HCPCS code V5210 – BICROS in-the-ear hearing aid

Key takeaways

V5210 described a BICROS in-the-ear hearing aid for patients with asymmetric hearing loss

CMS deleted V5210 effective January 1, 2019, with a termination date of December 31, 2018 in the HCPCS file

No single code replaced V5210. Monaural fittings use V5171, V5172 or V5181, and binaural systems use V5211 through V5215 and V5221

Dispensing fees bill separately as V5200 for monaural fittings and V5240 for binaural ones, and neither is a device code

Medicare Part B excludes hearing aids by statute, so these devices are not covered for most Medicare beneficiaries

Pabau’s claims management software tracks HCPCS V-code claims, flags missing documentation, and routes denials for correction

HCPCS code V5210 at a glance

HCPCS code V5210 sat within the V5000-series of the HCPCS Level II code set. That set is the alphanumeric system CMS administers for products and services CPT does not cover. The code is now retired. The table below summarizes the reference fields a coder needs when a V5210 claim or an old record turns up.

What V5210 covered: BICROS in-the-ear hearing aids explained

A BICROS (Bilateral Contralateral Routing of Signal) hearing aid system routes sound from the non-hearing ear to the ear that retains usable hearing. It also amplifies the sound arriving at that better ear.

The in-the-ear (ITE) style means both the microphone on the poorer-hearing side and the receiver on the better side are housed in custom shells. Those shells sit within the ear canal or concha, rather than behind the ear or in a body-worn unit.

V5210 was the right code for that device until the end of 2018. The clinical picture has not changed, and it still holds when all three conditions are met.

The patient has profound or total sensorineural or conductive hearing loss in one ear. The contralateral ear has measurable residual hearing that benefits from amplification. The device delivered is an ITE-style BICROS system, rather than a behind-the-ear (BTE) or eyeglass-style variant. For a fitting today, that combination is billed as V5211.

• Signal routing: The microphone on the non-hearing side picks up sound and transmits it wirelessly to the receiver on the better ear
• Amplification at the better ear: Unlike a CROS system, a BICROS unit adds gain at the receiving ear rather than simply routing signal
• Custom fit: ITE shells are made from ear impressions taken by the dispensing audiologist
• Fitting prerequisite: Audiogram documenting the asymmetric loss pattern is required before the device is fitted and before the claim is submitted

Where both ears have loss that benefits from amplification, contralateral routing is not indicated. A conventional binaural ITE pair applies instead, and a digitally programmable pair bills as V5252.

BICROS vs CROS: Choosing the right code

Mixing up CROS and BICROS codes is one of the most common miscoding errors in audiology billing. It triggers automatic denials on payers that adjudicate based on device type. The distinction turns on whether the better ear also needs amplification. It survived the 2019 code overhaul intact, even though every code number changed.

One cell in this comparison trips up coders more than any other. V5200 is not a CROS device code. It is the dispensing fee for a monaural fitting, revised in 2019 to read “dispensing fee, contralateral, monaural”. V5240 is the binaural equivalent. The CROS in-the-ear device code was V5170, which CMS deleted on the same date as V5210.

If the chart shows the better ear has thresholds in the mild-to-moderate impairment range, the clinically correct device is BICROS. Bill that fitting with a binaural contralateral routing code. Submitting a monaural CROS code for a BICROS device, or the reverse, is a coding error. Payers that audit device types will recoup payments on this basis.

Code status: HCPCS code V5210 was deleted in 2019

CMS deleted V5210 effective January 1, 2019. The current HCPCS Alpha-Numeric master file carries a termination date of December 31, 2018 for the code. Both dates come straight from the CMS file. Any claim with a date of service on or after January 1, 2019 must carry a current contralateral routing code instead.

Some lookup sites still show V5210 as if it were live, which is where the confusion starts. The CMS master file is cumulative. It retains terminated codes with a termination date rather than dropping them from the download.

A tool that reads the descriptor column without reading the termination column will report the code as present. Present in the file is not the same as valid for billing.

V5210 was not deleted on its own. The same 2019 overhaul also deleted V5170 (CROS, in the ear), V5180 (CROS, behind the ear) and V5220 (BICROS, behind the ear).

CMS rebuilt the family around monaural and binaural descriptors, so there is no single one-to-one successor to V5210. The replacement code depends on the pair of device styles actually fitted.

