Summary & Overview
HCPCS V5240: Dispensing Fee for Contralateral Routing System, Binaural
HCPCS Level II code V5240 represents the dispensing fee for a contralateral routing of signal (CROS) system configured for binaural use. This code captures the supplier or clinician charge tied to dispensing and fitting a hearing device that routes sound from one ear to the opposite ear, supporting patients with unilateral hearing loss or asymmetric hearing profiles. Nationally, the code matters for consistent billing of specialized hearing-device dispensing services and for payers to distinguish device dispensing fees from device purchase and professional services.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the payer landscape. The publication outlines benchmark considerations, common modifiers reported with the code (input provided), and practical notes on where this fee is billed relative to device costs and professional fitting services.
The piece is structured to help billing managers, audiology suppliers, and policy analysts understand how V5240 is used in claims, what to expect from major national payers, and which operational areas—dispensing, fitting, and ambulatory service sites—are most relevant when this code is submitted. Data not available in the input is identified in context.
Billing Code Overview
HCPCS Level II code V5240 denotes a dispensing fee for a contralateral routing of signal (CROS) system, binaural. This code applies to the professional or supplier charge associated with dispensing a hearing device configuration in which sound from one ear is routed to the contralateral ear to provide binaural hearing benefit.
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Service type: Dispensing and fitting of a contralateral routing system for binaural hearing
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Typical site of service: Audiology clinics, hearing aid dispensaries, outpatient specialty clinics, or other ambulatory care settings where hearing devices are dispensed
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with unilateral severe sensorineural hearing loss and a functioning contralateral ear is fitted with a contralateral routing of signal (CROS) or bilateral CROS (binaural) system. The dispensing fee V5240 is billed by an audiology clinic or dispensing hearing-device provider after delivery and programming of the CROS/binaural hardware and associated patient counseling. Typical workflow: audiologic assessment (pure-tone and speech testing), discussion of amplification options, selection of a CROS/binaural solution, device ordering, device receipt and verification, individualized fitting and programming, patient education on use and maintenance, and a follow-up visit to confirm benefit. Typical site of service is an outpatient audiology clinic, hearing center, or physician office (ENT/audiology). The patient scenario includes device dispensing for contralateral routing where the fee covers professional time and services related to final device delivery, orientation, and verification testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Routine billing when no additional modifier applies |
22 |