V2301 — Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d, per lens
HCPCS Level II V-code · short descriptor: “Lens sphere trifocal 4.12-7.”
- 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.
V2301 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $94.18 to $123.97 depending on state and rural status.
Former-CBA payment limits: ceiling $125.58 · floor $94.18
| State | Non-rural | Rural |
|---|---|---|
| AK | $115.37 | — |
| AL | $94.52 | — |
| AR | $123.97 | — |
| AZ | $109.16 | — |
| CA | $109.16 | — |
| CO | $94.18 | — |
| CT | $120.38 | — |
| DC | $113.69 | — |
| DE | $113.69 | — |
| FL | $94.52 | — |
| GA | $94.52 | — |
| HI | $123.31 | — |
| IA | $94.18 | — |
| ID | $97.11 | — |
| IL | $107.47 | — |
| IN | $107.47 | — |
| KS | $94.18 | — |
| KY | $94.52 | — |
| LA | $123.97 | — |
| MA | $120.38 | — |
| MD | $113.69 | — |
| ME | $120.38 | — |
| MI | $107.47 | — |
| MN | $107.47 | — |
| MO | $94.18 | — |
| MS | $94.52 | — |
| MT | $94.18 | — |
| NC | $94.52 | — |
| ND | $94.18 | — |
| NE | $94.18 | — |
| NH | $120.38 | — |
| NJ | $99.69 | — |
| NM | $123.97 | — |
| NV | $109.16 | — |
| NY | $99.69 | — |
| OH | $107.47 | — |
| OK | $123.97 | — |
| OR | $97.11 | — |
| PA | $113.69 | — |
| PR | $98.71 | — |
| RI | $120.38 | — |
| SC | $94.52 | — |
| SD | $94.18 | — |
| TN | $94.52 | — |
| TX | $123.97 | — |
| UT | $94.18 | — |
| VA | $113.69 | — |
| VI | $99.69 | — |
| VT | $120.38 | — |
| WA | $97.11 | — |
| WI | $107.47 | — |
| WV | $113.69 | — |
| WY | $94.18 | — |
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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