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June 09, 2022, 11:08 EDT

Chapter : Appendix B HCPCS Vision Services Codes

Updated: 2/1/1988

 

HCFA Assignment of Vision Services Codes

VISION CARE EXAMINATION

 

 

 

Z9501

Routine comprehensive eye examination (once every 24 months)

 

 

 

 

FRAMES

 

 

 

Z9510

FRAMES, purchases (once every 24 months)

 

 

Z9511

FRAMES, replacement due to unrepairable damage

 

 

Z9512

FRAMES, repair and parts replacement

 

 

Z9519

FRAMES, dispensing fee

 

 

 

 

LENS

 

 

 

Z9520

LENS, dispensing fee

 

 

LENS

SINGLE VISION, glass or plastic, with scratch resistant coating (per lens)

 

 

V2100

SPHERE, single vision, plano to plus or minus 4.00D, per lens

 

 

V2101

SPHERE, single vision, plus or minus 4.12 to plus or minus 7.00D, per lens

 

 

V2102

SPHERE, single vision, plus or minus 7.12 to plus or minus 20.00D, per lens

 

 

V2103

SPHEROCYLINDER, single vision, plano to plus or minus 4.00D sphere, .12 to 2.00D cylinder, per lens

 

 

V2104

SPHEROCYLINDER, single vision, plano to plus or minus 4.00D sphere, 2.12 to 4.00D cylinder, per lens

 

 

V2105

SPHEROCYLINDER, single vision, plano to plus or minus 4.00D sphere, 4.25 to 6.00D cylinder, per lens

     

 

 

LENS 

SINGLE VISION, glass or plastic (continued)

 

 

V2106

SPHEROCYLINDER, single vision, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens

 

 

V2107

SPHEROCYLINDER, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, .12 to 2.00D cylinder, per lens

 

 

V2108

SPHEROCYLINDER, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 to 4.00D cylinder, per lens

 

 

V2109

SPHEROCYLINDER, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens

 

 

V2110

SPHEROCYLINDER, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens

 

 

V2111

SPHEROCYLINDER, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens

 

 

V2112

SPHEROCYLINDER, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25D to 4.00D cylinder, per lens

 

 

V2113

SPHEROCYLINDER, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens

 

 

V2114

SPHEROCYLINDER, single vision, sphere over plus or minus 12.00D per lens

 

 

V2115

LENTICULAR, (myodisc), per lens, single vision

 

 

V2116

LENTICULAR LENS, nonaspheric, per lens, single vision

 

 

V2117

LENTICULAR, aspheric, per lens, single vision

 

 

V2118

ANISEIKONIC LENS, single vision

 

 

V2199

NOT OTHERWISE CLASSIFIED, single vision lens

 

 

 

 

LENS -

BIFOCAL, glass or plastic, with scratch resistant coating, per lens (up to and including 28mm seg width, add power up to and including 3.25D)

 

 

V2200

SPHERE, bifocal, plano to plus or minus 4.00D, per lens

 

 

V2201

SPHERE, bifocal, plus or minus 4.12 to plus or minus 7.00D, per lens

 

 

LENS 

BIFOCAL, glass or plastic (continued)

 

 

V2202

SPHERE, bifocal, plus or minus 7.12 to plus or minus 20.00D, per lens

 

 

V2203

SPHEROCYLINDER, bifocal, plano to plus or minus 4.00D sphere, .12 to 2.00D cylinder, per lens

 

 

V2204

SPHEROCYLINDER, bifocal, plano to plus or minus 4.00D sphere, 2.12 to 4.00D cylinder, per lens

 

 

V2205

SPHEROCYLINDER, bifocal, plano to plus or minus 4.00D sphere, 4.25 to 6.00D cylinder, per lens

 

 

V2206

SPHEROCYLINDER, bifocal, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens

 

 

V2207

SPHEROCYLINDER, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, .12 to 2.00D cylinder, per lens

 

 

V2208

SPHEROCYLINDER, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 to 4.00D cylinder, per lens

 

 

V2209

SPHEROCYLINDER, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens

 

 

V2210

SPHEROCYLINDER, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens

 

 

V2211

SPHEROCYLINDER, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens

 

 

V2212

SPHEROCYLINDER, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25 to 4.00D cylinder, per lens

 

 

V2213

SPHEROCYLINDER, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens

 

 

V2214

SPHEROCYLINDER, bifocal, sphere over plus or minus 12.00D, per lens

 

 

V2215

LENTICULAR (myodisc), per lens, bifocal

 

 

V2216

LENTICULAR, nonaspheric, per lens, bifocal

 

 

V2217

LENTICULAR, aspheric, per lens, bifocal

 

 

V2218

ANISEIKONIC, per lens, bifocal

 

 

