HCPCS code V5247 – Monaural digitally programmable BTE hearing aid

Key takeaways

HCPCS code V5247 covers one digitally programmable analog hearing aid worn behind the ear and fitted to a single ear.

V5247 is billed per ear with the RT or LT modifier. A binaural fitting of the same device type bills as V5253 instead.

A fully digital BTE aid is not V5247. It bills as V5257 for one ear or V5261 for both ears.

Medicare Part B excludes hearing aids under Section 1862(a)(7) of the Social Security Act, so payment comes from Medicaid, Medicare Advantage or commercial plans.

Pabau, the practice management platform we build, stores the audiogram, device specifications and PA number on one patient record. Each V5247 claim then goes out complete.

HCPCS code V5247: Official descriptor and code family

HCPCS code V5247 is the Level II code for a single digitally programmable analog hearing aid worn behind the ear (BTE). It sits in the V5120-V5267 hearing aid range maintained by the Centers for Medicare and Medicaid Services (CMS). The official descriptor is Hearing aid, digitally programmable analog, monaural, BTE (behind the ear).

Each part of that descriptor narrows the code. Digitally programmable analog means the aid processes sound through analog circuitry, while an audiologist adjusts its settings by computer. Monaural means one aid for one ear. BTE means the case sits behind the ear, with sound delivered through tubing or a receiver wire.

The table below lists the attributes billers need to confirm before submitting a claim.

What V5247 covers and what it excludes

V5247 applies when an audiologist or hearing instrument specialist dispenses one BTE aid with digitally programmable analog circuitry to one ear. Three facts must all be true: one ear, BTE style and digitally programmable analog technology. If any of them changes, the code changes too.

Clinical situations that typically support a monaural V5247 fitting include:

• Unilateral hearing loss that meets the payer’s audiometric criteria, with normal or near-normal hearing in the other ear
• Asymmetric loss where only one ear is aidable, or where the audiologist documents why a second aid would not help
• Replacement of one lost or damaged aid from a pair, when the other aid is still working
• A staged fitting, where the patient trials one aid before a second ear is considered

These scenarios fall outside V5247 and need a different code:

• Both ears fitted with the same device type: A binaural digitally programmable BTE fitting bills as V5253, not two lines of V5247.
• Fully digital aids: A monaural digital BTE aid bills as V5257, and a binaural digital BTE pair bills as V5261.
• Other styles: A monaural digitally programmable analog aid bills as V5244 for CIC, V5245 for ITC and V5246 for ITE.
• CROS and BiCROS systems: Contralateral routing devices have their own codes, such as V5181 for a monaural BTE CROS aid.
• Dispensing fees: The fitting service bills separately, usually as V5241 for a monaural hearing aid of any type.
• Accessories and supplies: Ear molds (V5264), batteries (V5266) and other hearing aid supplies (V5267) are never bundled into V5247.
• Implanted devices: Cochlear implants and bone-anchored hearing devices use their own L-codes.

V5247 vs V5253, V5257 and neighboring hearing aid codes

The costliest V5247 errors come from picking a code one attribute away. Billers swap in the binaural code, the fully digital code or the wrong style. The table below maps the neighbors that coders most often confuse with V5247.

Check the technology before the ear count. Most hearing aids dispensed today are fully digital, which makes V5257 far more common than V5247. Confirm the circuitry on the manufacturer’s specification sheet before coding, and keep that sheet with the fitting record. The AAPC hearing aid code range lists every descriptor in the family. For behind-the-ear aids, the grid below reduces the choice to those two questions.

Payer coverage for V5247

Whether V5247 gets paid depends on the payer type, so verify current plan benefits before dispensing.

Per-ear caps matter more for V5247 than for a binaural code. When a plan pays a fixed amount per ear, a monaural claim draws on one ear’s allowance only. That leaves the other ear’s allowance available if the patient needs a second aid later.

Prior authorization requirements for V5247

Many state Medicaid programs and commercial plans require prior authorization (PA) before paying a V5247 claim. A missing PA number is one of the most preventable denials in hearing aid billing. Confirm insurance eligibility and PA status before you book the fitting appointment.

Typical PA criteria include:

• A current audiogram showing qualifying loss in the ear being fitted
• A physician referral or audiologist order for a hearing aid evaluation
• A medical necessity statement that explains why one ear is being fitted
• The manufacturer, model and technology type of the device, with the ear noted
• Trial-period or loaner documentation where the payer requires it

Documentation requirements for V5247 claims

Every V5247 claim needs a contemporaneous record that proves medical necessity and confirms the aid was dispensed. Work through this checklist at the fitting appointment, while the patient is still in the office.

