HCPCS Level II V5261: Hearing Aid, Digital, Binaural, BTE

HCPCS Level II code V5261 represents a digital, binaural, behind-the-ear (BTE) hearing aid device; the service is provision of a bilateral BTE digital hearing aid set, typically involving dispensing and fitting by an audiologist or hearing instrument specialist and provided in an audiology clinic or outpatient hearing center setting.

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 V5261: Hearing Aid, Digital, Binaural, BTE

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 V5261 policy alerts

Get alerted when payer policies referencing V5261 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 male with progressive bilateral sensorineural hearing loss is evaluated in an outpatient audiology clinic. He reports difficulty understanding speech in group settings and on the telephone. Audiometric testing (pure-tone audiometry and speech discrimination) demonstrates moderate-to-severe, symmetric, high-frequency sensorineural hearing loss with reduced speech discrimination scores. The audiologist and otolaryngologist determine amplification is appropriate and select a digital behind-the-ear (BTE) binaural hearing aid system. The clinical workflow includes: referral from primary care or self-referral; comprehensive audiologic assessment; ear inspection and cerumen management if needed; real-ear measurement and hearing aid programming; fitting of two V5261 devices (digital, binaural, BTE); patient education on device use and maintenance; verification with aided testing; and scheduling follow-up visits for adjustment and warranty/repair management. Typical sites of service are ambulatory audiology clinics, otolaryngology offices, and specialty hearing aid dispensaries where Medicare/insurance-covered durable medical equipment is dispensed and coded as HCPCS Level II V5261 for binaural digital BTE hearing aids.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92557`	Comprehensive audiometry threshold evaluation and speech recognition	Performed before dispensing to document hearing thresholds and speech discrimination; used to determine candidacy for `V5261` binaural BTE hearing aids.
`92590`	Hearing aid examination and selection; monaural	Used when selecting and counseling on hearing aid options; for binaural fittings, two units or bilateral selection services may be documented.
`92591`	Hearing aid examination and selection; binaural	Directly documents selection and orientation for bilateral hearing aids such as `V5261`.
`92626`	Evaluation of auditory rehabilitation status, first hour	Used for detailed follow-up counseling and aural rehabilitation after hearing aid fitting.
`92601`	Diagnostic analysis of cochlear implant, patient, with programming	Not directly part of routine BTE hearing aid workflow but relevant when considering alternate interventions if amplification is inadequate.
`92630`	Evaluation for prescription of non-custom assistive listening device	May be used when evaluating alternative or adjunct assistive listening devices to complement binaural BTE hearing aids.

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…
P5	Modifier P5 denotes a moribund patient who is not expected to survive without the operative procedure and is used only with anesthesia CPT codes 00100–01999. The anesthesia provider must append P5…	- Use modifier P5 only when the anesthesia provider determines the patient is moribund and not expected to survive without the operation, and append it only to anesthesia CPT codes 00100–01999…

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…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
261QM2500X	Medical Specialty Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical s…
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
208200000X	Plastic Surgery Physician	A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal sys…
2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to ob…
224Z00000X	Occupational Therapy Assistant	An occupational therapy assistant is a person who has graduated from an occupational therapy assistant program accredited by the Accreditation Council…
364SR0400X	Rehabilitation Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

Related ICD-10-CM Codes

21 rows

ICD-10-CM Code	Description
E11.40	Type 2 diabetes mellitus with diabetic neuropathy, unspecified
G31.84	Mild cognitive impairment of uncertain or unknown etiology
H90.0	Conductive hearing loss, bilateral
H90.11	Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.12	Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.3	Sensorineural hearing loss, bilateral
H90.41	Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.42	Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.5	Unspecified sensorineural hearing loss
H90.6	Mixed conductive and sensorineural hearing loss, bilateral

Showing 1–10 of 21

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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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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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	Performed before dispensing to document hearing thresholds and speech discrimination; used to determine candidacy for `V5261` binaural BTE hearing aids.
`92590`	Hearing aid examination and selection; monaural	Used when selecting and counseling on hearing aid options; for binaural fittings, two units or bilateral selection services may be documented.
`92591`	Hearing aid examination and selection; binaural	Directly documents selection and orientation for bilateral hearing aids such as `V5261`.
`92626`	Evaluation of auditory rehabilitation status, first hour	Used for detailed follow-up counseling and aural rehabilitation after hearing aid fitting.
`92601`	Diagnostic analysis of cochlear implant, patient, with programming	Not directly part of routine BTE hearing aid workflow but relevant when considering alternate interventions if amplification is inadequate.
`92630`	Evaluation for prescription of non-custom assistive listening device	May be used when evaluating alternative or adjunct assistive listening devices to complement binaural BTE hearing aids.

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…
P5	Modifier P5 denotes a moribund patient who is not expected to survive without the operative procedure and is used only with anesthesia CPT codes 00100–01999. The anesthesia provider must append P5…	- Use modifier P5 only when the anesthesia provider determines the patient is moribund and not expected to survive without the operation, and append it only to anesthesia CPT codes 00100–01999…

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…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
261QM2500X	Medical Specialty Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical s…
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
208200000X	Plastic Surgery Physician	A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal sys…
2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to ob…
224Z00000X	Occupational Therapy Assistant	An occupational therapy assistant is a person who has graduated from an occupational therapy assistant program accredited by the Accreditation Council…
364SR0400X	Rehabilitation Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

Related ICD-10-CM Codes

21 rows

ICD-10-CM Code	Description
E11.40	Type 2 diabetes mellitus with diabetic neuropathy, unspecified
G31.84	Mild cognitive impairment of uncertain or unknown etiology
H90.0	Conductive hearing loss, bilateral
H90.11	Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.12	Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.3	Sensorineural hearing loss, bilateral
H90.41	Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.42	Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.5	Unspecified sensorineural hearing loss
H90.6	Mixed conductive and sensorineural hearing loss, bilateral

Showing 1–10 of 21

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 V5261: Hearing Aid, Digital, Binaural, BTE

Sign up for hcpcs V5261 policy alerts

HCPCS Level II V5261: Hearing Aid, Digital, Binaural, BTE

Sign up for hcpcs V5261 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code V5261 represent and where is it typically billed?

Which CPT codes are commonly associated with the evaluation and fitting workflow for V5261?

Which ICD-10 diagnoses are documented with V5261 fittings?

What clinical steps are typically performed when dispensing and fitting V5261 binaural BTE hearing aids?

Which payers and sites of service are associated with V5261 billing?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code V5261 represent and where is it typically billed?

Which CPT codes are commonly associated with the evaluation and fitting workflow for V5261?

Which ICD-10 diagnoses are documented with V5261 fittings?

What clinical steps are typically performed when dispensing and fitting V5261 binaural BTE hearing aids?

Which payers and sites of service are associated with V5261 billing?

References