HCPCS Code V5010: Assessment for hearing aid

Key Takeaways

HCPCS Code V5010 describes an assessment for hearing aid, used to evaluate whether a patient needs a hearing aid and which device is appropriate.

Medicare generally does not cover V5010, but state Medicaid programs (including Medi-Cal and New York Medicaid) may reimburse it when billed with correct prior authorization.

CPT 92590/92591 (hearing aid examination and selection) were deleted on January 1, 2026; V5010 remains an active HCPCS Level II code for payers and Medicaid programs that mandate V-code billing.

New hearing aid service CPT codes (92628-92642), effective January 1, 2026, replaced the deleted 92590-92595 family and may affect how hearing instrument specialists and audiologists bill for these evaluations.

HCPCS Code V5010 carries a short and long description of “Assessment for hearing aid.” It falls within the V5008-V5020 Hearing Assessments and Evaluations range, classified under Vision/Hearing Services by the Centers for Medicare and Medicaid Services (CMS). The action code is “N” (no maintenance), with an action effective date of January 1, 1995, indicating the code has remained stable without modification for over three decades.

Clinically, V5010 represents the assessment process used to determine whether a patient needs a hearing aid and, if so, to select the appropriate device. It covers the full evaluation workflow: reviewing audiometric test results, assessing functional hearing in real-world conditions, determining candidacy, and selecting device type, style, and features based on individual need.

Billing guidelines and documentation requirements

Submitting HCPCS Code V5010 without adequate supporting documentation is the fastest path to a denial. Payers expect the claim to be backed by a complete clinical record that substantiates both medical necessity and the scope of service delivered.

Required documentation

At minimum, the patient record should include a current audiogram (typically within six months), documentation of the specific assessment activities performed, the clinician’s candidacy determination, and a record of the recommended device type. Practices using digital intake forms can streamline this capture at the point of service, reducing the chance of missing fields that trigger retrospective denials.

• Audiogram: Pure-tone air and bone conduction results, typically within 6 months of the assessment
• Speech recognition testing: Word recognition scores supporting candidacy determination
• Candidacy statement: Clinician’s documented rationale for recommending a hearing aid
• Device selection notes: Style, features, and fitting recommendation based on lifestyle and audiometric profile
• Functional assessment: Real-world hearing performance in communication settings
• Referring physician order: Required by some Medicaid programs and commercial payers before a hearing aid assessment can be billed

Who can bill V5010

Both licensed audiologists and hearing instrument specialists (HIS) may bill V5010, but credentialing requirements vary by payer and state. Audiologists bill under their National Provider Identifier (NPI) with the appropriate taxonomy code. Hearing instrument specialists, whose scope of practice is more limited, face stricter credentialing checks from commercial payers and some Medicaid programs. Practices that manage multiple provider types benefit from patient record documentation systems that tie service delivery to the specific licensed provider, reducing audit risk.

Place of service and modifiers

Place of service (POS) code 11 (Office) applies in most outpatient audiology settings. Some Medicaid programs accept POS 12 (Home) when assessments are conducted at the patient’s residence. Modifier use with V5010 is payer-specific. Common modifiers applied include:

• Modifier -52: Reduced services, when a full assessment was not completed
• Modifier -59: Distinct procedural service, when V5010 is billed on the same date as an audiological evaluation
• State Medicaid modifiers: Some programs require proprietary modifiers to indicate prior authorization approval

Always verify modifier requirements against the specific payer’s policy before submitting. Modifier misuse is consistently cited as a top denial trigger for hearing services billing. Practices that integrate claims management workflows into their practice management system can flag modifier requirements before submission rather than addressing them at the appeal stage.

Medicare and Medicaid coverage rules

Coverage for HCPCS Code V5010 is one of the most misunderstood aspects of hearing services billing. The short answer: Medicare typically does not cover it. The nuanced answer: several state Medicaid programs do, under specific conditions.

Medicare Part B coverage

Medicare Part B generally excludes coverage for routine hearing examinations and hearing aids. Because V5010 is an assessment oriented toward hearing aid candidacy and selection, it falls within this exclusion for most Medicare beneficiaries. CMS does not reimburse V5010 as a covered service under the standard Part B benefit. You can verify current payment status and any applicable fee schedule data using the CMS Physician Fee Schedule lookup tool.

Some Medicare Advantage (Part C) plans may cover hearing services beyond the traditional Part B benefit, including hearing aid assessments. Coverage terms vary by plan and contract year. Billers should check each plan’s Evidence of Coverage document and confirm coverage before rendering the service.

Medicaid coverage by state

State Medicaid programs represent the primary payer landscape for V5010 outside of commercial insurance. Coverage rules, reimbursement rates, and prior authorization requirements differ significantly across states.

• California Medi-Cal: V5010 is classified as a non-Medicare-covered code billed directly to Medi-Cal. The state’s audiology billing manual historically listed a maximum allowance of $52.70 for V5010, though rates are updated annually. Always verify the current fee schedule before billing.
• New York Medicaid (eMedNY): V5010 is covered and described as “Assessment for hearing aid (Hearing aid evaluation test, free field testing).” Prior authorization identifies the specific procedure code; claims submitted without authorization referencing V5010 are denied.
• Illinois Medicaid: Historical program guidance required an authorization number identifying V5010 before billing. Rates as of older fee schedules placed V5010 at $57.29 per unit. Current rates should be verified through the Illinois Medicaid provider portal.

