Table of content for "Spherocylindr 4.00d/2.12-4d" (HCPCS V2104)
General information on the “V2104” code
HCPCS Code: V2104
Long Description: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens
Short Description: Spherocylindr 4.00d/2.12-4d
Original information is taken from V2104 page
Pricing indicators
Pricing Indicator Code 1: 38 – Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) . Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: C – Carrier judgment
Type of service
Berenson-Eggers Type of Service (BETOS): D1F – Prosthetic/Orthotic devices
Type Of Service 1: Q – Vision items or services
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 19850101
Code Effective Date: 20031001
Action Code: N – No maintenance for this code