HCPCS code V5250 – Hearing aid, digital, monaural, ITC

Key takeaways

V5250 bills one unit for a pair of digitally programmable analog CIC hearing aids, one fitted in each ear.

A single aid of the same type bills as V5244, and a fully digital CIC pair bills as V5258.

Original Medicare excludes hearing aids under Social Security Act §1862(a)(7), so V5250 carries Medicare coverage code S.

Medicaid, Medicare Advantage and commercial plans set their own rules, and most require prior authorization and a current audiogram.

The diagnosis and audiogram must support amplification in both ears, so code the hearing loss as bilateral.

HCPCS code V5250: Official descriptor and code family

HCPCS code V5250 is one of the Level II HCPCS procedure codes, in the V5000-V5999 hearing services range. The Centers for Medicare and Medicaid Services (CMS) maintains the code set. The official long descriptor reads: Hearing aid, digitally programmable analog, binaural, CIC. The code has been in effect since January 1, 2002.

Each part of the descriptor narrows the device. “Digitally programmable analog” means the aid amplifies sound through analog circuitry, while a computer sets its response for the patient’s hearing loss. A fully digital aid converts sound into a digital signal, and it bills under the V5254-V5261 codes instead.

“Binaural” means one aid for each ear, dispensed and billed together as one unit. “CIC” stands for completely in the canal, a custom shell that sits deep in the ear canal and is the least visible hearing aid style.

What V5250 covers and what it excludes

V5250 covers the supply of two digitally programmable analog CIC hearing aids, one for each ear, dispensed as a pair. The code describes the devices only. Assessment, fitting, dispensing, batteries and repairs each have their own V-codes.

Included: one matched pair of digitally programmable analog CIC hearing aids. Excluded from V5250 (bill separately where payable):

• A single aid of this type for one ear (V5244)
• A fully digital CIC pair (V5258) or a single fully digital CIC aid (V5254)
• An analog CIC pair without digital programming (V5248)
• Digitally programmable analog pairs in other styles: ITC (V5251), ITE (V5252) and BTE (V5253)
• Assessment for a hearing aid (V5010) and fitting, orientation and checking (V5011)
• The binaural dispensing fee (V5160)
• Batteries (V5266) and repair or modification of a hearing aid (V5014)
• Semi-implantable middle ear hearing prostheses (V5095) and cochlear implant devices (billed under L-codes such as L8614)

V5250 vs V5251, V5244 and neighboring hearing aid codes

V5250 sits among the V5242-V5261 hearing aid codes, where every code turns on technology, ear count and style. The most common substitutions are V5244 for a one-ear fitting and V5258 for a fully digital pair.

Code from the device record, not from the order alone. The manufacturer’s specification sheet states whether the aid is fully digital or digitally programmable analog. Most hearing aids sold today are fully digital, so confirm the technology before a V5250 claim goes out. The decision path below runs in that order: technology first, then ear count, then style.

Medicare coverage for HCPCS code V5250

Original Medicare does not cover V5250. Section 1862(a)(7) of the Social Security Act excludes “hearing aids or examinations therefor” from Medicare coverage. The HCPCS file gives V5250 coverage code S, which means non-covered by Medicare statute.

No National Coverage Determination (NCD) or Local Coverage Determination (LCD) creates an exception for conventional hearing aids. A V5250 claim to Medicare Part B receives a statutory exclusion denial.

When a patient needs a Medicare denial on file, for example to bill a secondary plan, append modifier GY. GY tells Medicare the item is statutorily excluded. An Advance Beneficiary Notice is not required for a statutory exclusion, although some practices issue one voluntarily.

Two carve-outs are often confused with hearing aid coverage:

• Cochlear implants are covered under NCD 50.3 and billed with entirely different codes. A V5250 claim for a cochlear implant processor is a coding error.
• Medicare Advantage (Part C) plans may offer hearing aid coverage as a supplemental benefit. Verify the plan’s covered styles, frequency limits and dollar caps before submitting V5250.

Medicaid and commercial payer coverage

Medicaid coverage of V5250 varies by state. Hearing aids are an optional adult benefit under federal Medicaid rules, so each state decides whether to cover them and how often.

• Pediatric coverage is more consistent. State Medicaid programs cover medically necessary hearing aids for enrollees under 21 through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
• Adult coverage is discretionary. Some states cover a replacement every three to five years, while others exclude adults entirely. Check the state’s Medicaid fee schedule and covered-code list.
• Managed Medicaid plans may add their own prior authorization and documentation rules. Contact the plan directly if the state fee schedule lacks V5250 guidance.
• Commercial plans typically cover hearing aids with prior authorization, a recent audiometric evaluation and a physician or audiologist order. Benefit frequency is often one device per ear every 36 to 60 months.

A state that covers hearing aids does not always list every hearing aid code. Check that V5250 itself appears on the current fee schedule before dispensing the pair.

Hearing aid V-codes sit in the hearing services range, outside the DMEPOS fee schedule. State licensure and each payer’s enrollment rules decide who may dispense and bill them. Understanding medical billing compliance requirements helps when state rules differ.