Because Medicaid rates and prior authorization requirements change on an annual or biennial basis, maintaining current access to state provider manuals is essential. Practices with HIPAA compliance for medical offices processes already in place typically have the documentation audit controls needed to satisfy Medicaid’s pre-authorization record-keeping requirements.

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Comparing V5010 to the CPT hearing aid codes and related HCPCS codes

One of the more confusing decisions in hearing services billing has been choosing between HCPCS Code V5010 and the CPT codes for hearing aid examination and selection. Until recently that meant weighing V5010 against CPT 92590 and 92591, but the AMA deleted those CPT codes on January 1, 2026 and replaced them with a new family of hearing-device service codes (92628-92642). Payer rules and provider type still determine which code set applies.

V5010 vs the new 92628-92642 CPT family

According to the AAPC HCPCS code reference, and consistent with guidance from the American Speech-Language-Hearing Association (ASHA), hearing aid examination and selection was historically reported using CPT Code 92590 (monaural) or CPT Code 92591 (binaural). Effective January 1, 2026, the AMA deleted the entire 92590-92595 family and replaced it with a new set of hearing-device service codes (92628-92642). HCPCS Code V5010 was not affected and remains available as the Level II alternative. The key distinction now is payer acceptance:

• New CPT codes 92628-92642 (effective January 1, 2026): Replace the deleted 92590-92595 family with a more granular set of hearing-device service codes covering candidacy, selection, fitting, follow-up, and verification. Adopted by commercial insurers and audiologist contracts as payers complete the transition.
• CPT 92590/92591 (deleted January 1, 2026): Formerly the monaural (92590) and binaural (92591) hearing aid examination and selection codes. Retired by the AMA and no longer valid for dates of service on or after January 1, 2026.
• HCPCS V5010: The HCPCS Level II alternative, widely used by hearing instrument specialists who may not have access to CPT billing through their payer contracts. Also required by certain Medicaid programs that mandate HCPCS coding for this service category. Unaffected by the 2026 CPT changes and still active.

Check your payer contract first. For dates of service on or after January 1, 2026, commercial payers that have transitioned will expect the new CPT codes (92628-92642) rather than the deleted 92590/92591. Medicaid programs in states that mandate HCPCS V-codes for hearing services still require V5010, and some Medicaid-managed care organizations (MCOs) accept either family. When in doubt, call the payer’s provider services line before submitting. Using EHR integration between your clinical and billing systems reduces the risk of submitting the wrong code family by keeping payer-specific rules visible at the point of coding.

Related HCPCS codes in the V5008-V5020 range

V5010 does not stand alone. Audiology practices routinely bill multiple V-codes across a single patient encounter or episode of care. Understanding the neighboring codes prevents both undercoding and duplicate billing errors.

ICD-10-CM diagnosis codes most commonly paired with V5010 include H90 series codes (Conductive and sensorineural hearing loss, including H90.3 for sensorineural hearing loss, bilateral) and H91 series codes (Other and unspecified hearing loss). Correct ICD-10 pairing supports medical necessity and reduces the chance of LCD-based denials.

2026 CPT transition and implications for V-code billers

The billing landscape for hearing services is shifting. New hearing aid service CPT codes took effect January 1, 2026, a change confirmed by the Academy of Doctors of Audiology (ADA). On that date the AMA deleted the legacy CPT codes 92590-92595 (hearing aid examination, selection, and check) and replaced them with a new family of 12 hearing-device service codes (92628-92642). Importantly, this change applies to CPT codes only: per ASHA, the HCPCS Level II V-codes, including V5010, V5011, and V5020, were not affected and remain active.

Who is most affected

Audiologists who already use CPT codes in their practice (for diagnostic evaluations, for example) are better positioned for the transition. The new hearing aid service CPT codes expand their ability to bill for fitting and selection services under the same code set they use elsewhere.

Hearing instrument specialists who rely exclusively on HCPCS V-codes face a more complex decision. Their payer contracts may not yet accept the new CPT codes, and some Medicaid programs may continue requiring V-codes for a transitional period. The ADA has released member resources to assist with this transition, but providers should verify acceptance with every payer before switching code families.

Does V5010 remain valid after 2026

V5010 has not been retired. CMS has not published a sunset date for the V5010 code, and the code remains in the 2025 and 2026 HCPCS Level II data files as an active code. Providers whose payer contracts specify HCPCS V-code billing for hearing aid services, particularly Medicaid-contracted providers in states that mandate V-codes, should continue using V5010 until their specific payers communicate otherwise. Using automated billing workflows that flag code-family requirements by payer can reduce the transition risk for multi-payer practices. You can verify current code status and fee schedule applicability via the PGM Billing HCPCS lookup tool.

The safest approach for 2026: maintain V5010 as your primary code for Medicaid and hearing-instrument-specialist-contract payers, while evaluating the new CPT codes for commercial payers and audiologist-specific contracts where acceptance has been confirmed. Practices managing this dual-code environment benefit from practice management software that supports payer-specific billing rules at the claim level.

Conclusion

Billing HCPCS Code V5010 correctly requires more than knowing the code description. Payer-specific coverage rules, prior authorization requirements, correct modifier use, and the 2026 CPT transition all affect whether a claim is paid on first submission. Getting documentation right before the claim goes out is the only reliable way to avoid the denial-appeal cycle.

Pabau’s compliance management tools help audiology and multi-specialty practices capture structured clinical documentation at every patient touchpoint, reducing the gap between what was delivered and what the claim can prove. If you want to see how Pabau handles billing documentation and patient record workflows for specialty practices, book a demo.

Continue your research

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