V2315 Medicaid reimbursement rate by state (2026)
Lenticular, (myodisc), per lens, trifocal. Medicaid pays a median of $116.80 for V2315 across 25 states, from $10.50 in New Hampshire to $218.40 in Hawaii.
- States publishing
- 25
- National median
- $116.80units vary by state
- Lowest
- $10.50New Hampshire
- Highest
- $218.40Hawaii
What does Medicaid pay for V2315?
25 state Medicaid programs publish a fee-for-service rate for V2315. The national median is $116.80 (units differ between states). Hawaii pays the most, $218.40, and New Hampshire the least, $10.50, a 20.8x spread.
V2315 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 25 states with every variant, modifier and effective date.
How to read this table
- Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for V2315, so the order is by published amount and is not a like-for-like rank.
- Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 10 of the 25 states list more than one rate for V2315, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
- Unit. Of the 25 states, 1 publish V2315 per unit, and 24 schedules print no unit at all (a flat amount per service).
- Per hour. V2315 is not billed in time units in these states, so no hourly figure is shown.
- Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
- % of Medicare. No Medicare physician fee schedule amount is on file for V2315, so there is no percentage.
- Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.
Why V2315 rates differ between states
Published rates for V2315 run from $10.50 in New Hampshire to $218.40 in Hawaii, a 20.8x gap in the same unit. Half the states pay more than the median of $116.80 and half pay less. The usual reasons for a spread like this in vision & hearing rates:
- Some states buy eyeglasses through a single contracted laboratory, which changes what a provider is paid for the materials.
- Hearing aids and some lenses are priced at invoice or acquisition cost in some states and at a fixed fee in others.
- Adult vision and hearing benefits are optional for states, so coverage, limits and fees vary widely.
Timing matters too. 12 states set the current rate for V2315 in 2026 or later, while 7 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.
What managed-care plans pay for V2315
No managed-care plan publishes what it pays for V2315. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.
In 7 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 13 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 5 states is not classified yet.
- Plans negotiate; the published rate applies out of network (13 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
- Plans must pay at least the published rate (7 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Hawaii managed care.
Units and billing for V2315
V2315 is a HCPCS Level II vision, hearing and speech code in the vision & hearing line, billed mostly by optometrists, opticians, audiologists and hearing aid dispensers. V codes cover lenses, frames, prosthetic eyes, hearing aids and related services, generally paid per item and per side.
Vision and hearing materials are billed per item, per lens or per device, and hearing aids per ear (monaural or binaural).
Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.
Frequently asked questions
What does Medicaid pay for V2315?
It depends on the state. Of the 25 states with a published fee-for-service rate, the median is $116.80. Hawaii pays the most ($218.40) and New Hampshire the least ($10.50).
Which state pays the highest Medicaid rate for V2315?
Hawaii, at $218.40, effective 2026-06-01.
Which state pays the lowest Medicaid rate for V2315?
New Hampshire, at $10.50, effective 2025-07-01.
What unit is V2315 billed in?
Of the 25 states, 1 publish V2315 per unit, and 24 schedules print no unit at all (a flat amount per service).
Do managed-care plans pay the same rate for V2315?
Not necessarily. In 7 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 13 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 5 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.