Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens
Medicare coverage: Carrier judgment
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 2 units per day (clinical), rationale: Clinical: Data
DME supplier: max 2 units per day (clinical), rationale: Clinical: Data
Medicare pricing for V2103
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $41.63 to $55.51 in the contiguous states; $46.64 to $58.09 in AK, HI, PR and VI; ceiling $55.51, floor $41.63
Physician Fee Schedule (CY 2026, RVU26D)
Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for V2103
Payer coverage policies that name V2103
V2103 appears in 4 coverage policies from Aetna, Capital Blue Cross.
VT: $2.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $31.84 (professional), effective Jan 1, 2021
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.