Summary & Overview
HCPCS V2313: Spherocylinder Trifocal Lens, Per Lens
HCPCS Level II code V2313 designates a spherocylinder trifocal lens (per lens) with spherical power from ±7.25 to ±12.00 diopters and cylindrical power from 4.25 to 6.00 diopters. The code captures supply of a specialized ophthalmic prosthetic lens used to address high refractive errors and astigmatism while providing trifocal vision correction. Nationally, this code is relevant for ophthalmology practices, optical suppliers, ambulatory surgical centers, and payers managing coverage for specialty intraocular and prosthetic lenses.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the device, typical sites of service, and the payer landscape addressed. The analysis highlights billing considerations tied to lens specifications and expected contexts of use. Additionally, readers will learn what benchmark and policy topics are relevant for this code: reimbursement characterization for specialty lenses, payer coverage patterns, and coding clarity for per-lens supply.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Billing Code Overview
HCPCS Level II code V2313 describes a spherocylinder trifocal lens specified as plus or minus 7.25 to plus or minus 12.00 diopter sphere with 4.25 to 6.00 diopter cylinder, billed per lens. This code represents a specialty ophthalmic prosthetic lens designed to correct both spherical and cylindrical refractive errors with a trifocal optical design for patients requiring multiple focal zones.
Service Type: Ophthalmic prosthetic lens fitting and supply
Typical Site of Service: Outpatient ophthalmology clinics, optical dispensaries, and ambulatory surgical centers where intraoperative or postoperative lenses are provided
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Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive presbyopia and coexisting cataract presents for evaluation for trifocal intraocular lens implantation. Preoperative biometry reveals high spherical power requirement within the range of +7.25 to +12.00 diopters and a spherocylindrical refractive error with cylinder between 4.25 and 6.00 diopters. The ophthalmic surgeon documents visual needs, informed consent, and selects a trifocal toric intraocular lens per eye. The workflow includes preoperative refraction and keratometry, axial length and anterior chamber measurements, IOL power calculation, surgical implantation in an operating room or ambulatory surgery center, and postoperative refractive follow-up with potential spectacle or contact lens adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the surgeon's professional service separate from facility charges for the lens insertion or related imaging interpretation. |