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
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.

V2319 Medicare fee schedule (October 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 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 V2319 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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