Summary & Overview
HCPCS Level II V2530: Scleral Gas-Impermeable Contact Lens, Per Lens
HCPCS Level II code V2530 designates a scleral, gas-impermeable contact lens billed per lens. These specialized lenses address complex ocular surface and corneal conditions, including severe dry eye, irregular corneas, and post-surgical management. Nationally, use of scleral lenses is clinically significant due to their role in vision rehabilitation and in reducing downstream surgical interventions and complications.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical indications and the typical sites of service, plus an outline of what information is covered in the full publication: national reimbursement benchmarks where available, common billing and modifier practices, and policy or coverage considerations that influence access to scleral lenses. The full publication also situates V2530 within outpatient and specialty ophthalmic care workflows and highlights areas where documentation and coding precision are most important.
Data not available in the input is noted where applicable; the summary focuses on nationally relevant clinical and billing context for HCPCS Level II code V2530.
Billing Code Overview
HCPCS Level II code V2530 represents a scleral gas-impermeable contact lens, billed per lens. The code describes a specialized contact lens used to manage ocular surface irregularities, severe dry eye, corneal ectasia, or other conditions requiring a rigid, large-diameter scleral lens.
Service type: Durable medical device / specialty contact lens fitting and supply
Typical site of service: Ophthalmology or optometry clinic; specialty contact lens service centers; outpatient ambulatory care settings
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient with advanced irregular corneal surface and severe ocular surface disease presents to an ophthalmology specialty clinic for visual rehabilitation. The patient has a history of keratoconus with prior scarring and significant irregular astigmatism causing reduced best-corrected visual acuity with standard soft contact lenses and spectacles. The cornea specialist evaluates the patient in an outpatient ophthalmology clinic or ambulatory surgery center, performs a detailed slit-lamp exam, corneal topography, and discusses scleral lens options. A custom gas-impermeable scleral contact lens is ordered and fabricated to vault the cornea and rest on the sclera to improve vision, mask corneal irregularity, and provide a stable tear reservoir. Fitting visits include trial lens evaluation, measurement, and adjustments. Final delivery occurs at a clinic visit where fit, comfort, and over-refraction are completed. Billing for the custom lens uses V2530 for a gas-impermeable scleral lens per lens; modifications of the lens fit are captured separately per guidance (see professional fitting and diagnostic codes such as contact lens evaluation codes). Typical site of service: outpatient ophthalmology clinic or ambulatory surgery center specialized in corneal/contact lens services. Payers commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |