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2025 HCPCS code V5040

Supply of a monaural, body-worn bone conduction hearing aid (BAHA).

Appropriate modifiers (LT for left, RT for right) should be appended as necessary.Check payer specific guidelines for coverage and authorization requirements.Separate billing codes are used for fitting and evaluation services.

Modifiers LT (left) and RT (right) are allowed to specify which ear the device is for.

Medical necessity for a V5040 BAHA is established when a patient presents with significant conductive hearing loss or single-sided deafness where conventional air conduction hearing aids have proven ineffective. Thorough audiological testing must document the extent of hearing loss and the appropriateness of bone conduction amplification as determined by the fitting audiologist. Supporting medical documentation confirming the underlying condition should also be present.

Audiologist or otolaryngologist (ENT) responsible for fitting and dispensing the hearing aid.May involve collaboration with other healthcare professionals depending on the patient's specific needs and medical history.

IMPORTANT:V5030 (monaural, air conduction), V5100 (bilateral, body-worn), V5050 (monaural, in-the-ear), V5060 (monaural, behind-the-ear)

In simple words: This code is for a special type of hearing aid called a bone-anchored hearing aid (BAHA).It's worn on the body and sends sound vibrations directly to the inner ear through the bones of the skull. This helps people who can't use regular hearing aids because of problems with their outer or middle ear.

This HCPCS code, V5040, covers the supply of a single, body-worn bone conduction hearing aid, also known as a bone-anchored hearing aid (BAHA).These devices transmit sound vibrations directly through the bones of the skull to the inner ear, bypassing the outer and middle ear.BAHAs are indicated for individuals with conductive or mixed hearing loss, or single-sided deafness where a traditional air conduction hearing aid is ineffective due to conditions like otitis media, ear canal atresia, or significant middle ear pathology. The code specifically applies to the supply of the device itself, not related services such as fitting or programming.

Example 1: A patient with single-sided deafness due to an ear canal abnormality receives a V5040 BAHA. The audiologist fits and programs the device. , A patient with chronic otitis media and significant conductive hearing loss is provided a V5040 BAHA after unsuccessful attempts with a conventional hearing aid. The otolaryngologist confirms the appropriateness of a BAHA before the audiologist fits and programs the device., A patient with a history of head trauma leading to bone conduction hearing loss receives a V5040 BAHA. The audiologist ensures it is properly fitted and programmed, collaborating with the patient's rehabilitation team.

* Patient's audiogram demonstrating the need for a bone conduction hearing aid.* Documentation of the patient's medical history, including relevant diagnoses and prior treatment attempts.*Detailed description of the selected device, including model and manufacturer.*Documentation of the fitting and dispensing process, including verification of appropriate device function and patient education.*Physician or audiologist order for the hearing aid.

** The V5040 code does not include services such as hearing evaluations, fitting, or programming of the device.These are typically billed using separate codes.Ensure compliance with all relevant payer guidelines and local regulations.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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