Billing for Deluxe Hearing Aids
Customize your policy alerts
Sign up for Blue KC Policy POL-PP-327 alerts
Get alerted when Policy POL-PP-327 changes without checking for updates manually.
Monitor payer policy activity
Describes Blue KC's reimbursement and billing process when members request a deluxe hearing aid that exceeds the cost of the insurer's standard medically necessary device; affects providers submitting claims and members with hearing aid benefits.
No material clinical or coverage changes in this revision.
Coverage stance and requirements
Coverage stance and submission requirements
Coverage applies only when the member has hearing aid benefits; Blue KC reimburses medically necessary hearing aids up to the base model and allows billing of the incremental deluxe charge to the member when the following submission and documentation requirements are met.
ALL of the following
- Claim Line #1: Submit the appropriate HCPCS (V-code) and the standard charge for the least expensive device that meets the member's medical needs and is considered medically necessary. Blue KC will process this line using member benefits and the HCPCS allowable per provider contract.
HCPCS codes for base and deluxe increments
| V5030 | Hearing aid, monaural, body worn, air conduction |
| V5040 | Hearing aid, monaural, body worn, bone conduction |
| V5050 | Hearing aid, monaural, in the ear |
| V5060 | Hearing aid, monaural, behind the ear |
| V5070 | Glasses, air conduction |
| V5100 | Hearing aid, bilateral, body worn |
| V5120 | Binaural, body |
| V5130 | Binaural, in the ear |
| V5140 | Binaural, behind the ear |
| V5150 | Binaural, glasses |
Submission and member billing instructions
Submission and member billing for deluxe hearing aids
Submit deluxe hearing-aid claims using two claim lines: one for the medically necessary base model (Blue KC covered hearing aid) and a second line for the incremental deluxe charge. The base-model line must include the appropriate HCPCS/V-code and the standard charge for the least expensive device that meets the member's medical needs; Blue KC will apply member benefits and the contract allowable to this line. The deluxe incremental charge must be submitted on a separate claim line using HCPCS code S1001 for the balance between the base model and the deluxe model. S1001 typically denies as member liability and may be billed to the member only when proper waiver documentation is obtained. Failure to follow these submission and billing instructions may cause denial or payment delay.
- Claim Line #1: Submit the HCPCS/V-code for the covered base model and the provider's standard charge for the least expensive medically necessary device.
- Claim Line #2: Submit HCPCS S1001 on a separate line for the incremental balance (deluxe minus base). This line represents the noncovered deluxe portion and will deny as member liability.
- Submit the standard charge on Line #1 and the balance (deluxe over base) on Line #2; do not combine amounts.
- The S1001 charge should equal the dollar amount the member agreed to in the signed waiver.
- Provider may bill the member for S1001 only when the remittance or waiver indicates member liability; otherwise amounts not paid cannot be billed to the member.
- Obtain and retain a signed member waiver prior to dispensing the deluxe device stating the member acknowledges the deluxe model is not covered and accepts responsibility for the difference.
- Example: Deluxe total charge $1,000. Claim Line 1 (base model) V-code $300 — Blue KC processes per contract allowable. Claim Line 2 S1001 $700 — billed as member liability and may be collected from member if waiver is on file.
- Ensure the balance billed on S1001 exactly matches the amount on the member waiver; attach waiver to claim or retain in member file per documentation requirements.
- Failure to follow these steps may result in denial of the S1001 line or delay in payment of the covered base-model line.
Key terms and codes
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.