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2025 HCPCS code V5212

Hearing aid, contralateral routing system, binaural, ite/itc

Medical necessity for this code requires documentation supporting the diagnosis of hearing loss and the need for amplification. The documentation should clearly establish that the binaural contralateral routing system is appropriate for the patient's specific type and degree of hearing loss.The medical record should justify why this specific type of hearing aid is chosen over other available options.

This code is reported when a patient receives the described hearing aid system.It is the responsibility of the clinician to ensure proper fitting, adjustment, and patient education regarding the use and care of the device. Diagnosis of hearing loss and determination of the appropriate type of hearing aid are crucial aspects of clinical responsibility.

In simple words: This code covers a hearing aid system for both ears, worn inside the ear or ear canal. It's designed for people who have hearing loss in both ears, but more severe loss in one.The system has two microphones, one for each ear, and amplifies sound based on the level of hearing loss in each ear. The hearing aids are custom-made to fit inside your ears.

This code represents a binaural (both ears), in-the-ear/in-the-canal (ITE/ITC) contralateral routing hearing aid system. It is typically used for patients with hearing loss in one ear and some degree of hearing loss in the other ear.The system has two microphones: one near the ear with better hearing, and the other near the ear with greater hearing loss. Sound is amplified for the ear with greater hearing loss, while the ear with less hearing loss also receives some amplification. ITE and ITC hearing aids are custom-fitted to the individual patient's ear. ITE aids fit completely inside the outer ear, while ITC aids fit inside the ear canal. The casing for the electronic components is made of hard plastic.

Example 1: A patient presents with single-sided deafness (SSD) in the right ear and moderate hearing loss in the left ear. A binaural ITE/ITC contralateral routing hearing aid system is fitted to improve hearing in both ears., A child with congenital hearing loss in both ears, more severe in the left ear, is fitted with a binaural ITE/ITC contralateral routing hearing aid system to facilitate language development., An adult with asymmetrical hearing loss due to noise exposure receives a binaural ITE/ITC contralateral routing hearing aid system to improve hearing and speech comprehension in noisy environments.

Documentation should include the diagnosis of hearing loss (type and severity), the rationale for selecting a contralateral routing binaural system, the fitting and adjustment process, and patient education provided. Audiograms and other relevant diagnostic test results should be included in the patient's record.

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