Summary & Overview
HCPCS V2522: Contact Lens, Hydrophilic, Bifocal, Per Lens
HCPCS Level II code V2522 denotes a single hydrophilic bifocal contact lens supplied for refractive correction of both distance and near vision. Nationally, this supply code is relevant to vision benefit management, optical dispensing workflows, and coverage determinations across commercial and government payers. Its use affects claims processing, patient cost-sharing, and inventory management for eye care providers and suppliers.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, common billing considerations for optical supplies, and clinical context about bifocal soft contact lenses. The publication outlines benchmarks for reimbursement where available, policy update highlights that affect medical supply claims, and common administrative issues encountered in billing and coding for specialty contact lenses.
This summary is intended for a national audience of billing professionals, vision care providers, and policy analysts who need a concise reference on HCPCS Level II code V2522, including when the code applies, typical sites of service, and the types of topics covered in the full publication.
Billing Code Overview
HCPCS Level II code V2522 describes a contact lens, hydrophilic, bifocal, per lens. This code represents a vision care supply used to correct both distance and near vision in a single lens design, typically made from a hydrophilic (soft) material.
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Service type: Provision of a bifocal soft contact lens
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Typical site of service: Retail optical outlets, ophthalmology or optometry clinics, and other outpatient vision care settings
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with symptomatic presbyopia and age-related hyperopia presents to an optometry clinic for visual rehabilitation. The patient reports difficulty with near tasks such as reading and computer use despite previously wearing single-vision spectacles. The optometrist performs a comprehensive eye exam including refraction, slit-lamp anterior segment evaluation, tear assessment, and keratometry/topography as indicated. After confirming stable ocular surface and anatomy suitable for contact lens wear, the clinician discusses options and orders a prescription for V2522 — a hydrophilic bifocal contact lens, per lens. The workflow includes measurement, trial lens fitting when indicated, dispensing of lenses with patient education on insertion, removal, cleaning, and follow-up visits to assess fit, vision, and comfort. Typical sites of service are outpatient optometry or ophthalmology clinics and retail optical centers associated with licensed providers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional component of an associated service provided by the clinician (e.g., refraction or fitting) separate from supplies. |