LENS 

BIFOCAL, glass or plastic (continued)

 

 

V2219

BIFOCAL seg width over 28mm

 

 

V2220

BIFOCAL add over 3.25D

 

 

V2299

SPECIALTY BIFOCAL (by report)

 

 

 

 

LENS -

TRIFOCAL, glass or plastic, with scratch resistant coating, per lens (up to and including 28mm seg width, add power up to and including 3.25D)

 

 

V2300

SPHERE, trifocal, plano to plus or minus 4.00D, per lens

 

 

V2301

SPHERE, trifocal, plus or minus 4.12 to plus or minus 7.00D per lens

 

 

V2302

SPHERE, trifocal, plus or minus 7.12 to plus or minus 20.00D, per lens

 

 

V2303

SPHEROCYLINDER, trifocal, plano to plus or minus 4.00D sphere, .12 to 2.00D cylinder, per lens

 

 

V2304

SPHEROCYLINDER, trifocal, plano to plus or minus 4.00D sphere, 2.25 to 4.00D cylinder, per lens

 

 

V2305

SPHEROCYLINDER, trifocal, plano to plus or minus 4.00D sphere, 4.25 to 6.00 cylinder, per lens

 

 

V2306

SPHEROCYLINDER, trifocal, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens

 

 

V2307

SPHEROCYLINDER, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, .12 to 2.00D cylinder, per lens

 

 

V2308

SPHEROCYLINDER, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 to 4.00D cylinder, per lens

 

 

V2309

SPHEROCYLINDER, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 4.26 to 6.00D cylinder, per lens

 

 

V2310

SPHEROCYLINDER, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens

 

 

V2311

SPHEROCYLINDER, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens

 

 

LENS -

TRIFOCAL, glass or plastic (continued)

 

 

V2312

SPHEROCYLINDER, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25 to 4.00D cylinder, per lens

 

 

V2313

SPHEROCYLINDER, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens

 

 

V2314

SPHEROCYLINDER, trifocal, sphere over plus or minus 12.00D, per lens

 

 

V2315

LENTICULAR, (myodisc), per lens, trifocal

 

 

V2316

LENTICULAR nonaspheric, per lens, trifocal

 

 

V2317

LENTICULAR, aspheric, per lens, trifocal

 

 

V2318

ANISEIKONIC LENS, trifocal

 

 

V2319

TRIFOCAL seg width over 28mm

 

 

V2320

TRIFOCAL add over 3.25D

 

 

V2399

SPECIALTY TRIFOCAL (by report)

 

 

 

 

LENS 

VARIABLE SPHERICITY, Welsh 4-drop, hyphaspheric, double drop, etc.

 

 

V2410

VARIABLE SPHERICITY LENS, single vision, full field, glass or plastic, per lens

 

 

V2430

VARIABLE SPHERICITY LENS, bifocal, full field, glass or plastic, per lens

 

 

 

 

INTRAOCULAR LENS

 

 

 

V2630

ANTERIOR chamber intraocular lens

 

 

V2631

IRIS supported intraocular lens

 

 

V2632

POSTERIOR chamber intraocular lens

     

 

 

CONTACT LENSES

 

 

 

 

If procedure code 92391 or 92396 is reported, recode with specific lens type listed below (per lens).

 

 

V2500

CONTACT LENS, PMMA, spherical, per lens

 

 

V2501

CONTACT LENS, PMMA, toric or prism ballast, per lens

 

 

V2502

CONTACT LENS, PMMA, bifocal, per lens

 

 

V2503

CONTACT LENS, PMMA, color vision deficiency, per lens

 

 

V2510

CONTACT LENS, gas permeable, spherical, per lens

 

 

V2511

CONTACT LENS, gas permeable, toric, prism ballast, per lens

 

 

V2512

CONTACT LENS, gas permeable, bifocal, per lens

 

 

V2513

CONTACT LENS, gas permeable, extended wear, per lens

 

 

V2520

CONTACT LENS, hydrophilic, spherical, per lens

 

 

V2521

CONTACT LENS, hydrophilic, toric, or prism ballast, per lens

 

 

V2522

CONTACT LENS, hydrophilic, bifocal, per lens

 

 

V2523

CONTACT LENS, hydrophilic, extended wear, per lens

 

 

V2530

CONTACT LENS, scleral, per lens (for contact lens modification, see 92325)

 

 

V2599

NOT OTHERWISE CLASSIFIED, CONTACT LENS

 

 

 

 

LENS

TINT

 

 

V2740

Tint, plastic, rose 1 or 2 (per lens)

 

 

V2741

Tint, plastic, other than rose 1 or 2 (per lens)

 

 

V2742

Tint, glass, rose 1 or 2 (per lens)

 

 

V2743

Tint, glass, other than rose 1 or 2 (per lens)