HCPCS Level II V5259: Hearing Aid, Digital, Binaural, ITC

HCPCS Level II code V5259 describes a digital binaural in-the-canal (ITC) hearing aid device intended to provide amplification for bilateral hearing loss; the service represents provision and fitting of a bilateral ITC hearing aid system, typically delivered in an audiology or ENT clinic or a specialty hearing center, and includes device provision and associated fitting services as part of the clinical dispensing process.

For related coverage guidance, see recent payer policy updates: Oral Cancer Screening and Testing, Cochlear Implants, Balloon Dilation of the Eustachian Tube.

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HCPCS Level II V5259: Hearing Aid, Digital, Binaural, ITC

For related coverage guidance, see recent payer policy updates: Oral Cancer Screening and Testing, Cochlear Implants, Balloon Dilation of the Eustachian Tube.

Customize your policy alerts

Sign up for hcpcs V5259 policy alerts

Get alerted when payer policies referencing V5259 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with progressive bilateral sensorineural hearing loss is evaluated in an outpatient audiology clinic. The patient reports difficulty hearing conversations in noisy environments and on the telephone. The audiologist performs pure-tone audiometry, speech recognition testing, and real-ear measurements. After diagnostic testing confirms a moderate-to-severe bilateral sensorineural hearing loss and candidacy for amplification, the clinician recommends digital binaural in-the-canal (ITC) hearing aids. The clinical workflow includes pre-fitting counseling, ear impression or otoscopic confirmation of canal anatomy, device selection and programming, real-ear verification, fitting adjustments, patient education on insertion, removal, battery/rechargeable management, and scheduling follow-up for verification and a trial period. Billing uses HCPCS Level II code V5259 for the digital binaural ITC hearing aid. Typical site of service is an outpatient audiology clinic or specialty hearing aid center. Expected documentation includes audiometric test results, hearing aid selection records, device model and serial numbers, fitting and verification reports, informed consent for purchase/trial, and follow-up notes documenting benefit and any adjustments.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92557`	Comprehensive audiometry threshold evaluation and speech recognition (pure tone and speech tests)	Performed during the diagnostic evaluation that establishes candidacy for hearing aids and documents baseline thresholds and speech understanding
`92567`	Tympanometry and reflex threshold measurements	Performed to evaluate middle ear function prior to hearing aid fitting to rule out conductive components that may alter amplification strategy
`92590`	Hearing aid examination and selection; monaural	Used when documenting the professional service of hearing aid selection; bilateral selection would be billed as two units or as `92591` if available per payer rules
`92626`	Evaluation of cochlear implant programming (complex)	Not routine for ITC aids but listed as related for patients who may be candidates for implantable devices after evaluation
`96105`	Assessment of aphasia or auditory rehabilitation (when applicable)	May be used for counseling or rehabilitation services related to hearing aid use and communication strategies

Related Modifiers

5 rows

Modifier	Description	When to Use
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
99	Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…	- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
261QU0200X	Urgent Care Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
103K00000X	Behavior Analyst	A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential …
390200000X	Student in an Organized Health Care Education/Training Program	An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensur…
163WN1003X	Nutrition Support Registered Nurse	Nursing Service Providers · Registered Nurse
313M00000X	Nursing Facility/Intermediate Care Facility	An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related …
163WR0006X	Registered Nurse First Assistant	A perioperative registered nurse who works in collaboration with the surgeon and other health care team members to achieve optimal outcomes. The RNFA…
261QR0208X	Mobile Radiology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center

