Summary & Overview
HCPCS Level II V5255: Hearing Aid, Digital, Monaural, ITC
HCPCS Level II code V5255 identifies a digital, monaural, in-the-canal (ITC) hearing aid device. Nationally, this code matters because it standardizes billing for a common class of durable medical equipment that supports hearing rehabilitation for unilateral hearing loss or asymmetric needs. Standardized coding facilitates payment processing, eligibility determination, and utilization tracking for audiologic services and devices.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what the code represents, payer coverage considerations, and the clinical context for device use. The publication outlines typical benchmarks and policy factors that affect coverage and reimbursement for digital monaural ITC hearing aids, and provides a concise reference for coding and billing teams, clinical program managers, and compliance staff.
The content highlights what to expect when submitting claims with V5255, common sites of service where the device is dispensed, and the role of this code within hearing care workflows. Data not available in the input.
Billing Code Overview
HCPCS Level II code V5255 describes a hearing aid, digital, monaural, in-the-canal (ITC) device. The service type is durable medical equipment (hearing aid) intended to provide amplification for a single ear. The typical site of service for this device is audiology clinics, ENT offices, or outpatient specialty practices where hearing devices are evaluated, fitted, and dispensed.
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Clinical & Coding Specifications
Clinical Context
A 72-year-old patient presents to an audiology clinic reporting progressive difficulty understanding speech, especially in background noise, consistent with unilateral sensorineural hearing loss confirmed on audiometry. The audiologist performs a comprehensive evaluation including pure-tone and speech audiometry, real-ear measurement, and ear canal inspection, determines candidacy for a digital in-the-canal (ITC) hearing aid for one ear, and documents ear impressions or selects a ready-fit device. The device supplied corresponds to code V5255 (hearing aid, digital, monaural, ITC). The clinical workflow includes verification of device selection, fitting and programming, patient counseling on use and care, delivery of the device, and scheduling follow-up for hearing verification and adjustments. Billing occurs at delivery with documentation of medical necessity (audiogram, diagnosis, and prior trial or conservative measures if required by payer). Typical sites of service are outpatient audiology or hearing aid dispensing clinics and physician offices providing audiology services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default reporting when no special circumstances apply |