HCPCS V5250: Hearing Aid, Digitally Programmable Analog, Binaural, CIC

HCPCS Level II code V5250 identifies a binaural, custom-fit completely-in-canal (CIC) hearing aid using digitally programmable analog technology. This durable medical device code is relevant to audiology, otolaryngology, and hearing instrument specialists and matters nationally due to the prevalence of hearing loss and the role of hearing aids in restoring communication and quality of life.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for V5250, standard sites of service, and which payers commonly cover hearing aid devices. The publication outlines benchmarking and reimbursement context where available, notes prevailing coverage considerations across major payers, and summarizes policy updates that affect device coding and billing workflows.

This summary equips providers, billing staff, and policy analysts with a clear description of what V5250 represents, typical service settings, and the payer landscape to inform coding decisions and administrative processes. Data not available in the input is noted where applicable in detailed sections.

Billing Code Overview

HCPCS Level II code V5250 denotes a hearing aid, digitally programmable analog, binaural, cic. This code represents a pair of custom-fit completely-in-canal (CIC) hearing aids that use digitally programmable analog technology to amplify sound for individuals with hearing impairment.

Service Type: Hearing aid device provision and fitting

Typical Site of Service: Audiology clinic or hearing instrument specialist office; may also be provided in outpatient or retail hearing centers

Clinical Context

A 72-year-old patient with progressive bilateral sensorineural hearing loss presents to an audiology clinic after referral from primary care. Audiometric testing confirms moderate-to-severe, symmetrical high-frequency loss with difficulty hearing speech in noise. The audiologist performs ear impressions for custom in-the-canal (CIC) devices, programs and fits a pair of digitally programmable analog hearing aids described as binaural CIC devices. The clinical workflow includes: initial history and otologic exam, comprehensive audiometry (pure tone, speech audiometry), ear canal inspection and micro-suction if needed, ear impressions, device selection and ordering, device delivery with real-ear measurement and probe-mic verification, programming adjustments, patient education on insertion/care, documentation of objective test results and device settings, and scheduling of follow-up visits for real-world acclimatization and warranty/service coordination.

Coding Specifications

Modifier	Description	When to Use
`00`	Standard technical and professional components (no modifier)	Use when no specialty modifier applies and billing is for standard supply of the device.
`22`	Increased procedural services

Taxonomy Code	Specialty	Notes
`2084P0800X`	Audiology	Audiologists perform diagnostic testing, ear impressions, programming and verification.
`262L00000X`	Otolaryngology (ENT)	Otolaryngologists evaluate medical suitability, manage ear pathology and surgical interventions if needed.
`246QF0300X`	Hearing Aid Specialist	Hearing aid specialists handle device selection, fitting, and patient education per state scope.
`364S00000X`	Physical Medicine & Rehabilitation	PM&R physicians may coordinate care for patients with complex communication needs.
`2086S0122X`	Speech-Language Pathology	SLPs may be involved in aural rehabilitation and speech-in-noise training.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H90.3`	Sensorineural hearing loss, bilateral	Common indication for bilateral hearing aid provision, especially for CIC binaural devices.
`H90.41`	Unilateral sensorineural hearing loss, right ear, with unrestricted hearing on the left	May lead to consideration of amplification in the affected ear; bilateral device not indicated.
`H90.42`	Unilateral sensorineural hearing loss, left ear, with unrestricted hearing on the right	As above for left-sided loss.
`H91.90`	Unspecified hearing loss, unspecified ear	Used when the specific type/severity is not yet fully characterized but amplification is considered.
`H93.25`	Tinnitus, bilateral	Tinnitus often coexists with hearing loss and may influence hearing aid programming and counseling.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92557`	Comprehensive audiometry threshold evaluation and speech recognition (pure tone and speech testing)	Performed before hearing aid selection to document degree/type of hearing loss and speech understanding.
`92626`	Evaluation of auditory rehabilitation status; first hour	Used for hearing aid fitting and follow-up to assess aided performance and communication needs.
`92567`	Tympanometry (impedance testing)	Performed to assess middle ear status prior to impression-taking and device fitting.
`92590`	Hearing aid examination and selection; monaural	Used when selecting, programming and verifying a single hearing aid; for binaural fittings, two units are documented.
`92601`	Evaluation for prescription of non-implantable hearing aids for air and/or bone conduction devices; monaural	Applies to the clinical evaluation and prescription process that leads to selection of the CIC device.

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Summary & Overview