MyMedi-AI

V2511 — Contact lens, gas permeable, toric, prism ballast, per lens

HCPCS Level II V-code · short descriptor: “Cntct toric prism ballast”

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.

V2511 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $195.17 to $434.08 depending on state and rural status.

Former-CBA payment limits: ceiling $260.23 · floor $195.17

StateNon-ruralRural
AK$242.06—
AL$195.17—
AR$232.93—
AZ$233.89—
CA$233.89—
CO$195.17—
CT$260.23—
DC$232.57—
DE$232.57—
FL$195.17—
GA$195.17—
HI$258.78—
IA$239.56—
ID$195.17—
IL$222.63—
IN$222.63—
KS$239.56—
KY$195.17—
LA$232.93—
MA$260.23—
MD$232.57—
ME$260.23—
MI$222.63—
MN$222.63—
MO$239.56—
MS$195.17—
MT$195.17—
NC$195.17—
ND$195.17—
NE$239.56—
NH$260.23—
NJ$260.23—
NM$232.93—
NV$233.89—
NY$260.23—
OH$222.63—
OK$232.93—
OR$195.17—
PA$232.57—
PR$434.08—
RI$260.23—
SC$195.17—
SD$195.17—
TN$195.17—
TX$232.93—
UT$195.17—
VA$232.57—
VI$260.23—
VT$260.23—
WA$195.17—
WI$222.63—
WV$232.57—
WY$195.17—
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 V2511 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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