• Date of service before January 1, 2019: V5210 was valid then, so a retrospective or corrected claim for that period keeps the code. Retain the CMS file version for that year with the claim record in case of audit.
• Date of service on or after January 1, 2019: Refile with the binaural contralateral routing code that matches the two device styles fitted. For a pair of in-the-ear devices, that is V5211.
• A payer fee schedule that still lists V5210: Treat it as a stale payer table rather than proof the code is live. Ask for the payer’s current crosswalk in writing before you bill a deleted code.
• An order or chart note that names V5210: Recode at the claim line, and add a note recording which current code you selected and why. Do not change the clinician’s original documentation.

Which codes replaced V5210 after the 2019 revision

The 2019 revision changed how contralateral routing devices are described. The old codes named a single device style. The new codes split into two groups instead. Monaural codes describe one routing device worn with no aid on the other side, which is the CROS arrangement. Binaural codes describe a two-device system and name the style of each device in the pair, which is the BICROS arrangement.

Read the binaural descriptors as a pair of styles. V5211 covers an in-the-ear device on each side, which is why it is the nearest equivalent to the old V5210.

A patient fitted with an in-the-ear transmitter and a behind-the-ear receiver takes V5213 instead, even though the clinical system is identical. The grid below maps every style pair to its code.

Dispensing fees bill alongside a device code and never in place of one. Use V5200 for a monaural CROS fitting. A binaural BICROS fitting takes V5240 instead, so the fee code matches the device code on the claim. A monaural fitting without contralateral routing takes V5241, the general monaural dispensing fee.

Verify with each payer whether the device and the dispensing fee are separately reimbursable. Ask too whether the fee needs its own claim line or is bundled into the device allowable.

Documentation required before billing a BICROS hearing aid

Incomplete documentation is the second most common denial trigger for hearing aid claims, after non-coverage. These are the records that must be in the chart before the claim goes out. They follow the standards payers apply to durable medical equipment. Capturing them on a digital form at the fitting appointment means the chart is complete before the claim is built.

• Audiogram: Must show the degree of hearing loss in both ears and the asymmetric pattern that clinically justifies a BICROS system. The test date must fall inside the payer’s lookback window, commonly 6 or 12 months
• Physician or audiologist order: A signed order specifying the device type (BICROS) and style (ITE) from a qualified provider
• Device style on each side: The binaural codes name the pair of styles fitted. The notes must record what was placed on the transmitting ear and on the receiving ear
• Fitting and dispensing notes: Documentation of the audiologist’s selection rationale, fitting session, ear impressions, and any real-ear measurements
• Manufacturer and model documentation: Manufacturer name, device model, and serial number tied to the claim line
• Prior authorization approval (where required): Payer-issued PA number noted on the claim; check with each payer, as PA requirements vary
• Proof of delivery: Patient signature confirming receipt of the device, required by many payers as a condition of payment

Medicare and Medicaid coverage rules for BICROS hearing aids

Medicare Part B does not cover hearing aids. Section 1862(a)(7) of the Social Security Act explicitly excludes “hearing aids or examinations therefor” from Medicare coverage. The exclusion applied to V5210 and applies equally to its replacement codes. The device is therefore non-covered for most Medicare beneficiaries, regardless of medical necessity.

Two exceptions exist and both require verification before billing.

• Medicare Advantage (Part C) plans: Individual MA plans set their own supplemental benefit rules. Some cover hearing aids up to a fixed annual allowance. Verify coverage for each patient’s specific plan before fitting.
• State Medicaid programs: Medicaid coverage for hearing aids is determined at the state level. Minnesota Medicaid, for example, covers hearing aid services using HCPCS codes under its hearing aid services program. Other states vary widely. Check the relevant state Medicaid provider manual for the patient’s plan before billing.

For commercial insurance and Medicaid plans that do cover BICROS hearing aids, conduct insurance eligibility verification before the fitting appointment. Confirm that the current binaural contralateral routing code is on the plan’s covered list and whether a deductible applies. Ask about frequency limitations too, such as one hearing aid per ear every three years.

Step-by-step: How to bill a BICROS hearing aid correctly

This workflow applies to commercial payers and Medicaid plans that cover BICROS hearing aids. Skip to the denial section if Medicare Part B is the primary payer, as the claim will be denied as non-covered.

