Summary & Overview
HCPCS V2524: Hydrophilic Spherical Contact Lens with Photochromic Additive
HCPCS Level II code V2524 identifies a hydrophilic, spherical contact lens with a photochromic additive, billed per lens. This code captures a specialty optical device that combines soft lens material with light-adaptive (photochromic) properties, relevant for patients seeking vision correction with variable-light protection. Nationally, billing for specialty contact lenses touches medical and vision benefit boundaries and influences reimbursement pathways for ophthalmic devices.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and payer coverage considerations. The publication provides benchmarks for billing frequency and utilization where available, notes common billing modifiers, and outlines policy and coding implications relevant to suppliers and eye care providers.
The summary highlights clinical use—correction of refractive error with added photochromic functionality—and service delivery settings such as eye clinics and optical dispensaries. Where input data is missing, the publication indicates "Data not available in the input." The goal is to give payers, administrators, and clinicians a clear, national-level briefing on the code's purpose, typical application, and the payer landscape readers can expect when managing claims for specialty contact lenses.
Billing Code Overview
HCPCS Level II code V2524 describes a contact lens, hydrophilic, spherical, photochromic additive, per lens. This item is a specialty ophthalmic lens designed to provide vision correction with a hydrophilic (soft) material, spherical optical power, and an integrated photochromic additive that darkens in response to light.
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Service type: Dispensing of a specialty contact lens for vision correction with photochromic properties.
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Typical site of service: Eye care settings such as ophthalmology or optometry clinics, optical dispensing locations, and retail optical providers where contact lenses are fitted and dispensed.
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with high light sensitivity and regular refractive error presents to an optometry clinic requesting cosmetic and functional contact lenses. After a comprehensive eye exam including refraction and slit-lamp evaluation, the optometrist determines that a hydrophilic (soft) spherical contact lens with a photochromic additive is appropriate to provide vision correction and photochromic light adaptation. The typical clinical workflow includes: initial history and visual acuity assessment, manifest refraction, corneal curvature measurement (keratometry/topography), trial lens fitting, evaluation of lens comfort and movement on the eye, instruction on insertion/removal and lens care, and ordering of custom or stock V2524 lenses per lens. The typical site of service is an outpatient ophthalmology or optometry clinic, optical dispensary, or retail eye care center. Follow-up visits may include a contact lens check within 1–2 weeks and periodic annual contact lens evaluations. Billing for the lens uses HCPCS Level II code V2524 billed per lens, with appropriate modifiers applied as indicated by payer rules and the clinical circumstances. Payers commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified or default indicator (site/payer-specific) |