Summary & Overview
HCPCS V2319: Trifocal Segment Width Over 28 mm
HCPCS Level II code V2319 denotes a trifocal segment width over 28 mm for ophthalmic lenses. Nationally, accurate reporting of lens and optical appliance codes like V2319 matters for appropriate coverage determinations, claims processing, and uniform communication among eye care providers, payers, and suppliers. Trifocal lens specifications can affect benefit eligibility and allowances under vision and durable medical equipment policies.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what V2319 represents, how it is used in outpatient ophthalmology and optical dispensary settings, and which payers commonly adjudicate these lens-specific codes. The publication outlines typical billing contexts, common modifiers (listed separately), and the implications for claims submission.
This piece provides practical benchmarks and policy considerations relevant to national payer coverage and claims handling for trifocal lenses with larger segment widths. It summarizes where the code is applied clinically, who pays for the service, and what stakeholders should expect in terms of coding specificity and documentation needs. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code V2319 describes a trifocal segment width over 28 mm. This code is used to report lens-related services involving trifocal segments with a segment width greater than 28 millimeters. The service type is ophthalmic lens fitting or optical appliance specification related to trifocal lenses. The typical site of service is an outpatient ophthalmology or optometry clinic, optical dispensary, or other ambulatory eye care setting.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with presbyopia and cataract or post-refractive cataract extraction seeking spectacle independence who requires a trifocal intraocular lens (IOL) with a segment (optic) width greater than 28 mm. The clinical workflow begins with a comprehensive ophthalmic evaluation including visual acuity, refraction, slit-lamp exam, biometry (axial length and keratometry), corneal topography, and patient counseling about multifocal optics. On the day of surgery, the patient undergoes routine cataract extraction (phacoemulsification) with implantation of a trifocal IOL; billing for the device component uses V2319 to denote a trifocal segment width over 28 mm when applicable. Typical sites of service are ambulatory surgery centers and hospital outpatient departments. Postoperative follow-up includes day-1, week-1, and month-1 visits with refraction and assessment of visual outcomes and potential lens-related dysphotopsias or refractive surprises.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Use only if payer requires an unspecified modifier; rarely used in routine billing. |
11 |