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BETA v.3.0

2025 HCPCS code V5261

Supply of a binaural digital hearing aid (BTE).

Follow all applicable HCPCS coding guidelines. Consult with your payer for any specific requirements or limitations.Be aware of service limitations (e.g., one pair per 24 months).

Modifiers may be applicable depending on the circumstances of service.Always refer to the specific payer's guidelines.

Medical necessity is established by documentation of a hearing loss significant enough to warrant amplification with a hearing aid.The audiological evaluation should support the choice of a binaural, digital BTE hearing aid as the most appropriate type of device for the patient's specific needs.

Audiologist or hearing aid dispenser.The clinical responsibility includes assessment of hearing loss, fitting and dispensing of the hearing aid, and patient education on use and maintenance.

IMPORTANT:Some payers may prefer using separate codes for right and left hearing aids (e.g., V5257RT and V5257LT).Additionally, code V5160 (Dispensing fee, binaural) may also be applicable.Consult with individual payers for their specific billing preferences.

In simple words: This code covers the cost of two digital hearing aids that fit behind the ears. These aids make sounds louder and clearer for people with hearing problems in both ears.

This HCPCS code, V5261, represents the supply of a binaural (for both ears), digital, behind-the-ear (BTE) hearing aid.The device amplifies sound and converts sound waves into digital signals for improved clarity. It is typically indicated for patients with hearing loss in both ears.One unit of this code represents two hearing aids (one for each ear).

Example 1: A 65-year-old patient presents with bilateral sensorineural hearing loss.After a comprehensive audiological evaluation, the audiologist recommends two BTE digital hearing aids. Code V5261 is used to bill for the supply of the hearing aids., A 78-year-old patient with significant bilateral hearing loss requires new hearing aids due to damage to their existing pair.Following an audiological assessment and fitting, code V5261 is used to bill for the replacement hearing aids., A 40-year-old patient with sudden onset bilateral hearing loss following an illness is fitted with binaural BTE digital hearing aids. Code V5261 is reported for the supply of the hearing aids.

* Comprehensive audiological evaluation report including audiogram and hearing aid fitting details.* Documentation of the patient's hearing loss and the need for binaural hearing aids.* Documentation of the specific type and model of the hearing aids supplied.* Patient consent for treatment.

** This code should be billed as one unit, even though it represents two hearing aids.Always verify payer-specific coverage and billing guidelines.

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