Optometric Procedure Codes

Prosthetic Eye

Procedure Code Modifier Description
V2620   RT  Prosthetic, Eye, Glass, Stock  
V2620   LT Prosthetic, Eye, Glass, Stock
V2621 RT Prosthetic, Eye, Plastic, Stock  
V2621 LT Prosthetic, Eye, Plastic, Stock
V2622    RT Prosthetic, Eye, Glass, Custom  
V2622    LT Prosthetic, Eye, Glass, Custom
V2623    RT Prosthetic, Eye, Plastic, Custom
V2623    LT Prosthetic, Eye, Plastic, Custom
V2629 *   RT Prosthetic, Eye, Other Type
V2629 *   LT Prosthetic, Eye, Other Type

Other Lens

Procedure Code Modifier Description
V2630 *   RT  Anterior Chamber Intraocular Lens
V2630 *   LT Anterior Chamber Intraocular Lens
V2632 *  RT Posterior Chamber Intraocular Lens
V2632 *  LT Posterior Chamber Intraocular Lens
V2700     RT Balance Lens, Per Lens      
V2700     LT Balance Lens, Per Lens
V2710  RT Slab Off Prism, Glass Or Plastic, Per Lens
V2710  LT Slab Off Prism, Glass Or Plastic, Per Lens
V2715  RT Prism, Per Lens
V2715  LT Prism, Per Lens
V2718 RT Press-On Lens, Fresnell Prism, Per Lens
V2718 LT Press-On Lens, Fresnell Prism, Per Lens
V2730 RT Special Base Curve, Glass Or Plastic, Per Lens
V2730 LT Special Base Curve, Glass Or Plastic, Per Lens
V2499    RT   Variable Sphericity Lens, Other Type
V2499    LT Variable Sphericity Lens, Other Type
V2755  RT   U-V Lens, Per Lens  
V2755  LT U-V Lens, Per Lens
V2780 RT    Oversize Lens, Per Lens
V2780 LT Oversize Lens, Per Lens

Tints

Procedure Code Modifier Description
V2744     RT Tint, Photochromatic, Per Lens
V2744     LT Tint, Photochromatic, Per Lens

Miscellaneous Codes

Procedure Code Modifier Description
V2799        Vision Service, Miscellaneous

* Prior Authorization Required for this Procedure