Summary & Overview
HCPCS V5249: Hearing Aid, Analog, Binaural, ITC
HCPCS Level II code V5249 identifies an analog, binaural, in-the-canal (ITC) hearing aid and captures supply of two ear devices intended for bilateral hearing correction. Nationally, hearing aid codes like V5249 matter for coverage determination, benefit design, and out-of-pocket cost considerations for patients with hearing loss who require in-ear amplification. The code is used in claims to describe the device type and configuration when billing payers and Medicare.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what V5249 denotes, the typical service setting for device fitting and provision, and the clinical context for binaural ITC analog hearing aids.
The publication also outlines what readers can expect: benchmarking and coverage context where available, common billing and site-of-service considerations, and how V5249 fits into broader audiology service lines. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code V5249 represents a hearing aid, analog, binaural, in-the-canal (ITC) device. This code describes provision of two analog hearing instruments designed to fit partly or completely within the ear canal for bilateral hearing rehabilitation.
Service Type: Durable medical equipment — hearing aid fitting and supply
Typical Site of Service: Audiology clinic, ENT clinic, hearing aid dispenser office, or outpatient specialty clinic
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an audiology clinic with bilateral sensorineural hearing loss causing difficulty with speech perception in quiet and noisy environments. The patient has undergone audiometric testing including pure-tone air and bone conduction thresholds and speech discrimination testing demonstrating a symmetric mild-to-moderate sloping sensorineural loss. After counseling on amplification options, the audiologist programs and dispenses a pair of analog in-the-canal (ITC) hearing aids billed as V5249 (hearing aid, analog, binaural, itc). The clinical workflow includes: referral or self‑referral to audiology, comprehensive audiologic evaluation, selection of device style V5249, ear impressions if needed for ITC fit, verification of physical fit and acoustic function, real‑ear or simulated verification as appropriate, patient education and orientation, and scheduling of follow‑up visits for fine tuning and warranty/repair coordination. Typical sites of service are outpatient audiology clinics, otolaryngology (ENT) offices, and specialized hearing aid dispenser locations.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard use when no modifier applies |