V2203 HCPCS code: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens
V2203 is the HCPCS Level II code for spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens. The 2026 Medicare DMEPOS fee schedule pays $63.32 to $85.46 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 32% from 2022 to 2024 (90,097 to 61,200 services). In 2024, 4,677 suppliers billed Medicare for V2203 (purchases), serving 34,003 beneficiaries; Pennsylvania, California, Indiana accounted for 17% of services. Its average fee ranks 4 of 20 V22 codes (family range $52.13–$138.51).
Code details
| Field | Value |
|---|---|
| Section | V codes — Vision, hearing and speech-language pathology services |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1985-01-01 |
| Last action effective | 2003-10-01 |
2026 Medicare DMEPOS fee schedule for V2203
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $63.32 | $85.46 | $84.43 | $63.32 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $79.91 | — |
| AL | — | $63.32 | — |
| AR | — | $71.22 | — |
| AZ | — | $77.97 | — |
| CA | — | $77.97 | — |
| CO | — | $67.14 | — |
| CT | — | $67.23 | — |
| DC | — | $83.72 | — |
| DE | — | $83.72 | — |
| FL | — | $63.32 | — |
| GA | — | $63.32 | — |
| HI | — | $85.46 | — |
| IA | — | $64.18 | — |
| ID | — | $76.56 | — |
| IL | — | $66.01 | — |
| IN | — | $66.01 | — |
| KS | — | $64.18 | — |
| KY | — | $63.32 | — |
| LA | — | $71.22 | — |
| MA | — | $67.23 | — |
| MD | — | $83.72 | — |
| ME | — | $67.23 | — |
| MI | — | $66.01 | — |
| MN | — | $66.01 | — |
| MO | — | $64.18 | — |
| MS | — | $63.32 | — |
| MT | — | $67.14 | — |
| NC | — | $63.32 | — |
| ND | — | $67.14 | — |
| NE | — | $64.18 | — |
| NH | — | $67.23 | — |
| NJ | — | $84.43 | — |
| NM | — | $71.22 | — |
| NV | — | $77.97 | — |
| NY | — | $84.43 | — |
| OH | — | $66.01 | — |
| OK | — | $71.22 | — |
| OR | — | $76.56 | — |
| PA | — | $83.72 | — |
| PR | — | $72.09 | — |
| RI | — | $67.23 | — |
| SC | — | $63.32 | — |
| SD | — | $67.14 | — |
| TN | — | $63.32 | — |
| TX | — | $71.22 | — |
| UT | — | $67.14 | — |
| VA | — | $83.72 | — |
| VI | — | $84.43 | — |
| VT | — | $67.23 | — |
| WA | — | $76.56 | — |
| WI | — | $66.01 | — |
| WV | — | $83.72 | — |
| WY | — | $67.14 | — |
How the V2203 fee compares
| Measure | Value |
|---|---|
| Rank among 20 V22 codes (lowest = 1) | 4 |
| Family fee range (average of state fees) | $52.13–$138.51 |
| Rural fee uplift | — |
Who bills V2203 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 4,677 |
| Referring clinicians | 9,015 |
| Medicare beneficiaries | 34,003 |
| States with claims | 51 |
| Share of services in top 3 states (Pennsylvania, California, Indiana) | 17% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 5,861 | 49,943 |
| 2023 | 5,361 | 43,660 |
| 2024 | 4,677 | 34,003 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for V2203, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 90,097 | 49,943 | $51.71 | $38.59 |
| 2023 | 78,490 | 43,660 | $54.39 | $40.37 |
| 2024 | 61,200 | 34,003 | $55.00 | $40.86 |
States with the most V2203 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 3,530 | $50.24 |
| California | 3,338 | $49.64 |
| Indiana | 3,297 | $42.55 |
| Illinois | 2,934 | $40.53 |
| Florida | 2,601 | $36.02 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
Medicare policy articles for this code
- A52499: Refractive Lenses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (6 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| H27.00 | Aphakia, unspecified eye | 1 |
| H27.01 | Aphakia, right eye | 1 |
| H27.02 | Aphakia, left eye | 1 |
| H27.03 | Aphakia, bilateral | 1 |
| Q12.3 | Congenital aphakia | 1 |
| Z96.1 | Presence of intraocular lens | 1 |
What changed for V2203
- 2026-01-01: Average state fee rose 2.0%: $69.89 to $71.29
- 1985-01-01: V2203 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code V2203?
V2203 is the HCPCS Level II code for spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens. Short descriptor: "Lens sphcyl bifocal 4.00d/.1".
How much does Medicare pay for V2203?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $63.32–$85.46. Rural fees can be higher.
Does Medicare cover V2203?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for V2203?
Medicare policy articles that cite V2203 list 6 covered ICD-10-CM diagnosis codes across 1 article. The most cited include H27.00 (Aphakia, unspecified eye), H27.01 (Aphakia, right eye), H27.02 (Aphakia, left eye). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for V2203 change in 2026?
The average non-rural state fee moved from $69.89 in 2025 to $71.29 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of V2203 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related V22 codes
- V2200 — Sphere, bifocal, plano to plus or minus 4.00d, per lens ($62.77–$83.69)
- V2201 — Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens ($68.41–$97.51)
- V2202 — Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens ($72.09–$107.33)
- V2204 — Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens ($66.79–$88.26)
- V2205 — Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens ($71.57–$95.43)
- V2206 — Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens ($72.09–$102.53)
- V2207 — Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens ($69.95–$94.02)
- V2208 — Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens ($72.09–$104.60)
- V2209 — Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens ($72.09–$103.98)
- V2210 — Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens ($72.09–$116.25)
- V2211 — Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens ($90.41–$131.58)
- V2212 — Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens ($91.49–$124.48)
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Next steps
- Run a reimbursement report for a device billed under V2203
- Watch V2203 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for V2203
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.