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2025 HCPCS code V5130

Binaural in-the-ear (ITE) hearing aid.

V codes are used to report vision, speech, and hearing services, including hearing aids.These codes may or may not be covered depending on the payer's policies.

Medical necessity for binaural ITE hearing aids is established when a patient experiences significant functional limitations due to hearing loss in both ears, and where the use of hearing aids is expected to improve communication and quality of life. The specific criteria for medical necessity may vary between payers.

This code is reported when a provider dispenses binaural ITE hearing aids to a patient.Common reasons for dispensing these aids include stenosis (narrowing of the ear canal), otitis media (middle ear inflammation), wax impaction, bony growth in the ear canal, tympanic membrane perforation (ruptured eardrum), and otosclerosis.

In simple words: This code covers two custom-made hearing aids, one for each ear, that fit inside the ear canal. They are for people with mild to severe hearing loss in both ears.

This code covers the provision of a binaural in-the-ear (ITE) hearing aid for patients with mild to severe hearing loss in both ears.These are custom-made to fit the individual patient's ear. ITE hearing aids come in two main styles: full shell, covering the entire ear opening, and half shell, covering only the lower part. The shell houses all the electronic components, such as the battery and microphone.

Example 1: A patient with bilateral moderate sensorineural hearing loss due to presbycusis is fitted with binaural ITE hearing aids., A patient with bilateral severe conductive hearing loss secondary to chronic otitis media is fitted with binaural ITE hearing aids after medical treatment fails to improve hearing., A child with bilateral mild hearing loss due to congenital deformities of the ear canal is fitted with binaural ITE hearing aids to aid in speech and language development.

Documentation should include the type and degree of hearing loss in each ear, the medical necessity for binaural ITE hearing aids, and the specific style and features of the dispensed aids.The dispensing provider's notes should also detail the fitting process and any adjustments made.

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