MyMedi-AI

V2220 — Bifocal add over 3.25d

HCPCS Level II V-code · short descriptor: “Lens bifocal add over 3.25d”

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 2026-10-26; 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 2026-10-26; 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.

V2220 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $44.21 to $96.81 depending on state and rural status.

Former-CBA payment limits: ceiling $58.94 · floor $44.21

StateNon-ruralRural
AK$51.33—
AL$44.21—
AR$57.62—
AZ$51.51—
CA$51.51—
CO$45.72—
CT$44.21—
DC$58.94—
DE$58.94—
FL$44.21—
GA$44.21—
HI$54.91—
IA$58.94—
ID$44.21—
IL$54.22—
IN$54.22—
KS$58.94—
KY$44.21—
LA$57.62—
MA$44.21—
MD$58.94—
ME$44.21—
MI$54.22—
MN$54.22—
MO$58.94—
MS$44.21—
MT$45.72—
NC$44.21—
ND$45.72—
NE$58.94—
NH$44.21—
NJ$58.94—
NM$57.62—
NV$51.51—
NY$58.94—
OH$54.22—
OK$57.62—
OR$44.21—
PA$58.94—
PR$96.81—
RI$44.21—
SC$44.21—
SD$45.72—
TN$44.21—
TX$57.62—
UT$45.72—
VA$58.94—
VI$58.94—
VT$44.21—
WA$44.21—
WI$54.22—
WV$58.94—
WY$45.72—
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 V2220 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

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