CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Hearing aid repair claims (V5014) reimbursement guidance

Guidance for audiology providers on submission and reimbursement of hearing aid repair claims billed with procedure code V5014 for Neighborhood INTEGRITY for Duals (HMO D-SNP) members; explains documentation requirements, reconsideration process, and how claims will be adjudicated.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyHearing aid repair claims (V5014) reimbursement guidance

Policy CodePolicy N/A

Change TypeOperational update — reimbursement process revised

Effective DateMay 27, 2026

Next Review DateN/A

Key ActionWhen a claim denies or had no payment, submit a claim reconsideration with acquisition cost invoice, MSRP, and usual and customary charge attached.

SourceLink

POLICY UPDATE CHANGES

Neighborhood is updating how V5014 hearing aid repair claims are processed to match the State's approach; reimbursements are now on an individual consideration basis and must include documentation.

V5014procedure code affected

INTEGRITY D-SNPline of business impacted

3items requested

$0.00prior no-payment reason

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V5014 Reimbursement Criteria

V5014 reimbursement criteria

Claims for hearing aid repairs billed under code V5014 are reimbursed on an individual consideration basis and require documentation to support reimbursement.

ALL of the following

Provider's actual acquisition cost (per invoice)
Manufacturer's Suggested Retail Price (MSRP)
Provider's usual and customary charge (Charge Master)

Reimbursement determination

Neighborhood will review submitted documentation and determine reimbursement on an individual consideration basis
Reimbursement may vary by claim and provider because payment is based on documentation submitted.

Submission & reconsideration process

Submit the claim on paper with supporting documentation attached
Paper submission must include the required documentation.
Submit the claim electronically and if it denies for missing documentation submit a claim reconsideration with all required documentation attached
For claims previously processed with no payment, submit a claim reconsideration with the required documentation; a corrected claim is not required.

State fee schedule impact: Some prior claims were processed with no payment due to a State fee schedule rate of $0.00; those claims should be addressed via claim reconsideration with the required documentation for individual consideration-based reimbursement.

Procedure Code and Documentation Requirements

Hearing aid repair codeHCPCSCovered

V5014

Hearing aid repair

Documentation required for reimbursement

Provider acquisition cost (invoice)Provider's actual acquisition cost per invoice must be submitted.

Manufacturer's Suggested Retail Price (MSRP)Submit the manufacturer's suggested retail price for the repaired item or supply.

Provider usual and customary charge (Charge Master)Submit the provider's usual and customary charge (Charge Master).

Submission Options and Reconsideration Process

Note

Submission options for V5014 claims

For hearing aid repair claims billed with code V5014, providers may either submit the claim on paper with the supporting documentation attached, or submit electronically and, if the claim denies for missing documentation, file a claim reconsideration with the required documentation. When submitting paper claims, attach the provider's acquisition invoice, MSRP, and usual and customary charge to the claim; when submitting electronically, be prepared to attach those same documents to the reconsideration request if the claim denies.

Paper submission: attach supporting documentation to the paper claim.
Electronic submission: if denied for missing documentation, submit reconsideration with all required documents attached.

Prior Authorization

Reconsideration for denied or unpaid V5014 claims

When a claim denies for missing documentation or was previously processed with no payment, submit a claim reconsideration request attaching the required supporting documentation; a corrected claim is not required for claims previously processed with no payment.

Attach: provider's actual acquisition cost (per invoice).
Attach: Manufacturer's Suggested Retail Price (MSRP).
Attach: provider's usual and customary charge (Charge Master).
For claims processed with no payment due to a State fee schedule of $0.00, submit reconsideration with documentation — do not submit a corrected claim.

Key Terms and Required Documentation

Individual consideration — definition

MeaningReimbursement for V5014 is determined on an individual consideration basis: each claim is reviewed and paid (or not) based on the specific documentation submitted, so reimbursement may vary by claim and provider.

Implication for providersProviders must attach required documentation (acquisition invoice, MSRP, usual and customary charge) because payment is based on the submitted documentation.

ScopeApplies to hearing aid repair claims billed with procedure code V5014 for Neighborhood INTEGRITY for Duals (HMO D-SNP).

Required documentation for reconsideration

Actual acquisition cost (invoice)The provider's actual acquisition cost as shown on the invoice must be attached to support the claim.

Manufacturer's Suggested Retail Price (MSRP)Attach the MSRP for the repaired item or supply as part of the supporting documentation.

Provider usual and customary charge (Charge Master)Include the provider's usual and customary charge (Charge Master) with the reconsideration request.