Optometric Procedure Codes

Trifocals

Procedure Code Modifier Description
V2300    RT  Sphere, Triifocal, Plano to Plus or Minus 4.00d, Per Lens  
V2300    LT Sphere, Trifocal, Plano to Plus or Minus 4.00d, Per Lens  
V2301 RT Sphere, Trifocal, Plus or Minus 4.12 to Plus or Minus 7.00d, Per Lens  
V2301 LT Sphere, Trifocal, Plus or Minus 4.12 to Plus or Minus 7.00d, Per Lens  
V2302 RT Sphere, Trifocal, Plus oOr Minus 7.12 to Plus or Minus 20.00d, Per Lens
V2302 LT Sphere, Trifocal, Plus oOr Minus 7.12 to Plus or Minus 20.00d, Per Lens
V2303 RT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2303 LT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2304 RT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens
V2304 LT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens
V2305 RT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens 
V2305 LT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens 
V2306 RT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, Over 6.00d Cylinder, Per Lens  
V2306 LT Spherocylinder, Trifocal, Plano to Plus or Minus 4.00d Sphere, Over 6.00d Cylinder, Per Lens  
V2307 RT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, .12 to 2.00d Cylinder, Per Lens    
V2307 LT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, .12 to 2.00d Cylinder, Per Lens    
V2308 RT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 2.12 to 4.00d Cylinder, Per Lens
V2308 LT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 2.12 to 4.00d Cylinder, Per Lens
V2309 RT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2309 LT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens 
V2310 RT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, Over 6.00d Cylinder, Per Lens  
V2310 LT Spherocylinder, Trifocal, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, Over 6.00d Cylinder, Per Lens
V2311 RT Spherocylinder, Trifocal, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 25 to 2.25d Cylinder, Per Lens 
V2311 LT Spherocylinder, Trifocal, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 25 to 2.25d Cylinder, Per Lens 
V2312 RT Spherocylinder, Trifocal, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens
V2312 LT Spherocylinder, Trifocal, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens        
V2313 RT Spherocylinder, Trifocal, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2313 LT Spherocylinder, Trifocal, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V231 RT Spherocylinder, Trifocal, Sphere Over Plus or Minus 12.00d, Per Lens
V2314 LT Spherocylinder, Trifocal, Sphere Over Plus or Minus 12.00d, Per Lens
V2315 RT Lenticular (Myodisc), Per Lens, Trifocal 
V2315 LT Lenticular (Myodisc), Per Lens, Trifocal 
V2316 RT Lenticular, Nonaspheric, Per Lens, Trifocal
V2316 LT Lenticular, Nonaspheric, Per Lens, Trifocal
V2317 RT Lenticular, Aspheric Lens, Trifocal  
V2317 LT Lenticular, Aspheric Lens, Trifocal
V2318 RT Aniseikonic, Per Lens, Trifocal  
V2318 LT Aniseikonic, Per Lens, Trifocal  
V2319 RT Trifocal Seg Width Over 28 Mm
V2319 LT Trifocal Seg Width Over 28 Mm
V2399 RT Specialty Trifocal (By Report) Variable Asphericity (Welsh 4-Drop, Hyperaspheric, Double Drop, Etc.)
V2399 LT Specialty Trifocal (By Report) Variable Asphericity (Welsh 4-Drop, Hyperaspheric, Double Drop, Etc.)

Contact Lens

Procedure Code Modifier Description
V2500 *   RT  Contact Lens, Pmma, Spherical, Per Lens
V2500 *   LT Contact Lens, Pmma, Spherical, Per Lens
V2501 *  RT Contact Lens, Pmma, Toric Or Prism Ballast, Per Lens 
V2501 *  LT Contact Lens, Pmma, Toric Or Prism Ballast, Per Lens
V2502 *   RT Contact Lens, Pmma, Bifocal, Per Lens 
V2502 *   LT Contact Lens, Pmma, Bifocal, Per Lens
V2503 *   RT Contact Lens, Pmma, Color Vision Deficiency, Per Lens   
V2503 *   LT Contact Lens, Pmma, Color Vision Deficiency, Per Lens  
V2510 *  RT Contact Lens, Gas Permeable, Spherical, Per Lens  
V2510 *  LT Contact Lens, Gas Permeable, Spherical, Per Lens
V2511 *  RT Contact Lens, Gas Permeable, Toric, Prism Ballast, Per Lens 
V2511 *  LT Contact Lens, Gas Permeable, Toric, Prism Ballast, Per Lens     
V2512 *    RT Contact Lens, Gas Permeable, Bifocal, Per Lens   
V2512 *   LT Contact Lens, Gas Permeable, Bifocal, Per Lens   
V2513 *   RT Contact Lens, Gas Permeable, Extended Wear, Per Lens  
V2513 *    LT Contact Lens, Gas Permeable, Extended Wear, Per Lens   
V2520 *  RT Contact Lens Hydrophilic, Spherical, Per Lens
V2520 *  LT Contact Lens Hydrophilic, Spherical, Per Lens
V2521 *   RT Contact Lens Hydrophilic, Toric, Or Prism Ballast, Per Lens   
V2521 *   LT Contact Lens Hydrophilic, Toric, Or Prism Ballast, Per Lens   
V2522 * RT Contact Lens Hydrophilic, Bifocal, Per Lens  
V2522 * LT Contact Lens Hydrophilic, Bifocal, Per Lens  
V2523 * RT Contact Lens Hydrophilic, Extended Wear, Per Lens      
V2523 * LT Contact Lens Hydrophilic, Extended Wear, Per Lens  
V2530 *   RT Contact Lens Scleral, Per Lens 
V2530 *   LT Contact Lens Scleral, Per Lens

* Prior Authorization Required for this Procedure