MyMedi-AI

V2215 — Lenticular (myodisc), per lens, bifocal

HCPCS Level II V-code · short descriptor: “Lens lenticular bifocal”

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
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). 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 (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

V2215 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $91.49 to $197.13 depending on state and rural status.

Former-CBA payment limits: ceiling $138.75 · floor $104.07

StateNon-ruralRural
AK$184.37—
AL$121.04—
AR$116.89—
AZ$138.75—
CA$138.75—
CO$106.46—
CT$104.07—
DC$116.34—
DE$116.34—
FL$121.04—
GA$121.04—
HI$197.13—
IA$104.07—
ID$128.42—
IL$129.85—
IN$129.85—
KS$104.07—
KY$121.04—
LA$116.89—
MA$104.07—
MD$116.34—
ME$104.07—
MI$129.85—
MN$129.85—
MO$104.07—
MS$121.04—
MT$106.46—
NC$121.04—
ND$106.46—
NE$104.07—
NH$104.07—
NJ$122.17—
NM$116.89—
NV$138.75—
NY$122.17—
OH$129.85—
OK$116.89—
OR$128.42—
PA$116.34—
PR$91.49—
RI$104.07—
SC$121.04—
SD$106.46—
TN$121.04—
TX$116.89—
UT$106.46—
VA$116.34—
VI$122.17—
VT$104.07—
WA$128.42—
WI$129.85—
WV$116.34—
WY$106.46—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps V2215 at 2 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related V-codes

Bill V2215 with confidence

Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, V2215 included, and starter credits via POST /bot-marketplace/register.