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