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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

StateNon-ruralRural
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
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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