V2104 Spherocylindr 4.00d/2.12-4d

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

• Medicare coverage: Carrier judgment
• Status: active (July 2026 file)
• MUE: max 0 units per day (practitioner), rationale: CMS Policy