Related Payer Policy Updates

Specialty: Otorhinolaryngology (ENT)1 / 2

10 rows

Policy	Payer	Effective Date
Oral Cancer Screening and Testing	Oscar Health	2026-10-01
Cochlear Implants	Blue Cross Blue Shield - Rhode Island	2026-09-01
Balloon Dilation of the Eustachian Tube	Blue Cross Blue Shield - Rhode Island	2026-09-01
Sinus Surgeries and Interventions (for New Mexico Only)	UnitedHealthcare	2026-08-01
Surgical Treatment of Snoring and Obstructive Sleep	Premera Bluecross	2026-08-01
Sinus Surgeries and Interventions (for Tennessee Only)	UnitedHealthcare	2026-08-01
Sinus Surgeries and Interventions (for Kentucky Only)	UnitedHealthcare	2026-08-01
Repair of Nasal Valve Compromise	Ambetter Georgia	2026-08-01
Surgical Treatment of Snoring and Obstructive Sleep (OSA)	Premera Bluecross	2026-08-01
Sinus Surgeries and Interventions (for Nebraska Only)	UnitedHealthcare	2026-08-01

Related Codes

HCPCS-V5008-HEARING-SCREENING

HCPCS Level II V5008: Hearing screening

HCPCS-V5010-HEARING-AID-ASSESSMENT

HCPCS V5010: Assessment for Hearing Aid

HCPCS-V5011-HEARING-AID-FITTING-ORIENTATION-CHECKING

HCPCS V5011: Fitting, Orientation, and Checking of Hearing Aid

HCPCS-V5014-HEARING-AID-REPAIR-MODIFICATION

HCPCS Level II V5014: Repair/Modification of a Hearing Aid

HCPCS-V5020-CONFORMITY-EVALUATION

HCPCS V5020: Conformity Evaluation

HCPCS-V5030-MONAURAL-BODY-WORN-AIR-CONDUCTION-HEARING-AID

HCPCS V5030: Hearing Aid, Monaural, Body-Worn, Air Conduction

HCPCS-V5040-BODY-WORN-BONE-CONDUCTION-HEARING-AID-MONAURAL

HCPCS V5040: Monaural Body-Worn Bone Conduction Hearing Aid

HCPCS-V5050-HEARING-AID-MONAURAL-IN-THE-EAR

HCPCS Level II V5050: Hearing aid, monaural, in the ear

HCPCS-V5060-MONAURAL-BEHIND-THE-EAR-HEARING-AID

HCPCS Level II V5060: Hearing Aid, Monaural, Behind-the-Ear

HCPCS-V5070-GLASSES-AIR-CONDUCTION

HCPCS Level II V5070: Glasses, Air Conduction

Showing 1–10 of 87

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92557`	Comprehensive audiometry threshold evaluation and speech recognition (pure tone and speech tests)	Performed during the diagnostic evaluation that establishes candidacy for hearing aids and documents baseline thresholds and speech understanding
`92567`	Tympanometry and reflex threshold measurements	Performed to evaluate middle ear function prior to hearing aid fitting to rule out conductive components that may alter amplification strategy
`92590`	Hearing aid examination and selection; monaural	Used when documenting the professional service of hearing aid selection; bilateral selection would be billed as two units or as `92591` if available per payer rules
`92626`	Evaluation of cochlear implant programming (complex)	Not routine for ITC aids but listed as related for patients who may be candidates for implantable devices after evaluation
`96105`	Assessment of aphasia or auditory rehabilitation (when applicable)	May be used for counseling or rehabilitation services related to hearing aid use and communication strategies

Related Modifiers

5 rows

Modifier	Description	When to Use
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
99	Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…	- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
261QU0200X	Urgent Care Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
103K00000X	Behavior Analyst	A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential …
390200000X	Student in an Organized Health Care Education/Training Program	An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensur…
163WN1003X	Nutrition Support Registered Nurse	Nursing Service Providers · Registered Nurse
313M00000X	Nursing Facility/Intermediate Care Facility	An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related …
163WR0006X	Registered Nurse First Assistant	A perioperative registered nurse who works in collaboration with the surgeon and other health care team members to achieve optimal outcomes. The RNFA…
261QR0208X	Mobile Radiology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center

