HCPCS code V5220 – BiCROS behind-the-ear hearing aid

Key takeaways

V5220 described a BiCROS behind-the-ear hearing aid, not a standard pair of hearing aids for both ears.

CMS deleted V5220 effective January 1, 2019, along with V5170, V5180 and V5210, and it has not been reinstated.

No single code replaced V5220. Binaural BiCROS systems now bill as V5211 to V5215 or V5221, chosen by the style worn on each ear.

V5221 covers a BTE/BTE contralateral routing system, and V5240 is the binaural contralateral routing dispensing fee.

A standard binaural behind-the-ear fitting with no signal routing is billed with V5140 and the V5160 dispensing fee, never V5220.

Medicare Part B excludes hearing aids by statute, so these claims go to Medicaid, Medicare Advantage or commercial plans.

HCPCS code V5220 at a glance

HCPCS code V5220 was the Level II code for a BiCROS hearing aid in the behind-the-ear (BTE) style. CMS retired it at the end of 2018, so it can’t be billed for any current date of service. The table summarizes what a coder needs when V5220 turns up on an old order, a payer table or a denial.

What V5220 covered: BiCROS behind-the-ear hearing aids

A BiCROS system serves a patient with little or no usable hearing in one ear and a hearing loss in the other. A transmitter on the poorer ear picks up sound and sends it to a hearing aid on the better ear. That hearing aid also amplifies sound for the better ear.

V5220 named the behind-the-ear version of that system. It was never a code for two ordinary hearing aids, one per ear. That reading is the most common misuse of the code, and it is covered in the next section.

• Signal routing: The transmitter on the poorer side sends sound to the device on the better ear
• Amplification at the better ear: A BiCROS device adds gain at the receiving ear, which a CROS device does not
• Behind-the-ear housing: The electronics sit in a case behind the ear, connected to the canal by tubing or a receiver wire
• Clinical prerequisite: An audiogram showing an unaidable ear on one side and an aidable loss on the other

V5220 vs V5140: BiCROS or a standard binaural fitting?

Both codes involve two ears and behind-the-ear devices, which is why they get confused. The difference is signal routing. If no sound crosses from one ear to the other, the fitting is a standard binaural pair and V5220 never applied.

Read the fitting note before the order. If the note records a transmitter or “routing” device, the claim needs a contralateral routing code. If it records two hearing aids that each amplify their own ear, it needs V5140 and V5160. The decision path below runs those checks in order, starting with the date of service.

Code status: HCPCS code V5220 was deleted in 2019

CMS deleted V5220 effective January 1, 2019, and it has not come back. A claim with a date of service on or after that date must carry a current code instead. The American Academy of Audiology summary of the 2019 changes lists the full set of deletions, additions and revisions.

V5220 went out in the same revision as V5170 (CROS, in the ear), V5180 (CROS, behind the ear) and V5210 (BiCROS, in the ear). CMS rebuilt the family around monaural devices and binaural systems, so no code inherited V5220 one for one.

Some lookup sites still show V5220 because the CMS master file keeps terminated codes alongside a termination date. A tool that reads the descriptor without the date will report the code as present. Present in the file does not mean valid for billing.

• Date of service before January 1, 2019: V5220 was valid then, so a corrected claim for that period keeps it. Keep the CMS file version for that year with the claim record.
• Date of service on or after January 1, 2019: Bill the binaural contralateral routing code that matches the two device styles fitted. For a BTE device on each side, that is V5221.
• A payer fee schedule that still lists V5220: The payer’s table is out of date, and the code is still deleted. Ask the payer for its current crosswalk in writing.
• An order or chart note that names V5220: Recode at the claim line and record which current code you chose and why. Leave the clinician’s original note unchanged.

Which codes replaced V5220 after the 2019 revision

The 2019 codes describe a BiCROS fitting as a binaural system and name the style of each device in the pair. The table lists the binaural system codes, their dispensing fee, and the monaural CROS code a BTE fitting most often gets confused with.

