MyMedi-AI

V2306 — Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens

HCPCS Level II V-code · short descriptor: “Lens sphcyl trifocal 4.00/>6”

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.

V2306 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $98.15 to $130.86 depending on state and rural status.

Former-CBA payment limits: ceiling $130.86 · floor $98.15

StateNon-ruralRural
AK$102.94—
AL$102.66—
AR$130.86—
AZ$100.34—
CA$100.34—
CO$113.55—
CT$110.49—
DC$127.70—
DE$127.70—
FL$102.66—
GA$102.66—
HI$110.08—
IA$98.15—
ID$98.15—
IL$98.15—
IN$98.15—
KS$98.15—
KY$102.66—
LA$130.86—
MA$110.49—
MD$127.70—
ME$110.49—
MI$98.15—
MN$98.15—
MO$98.15—
MS$102.66—
MT$113.55—
NC$102.66—
ND$113.55—
NE$98.15—
NH$110.49—
NJ$112.53—
NM$130.86—
NV$100.34—
NY$112.53—
OH$98.15—
OK$130.86—
OR$98.15—
PA$127.70—
PR$98.71—
RI$110.49—
SC$102.66—
SD$113.55—
TN$102.66—
TX$130.86—
UT$113.55—
VA$127.70—
VI$112.53—
VT$110.49—
WA$98.15—
WI$98.15—
WV$127.70—
WY$113.55—
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 V2306 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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