HCPCS Code V2755

Official Description

U-v lens, per lens

Short Descr	Uv lens/es
Coverage	Special coverage instructions apply
Pricing Indicator(s)	38 – Supplies And Surgical Dressings - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
MPI	A – Not applicable, as HCPCS priced under one methodology
MCM	2130B
BETOS	D1F – Prosthetic/Orthotic devices
TOS Code(s)	Q – Vision items or services
Added Date	1/1/1985
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
MUE	0
MUE	2
IOM	100-02, 15, 120
OTS Orthotic	No
CCS Clinical Classification	241 - Visual aids and other optical supplies

LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)
KX	Requirements specified in the medical policy have been met
GA	Waiver of liability statement issued as required by payer policy, individual case
EY	No physician or other licensed health care provider order for this item or service
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
55	Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.
VP	Aphakic patient
50	Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR	Catastrophe/disaster related
E2	Lower left, eyelid
ER	Items and services furnished by a provider-based, off-campus emergency department
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
GW	Service not related to the hospice patient's terminal condition
GX	Notice of liability issued, voluntary under payer policy
GZ	Item or service expected to be denied as not reasonable and necessary
KK	Dmepos item subject to dmepos competitive bidding program number 2
KT	Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KY	Dmepos item subject to dmepos competitive bidding program number 5
KZ	New coverage not implemented by managed care
LR	Laboratory round trip
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RA	Replacement of a dme, orthotic or prosthetic item
RE	Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems)
SC	Medically necessary service or supply