V5221 is the nearest successor because it names a BTE device on both sides. A patient with a BTE transmitter and an in-the-ear hearing aid takes V5213 instead, even though the clinical system is the same. The in-the-ear side of the same revision is covered on the V5210 page.

The dispensing fee bills alongside the device code and never in place of it. Confirm with each payer whether V5240 needs its own claim line or is bundled into the device allowable.

Documentation required before billing a BiCROS hearing aid

Payers that cover hearing aids review the chart against the device code. These records should be complete before the claim goes out.

• Audiogram: Shows an unaidable loss on one side and an aidable loss on the other. The test date must fall inside the payer’s lookback window.
• Order: A signed order from a qualified provider naming the device type (BiCROS) and the style on each side.
• Device style on each ear: The binaural codes are chosen from the pair, so the note records the transmitting and receiving devices separately.
• Fitting notes: The fitting session, verification measurements and the audiologist’s selection rationale.
• Device details: Manufacturer, model and serial number for both devices, tied to the claim line.
• Prior authorization: The payer’s approval number, where the plan requires one.
• Proof of delivery: The patient’s signature confirming receipt of the devices.

Medicare, Medicaid and commercial coverage

Medicare Part B does not cover hearing aids. Section 1862(a)(7) of the Social Security Act excludes “hearing aids or examinations therefor”. The exclusion applied to V5220 and applies equally to the codes that replaced it.

• Medicare Advantage (Part C): Some plans add a supplemental hearing benefit with their own allowances and supplier networks. Verify the patient’s specific plan before the fitting.
• State Medicaid: Hearing aid coverage is set state by state, including which codes, age groups and replacement intervals apply. Check the current state provider manual and fee schedule for the date of service.
• Commercial plans: Coverage depends on whether the policy includes a hearing aid benefit, and many do not.

Run insurance eligibility verification before the fitting appointment. Confirm that the current binaural code is on the plan’s covered list and ask about deductibles and replacement limits.

Common V5220 claim denials and how to fix them

Most denials on these claims trace back to the deleted code, a style mismatch or missing paperwork. The table pairs each one with its fix.

Reviewing denial reason codes after each remittance cycle shows which of these keeps recurring. A repeat pattern usually points to an order template or fitting note, so fix it there.

ICD-10 diagnosis codes for BiCROS hearing aid claims

Every hearing aid claim needs an ICD-10-CM code that supports the device. For a BiCROS fitting, that code has to reflect loss in both ears, because the better ear is also being aided. When both losses are sensorineural, the usual choice is H90.3.

Pick the code that matches the audiogram. If the better ear hears normally, the clinical picture is CROS rather than BiCROS, and the device code should change with it.

How Pabau keeps hearing aid claims on current codes

In many audiology practices, the fitting note and the claim live in separate systems. A biller rekeys the code from an order that may still say V5220, and nobody sees the error until the remittance arrives.

Pabau, the practice management and billing platform we build, keeps both on one patient record. Its claims tools for billers build the claim beside the audiogram, fitting note and delivery signature. Missing items are flagged before submission, so the code on the claim matches the devices in the chart.

Denials that still land are grouped by reason code. A deleted V-code or a style mismatch gets fixed once at the source instead of repeating across a month of fittings.

Bill hearing aid fittings with current codes

Pabau ties each hearing aid claim to the fitting record, flags missing documentation before submission, and groups denials by reason code. Your team fixes the cause once, not claim by claim.

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Conclusion

V5220 is a historical code. It belongs only on a corrected claim with a date of service before 2019. Any order that still names it needs recoding before it reaches a payer.

The harder question is which devices the patient wears. A routing transmitter means a binaural contralateral routing code, usually V5221 with V5240. Two conventional BTE aids mean V5140 with V5160. Settle that from the fitting note, and the rest of the claim follows.

Book a demo to see how Pabau keeps hearing aid claims matched to the fitting record.

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 rejections on first submission? What is a clean claim? explains the checks that get a claim paid the first time.

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

Checking your billing against payer audits? Medical billing compliance outlines the standards practices must meet to avoid recoupment.

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