Summary & Overview
HCPCS V5258: Hearing Aid, Digital, Binaural, CIC
HCPCS Level II code V5258 designates a digital, binaural, completely-in-canal (CIC) hearing aid. This code captures the supply and provision of two in-the-canal hearing devices intended to restore binaural auditory function. Hearing aids coded under V5258 are clinically significant for addressing sensorineural hearing loss and improving communication, safety, and quality of life for patients requiring amplification.
Key national payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what V5258 represents, typical sites of service where the devices are provided, and the clinical context for device use. The publication summarizes payer coverage patterns, common billing modifiers (listed separately), and typical service-line placement for hearing aid supply.
This report provides practical benchmarks for utilization and coding practice, highlights common documentation considerations, and identifies areas where policy updates or payer-specific rules commonly affect reimbursement. Data not available in the input for specific payer edits, fee schedules, associated taxonomies, ICD-10 mappings, and related codes are noted as unavailable.
Billing Code Overview
HCPCS Level II code V5258 describes a hearing aid, digital, binaural, cic (completely-in-canal). This code represents the supply of two digitally programmed in-the-canal hearing aids designed for binaural hearing support.
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Service type: Durable medical equipment / hearing aid provision and fitting
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Typical site of service: Audiology clinics, otolaryngology (ENT) practices, hearing aid dispensaries, and other outpatient settings providing hearing device evaluation and fitting
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with progressive bilateral sensorineural hearing loss is evaluated in an audiology clinic after difficulty hearing conversation and using the telephone. Audiometric testing demonstrates symmetrical moderate-to-severe sensorineural hearing loss with poor word recognition in quiet. The audiologist and otolaryngologist review amplification options and determine that a binaural, digital, completely-in-the-canal (CIC) hearing aid fitting is appropriate for ear canal anatomy and cosmetic preference. The clinical workflow includes pre-fitting diagnostic audiometry, ear otoscopy, real-ear probe-microphone verification, hearing aid programming and verification, patient counseling on use and maintenance, and a short-term follow-up visit for real-ear measurement adjustment and patient education. Device dispensation is documented with manufacturer model, serial numbers, and warranty information. Billing for the device itself uses HCPCS Level II code V5258 for a digital, binaural, CIC hearing aid, and professional services such as audiologic evaluation, fitting, and verification are billed separately using applicable CPT codes during the same episode of care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier or default indicator | Rarely appended; use payer-specific guidance if required by the claim form |