Lens fabrication and dispensing occur in an optical workshop or contracted laboratory; follow-up includes fit verification and any necessary adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the lens is for the left eye |