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2025 HCPCS code V5211

Supply of a binaural, in-the-ear (ITE) contralateral hearing aid system.

Appropriate coding requires accurate documentation of the type of hearing aid provided, including the binaural, ITE, and contralateral features.Ensure the documentation fully supports the medical necessity for the device.

Modifiers may be applicable depending on the circumstances of service. Consult local guidelines for specific modifier application rules.

Medical necessity is established through the audiological evaluation demonstrating significant hearing loss in at least one ear, impacting communication and quality of life. The contralateral feature is medically necessary when a disparity in hearing exists between both ears. The type of hearing aid (ITE) is selected based on the degree and configuration of hearing loss.

Audiologist or hearing aid specialist fits and dispenses the hearing aid.Physician may be involved in initial diagnosis and referral.

IMPORTANT For other contralateral routing hearing aids and systems, consider codes V5171V5172, V5181, V5212V5215, and V5221.

In simple words: This code covers the cost of a special hearing aid that helps people who have hearing problems in both ears, but one ear is worse than the other.It has two microphones to amplify sound in the ear that needs more help, and also provide some amplification to the other ear.The hearing aid is custom-made to fit inside the ear.

This HCPCS code, V5211, represents the provision of a binaural (both ears), in-the-ear (ITE) contralateral hearing aid system.This system is typically used for individuals experiencing hearing loss in one ear and some degree of loss in the other. The device features two microphones; one positioned near the better-hearing ear and the other near the ear with more significant hearing loss.ITE hearing aids are custom-fitted to the patient's ear and are suitable for treating mild to severe hearing loss. The electronic components are housed within a hard plastic casing. The contralateral binaural design amplifies sound for the ear with greater hearing loss while also providing some amplification to the ear with less severe hearing impairment.

Example 1: A 65-year-old patient presents with gradual hearing loss in both ears, more pronounced in the left ear due to age-related hearing loss and prior noise exposure. The audiologist recommends and fits a binaural ITE contralateral hearing aid (V5211)., A 40-year-old patient experiences sudden hearing loss in the right ear following an infection.The audiologist determines that they also have a mild hearing loss in the left ear, possibly genetic.A bilateral ITE contralateral hearing aid (V5211) is recommended to address both ears., A 78-year-old patient with sensorineural hearing loss in both ears, worsened in the right ear due to a previous head injury, is fitted with a V5211 hearing aid. The patient benefits from improved sound amplification in the more affected ear and some support to the less affected ear.

* Audiological evaluation report including pure-tone audiometry, speech audiometry, and immittance testing.* Hearing aid fitting report specifying the device's model, features, and specifications.* Patient's medical history and current medications, particularly noting any conditions that affect hearing or balance.* Documentation of patient counseling and education on hearing aid use and maintenance.

** The code is for the supply of the hearing aid only; fitting and adjustment services are separately coded.

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