2025 HCPCS code V5261
(Active) Effective Date: N/A Revision Date: N/A Audiology Services - Hearing and Other Audiology Related Devices and Services Hearing Aids Feed
Supply of a binaural digital hearing aid (BTE).
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.
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.
- RVU: Information not available.RVUs and reimbursement vary by payer and location.
- Global Days: Not applicable. This is a supply code, not a procedure code.
- Payment Status: Active (as of 03 December 2024)
- Modifier TC rule: Not applicable for this HCPCS supply code.
- Fee Schedule: Fee schedules vary by payer and location.Information not available.Check with the payer for historical fee schedule information.
- Specialties:Audiology
- Place of Service:Office,Audiology Clinic