Optometric Procedure Codes

Single Vision

Procedure Code Modifier Description
V2100   RT    Sphere, Single Vision, Plano to Plus or Minus 4.00, Per Lens
 
V2100   LT Sphere, Single Vision, Plano to Plus or Minus 4.00, Per Lens
 
V2101  RT Sphere, Single Vision, Plus or Minus 4.12 to Plus Or Minus 7.00d, Per Lens
V2101 LT Sphere, Single Vision, Plus or Minus 4.12 to Plus or Minus 7.00d, Per Lens
 
V2102 RT Sphere, Single Vision, Plus or Minus 7.12 to Plus or Minus 20.00d, Per Lens
 
V2102 LT Sphere, Single Vision, Plus or Minus 7.12 to Plus or Minus 20.00d, Per Lens
V2103  RT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2103  LT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2104   RT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 2.12 to 4.00d Cylinder, Per Lens
V2104   LT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 2.12 to 4.00d Cylinder, Per Lens
V2105   RT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2105   LT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2106   RT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, Over 6.00d Cylinder, Per Lens
V2106   LT Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, Over 6.00d Cylinder, Per Lens 

V2107  

RT Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2107   LT Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2108   RT Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere,V2.12 to 4.00d Cylinder, Per Lens
V2108   LT Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere,V2.12 to 4.00d Cylinder, Per Len
V2109  RT Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2109  LT Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2110  RT Spherocylinder, Single Vision, Plus or Minus 4.25 to 7.00d Sphere, Over 6.00d Cylinder, Per Lens
V2110  LT Spherocylinder, Single Vision, Plus or Minus 4.25 to 7.00d Sphere, Over 6.00d Cylinder, Per Lens
V2111 RT Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, .25 to 2.25d Cylinder, Per Lens 
V2111 LT Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, .25 to 2.25d Cylinder, Per Lens 
V2112 RT Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens
V2112 LT Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens
V2113   RT Spherocylinder, Single Vision, Plus or Minus 7.25to Plus or Minus 12.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens  
V2113   LT Spherocylinder, Single Vision, Plus or Minus 7.25to Plus or Minus 12.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens  
V2114   RT Spherocylinder, Single Vision, Sphere Over Plus or Minus 12.00d, Per Lens  
V2114 LT Spherocylinder, Single Vision, Sphere Over Plus or Minus 12.00d, Per Lens  
V2115   RT Lenticular, (Myodisc), Per Lens, Single Vision    
V2115   LT Lenticular, (Myodisc), Per Lens, Single Vision
V2116    RT Lenticular Lens, Nonaspheric, Per Lens, Single Vision
V2116    LT Lenticular Lens, Nonaspheric, Per Lens, Single Vision
V2117    RT Lenticular, Aspheric, Per Lens, Single Vision   
V2117    LT Lenticular, Aspheric, Per Lens, Single Vision 
V2118   RT Aniseikonic Lens, Single Vision 
V2118   LT Aniseikonic Lens, Single Vision  
V2199     RT Not Otherwise Classified, Single Vision Lens
V2199 LT Not Otherwise Classified, Single Vision Lens
V2410   RT  Variable Asphericity Lens, Single Vision, Full Field, Glass Or Plastic, Per Lens
V2410   LT  Variable Asphericity Lens, Single Vision, Full Field, Glass Or Plastic, Per Lens