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HCPCS V2203 · Level II · V code

V2203: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, HCPCS Level II V code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for V2203

Medicare payment
$63.32 to $84.43
DMEPOS non-rural state fees
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
2
MAI 3
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

V2203 is a Level II code from the V section (vision, hearing and speech-language pathology services), in use since 1985: "Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens". The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets V2203 at $63.32 in AL, FL, GA and 5 more to $84.43 in NJ, NY (floor $63.32, ceiling $84.43). CMS caps V2203 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. 1 active LCD lists V2203: L33793 (Refractive Lenses). OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service Q (vision items or services). 35 other active codes open with "Spherocylinder"; related codes: V2204, V2205, V2207, V2208.

V2203 descriptor and code status

The October 2026 HCPCS Level II file describes V2203 as “Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens”. It sits in the V section (vision, hearing and speech-language pathology services), listed with the other V codes. Although searches often call it the "V2203 CPT code", V2203 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of V2203
FieldValue
Short descriptorLens sphcyl bifocal 4.00d/.1
Added to HCPCS1985-01-01
Last actionN (no maintenance), effective 2003-10-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator38: DMEPOS orthotics, prosthetics, prosthetic devices and vision services (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceQ: vision items or services

Medicare payment for V2203

The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets V2203 at $63.32 in AL, FL, GA and 5 more to $84.43 in NJ, NY (floor $63.32, ceiling $84.43). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category PO (prosthetics and orthotics). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for V2203 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$63.32 / $84.43$63.32 (AL, FL, GA…) to $84.43 (NJ, NY)—AK $79.91, HI $85.46, PR $72.09, VI $84.43

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for V2203

CMS caps V2203 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for V2203 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital23 Date of Service Edit: ClinicalAnatomic Consideration
DME supplier23 Date of Service Edit: ClinicalAnatomic Consideration

The MUE lookup for V2203 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists V2203 in v323r0.

V2203 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check V2203 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for V2203

1 active Local Coverage Determination and 0 billing and coding articles list V2203. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on V2203

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists V2203

CARC 151 · N362

units of V2203 exceed the DME supplier MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for V2203 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for V2203 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS V2203

What does HCPCS code V2203 describe?

"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"), in the V section (vision, hearing and speech-language pathology services). Added 1985-01-01; last action N (no maintenance) effective 2003-10-01.

Is V2203 a CPT code?

It is not. V2203 belongs to the V section (vision, hearing and speech-language pathology services) of HCPCS Level II, the CMS code set, not to AMA CPT. "V2203 CPT code" searches refer to it.

What does Medicare pay for V2203?

The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets V2203 at $63.32 in AL, FL, GA and 5 more to $84.43 in NJ, NY (floor $63.32, ceiling $84.43).

How many units of V2203 can be billed per day?

CMS caps V2203 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover V2203?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD lists V2203: L33793 (Refractive Lenses).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.