MyMedi-AI

V2319 — Trifocal seg width over 28 mm

HCPCS Level II V-code · short descriptor: “Lens trifocal seg width > 28”

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.

V2319 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $28.73 to $81.07 depending on state and rural status.

Former-CBA payment limits: ceiling $81.07 · floor $60.80

StateNon-ruralRural
AK$28.73
AL$60.80
AR$68.64
AZ$60.80
CA$60.80
CO$60.80
CT$65.12
DC$81.07
DE$81.07
FL$60.80
GA$60.80
HI$30.67
IA$60.80
ID$60.80
IL$81.07
IN$81.07
KS$60.80
KY$60.80
LA$68.64
MA$65.12
MD$81.07
ME$65.12
MI$81.07
MN$81.07
MO$60.80
MS$60.80
MT$60.80
NC$60.80
ND$60.80
NE$60.80
NH$65.12
NJ$69.67
NM$68.64
NV$60.80
NY$69.67
OH$81.07
OK$68.64
OR$60.80
PA$81.07
PR$52.35
RI$65.12
SC$60.80
SD$60.80
TN$60.80
TX$68.64
UT$60.80
VA$81.07
VI$69.67
VT$65.12
WA$60.80
WI$81.07
WV$81.07
WY$60.80
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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