| HCPCS Code: |
V2105 |
| Long Description: |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
| Short Description: |
Spherocylinder 4.00d/4.25-6d |
| Pricing Indicator 1: |
38 (Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
|
| Coverage Code: |
C (Carrier judgment) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
D1F (Orthotic devices) |
| Type of Service Code 1: |
Q (Vision items or services) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-1985 |
| Action Effective Date: |
01-10-2003 |
| Action Code: |
N (No maintenance for this code) |
