Summary & Overview
HCPCS Level II V2214: Bifocal Spherocylindrical Lens, >±12.00D
HCPCS Level II code V2214 denotes a bifocal spherocylindrical ophthalmic lens with spherical power over ±12.00 diopters, billed per lens. This code is used by vision benefit administrators and medical payers to classify and reimburse specialized high-power bifocal lenses dispensed to patients with significant refractive error. Nationally, accurate use of V2214 affects coverage determinations, claim adjudication, and benefit design for high-prescription eyewear.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise clinical and billing overview of the lens type represented by this code, see how it maps to service settings where lenses are dispensed, and find guidance on the kinds of documentation and claim lines that commonly accompany this HCPCS Level II code. The publication also summarizes common modifiers and administrative considerations where available, and highlights areas where data was not provided. This material is intended to support coding accuracy, payer communication, and operational workflows related to dispensing high-power bifocal lenses.
Billing Code Overview
HCPCS Level II code V2214 describes a spherocylinder, bifocal, sphere over plus or minus 12.00d, per lens. This item denotes a prescription ophthalmic lens with a bifocal segment and a spherocylindrical correction where the spherical power exceeds ±12.00 diopters per lens.
Service type: Dispensing of prescription ophthalmic lens (bifocal spherocylindrical lens).
Typical site of service: Optical dispensary, ophthalmology clinic, optometry office, or retail optical shop where lenses are fabricated or dispensed to patients.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with high hyperopia and astigmatism presents to an optometry clinic complaining of progressive blurred distance and near vision. Refraction reveals a spherical equivalent exceeding +12.00 diopters with a significant cylindrical component and the patient requires bifocal correction for near tasks. The optometrist documents the manifest refraction, selects a spherocylinder bifocal lens with sphere over plus or minus +12.00D (per lens), and places an order with a dispensing optical lab. Typical workflow: initial history and visual acuity testing, manifest and cycloplegic refraction as indicated, slit-lamp anterior segment exam to verify ocular health, documentation of prescription and lens specifications, verification of medical necessity when applicable, submission of the lens order to the optical supplier, and post-dispense fitting and patient education. Typical site of service: outpatient optometry or ophthalmology clinic and an optical dispensing facility associated with the practice or a retail optical supplier.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Clinical service performed by treating provider | When the usual, non-telehealth optometry/ophthalmology service is furnished by the billing provider |