V2500 PMMA Spherical Lens | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS V2500: Contact Lens, PMMA, Spherical, Per Lens

HCPCS Level II code V2500 identifies a single polymethyl methacrylate (PMMA) spherical contact lens dispensed per lens. This supply-oriented HCPCS code matters nationally because it standardizes billing for a specific type of rigid contact lens used for refractive correction, enabling consistent coverage determinations and claims processing across payers. The code applies to outpatient dispensing in optical and ambulatory eye-care settings and is commonly used when PMMA spherical lenses are supplied to patients.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what V2500 represents, payer inclusion, and the clinical and billing context for dispensing PMMA spherical lenses. The publication outlines typical use cases, expected site-of-service patterns, and what information is available or missing from the input (for example, associated taxonomies, ICD-10 diagnoses, and related codes are not provided). The content is focused on benchmarks, coverage considerations, and coding context useful for billing professionals, revenue cycle staff, and policy analysts seeking a national perspective on this durable medical device supply code.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareV2500HCPCS Level IIcontact lensPMMAvision supplyoutpatient eye caredurable medical equipmentspherical lensmedical billing

Billing Code Overview

HCPCS Level II code V2500 describes a contact lens made of polymethyl methacrylate (PMMA), spherical, billed per lens. This item represents a single, rigid spherical contact lens intended for vision correction.

Service type: Durable medical device/vision correction supply
Typical site of service: Dispensed in outpatient settings such as optical shops, eye clinics, ambulatory care centers, and retail vision providers

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient presents to an optometry clinic for routine vision correction and requests contact lenses for refractive correction. After a comprehensive eye examination including refraction, slit-lamp anterior segment exam, and corneal topography, the clinician determines a fit for a rigid polymethyl methacrylate (PMMA) spherical contact lens. The clinical workflow includes: initial history and visual acuity assessment, manifest and/or cycloplegic refraction, corneal measurements, trial lens fitting with assessment of fit and vision, patient education on insertion, removal and care, ordering of the final lenses, and documentation of lens parameters and dispensing. The dispensing event is billed per lens using HCPCS Level II code V2500 for a PMMA spherical contact lens. Typical sites of service are outpatient optometry or ophthalmology clinics and retail optical shops associated with a licensed optometrist or ophthalmologist. Typical patient scenarios include simple spherical refractive errors (myopia or hyperopia) in patients who prefer or require a rigid PMMA lens type, including cases where rigid lens material is selected for durability or cost considerations.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	Use when billing a lens for the left eye

HCPCS V2304: Spherocylinder Trifocal Ophthalmic Lens, Plano to ±4.00D

HCPCS-V2510-GAS-PERMEABLE-SPHERICAL-CONTACT-LENS

HCPCS V2510: Contact Lens, Gas Permeable, Spherical, Per Lens

HCPCS-V2213-SPHEROCYLINDER-BIFOCAL-HIGH-POWER-LENS

HCPCS V2213: Spherocylinder Bifocal Lens, High Power

HCPCS-V2121-LENTICULAR-LENS-SINGLE-IMPLANTABLE-OPHTHALMIC-DEVICE

HCPCS V2121: Lenticular Lens, Per Lens, Single

HCPCS-V2626-REDUCTION-OCULAR-PROSTHESIS

HCPCS V2626: Reduction of Ocular Prosthesis

HCPCS-V2762-POLARIZATION-LENS-PER-LENS

HCPCS V2762: Polarization, Any Lens Material, Per Lens

HCPCS-V2305-TRIFOCAL-SPHEROCYLINDER-LENS

HCPCS V2305: Spherocylinder Trifocal Ophthalmic Lens, Per Lens

HCPCS-V2312-TRIFOCAL-SPHEROCYLINDER-LENS-PER-LENS

HCPCS V2312: Spherocylinder Trifocal Lens, Per Lens

HCPCS-V2309-TRIFOCAL-SPHEROCYLINDER-INTRAOCULAR-LENS

HCPCS V2309: Trifocal Spherocylinder Intraocular Lens, Per Lens

HCPCS-V2199-SINGLE-VISION-LENS-NOT-OTHERWISE-CLASSIFIED

HCPCS V2199: Single Vision Lens, Not Otherwise Classified

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Taxonomy Code	Specialty	Notes
`174400000X`	Optometrist	Primary providers who perform refraction, fitting, and dispensing of contact lenses
`207W00000X`	Ophthalmology	Eye physicians who may fit and prescribe rigid contact lenses and manage associated ocular pathology
`3336C0002X`	Optician	Licensed dispensing personnel who may perform lens measurements and provide patient education under supervision
`163W00000X`	Corneal Specialist	Ophthalmologists specializing in cornea who fit specialty rigid lenses for complex corneal conditions

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H52.13`	Myopia, bilateral	Myopia is a common indication for spherical contact lenses
`H52.03`	Hypermetropia, bilateral	Hyperopia corrected with spherical contact lenses
`H52.4`	Presbyopia	May be addressed concurrently with contact lens correction plans (monovision or multifocal strategies)
`H52.9`	Refractive error, unspecified	General refractive error frequently managed with contact lenses
`H18.8`	Other corneal disorders	May necessitate rigid lens fitting for corneal irregularities where PMMA lenses are chosen for specific reasons
`Z01.00`	Encounter for examination of eyes and vision without abnormal findings	Routine eye exams that can result in contact lens dispensing
`Z46.1`	Fitting and adjustment of external prosthetic device of head and neck	Administrative code sometimes used for fitting and adjustment of contact lenses

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92004`	Ophthalmological services: medical examination and evaluation, new patient, intermediate or complete, with initiation of diagnostic and treatment program; comprehensive, one or more visits	Performed when a new patient requires a comprehensive eye exam prior to contact lens fitting and prescription
`92014`	Ophthalmological services: medical examination and evaluation, established patient, comprehensive, with initiation/continuation of diagnostic and treatment program	Used for follow-up comprehensive exams when refitting or evaluating contact lens performance
`92310`	Prescription of optical and physical attributes of contact lens, with medical supervision of adaptation; corneal lens, spherical (per lens)	Directly related fitting/prescription procedure for a corneal rigid spherical lens; often billed in conjunction with lens dispensing
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	Used for non-covered material costs or special supplies associated with lens dispensing
`99001`	Handling and/or conveyance, contact lens (example non-specific)	Used by some payers or facilities to account for handling or shipping of contact lenses (note: payer-specific acceptance varies)

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