• Audiogram: Pure-tone and speech results within the payer’s lookback window, signed by the performing audiologist.
• Order: A written referral or prescription for the hearing aid evaluation and fitting.
• Medical necessity statement: The audiometric findings for the fitted ear, and why a monaural fitting is appropriate.
• Device details: Manufacturer, model, serial number and a specification sheet confirming digitally programmable analog BTE circuitry.
• Laterality: The ear fitted, recorded in the chart so it matches the RT or LT modifier on the claim.
• Proof of delivery: A patient signature confirming receipt, dated on the claim’s service date.
• PA number: Where PA is required, a valid approval number that covers the service date.

A superbill built for audiology encounters helps staff capture these fields before the patient leaves. Add a required “ear fitted” field so laterality is never left to memory.

How to bill HCPCS code V5247: Units, modifiers and claim setup

V5247 is billed as one unit per aid, on its own claim line, with the RT or LT modifier. Audiology claims management software that checks modifiers and units before submission catches most setup errors before the payer does.

Follow the payer’s own billing manual when it differs from these defaults. A few Medicaid programs publish code-specific instructions for laterality and dispensing fees. Provider eligibility also varies, since some states let hearing instrument specialists bill and others enroll only audiologists or DME suppliers.

Common reasons V5247 claims are denied

Most V5247 denials are predictable. The table below maps the leading causes to their fixes. For the remittance side, cross-reference each adjustment reason against the medical billing denial codes.

Replacement frequency and benefit period rules for V5247

Replacement rules decide how often a patient can receive a new aid under their coverage. Because V5247 covers one ear, the benefit clock usually runs per ear, not per pair. Replacing one lost aid from a pair bills as V5247 with that ear’s modifier, not as a binaural code.

For an early replacement, the record must state the clinical reason and the ear affected. A new audiogram showing a threshold shift carries far more weight than a chart note saying the aid was lost. For theft, attach the police report.

V5247 in 2026: Code status and reimbursement

V5247 is active and unchanged for 2026. The 2026 hearing aid changes added new CPT codes for hearing aid services, while the HCPCS V-codes for the devices stayed the same.

Reimbursement for V5247 is set payer by payer and changes at least once a year. Pull current amounts from each payer’s published fee schedule rather than relying on last year’s figures.

How claims management software prevents V5247 denials

A V5247 claim depends on details that often sit in different places. The ear fitted is in the chart notes, the device specification is in a supplier email and the PA number is in a payer portal. When one of them is missing, the claim goes out with the wrong modifier or code.

Pabau keeps those details on one patient record. Digital forms capture the order, the device details and the ear fitted before the appointment ends. The audiogram and PA approval are stored against the same record, so staff can find them when the claim is built.

Pabau’s claims management then submits the claim electronically and tracks its status. Your billing team can see where each V5247 claim sits and follow up on a denial before the appeal window closes.

Bill every hearing aid claim to the right ear

Pabau keeps the audiogram, device details and PA number on the patient record. It then submits and tracks each hearing aid claim, so denials get caught early.

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Conclusion

V5247 is only the right code when three facts line up: one ear, a BTE aid and digitally programmable analog circuitry. Confirm all three from the specification sheet at the fitting, and most wrong-code denials disappear.

The ear is the detail that trips teams up most. Record it in the chart, put it in the PA request and carry it onto the claim as RT or LT. When both ears get the same device, switch to V5253 rather than billing V5247 twice.

If your team still matches fitting notes to payer rules by hand, one patient record removes that step. Book a demo to see how Pabau keeps hearing aid documentation and claims together for your audiology practice.

Continue your research

Need to understand how clearinghouses process hearing aid claims? Medical claims clearinghouse guide explains how HCPCS claims move from practice to payer.

Looking to reduce hearing aid billing denials at the source? Denial management in healthcare covers denial tracking and root-cause analysis for specialty practices.

Want every hearing aid claim to pass on the first submission? What makes a clean claim outlines the pre-submission checks that prevent common HCPCS rejections.

Billing the hearing aid assessment before the fitting? HCPCS code V5010 explains assessment billing and the 2026 CPT hearing aid service codes.

Frequently asked questions