Summary & Overview
HCPCS V5242: Hearing Aid, Analog, Monaural, CIC
HCPCS Level II code V5242 represents supply and fitting of an analog, monaural, completely in the ear canal (CIC) hearing aid. This code identifies provision of a single-ear analog CIC device and is used in billing for audiology services and hearing device dispensing. Nationally, hearing aid benefit coverage and billing practices affect access to amplification for patients with hearing loss and influence device availability across public and commercial payers.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how V5242 is used in practice, typical sites of service, and the clinical context for prescribing and fitting an analog CIC hearing aid. The publication outlines benchmarking elements and highlights where policy updates and payer coverage rules commonly affect billing for hearing devices. It also clarifies service-level expectations for device provision and fitting workflows.
The content serves clinicians, billing staff, and policy analysts seeking a national perspective on coding for analog monaural CIC hearing aids, including what the code denotes, common billing considerations, and areas where payer policies frequently influence reimbursement and patient access.
Billing Code Overview
HCPCS Level II code V5242 describes a hearing aid, analog, monaural, completely in the ear canal (CIC). The service type is hearing aid device provision and fitting, focused on supplying a single-ear analog CIC hearing aid. The typical site of service is audiology or hearing device specialty clinics and retail hearing centers, where device selection, fitting, and basic in-office adjustments occur.
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Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with progressive bilateral sensorineural hearing loss presents to an audiology clinic after difficulty hearing conversations and using the telephone. Otologic exam is unremarkable for active infection; tympanic membranes intact. Audiometric testing demonstrates a moderate-to-severe high-frequency sensorineural hearing loss in the right ear with poorer word recognition scores compared with the left. The patient elects to be fitted with a single completely-in-canal analog hearing aid for the right ear.
The clinical workflow includes: history and medication review, otoscopic inspection, pure-tone audiometry and speech recognition testing, candidacy discussion, ear impression if a custom CIC device is ordered, selection and programming of the analog monaural CIC device, real‑ear or functional gain verification as available, patient education on insertion/care, scheduling of follow-up for adjustments and warranty information, and documentation of device model and serial number for durable medical equipment records.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Routine use when no specific modifier applies |
22 |