V2212 Bifocal Spherocylinder Lens HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS V2212: Bifocal Spherocylinder Lens, High Sphere and Cylinder

HCPCS Level II code V2212 denotes a specialized bifocal spherocylinder eyeglass lens with high spherical correction (±7.25 to ±12.00 D) and substantial cylinder power (2.25 to 4.00 D), billed per lens. This code is used when dispensing prescribed ophthalmic lenses that combine significant spherical and cylindrical refractive corrections with a bifocal segment. Nationally, accurate coding for high-power bifocal lenses supports appropriate coverage determinations, claims adjudication, and supplier reimbursement for vision benefits.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the clinical and supply context for V2212, typical sites of service, and the kinds of documentation and lens specifications that commonly accompany claims for high-power bifocal spherocylinder lenses. The publication summarizes common modifier usage and payer considerations where available, highlights benchmarking categories used to compare coverage and reimbursement across major payers, and notes areas where input data was not provided.

This analysis is intended for national audiences involved in vision benefit administration, billing and coding staff in ophthalmology and optometry practices, optical suppliers, and policy analysts seeking a clear reference for claims involving high-power bifocal spherocylinder lenses.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareV2212HCPCS Level IIbifocal lensspherocylindervision suppliesoptical billingophthalmologyoptometryeyewear

Billing Code Overview

HCPCS Level II code V2212 describes a spherocylinder bifocal lens with a spherical power range of +/- 7.25 to +/- 12.00 diopters and a cylindrical power range of 2.25 to 4.00 diopters, billed per lens.

Service Type: Eyewear lens supply — specialized bifocal spherocylinder prescription lens

Typical Site of Service: Optical dispensary, outpatient ophthalmology/optometry office, or vision supply retail setting

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with age-related presbyopia and clinically significant astigmatism presents to an ophthalmic optical dispensary after a comprehensive eye examination by an optometrist. The refractive assessment documents high hyperopic spherical power and a moderate-to-high cylindrical correction requiring a bifocal segment. The optical lab is provided an order for a single lens fabrication: a spherocylinder bifocal lens with spherical power between +7.25D and +12.00D and cylinder between 2.25D and 4.00D, billed per lens as V2212.

Typical clinical workflow:

Referral and prescription: The eye care provider documents the refraction and medical necessity for high-plus, high-cylinder bifocal lenses in the patient’s chart and issues a signed eyeglass prescription.
Lens selection and measurement: Dispensing optician confirms desired bifocal segment type, verifies pupil distance and fitting height, and records lens parameters for lab fabrication.
Prior authorization / payment determination: If required by the payer, the dispenser or clinic obtains authorization for specialty lenses, supplies the diagnosis codes supporting vision correction and any functional limitation.
Fabrication and delivery: Optical lab manufactures the lens to the specified powers and returns to the dispensing site. Technician inspects quality and verifies the lens meets the ordered spherical and cylindrical ranges before delivery.
Dispensing and follow-up: Patient receives the eyeglasses, is instructed on bifocal use, and has follow-up with the prescriber if adaptation issues or visual complaints occur.

