V2213 Spherocylinder Bifocal Lens - HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS V2213: Spherocylinder Bifocal Lens, High Power

HCPCS Level II code V2213 designates a high-power spherocylinder bifocal lens billed per lens. It covers lenses with spherical powers from +/- 7.25 to +/- 12.00 diopters and cylindrical powers of 4.25 to 6.00 diopters. This code matters nationally because it identifies a specialized optical device used to address severe refractive errors and supports consistent billing for suppliers, vision clinics, and payers managing coverage for corrective lenses.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise national overview of how this code is used in clinical practice and billing workflows, and what stakeholders can expect when this high-power bifocal lens is billed.

Readers will learn the clinical context for V2213, typical sites of service where these lenses are provided, and what elements are commonly evaluated when accounting for coverage and claims (service description, device specifications, and billing unit). Where available, the report summarizes benchmark considerations, relevant policy features from major payers, and coding notes for supply-side billing. Data not available in the input is identified explicitly when relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareV2213HCPCS Level IIophthalmic lensbifocal lenshigh-power spherocylinderdurable medical equipmentvision servicesoptical device

Billing Code Overview

HCPCS Level II code V2213 describes a spherocylinder bifocal lens with a spherical power range of +/- 7.25 to +/- 12.00 diopters and a cylindrical power of 4.25 to 6.00 diopters, billed per lens. This code represents a specific ophthalmic lens product used to correct significant refractive errors that require both high spherical and cylindrical powers in a bifocal configuration.

Service Type: Durable medical equipment / Vision optical device

Typical Site of Service: Outpatient ophthalmology or optometry clinics, optical dispensaries, and vision specialty suppliers

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with progressive presbyopia and a significant refractive error presents to an optometry or ophthalmology clinic for spectacles. Manifest refraction reveals high hyperopic sphere with astigmatism requiring bifocal correction. The clinician documents refraction values within the range of +7.25 to +12.00 diopters sphere and 4.25 to 6.00 diopters cylinder, and orders custom bifocal spherocylinder lenses, billed as V2213 per lens. The clinical workflow includes vision assessment (distance and near acuity), objective and manifest refraction, binocular vision and ocular health evaluation, lens material and bifocal segment selection, measurement for frame fitting, verification of prescription, ordering from optical lab, receipt and inspection of finished lenses, patient dispensing, and documentation of final lens parameters and patient acceptance. If medically indicated (e.g., monocular conditions, bilateral differences), modifiers for laterality or professional component may be applied on claim submission. Typical sites of service are outpatient optometry clinics, ophthalmology offices, optical dispensaries within medical practices, and retail optical centers affiliated with clinical providers. The patient scenario commonly involves age-related presbyopia with high ametropia and astigmatism requiring specialty bifocal lenses per lens V2213.

Coding Specifications

Modifier

HCPCS Level II V2025: Deluxe Frame

HCPCS-V2627-SCLERAL-COVER-SHELL

HCPCS V2627: Scleral Cover Shell

HCPCS-V2503-CONTACT-LENS-PMMA-COLOR-VISION-DEFICIENCY

HCPCS Level II V2503: Contact Lens, PMMA, Color Vision Deficiency

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

HCPCS V2320: Trifocal Add Over 3.25d

HCPCS-V2110-SPHEROCYLINDER-SINGLE-VISION-HIGH-POWER-LENS

HCPCS V2110: Spherocylinder Single-Vision Lens, High Power

HCPCS-V2206-BIFOCAL-SPHEROCYLINDER-HIGH-CYLINDER-LENS-PER-LENS

HCPCS V2206: Spherocylinder Bifocal Lens, High Cylinder, Per Lens

HCPCS-V2715-PRISM-PER-LENS

HCPCS V2715: Prism, Per Lens

HCPCS-V2105-SPHEROCYLINDER-SINGLE-VISION-LENS

HCPCS V2105: Spherocylinder Single-Vision Lens (per lens)

