Summary & Overview
HCPCS V2526: Contact Lens, Hydrophilic with Blue-Violet Filter
HCPCS Level II code V2526 denotes a single hydrophilic (soft) contact lens with a blue-violet light filter. The code is used when this specialized lens is supplied to a patient and is relevant for vision care billing and supply-chain management in ophthalmology and optometry. Nationally, items like these are important for payers and providers because they intersect medical necessity determinations, durable medical equipment or supply policies, and vision benefit design.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how this code is classified, typical sites of service for supply and fitting, and the clinical context for use of blue-violet filtering lenses. The publication also outlines common billing modifiers and payer considerations where available, benchmark frames for reimbursement categories, and coding relationships relevant to claims processing.
The piece is intended to help billing managers, practice administrators, and policy analysts understand where V2526 fits within supply coding, what documentation is commonly relevant for claims, and what payer policies frequently address for specialized contact lenses. Data not available in the input.
Billing Code Overview
HCPCS Level II code V2526 describes a contact lens, hydrophilic, with blue-violet filter, per lens. This item represents a single soft (hydrophilic) contact lens manufactured with a blue-violet light filtering feature intended to alter light transmission to the eye. The service type is the provision or supply of a specialized contact lens.
The typical site of service for this supply is outpatient clinical settings, including ophthalmology or optometry offices, optical dispensaries, and retail medical supply locations where contact lenses are fitted and dispensed. The code applies per lens supplied to the patient.
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Clinical & Coding Specifications
Clinical Context
A patient with light sensitivity, photophobia, or difficulty with glare presents to an ophthalmology or optometry clinic and is fitted for specialty contact lenses. The clinician evaluates visual acuity, refraction, anterior segment health, and patient history of light intolerance. Trial lenses with a blue-violet filter are selected to reduce high-energy visible (HEV) light exposure and improve comfort for tasks like computer work, outdoor activities, or post-surgical photophobia. The workflow includes: pre-fit evaluation (history, slit-lamp exam, refraction), lens trial and fit assessment, patient education on insertion/removal and lens care, and documentation of medical necessity when lenses are provided for therapeutic indications. Dispensing of V2526 occurs per lens with fitting adjustments and follow-up visits scheduled to assess tolerance and ocular surface health. Typical site of service is an ophthalmology outpatient clinic, optometry office, or specialty contact lens center; lenses may be provided on the same day as fitting or ordered and dispensed at a subsequent visit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when services required substantially greater work than usual for lens fitting due to complex medical issues. |