Optometric Procedure Codes

Single Vision

Procedure Code	Modifier	Description
V2100	RT	Sphere, Single Vision, Plano to Plus or Minus 4.00, Per Lens
V2100	LT	Sphere, Single Vision, Plano to Plus or Minus 4.00, Per Lens
V2101	RT	Sphere, Single Vision, Plus or Minus 4.12 to Plus Or Minus 7.00d, Per Lens
V2101	LT	Sphere, Single Vision, Plus or Minus 4.12 to Plus or Minus 7.00d, Per Lens
V2102	RT	Sphere, Single Vision, Plus or Minus 7.12 to Plus or Minus 20.00d, Per Lens
V2102	LT	Sphere, Single Vision, Plus or Minus 7.12 to Plus or Minus 20.00d, Per Lens
V2103	RT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2103	LT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2104	RT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 2.12 to 4.00d Cylinder, Per Lens
V2104	LT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 2.12 to 4.00d Cylinder, Per Lens
V2105	RT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2105	LT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2106	RT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, Over 6.00d Cylinder, Per Lens
V2106	LT	Spherocylinder, Single Vision, Plano to Plus or Minus 4.00d Sphere, Over 6.00d Cylinder, Per Lens
V2107	RT	Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2107	LT	Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, .12 to 2.00d Cylinder, Per Lens
V2108	RT	Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere,V2.12 to 4.00d Cylinder, Per Lens
V2108	LT	Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere,V2.12 to 4.00d Cylinder, Per Len
V2109	RT	Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2109	LT	Spherocylinder, Single Vision, Plus or Minus 4.25 to Plus or Minus 7.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2110	RT	Spherocylinder, Single Vision, Plus or Minus 4.25 to 7.00d Sphere, Over 6.00d Cylinder, Per Lens
V2110	LT	Spherocylinder, Single Vision, Plus or Minus 4.25 to 7.00d Sphere, Over 6.00d Cylinder, Per Lens
V2111	RT	Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, .25 to 2.25d Cylinder, Per Lens
V2111	LT	Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, .25 to 2.25d Cylinder, Per Lens
V2112	RT	Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens
V2112	LT	Spherocylinder, Single Vision, Plus or Minus 7.25 to Plus or Minus 12.00d Sphere, 2.25 to 4.00d Cylinder, Per Lens
V2113	RT	Spherocylinder, Single Vision, Plus or Minus 7.25to Plus or Minus 12.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2113	LT	Spherocylinder, Single Vision, Plus or Minus 7.25to Plus or Minus 12.00d Sphere, 4.25 to 6.00d Cylinder, Per Lens
V2114	RT	Spherocylinder, Single Vision, Sphere Over Plus or Minus 12.00d, Per Lens
V2114	LT	Spherocylinder, Single Vision, Sphere Over Plus or Minus 12.00d, Per Lens
V2115	RT	Lenticular, (Myodisc), Per Lens, Single Vision
V2115	LT	Lenticular, (Myodisc), Per Lens, Single Vision
V2116	RT	Lenticular Lens, Nonaspheric, Per Lens, Single Vision
V2116	LT	Lenticular Lens, Nonaspheric, Per Lens, Single Vision
V2117	RT	Lenticular, Aspheric, Per Lens, Single Vision
V2117	LT	Lenticular, Aspheric, Per Lens, Single Vision
V2118	RT	Aniseikonic Lens, Single Vision
V2118	LT	Aniseikonic Lens, Single Vision
V2199	RT	Not Otherwise Classified, Single Vision Lens
V2199	LT	Not Otherwise Classified, Single Vision Lens
V2410	RT	Variable Asphericity Lens, Single Vision, Full Field, Glass Or Plastic, Per Lens
V2410	LT	Variable Asphericity Lens, Single Vision, Full Field, Glass Or Plastic, Per Lens