Related Payer Policy Updates

Specialty: Otorhinolaryngology (ENT)1 / 2

10 rows

Policy	Payer	Effective Date
Oral Cancer Screening and Testing	Oscar Health	2026-10-01
Cochlear Implants	Blue Cross Blue Shield - Rhode Island	2026-09-01
Balloon Dilation of the Eustachian Tube	Blue Cross Blue Shield - Rhode Island	2026-09-01
Sinus Surgeries and Interventions (for New Mexico Only)	UnitedHealthcare	2026-08-01
Surgical Treatment of Snoring and Obstructive Sleep	Premera Bluecross	2026-08-01
Sinus Surgeries and Interventions (for Tennessee Only)	UnitedHealthcare	2026-08-01
Sinus Surgeries and Interventions (for Kentucky Only)	UnitedHealthcare	2026-08-01
Repair of Nasal Valve Compromise	Ambetter Georgia	2026-08-01
Surgical Treatment of Snoring and Obstructive Sleep (OSA)	Premera Bluecross	2026-08-01
Sinus Surgeries and Interventions (for Nebraska Only)	UnitedHealthcare	2026-08-01

Related Codes

HCPCS-V5008-HEARING-SCREENING

HCPCS Level II V5008: Hearing screening

HCPCS-V5010-HEARING-AID-ASSESSMENT

HCPCS V5010: Assessment for Hearing Aid

HCPCS-V5011-HEARING-AID-FITTING-ORIENTATION-CHECKING

HCPCS V5011: Fitting, Orientation, and Checking of Hearing Aid

HCPCS-V5014-HEARING-AID-REPAIR-MODIFICATION

HCPCS Level II V5014: Repair/Modification of a Hearing Aid

HCPCS-V5020-CONFORMITY-EVALUATION

HCPCS V5020: Conformity Evaluation

HCPCS-V5030-MONAURAL-BODY-WORN-AIR-CONDUCTION-HEARING-AID

HCPCS V5030: Hearing Aid, Monaural, Body-Worn, Air Conduction

HCPCS-V5040-BODY-WORN-BONE-CONDUCTION-HEARING-AID-MONAURAL

HCPCS V5040: Monaural Body-Worn Bone Conduction Hearing Aid

HCPCS-V5050-HEARING-AID-MONAURAL-IN-THE-EAR

HCPCS Level II V5050: Hearing aid, monaural, in the ear

HCPCS-V5060-MONAURAL-BEHIND-THE-EAR-HEARING-AID

HCPCS Level II V5060: Hearing Aid, Monaural, Behind-the-Ear

HCPCS-V5070-GLASSES-AIR-CONDUCTION

HCPCS Level II V5070: Glasses, Air Conduction

Showing 1–10 of 87

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II V5259: Hearing Aid, Digital, Binaural, ITC

Sign up for hcpcs V5259 policy alerts

HCPCS Level II V5259: Hearing Aid, Digital, Binaural, ITC

Sign up for hcpcs V5259 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What is the clinical context for the use of HCPCS Level II code `V5259`?

Which related CPT codes are commonly used in conjunction with HCPCS Level II code `V5259`?

What are the common diagnoses associated with the use of HCPCS Level II code `V5259`?

Where is the typical site of service for the provision and fitting of a digital binaural ITC hearing aid system using HCPCS Level II code `V5259`?

What documentation is expected when billing for a digital binaural ITC hearing aid system using HCPCS Level II code `V5259`?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What is the clinical context for the use of HCPCS Level II code `V5259`?

Which related CPT codes are commonly used in conjunction with HCPCS Level II code `V5259`?

What are the common diagnoses associated with the use of HCPCS Level II code `V5259`?

Where is the typical site of service for the provision and fitting of a digital binaural ITC hearing aid system using HCPCS Level II code `V5259`?

What documentation is expected when billing for a digital binaural ITC hearing aid system using HCPCS Level II code `V5259`?

References