V2205 — Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens
HCPCS Level II V-code · short descriptor: “Lens sphcy bifocal 4.00d/4.2”
- 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.
V2205 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $71.57 to $95.43 depending on state and rural status.
Former-CBA payment limits: ceiling $95.43 · floor $71.57
| State | Non-rural | Rural |
|---|---|---|
| AK | $79.93 | — |
| AL | $75.34 | — |
| AR | $75.59 | — |
| AZ | $78.11 | — |
| CA | $78.11 | — |
| CO | $81.30 | — |
| CT | $75.43 | — |
| DC | $95.43 | — |
| DE | $95.43 | — |
| FL | $75.34 | — |
| GA | $75.34 | — |
| HI | $85.48 | — |
| IA | $71.57 | — |
| ID | $79.61 | — |
| IL | $75.31 | — |
| IN | $75.31 | — |
| KS | $71.57 | — |
| KY | $75.34 | — |
| LA | $75.59 | — |
| MA | $75.43 | — |
| MD | $95.43 | — |
| ME | $75.43 | — |
| MI | $75.31 | — |
| MN | $75.31 | — |
| MO | $71.57 | — |
| MS | $75.34 | — |
| MT | $81.30 | — |
| NC | $75.34 | — |
| ND | $81.30 | — |
| NE | $71.57 | — |
| NH | $75.43 | — |
| NJ | $94.50 | — |
| NM | $75.59 | — |
| NV | $78.11 | — |
| NY | $94.50 | — |
| OH | $75.31 | — |
| OK | $75.59 | — |
| OR | $79.61 | — |
| PA | $95.43 | — |
| PR | $72.09 | — |
| RI | $75.43 | — |
| SC | $75.34 | — |
| SD | $81.30 | — |
| TN | $75.34 | — |
| TX | $75.59 | — |
| UT | $81.30 | — |
| VA | $95.43 | — |
| VI | $94.50 | — |
| VT | $75.43 | — |
| WA | $79.61 | — |
| WI | $75.31 | — |
| WV | $95.43 | — |
| WY | $81.30 | — |
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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