V2521 HCPCS code: Contact lens, hydrophilic, toric, or prism ballast, per lens
V2521 is the HCPCS Level II code for contact lens, hydrophilic, toric, or prism ballast, per lens. The 2026 Medicare DMEPOS fee schedule pays $214.82 to $435.59 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 43% from 2022 to 2024 (47 to 27 services). In 2024, 14 suppliers billed Medicare for V2521 (purchases), serving 14 beneficiaries. Its average fee ranks 11 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 | D — Special coverage instructions apply |
| 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 V2521
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $214.82 | $435.59 | $296.38 | $222.28 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $214.82 | — |
| AL | — | $222.28 | — |
| AR | — | $236.36 | — |
| AZ | — | $222.28 | — |
| CA | — | $222.28 | — |
| CO | — | $247.23 | — |
| CT | — | $230.86 | — |
| DC | — | $262.20 | — |
| DE | — | $262.20 | — |
| FL | — | $222.28 | — |
| GA | — | $222.28 | — |
| HI | — | $229.73 | — |
| IA | — | $263.64 | — |
| ID | — | $222.28 | — |
| IL | — | $296.38 | — |
| IN | — | $296.38 | — |
| KS | — | $263.64 | — |
| KY | — | $222.28 | — |
| LA | — | $236.36 | — |
| MA | — | $230.86 | — |
| MD | — | $262.20 | — |
| ME | — | $230.86 | — |
| MI | — | $296.38 | — |
| MN | — | $296.38 | — |
| MO | — | $263.64 | — |
| MS | — | $222.28 | — |
| MT | — | $247.23 | — |
| NC | — | $222.28 | — |
| ND | — | $247.23 | — |
| NE | — | $263.64 | — |
| NH | — | $230.86 | — |
| NJ | — | $296.38 | — |
| NM | — | $236.36 | — |
| NV | — | $222.28 | — |
| NY | — | $296.38 | — |
| OH | — | $296.38 | — |
| OK | — | $236.36 | — |
| OR | — | $222.28 | — |
| PA | — | $262.20 | — |
| PR | — | $435.59 | — |
| RI | — | $230.86 | — |
| SC | — | $222.28 | — |
| SD | — | $247.23 | — |
| TN | — | $222.28 | — |
| TX | — | $236.36 | — |
| UT | — | $247.23 | — |
| VA | — | $262.20 | — |
| VI | — | $296.38 | — |
| VT | — | $230.86 | — |
| WA | — | $222.28 | — |
| WI | — | $296.38 | — |
| WV | — | $262.20 | — |
| WY | — | $247.23 | — |
How the V2521 fee compares
| Measure | Value |
|---|---|
| Rank among 15 V25 codes (lowest = 1) | 11 |
| Family fee range (average of state fees) | $118.70–$668.43 |
| Rural fee uplift | — |
Who bills V2521 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 14 |
| Referring clinicians | 14 |
| Medicare beneficiaries | 14 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 23 | 25 |
| 2023 | 15 | 20 |
| 2024 | 14 | 14 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for V2521, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 47 | 25 | $136.12 | $101.23 |
| 2023 | 38 | 20 | $161.59 | $122.98 |
| 2024 | 27 | 14 | $156.57 | $113.17 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
| practitioner 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 V2521
- 2026-01-01: Average state fee rose 2.0%: $246.72 to $251.65
- 1985-01-01: V2521 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 V2521?
V2521 is the HCPCS Level II code for contact lens, hydrophilic, toric, or prism ballast, per lens. Short descriptor: "Cntct lens hydrophilic toric".
How much does Medicare pay for V2521?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $214.82–$435.59. Rural fees can be higher.
Does Medicare cover V2521?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for V2521?
Medicare policy articles that cite V2521 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 V2521 change in 2026?
The average non-rural state fee moved from $246.72 in 2025 to $251.65 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of V2521 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims; 2 on practitioner claims (NCCI medically unlikely edits).
Related V25 codes
- V2500 — Contact lens, pmma, spherical, per lens ($99.50–$387.16)
- V2501 — Contact lens, pmma, toric or prism ballast, per lens ($151.57–$435.59)
- 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)
- 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)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under V2521
- Watch V2521 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for V2521
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.