V2501 HCPCS code: Contact lens, pmma, toric or prism ballast, per lens
V2501 is the HCPCS Level II code for contact lens, pmma, toric or prism ballast, per lens. The 2026 Medicare DMEPOS fee schedule pays $151.57 to $435.59 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. Its average fee ranks 5 of 15 V25 codes (family range $118.70–$668.43).
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 V2501
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $151.57 | $435.59 | $202.09 | $151.57 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $196.99 | — |
| AL | — | $151.57 | — |
| AR | — | $151.57 | — |
| AZ | — | $169.32 | — |
| CA | — | $169.32 | — |
| CO | — | $185.22 | — |
| CT | — | $202.09 | — |
| DC | — | $180.36 | — |
| DE | — | $180.36 | — |
| FL | — | $151.57 | — |
| GA | — | $151.57 | — |
| HI | — | $210.65 | — |
| IA | — | $202.09 | — |
| ID | — | $151.57 | — |
| IL | — | $159.84 | — |
| IN | — | $159.84 | — |
| KS | — | $202.09 | — |
| KY | — | $151.57 | — |
| LA | — | $151.57 | — |
| MA | — | $202.09 | — |
| MD | — | $180.36 | — |
| ME | — | $202.09 | — |
| MI | — | $159.84 | — |
| MN | — | $159.84 | — |
| MO | — | $202.09 | — |
| MS | — | $151.57 | — |
| MT | — | $185.22 | — |
| NC | — | $151.57 | — |
| ND | — | $185.22 | — |
| NE | — | $202.09 | — |
| NH | — | $202.09 | — |
| NJ | — | $202.09 | — |
| NM | — | $151.57 | — |
| NV | — | $169.32 | — |
| NY | — | $202.09 | — |
| OH | — | $159.84 | — |
| OK | — | $151.57 | — |
| OR | — | $151.57 | — |
| PA | — | $180.36 | — |
| PR | — | $435.59 | — |
| RI | — | $202.09 | — |
| SC | — | $151.57 | — |
| SD | — | $185.22 | — |
| TN | — | $151.57 | — |
| TX | — | $151.57 | — |
| UT | — | $185.22 | — |
| VA | — | $180.36 | — |
| VI | — | $202.09 | — |
| VT | — | $202.09 | — |
| WA | — | $151.57 | — |
| WI | — | $159.84 | — |
| WV | — | $180.36 | — |
| WY | — | $185.22 | — |
How the V2501 fee compares
| Measure | Value |
|---|---|
| Rank among 15 V25 codes (lowest = 1) | 5 |
| Family fee range (average of state fees) | $118.70–$668.43 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
What changed for V2501
- 2026-01-01: Average state fee rose 2.0%: $176.77 to $180.30
- 1985-01-01: V2501 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 V2501?
V2501 is the HCPCS Level II code for contact lens, pmma, toric or prism ballast, per lens. Short descriptor: "Cntct lens pmma-toric/prism".
How much does Medicare pay for V2501?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $151.57–$435.59. Rural fees can be higher.
Does Medicare cover V2501?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for V2501 change in 2026?
The average non-rural state fee moved from $176.77 in 2025 to $180.30 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of V2501 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related V25 codes
- V2500 — Contact lens, pmma, spherical, per lens ($99.50–$387.16)
- V2502 — Contact lens, pmma, bifocal, per lens ($186.72–$434.08)
- V2503 — Contact lens, pmma, color vision deficiency, per lens ($171.97–$241.70)
- V2510 — Contact lens, gas permeable, spherical, per lens ($135.83–$387.16)
- V2511 — Contact lens, gas permeable, toric, prism ballast, per lens ($195.17–$434.08)
- V2512 — Contact lens, gas permeable, bifocal, per lens ($230.62–$434.08)
- V2513 — Contact lens, gas permeable, extended wear, per lens ($193.62–$387.16)
- V2520 — Contact lens, hydrophilic, spherical, per lens ($119.79–$387.16)
- V2521 — Contact lens, hydrophilic, toric, or prism ballast, per lens ($214.82–$435.59)
- V2522 — Contact lens, hydrophilic, bifocal, per lens ($216.33–$435.59)
- V2523 — Contact lens, hydrophilic, extended wear, per lens ($178.06–$388.84)
- V2524 — Contact lens, hydrophilic, spherical, photochromic additive, per lens ($135.23–$402.59)
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Next steps
- Run a reimbursement report for a device billed under V2501
- Watch V2501 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for V2501
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.