HCPCS Code V2025: Deluxe Frame

HCPCS Code V2025 covers deluxe eyeglass frames, billed with Medicare after cataract surgery. Learn billing, modifiers, and reimbursement guidelines.

Use Code

## **What is HCPCS Code V2025?** HCPCS code V2025 refers to a "deluxe frame" for eyeglasses and is maintained by CMS under the Vision Services code range, specifically within the Spectacle Frames category (V2020–V2025). This code is used when billing for eyeglass frames that exceed the standard frame allowance, typically offering upgraded materials, design features, or higher quality than basic frames. Under Medicare Part B, beneficiaries are entitled to one pair of standard eyeglass frames (V2020) following cataract surgery with intraocular lens (IOL) implantation. If a patient chooses a deluxe frame instead, providers should bill V2020 for the covered standard frame allowance and then bill V2025 on a separate claim line to represent the patient’s financial responsibility for the upgrade amount (i.e., the difference between the deluxe frame and standard frame costs). Providers must issue an Advance Beneficiary Notice of Noncoverage (ABN) when billing for the upgrade so the patient is informed that the additional cost is non-covered. While RT/LT modifiers are not used with V2020 or V2025, appropriate upgrade modifiers (e.g., GA/GZ with GK/GL, per MAC policy) should be appended when required to indicate a patient-requested upgrade.

## **HCPCS Code V2025 Documentation Requirements** CMS does not publish unique, standalone documentation requirements specifically for V2025 (deluxe frame). Instead, providers must follow Medicare’s general rules for refractive lenses and frame upgrades. Key documentation elements should include: - Record the eyeglass prescription and confirm that the patient is eligible for coverage (e.g., post-cataract surgery with IOL implantation or other Medicare-covered indication). - Document that the patient qualifies for the standard frame benefit and that V2020 was billed at the Medicare-allowable amount. - Include an Advance Beneficiary Notice of Noncoverage (ABN) or similar form showing that the patient elected to receive a deluxe frame and agreed to pay the upgrade cost (the difference between the deluxe and standard frame). - The claim should reflect two lines—V2020 for the covered standard allowance and V2025 for the upgrade portion. Documentation should make this distinction clear. - Ensure the record and claim follow local Medicare Administrative Contractor (MAC) policies for refractive lenses, including use of required upgrade modifiers (e.g., GA/GZ with GK/GL when applicable).

## **V2025 billing requirements** When billing HCPCS code V2025 (deluxe frame) under Medicare, providers must follow CMS upgrade rules for spectacle frames: - Report V2020 for the covered standard frame allowance and V2025 for the patient-requested deluxe frame upgrade. - V2020 should be billed at the Medicare-allowable amount. V2025 represents the non-covered upgrade charge and reflects the patient’s financial responsibility for the difference in cost. - Do not append RT or LT modifiers to V2020 or V2025, as they are not required for spectacle frame billing. - While no modifiers are typically required on V2025, CMS requires an Advance Beneficiary Notice of Noncoverage (ABN) when billing for upgrades. Append the appropriate upgrade modifiers (e.g., GA/GZ with GK/GL, per MAC policy) to indicate that the beneficiary has agreed to pay for the deluxe frame upgrade. - Regional Medicare Administrative Contractors (MACs) may issue additional billing instructions, so verify local coverage determinations (LCDs) before submitting claims. - The medical record and claim should clearly show the patient’s eligibility for the standard frame benefit, their choice to upgrade, and the amount of the non-covered upgrade charge.

## **Other relevant codes** Other relevant HCPCS codes related to V2025 (deluxe frame) include: - **V2020** - Frame, standard - the basic frame code used to bill standard eyeglass frames - **V2100** - Sphere, single vision, plano to plus or minus 4.00, per lens - **V2101** - Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens - **V2102** - Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens

Frequently asked questions

HCPCS code V2025 is for a deluxe spectacle frame used in vision care services.

Procedure code V2025 refers to billing for a deluxe eyeglass frame upgrade.

The CPT code for eyeglass frames varies; V2020 covers standard frames while V2025 is for deluxe frames. Both are essential for billing, reimbursement, and ensuring patients have access to covered services.

While Medicare and insurers cover only the standard frame cost, any sign of a deluxe frame upgrade is billed separately. Providers may offer an office note or guarantee regarding frame quality, but this is not a CMS requirement.