MyMedi-AI

V2512 — Contact lens, gas permeable, bifocal, per lens

HCPCS Level II V-code · short descriptor: “Cntct lens gas permbl bifocl”

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 2026-10-27; 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 2026-10-27; 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.

V2512 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $230.62 to $434.08 depending on state and rural status.

Former-CBA payment limits: ceiling $307.49 · floor $230.62

StateNon-ruralRural
AK$289.90—
AL$230.62—
AR$307.49—
AZ$271.53—
CA$271.53—
CO$230.62—
CT$272.68—
DC$286.17—
DE$286.17—
FL$230.62—
GA$230.62—
HI$309.92—
IA$282.10—
ID$230.62—
IL$256.25—
IN$256.25—
KS$282.10—
KY$230.62—
LA$307.49—
MA$272.68—
MD$286.17—
ME$272.68—
MI$256.25—
MN$256.25—
MO$282.10—
MS$230.62—
MT$230.62—
NC$230.62—
ND$230.62—
NE$282.10—
NH$272.68—
NJ$307.49—
NM$307.49—
NV$271.53—
NY$307.49—
OH$256.25—
OK$307.49—
OR$230.62—
PA$286.17—
PR$434.08—
RI$272.68—
SC$230.62—
SD$230.62—
TN$230.62—
TX$307.49—
UT$230.62—
VA$286.17—
VI$307.49—
VT$272.68—
WA$230.62—
WI$256.25—
WV$286.17—
WY$230.62—
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 V2512 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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