Summary & Overview
HCPCS V2513: Gas-Permeable Contact Lens, Extended Wear
HCPCS Level II code V2513 denotes a gas-permeable contact lens intended for extended wear, billed per lens. This code is used when durable medical device suppliers, ophthalmology or optometry clinics, and specialty optical dispensers provide gas-permeable lenses designed to be worn overnight or continuously for multiple days. Nationally, billing for extended-wear gas-permeable lenses is relevant to vision benefit management, Medicare durable medical equipment coverage determinations, and payer medical necessity policies.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage considerations, typical sites of service, and the clinical context for extended-wear gas-permeable lenses. The publication outlines common billing practices, potential documentation elements needed to support medical necessity, and how this supply code integrates with typical ophthalmology and optometry service lines.
This summary provides national-level context, benchmarks where available, and pointers to policy language and coding combinations to consider when submitting claims. Data not available in the input will be noted in the relevant sections of the full publication.
Billing Code Overview
HCPCS Level II code V2513 describes a contact lens, gas permeable, extended wear, per lens. This code represents the provision of gas-permeable contact lenses designed and intended for extended wear (overnight or continuous wear for multiple days) and is billed on a per lens basis.
Service type: Durable medical device / Prosthetic/sensory device — Contact lens fitting and supply
Typical site of service: Outpatient clinic, ophthalmology or optometry office, specialty optical dispenser
Clinical & Coding Specifications
Clinical Context
A patient presents to an optometry or ophthalmology clinic for evaluation of contact lens needs due to refractive error, irregular corneal shape, or intolerance to soft lenses. The clinician assesses ocular history, performs visual acuity, slit-lamp exam, keratometry/topography, and refraction. For patients who require gas permeable extended wear lenses (V2513), the practitioner takes corneal measurements, discusses wear schedule and risks, orders custom rigid gas permeable lenses, and documents medical necessity when indicated (e.g., keratoconus, high astigmatism, irregular cornea, or poor tolerance to soft lenses). Typical workflow includes diagnostic fitting, trial lens wear, follow-up visits to assess fit and ocular health, final lens fabrication and dispensing, and periodic monitoring for complications such as corneal edema or infection. Typical site of service is an outpatient ophthalmology or optometry clinic; lenses may be dispensed in-office or through a contracted optical lab. A realistic patient scenario: a 28-year-old with keratoconus and progressive irregular astigmatism who failed soft lens tolerance is fitted with custom gas permeable extended wear lenses for improved vision and corneal support, with documented measurements and informed consent for extended wear risks.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the lens is for the left eye |