1. Verify eligibility and benefits: Confirm the patient’s plan covers hearing aids, identify any frequency limits, and obtain the PA requirement status before scheduling the fitting.
2. Obtain prior authorization: If the payer requires PA, submit the audiogram and physician order with the PA request. Do not fit the device before PA is approved; post-hoc PA requests are rarely granted.
3. Conduct the audiological evaluation: Ensure the audiogram is current and documents the degree and type of loss in each ear. It must support the BICROS clinical indication.
4. Fit and dispense the device: Document the fitting session in clinical notes. Record the style fitted on each side, model, serial number, ear impressions, real-ear measurements, and the patient’s delivery signature.
5. Select the code from the styles fitted: Match the pair to the binaural list above (V5211 for ITE/ITE, V5213 for ITE/BTE, and so on). Never submit V5210 for a date of service in 2019 or later.
6. Prepare the claim: Add the matched ICD-10 diagnosis code, covered in the next section. Enter the place of service, typically 11 for office or 49 for independent clinic. Attach the PA number if required, and add V5240 where the payer reimburses the binaural dispensing fee separately.
7. Submit the claim and retain all supporting documentation. Practice management software like Pabau tracks HCPCS claim status, flags incomplete claim lines, and queues denials for review.
8. Follow up on remittance: Review the electronic remittance advice (ERA) for any adjustment reason codes. Appeals for hearing aid denials are typically adjudicated within 30 to 60 days depending on payer.

Common V5210 claim denials and how to fix them

Hearing aid claims have a higher denial rate than most HCPCS categories because coverage is non-universal and documentation requirements are strict. Working the denials in a set order reduces rework time and stops the same error repeating on the next claim.

Reviewing denial reason codes against this table after each remittance cycle shows which denial types keep recurring. A pattern usually traces back to the fitting record rather than to the coder, so the fix belongs upstream in the documentation workflow.

ICD-10 diagnosis codes for BICROS hearing aid claims

Every HCPCS claim requires a supporting ICD-10-CM diagnosis code that establishes medical necessity. For a BICROS in-the-ear hearing aid, the diagnosis code must document the hearing loss pattern that justifies the device.

Some ICD-10-CM hearing loss codes split by laterality and others do not, which is where coders lose time. H90.3 is a single bilateral code with no right or left sub-codes, while H90.41 and H90.42 do name a side.

Always select the code that most precisely matches the audiogram findings. A BICROS fitting is justified because the better ear also has measurable loss, so the bilateral code usually carries the claim. The CMS Physician Fee Schedule lookup and the NLM HCPCS API are useful cross-references for validating code pairings before submission.

How Pabau keeps HCPCS hearing aid claims clean

In most audiology practices the fitting record and the claim live in different systems. The audiologist writes the styles fitted, the serial numbers and the delivery signature into the chart. A biller then rekeys the code from an order that may still name V5210.

Pabau keeps both in one record. Its claims management software reads the claim off the same patient record that holds the audiogram, the fitting note and the proof of delivery. Missing items are flagged before submission rather than after a denial.

For a practice fitting contralateral routing devices, the style pair on the chart and the code on the claim line stay in step. Denials that do land are queued by reason code, so the same V-code error does not repeat across a month of fittings.

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Conclusion

Treat V5210 as history and the rest of these claims get easier. The code has been dead since January 1, 2019. The only place it still belongs is a retrospective claim with a pre-2019 date of service.

Three habits keep these claims clean. Record the device style on each ear, because the binaural codes are chosen from the pair. Pair the device code with the right dispensing fee, V5200 for monaural and V5240 for binaural.

Check payer fee schedules against the CMS file rather than the other way round, since payer tables are the ones that go stale. Medicare’s statutory exclusion means most of these claims land with commercial or Medicaid payers that carry an explicit hearing aid benefit.

Book a demo to see how Pabau handles HCPCS billing from intake to remittance.

Continue your research

Working a stack of hearing aid denials? Denial management in healthcare sets out the workflow for triaging, appealing and tracking denied claims.

Want fewer denials in the first place? What is a clean claim? explains the checks that get a claim paid on first submission.

Reading remittance files each week? Electronic remittance advice breaks down the adjustment reason codes that explain a V-code denial.

Not sure a hearing aid benefit applies? Insurance eligibility verification covers what to confirm before the fitting appointment.

New to HCPCS and CPT claims? What is medical billing? walks through the full path from encounter to payment.

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