Summary & Overview
HCPCS V5190: Hearing Aid, Contralateral Routing, Monaural, Glasses
HCPCS Level II code V5190 designates a contralateral routing, monaural hearing aid integrated into a glasses frame. This device is used to route sound from the impaired ear to the better-hearing ear and is a specialized form of durable medical equipment for patients with unilateral hearing loss. Nationally, V5190 matters for coverage policy, benefit design, and device access because it intersects audiology care, optical dispensing, and DME benefit administration.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and common settings for service delivery, the typical service line classification, and national considerations for billing and coverage. The publication will also summarize benchmark themes such as utilization patterns and reimbursement considerations where available, highlight any recent policy updates affecting HCPCS hearing-aid codes, and provide plain-language guidance on documentation and coding context necessary for claims processing.
This summary is written for a national audience and focuses on what V5190 represents clinically and administratively, what payers typically consider when adjudicating claims for contralateral routing glasses-based hearing aids, and where to look for payer-specific coverage policies.
Billing Code Overview
HCPCS Level II code V5190 describes a hearing aid, contralateral routing, monaural, glasses. This device routes sound from one ear to the opposite ear and is integrated into a glasses frame, providing an assistive hearing solution for unilateral hearing loss.
Service type: Durable Medical Equipment / Assistive Hearing Device
Typical site of service: Outpatient settings, audiology clinics, specialty dispensaries, and retail/optical settings where hearing aids are dispensed and fitted.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with single-sided deafness (SSD) presents to an audiology clinic seeking improved sound awareness from the deaf ear side. The audiologist and otologist evaluate hearing thresholds and determine the patient is a candidate for a contralateral routing of signal (CROS) hearing aid mounted on eyeglasses because the patient already wears glasses and has poor or non-serviceable hearing in one ear with normal-to-near-normal hearing in the contralateral ear. The clinical workflow includes: an audiologic evaluation with pure-tone and speech audiometry; counseling on CROS technology and alternatives; measurement and ordering of a V5190 device (hearing aid, contralateral routing, monaural, glasses); verification of frame fit and device placement; real-ear or functional gain verification as appropriate; user orientation and earmold/glasses maintenance instruction; and scheduling of follow-up for fine-tuning and warranty/repair coordination. Typical sites of service are outpatient audiology clinics, otolaryngology offices, or specialty hearing centers. Typical patient scenario features an adult with unilateral severe-to-profound sensorineural hearing loss on one side and normal or near-normal hearing on the opposite side, who uses eyeglasses and prefers an integrated glasses-mounted CROS solution for daily activities such as conversations, telephone use, and environmental awareness.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |