MyMedi-AI

V2513 — Contact lens, gas permeable, extended wear, per lens

HCPCS Level II V-code · short descriptor: “Contact lens extended wear”

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.

V2513 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $193.62 to $387.16 depending on state and rural status.

Former-CBA payment limits: ceiling $258.16 · floor $193.62

StateNon-ruralRural
AK$261.74—
AL$193.62—
AR$258.16—
AZ$249.14—
CA$249.14—
CO$193.62—
CT$220.94—
DC$233.21—
DE$233.21—
FL$193.62—
GA$193.62—
HI$279.94—
IA$193.62—
ID$211.42—
IL$258.16—
IN$258.16—
KS$193.62—
KY$193.62—
LA$258.16—
MA$220.94—
MD$233.21—
ME$220.94—
MI$258.16—
MN$258.16—
MO$193.62—
MS$193.62—
MT$193.62—
NC$193.62—
ND$193.62—
NE$193.62—
NH$220.94—
NJ$258.16—
NM$258.16—
NV$249.14—
NY$258.16—
OH$258.16—
OK$258.16—
OR$211.42—
PA$233.21—
PR$387.16—
RI$220.94—
SC$193.62—
SD$193.62—
TN$193.62—
TX$258.16—
UT$193.62—
VA$233.21—
VI$258.16—
VT$220.94—
WA$211.42—
WI$258.16—
WV$233.21—
WY$193.62—
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 V2513 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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