Summary & Overview
HCPCS V5220: Hearing Aid, BICROS, Behind-the-Ear
HCPCS Level II code V5220 represents the provision of a BICROS behind-the-ear hearing aid, a specialized device for patients with asymmetric or unilateral severe hearing loss where sound from the poorer ear is routed and amplified for the better ear. Nationally, hearing aid codes such as V5220 matter for coverage determinations, benefit design, and access to amplification technologies for populations with hearing impairment.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what this code denotes clinically and operationally, typical sites of service, and what to expect when this device is billed. The publication summarizes common benchmarking topics and policy-relevant considerations, including coverage variability across major payers, coding practice implications, and clinical context for BICROS devices.
This summary equips billing staff, audiology providers, and policy analysts with concise information on the code meaning, payer landscape, and areas where organizations commonly focus when reviewing hearing aid services and reimbursement. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code V5220 describes a hearing aid, BICROS, behind-the-ear device. The service represented is the provision and fitting of a BICROS (BiCROS) behind-the-ear hearing aid, a device designed for patients with hearing loss in both ears where one ear has better residual hearing; the BICROS configuration routes sound from the poorer-hearing ear to the better-hearing ear while providing amplification behind the ear.
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Service type: Hearing aid fitting and provision
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Typical site of service: Audiology clinic, hearing aid dispenser office, or outpatient otolaryngology/audiology setting
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Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with asymmetric sensorineural hearing loss and poor word recognition in one ear presents to a licensed audiologist for evaluation. The audiologist performs pure-tone air and bone conduction testing, speech audiometry, and immittance measures. Testing demonstrates a severe-to-profound sensorineural loss in the poorer ear with near-normal hearing in the better ear, creating a single-sided functional deficit. The audiologist discusses assistive options and fits a behind-the-ear (BTE) BiCROS hearing aid system (V5220) that routes sound from the poorer ear to the better ear while amplifying input for the better-hearing ear.
In the clinical workflow: the patient undergoes a comprehensive hearing evaluation, counseling regarding BiCROS candidacy, ear impressions and earmold fabrication if needed, device selection and programming in the clinic, real-ear verification or functional gain measures, patient orientation and device care training, and follow-up adjustments. Durable medical equipment billing for the BiCROS behind-the-ear hearing aid is submitted using V5220 with appropriate documentation of audiologic findings, device specifications, and justification for medical necessity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |