Summary & Overview
HCPCS V5246: Digitally Programmable Analog Monaural ITE Hearing Aid
HCPCS Level II code V5246 denotes a single, in-the-ear (ITE), digitally programmable analog hearing aid. Nationally, this code is used to bill for the provision and fitting of a monaural, ear-specific device intended to improve hearing function. Hearing aids billed under V5246 are relevant to audiology, otolaryngology, and durable medical equipment suppliers.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what V5246 represents, how it maps to service settings, and which payers commonly adjudicate claims for this device. The report outlines typical reimbursement considerations, common billing modifiers supplied in the input, and how V5246 fits within the broader hearing aid supply landscape.
This summary provides clinical context for the device type, the typical site of service for provision and fitting, and what to expect when coding for a monaural, digitally programmable analog ITE hearing aid. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code V5246 describes a hearing aid, digitally programmable analog, monaural, in-the-ear (ITE) device. This code represents the provision of a single, ear-specific hearing aid that is digitally programmable while using analog signal processing, designed to fit within the ear canal and concha.
Service type: Durable medical equipment — hearing aid provision and fitting
Typical site of service: Outpatient audiology clinic or ENT (otolaryngology) practice; retail hearing aid dispensary
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive sensorineural hearing loss is evaluated in an outpatient audiology clinic after difficulty hearing conversational speech, especially in noisy environments. Otologic history and otoscopy are performed, pure-tone air and bone conduction audiometry and speech discrimination testing confirm a high-frequency, bilateral sloping sensorineural hearing loss with one ear meeting criteria for monaural amplification. The audiologist programs and fits a digitally programmable analog in-the-ear (ITE) hearing aid billed as V5246. The clinical workflow includes pre-fitting assessment (otoscopy, audiometry, speech testing), ear impression for custom ITE shell, device fitting and programming, real-ear measurements or probe-microphone verification as indicated, patient counseling on use and maintenance, and a short-term follow-up for fine-tuning and verification of benefit. Typical site of service is an outpatient audiology clinic or hearing aid center; services may also occur in otolaryngology offices. Typical patient scenario: an older adult with documented unilateral hearing impairment requiring a monaural, custom ITE digitally programmable analog hearing aid, with device selection, custom mold fabrication, programming, and verification visits documented in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard EO/NO modifier (not commonly used for HCPCS) |