V2213 — Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens
HCPCS Level II V-code · short descriptor: “Lens sphcyl bifo 7.25-12/4.2”
- 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
- Face-to-face & WOPD
- Not on the required 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.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
V2213 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $72.09 to $125.75 depending on state and rural status.
Former-CBA payment limits: ceiling $125.75 · floor $94.31
| State | Non-rural | Rural |
|---|---|---|
| AK | $105.81 | — |
| AL | $104.36 | — |
| AR | $99.77 | — |
| AZ | $99.77 | — |
| CA | $99.77 | — |
| CO | $125.75 | — |
| CT | $103.68 | — |
| DC | $105.92 | — |
| DE | $105.92 | — |
| FL | $104.36 | — |
| GA | $104.36 | — |
| HI | $113.18 | — |
| IA | $94.31 | — |
| ID | $101.82 | — |
| IL | $99.51 | — |
| IN | $99.51 | — |
| KS | $94.31 | — |
| KY | $104.36 | — |
| LA | $99.77 | — |
| MA | $103.68 | — |
| MD | $105.92 | — |
| ME | $103.68 | — |
| MI | $99.51 | — |
| MN | $99.51 | — |
| MO | $94.31 | — |
| MS | $104.36 | — |
| MT | $125.75 | — |
| NC | $104.36 | — |
| ND | $125.75 | — |
| NE | $94.31 | — |
| NH | $103.68 | — |
| NJ | $107.88 | — |
| NM | $99.77 | — |
| NV | $99.77 | — |
| NY | $107.88 | — |
| OH | $99.51 | — |
| OK | $99.77 | — |
| OR | $101.82 | — |
| PA | $105.92 | — |
| PR | $72.09 | — |
| RI | $103.68 | — |
| SC | $104.36 | — |
| SD | $125.75 | — |
| TN | $104.36 | — |
| TX | $99.77 | — |
| UT | $125.75 | — |
| VA | $105.92 | — |
| VI | $107.88 | — |
| VT | $103.68 | — |
| WA | $101.82 | — |
| WI | $99.51 | — |
| WV | $105.92 | — |
| WY | $125.75 | — |
Common denial codes to watch
Related V-codes
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