V2204 — Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens
HCPCS Level II V-code · short descriptor: “Lens sphcy bifocal 4.00d/2.1”
- Code system
- HCPCS Level II
- Family
- V — Vision & hearing services
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
V2204 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $66.79 to $88.26 depending on state and rural status.
Former-CBA payment limits: ceiling $88.26 · floor $66.20
| State | Non-rural | Rural |
|---|---|---|
| AK | $81.51 | — |
| AL | $68.67 | — |
| AR | $72.45 | — |
| AZ | $79.13 | — |
| CA | $79.13 | — |
| CO | $69.77 | — |
| CT | $70.99 | — |
| DC | $88.26 | — |
| DE | $88.26 | — |
| FL | $68.67 | — |
| GA | $68.67 | — |
| HI | $87.16 | — |
| IA | $66.79 | — |
| ID | $76.94 | — |
| IL | $67.92 | — |
| IN | $67.92 | — |
| KS | $66.79 | — |
| KY | $68.67 | — |
| LA | $72.45 | — |
| MA | $70.99 | — |
| MD | $88.26 | — |
| ME | $70.99 | — |
| MI | $67.92 | — |
| MN | $67.92 | — |
| MO | $66.79 | — |
| MS | $68.67 | — |
| MT | $69.77 | — |
| NC | $68.67 | — |
| ND | $69.77 | — |
| NE | $66.79 | — |
| NH | $70.99 | — |
| NJ | $86.66 | — |
| NM | $72.45 | — |
| NV | $79.13 | — |
| NY | $86.66 | — |
| OH | $67.92 | — |
| OK | $72.45 | — |
| OR | $76.94 | — |
| PA | $88.26 | — |
| PR | $72.09 | — |
| RI | $70.99 | — |
| SC | $68.67 | — |
| SD | $69.77 | — |
| TN | $68.67 | — |
| TX | $72.45 | — |
| UT | $69.77 | — |
| VA | $88.26 | — |
| VI | $86.66 | — |
| VT | $70.99 | — |
| WA | $76.94 | — |
| WI | $67.92 | — |
| WV | $88.26 | — |
| WY | $69.77 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related V-codes
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