Coding Specifications

HCPCS V2410: Variable Asphericity Single-Vision Lens

HCPCS-V2744-PHOTOCHROMATIC-LENS-TINT

HCPCS Level II V2744: Tint, Photochromatic, Per Lens

HCPCS-V2220-BIFOCAL-ADD-OVER-3-25D

HCPCS V2220: Bifocal Add Over 3.25 Diopters

HCPCS-V2786-SPECIALTY-OCCUPATIONAL-MULTIFOCAL-LENS

HCPCS V2786: Specialty Occupational Multifocal Lens, Per Lens

HCPCS-V2632-POSTERIOR-CHAMBER-INTRAOCULAR-LENS

HCPCS V2632: Posterior Chamber Intraocular Lens

HCPCS-V2320-TRIFOCAL-ADD-OVER-3-25D

HCPCS V2320: Trifocal Add Over 3.25d

HCPCS-V2624-OCULAR-PROSTHESIS-POLISHING-RESURFACING

HCPCS V2624: Polishing/Resurfacing of Ocular Prosthesis

HCPCS-V2526-CONTACT-LENS-HYDROPHILIC-BLUE-VIOLET-FILTER

HCPCS V2526: Contact Lens, Hydrophilic with Blue-Violet Filter

HCPCS-V2610-SINGLE-LENS-SPECTACLE-MOUNTED-LOW-VISION-AID

HCPCS V2610: Single Lens Spectacle Mounted Low Vision Aid

HCPCS-V2629-PROSTHETIC-EYE-OTHER-TYPE

HCPCS Level II V2629: Prosthetic Eye, Other Type

Showing 1–10 of 123

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of a vision service separate from the supply of lenses when applicable.
`50`	Bilateral procedure	Use when reporting identical lens supply for both eyes on a single claim line when payer allows; otherwise submit one line per lens.
`52`	Reduced services	Use if the lens supplied is of lesser scope than prescribed (rare for this HCPCS).
`53`	Discontinued procedure	Use if fabrication was started but canceled for clinical reasons before completion.
`54`	Surgical care only	Not typically used for lens supply; included when adjunct surgical services are billed separately.
`55`	Postoperative management only	Not typically applicable to lens supply; used when only postop care is billed by a provider.
`62`	Two surgeons	Use only if two qualified providers share responsibility for a related surgical procedure; typically not applicable to lens supply.
`78`	Unplanned return to OR	Not applicable to lens supply; included for completeness when related surgical reintervention occurs.
`80`	Assistant at surgery	Not applicable to lens supply; relevant when surgical services accompany refractive procedures.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when a qualified non-physician practitioner provides an associated service covered by payer rules.
`QK`	Medical dirigible oversight/CRNA service	Use if a certified registered nurse anesthetist provides billable anesthesia in an associated surgical case.
`QX`	CRNA service with medical direction by physician	Use in combination with `QK`/`QX` billing structures for anesthesia when applicable.
`QY`	Medical direction of two, three, or four concurrent anesthesia procedures	Use only for anesthesia billing contexts.

Taxonomy Code	Specialty	Notes
`252B00000X`	Ophthalmology	Ophthalmologists diagnose and prescribe complex refractive corrections and manage ocular disease influencing lens selection.
`152W00000X`	Optometry	Optometrists perform refraction and prescribe eyeglasses including high-plus/high-cylinder bifocals.
`174400000X`	Optician	Dispensing opticians measure, order, and fit spectacle lenses and coordinate fabrication.
`363L00000X`	Ophthalmic Laboratory	Optical laboratory technologists fabricate specialty lenses to prescription specifications.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H52.03`	Hypermetropia, bilateral	High hyperopia commonly necessitates high-plus spherical lenses within the `V2212` range.
`H52.23`	Astigmatism, regular, bilateral	Regular astigmatism requiring cylindrical correction in the 2.25D–4.00D range is addressed by spherocylinder lenses.
`H52.4`	Presbyopia	Need for bifocal segment to correct near vision deficits in presbyopic patients.
`H52.5`	Hypermetropia with astigmatism	Combined spherical and cylindrical refractive errors indicating spherocylinder bifocal lenses.
`Z46.1`	Encounter for fitting and adjustment of eyeglasses and contact lenses	Administrative code for encounters related to lens fitting and dispensing of `V2212` lenses.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92015`	Determination of refractive state (refraction), unilateral or bilateral, performed with measurement of visual acuity	Refraction is the diagnostic service that produces the prescription used to order `V2212` lenses.
`92002`	Ophthalmological services: medical examination and evaluation, new patient, intermediate, without initiation of diagnostic or treatment program	Performed when a new patient evaluation precedes lens prescription; documents medical necessity for specialty lenses.
`92004`	Ophthalmological services: medical examination and evaluation, new patient, comprehensive, with initiation of diagnostic or treatment program	Comprehensive exam that may detect ocular pathology affecting lens selection.
`92392`	Therapeutic or prosthetic spectacle materials; basic spectacle lenses, single vision, per lens	Provides context for spectacle material coding; used for comparison to specialty lens HCPCS supply codes like `V2212`.
`92399`	Unlisted ophthalmic service or procedure	Used when a specific lens configuration or supply is not described by existing CPT/HCPCS and additional documentation is required.

OpenPayer