HCPCS Code Section: HCPCS V Codes

Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens Short Description: Lens sphcyl bifocal 4.00d/.1 Coverage Code: Carrier judgment Action Code: No maintenance …

Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens Short Description: Lens sphere bifocal 7.12-20. Coverage Code: Carrier judgment Action Code: No maintenance for this …

Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens Short Description: Lens sphere bifocal 4.12-7.0 Coverage Code: Carrier judgment Action Code: No maintenance for this …

Sphere, bifocal, plano to plus or minus 4.00d, per lens Short Description: Lens spher bifoc plano 4.00d Coverage Code: Carrier judgment Action Code: No maintenance for this code Date …

Not otherwise classified, single vision lens Short Description: Lens single vision not oth c Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, …

Lenticular lens, per lens, single Short Description: Lenticular lens, single Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 2004 Effective …

Aniseikonic lens, single vision Short Description: Lens aniseikonic single Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 1985 Effective Date: October 1, …

Lenticular, (myodisc), per lens, single vision Short Description: Lens lenticular bifocal Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 1985 Effective Date: …

Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens Short Description: Spherocylinder over 12.00d Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: …

Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens Short Description: Lens sphcy trifocal 4.0/4.25 Coverage Code: Carrier judgment Action Code: No maintenance …