Summary & Overview
HCPCS Level II V5264: Ear Mold/Insert, Non-Disposable
HCPCS Level II code V5264 denotes a non-disposable ear mold or insert used with hearing devices or for ear protection. This supply-level code captures the provision of custom or reusable ear inserts, an item that affects device fitting, patient comfort, and accessory billing. Nationally, accurate use of this HCPCS Level II code matters for claims consistency, accessory coverage determinations, and cost transparency for hearing-related services.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what V5264 represents, typical settings where the item is provided, and the relevance to billing workflows. The publication outlines benchmark considerations, common payer coverage patterns, and clinical context for ear molds and inserts to inform coding accuracy and reimbursement expectations. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code V5264 describes an ear mold/insert, not disposable, any type. This item represents a custom or reusable ear insert used with hearing devices or for ear protection. The service type is manufacture or provision of a non-disposable ear mold/insert, and the typical site of service is outpatient clinics, audiology offices, hearing aid dispensaries, or retail medical supply settings where hearing devices and accessories are fitted and dispensed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with hearing loss or a need for an improved hearing aid fit presents to an audiology clinic or ENT office for ear mold fabrication. Typical patients include adults or children who use behind-the-ear (BTE) or in-the-ear (ITE) hearing aids and require a custom, durable, non-disposable ear mold/insert for retention, acoustic coupling, or earmold venting. The clinical workflow: the audiologist or hearing instrument specialist evaluates the patient, performs otoscopy and hearing aid fitting verification, selects materials and style for the ear mold, takes an ear impression, and sends the impression to an on-site or off-site laboratory for fabrication of a custom, non-disposable ear mold (V5264). At a follow-up visit the provider verifies fit, adjusts the mold as needed, documents device details (material, style, laterality), and updates the hearing aid programming. Typical site of service is an outpatient audiology clinic, otolaryngology practice, or hearing aid dispensing office. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for beneficiaries meeting coverage criteria.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no modifier applies; standard claim line |