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PAYER POLICY CHANGES

V2104 Insurance Policy Changes

HCPCS V2104 is officially defined as "Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens." HCPCS V2104 is referenced in 1 tracked payer policy change from Independence Blue Cross. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS V2104 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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Get one email when a payer policy names V2104, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

  • Arizona Complete Health · Effective December 31, 2025

    Prior authorization required

    Arizona Complete Health CMS-0057-F prior authorization requirements

  • Carolina Complete Health · Effective December 31, 2025

    Prior authorization required

    Carolina Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for V2104?

Ambetter lists V2104 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for V2104?

Arizona Complete Health lists V2104 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Carolina Complete Health require prior authorization for V2104?

Carolina Complete Health lists V2104 on Carolina Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for V2104?

Centene lists V2104 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS V2104?

There are 1 tracked policy change affecting HCPCS V2104, including updates from Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS V2104?

Payers that have issued tracked updates for HCPCS V2104 include: Independence Blue Cross.

How do I get notified when HCPCS V2104 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS V2104. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS V2104?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for V2104

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for V2104 in one place.

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RELATED

All billing codesJ3590C9399J3490992159921399202

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