HCPCS-V2321-LENTICULAR-TRIFOCAL-LENS

HCPCS V2321: Lenticular Trifocal Intraocular Lens

HCPCS-V2201-BIFOCAL-SPHERICAL-LENS-PLUS-MINUS-4-12-TO-7-00

HCPCS V2201: Bifocal Spherical Lens, ±4.12 to ±7.00D, Per Lens

Showing 1–10 of 123

Taxonomy Code	Specialty	Notes
`152W00000X`	Optometrist	Primary providers performing refraction, prescribing and dispensing eyeglasses; common in outpatient optical services.
`207W00000X`	Ophthalmologist	Medical/surgical eye specialists who evaluate ocular health, prescribe complex corrective lenses and manage ocular disease before dispensing.
`363L00000X`	Optician	Licensed dispensing specialists who measure, order, and fit lenses and frames; perform verification and adjustments.
`261QM0700X`	Ophthalmic Technician/Technologist	Support role performing measurements, lensometry, and assisting with dispensing workflows.
`163W00000X`	Orthoptist	In practices addressing binocular vision or strabismus-related refractive management where specialty lens prescriptions are part of care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H52.12`	Hypermetropia, bilateral	High hyperopia is within the sphere range indicated by `V2213` and commonly requires high-power bifocal lenses.
`H52.21`	Astigmatism, right eye	Significant cylinder correction (4.25–6.00 D) necessitates spherocylinder lens fabrication per lens `V2213`.
`H52.22`	Astigmatism, left eye	Same clinical relevance for the left eye when high astigmatic correction is required.
`H52.4`	Presbyopia	Need for bifocal segments for near addition in older patients; bifocal spherocylinder lenses address both distance and near.
`H54.7`	Unspecified visual loss	When high refractive errors lead to decreased acuity, specialized high-power bifocal lenses may be prescribed as part of rehabilitation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92015`	Determination of refractive state (refraction), unilateral or bilateral, includes cycloplegic refraction when performed	Performed prior to ordering `V2213` to determine accurate spherical and cylindrical lens powers and bifocal add; documents prescription used for lens fabrication.
`92004`	Ophthalmological services: medical examination and evaluation, comprehensive, new patient	Provides ocular health assessment and diagnosis that may necessitate high-power bifocal lenses; used when a new patient requires comprehensive eye exam before ordering lenses.
`92014`	Ophthalmological services: comprehensive, established patient	Used for ongoing ocular disease management and refraction updates prior to lens ordering when patient is established.
`92310`	Prescription of contact lens for aphakia, hard contact lens	Not directly for spectacle lenses but may be performed in parallel in practices evaluating alternatives to high-power spectacle correction.
`99070`	Supplies and materials (used only when not included)	May be appended by some payors when special materials or coatings for `V2213` lenses incur additional charge outside the HCPCS supply code.

`26`	Professional component	Use when billing only the professional portion of a service (e.g., refraction or fitting) separate from the technical dispensing.
`50`	Bilateral procedure	Use when both right and left lenses of the same `V2213` specification are provided and payor requires bilateral modifier.
`52`	Reduced services	Use when the full scope of lens services is not performed (partial fabrication or limited fitting).
`53`	Discontinued procedure	Use if the lens order is canceled after initiation for reasons beyond provider control.
`54`	Surgical care only	Rare for lens fabrication; use if a procedure-related surgical episode is billed separately and lens supply is only part of follow-up technical care.
`55`	Post-operative management only	Use when billing only for post-operative optical services distinct from initial surgical billing.
`62`	Two surgeons	Use when two qualified providers share significant portions of care related to complex optical rehabilitation.
`78`	Return to operating room for a related procedure	Use if lens replacement occurs in an operative context requiring return to OR.
`80`	Assistant surgeon	Use when an assistant surgeon performs part of related surgical care tied to optical rehabilitation.
`82`	Assistant surgeon (when qualified resident unavailable)	Use when a qualified assistant is needed and a resident is not available.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare	Use when these clinicians furnish professional services related to the optical fitting under Medicare rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Generally not applicable to lens supply; included only when anesthesia services intersect with related surgical care.
`RR`	Resident in teaching setting	Use when a resident provides services under a teaching hospital program that affects billing.
`76`	Repeat procedure by same physician	Use when an identical lens order is refabricated and billed again (note: `76` not in raw list; excluded).

OpenPayer