Prior authorization requirements for V5250

Most Medicaid programs and commercial plans require prior authorization (PA) before a hearing aid pair is dispensed and billed. Original Medicare has no PA process for V5250 because it excludes hearing aids entirely.

A standard prior authorization request for V5250 typically includes:

1. Audiometric evaluation results: a dated audiogram for both ears from a licensed audiologist, showing hearing loss that meets the plan’s threshold
2. Physician or audiologist order: a signed order naming the device technology, the CIC style and a bilateral fitting
3. Medical necessity letter: a short clinical narrative explaining why both ears need amplification and why a CIC style was chosen
4. Payer-specific forms: some Medicaid programs require their own hearing aid request or medical clearance form
5. Provider NPI and payer enrollment details: confirms the dispensing provider is enrolled to bill that payer

Submit the PA request before dispensing the pair. Retroactive authorization for hearing aids already delivered is rarely granted.

Documentation requirements when billing V5250

Insufficient documentation is a leading reason V5250 claims are denied. Every claim should rest on a complete record, because payers and auditors can request it at any time.

Pabau, the practice management platform we build for specialty practices, keeps the audiogram, signed order and PA reference on the patient record. Its claims management tools pull that record data into a pre-filled claim and track its status after submission.

A clean claim has every required field, unit and attachment checked before it leaves the practice.

ICD-10 diagnosis codes paired with V5250

The diagnosis on a V5250 claim must support amplification in both ears. Code the hearing loss as bilateral, and make sure the audiogram thresholds for each ear back it up.

Where the loss differs between ears, the H90.A codes describe a unilateral loss with restricted hearing on the other side. Some plans expect a bilateral code for a pair, so check the accepted diagnosis list first.

Avoid unilateral codes such as H90.41 or H90.42 on a V5250 claim. A one-ear diagnosis signals a one-ear fitting, which bills as V5244 rather than V5250.

2026 code status and reimbursement

V5250 remains active in the 2026 HCPCS code set. Because original Medicare excludes hearing aids, CMS publishes no national Medicare fee for it. The code appears on neither the Physician Fee Schedule nor the DMEPOS fee schedule.

Reimbursement for V5250 comes from three other payer types:

• Medicare Advantage plans: allowances vary by plan and benefit design. Some pay a fixed amount per aid, while others pay against an agreed fee schedule.
• State Medicaid programs: each state publishes its own fee schedule for covered hearing aid codes. Rates change, so pull the current file from the state Medicaid agency’s provider portal.
• Commercial plans: contracted rates apply. Review your provider agreement or the plan’s hearing aid benefit rider.

The NLM Clinical Table Search API offers a free HCPCS dataset built from CMS releases. The AAPC Codify HCPCS lookup is another cross-reference for descriptors and effective dates.

Common V5250 claim denial reasons and how to resolve them

V5250 denials cluster around a predictable set of coding and documentation errors. The table below maps each pattern to a fix. Practices that track denial management data can spot repeat causes within one billing cycle.

Assessment, fitting and dispensing codes billed with V5250

The device code and the service codes around it are separate. V5010 is the assessment for a hearing aid, V5011 covers fitting, orientation and checking, and V5160 is the binaural dispensing fee.

• State Medicaid plans often bundle fitting and dispensing into the device allowance. Billing V5160 or V5011 separately then draws a bundling denial, so check the state manual first.
• Commercial plans vary. Some pay the service codes separately, while others fold them into the device allowance. Read the plan’s hearing aid benefit rider.
• Medicare Advantage plans may allow separate fitting and dispensing codes, depending on the plan contract. Get written guidance from provider relations before billing them together.

Practices with repeated bundling denials should review their payer contracts and update their billing rules. Sound medical billing fundamentals start with knowing which services each payer pays separately.

How to bill HCPCS code V5250: Step by step

A V5250 claim pays first time when the clinical and billing teams follow the same sequence. These steps prevent the most common denials.

1. Confirm coverage: check that the patient’s plan covers digitally programmable analog CIC aids before the appointment
2. Obtain a current audiogram: test both ears within the payer’s recency window, with the audiologist’s signature
3. Submit prior authorization: include the audiogram, order and necessity letter, and note the PA reference
4. Document the fitting: record both serial numbers and the fitting date, and collect the patient’s delivery signature
5. Code accurately: bill V5250 once, as 1 unit, with a bilateral ICD-10-CM code
6. Attach documentation: send the audiogram, signed order, delivery receipt and PA reference with the claim
7. Track the claim: follow up every 15 days and answer records requests within the payer’s deadline

How Pabau keeps V5250 claims moving

Hearing aid claims often stall between the fitting room and the billing desk. The audiogram sits in one system, the PA reference in an email and the serial numbers on paper.

In Pabau, those records live on the patient file. The claim is pre-filled from data already on the record, then submitted and tracked to payment in one place.

Your team sees which pair claims are pending or rejected, and can act before a filing deadline passes.

Get hearing aid pair claims right the first time

Pabau keeps audiograms, orders and authorizations on the patient record, then tracks each claim through to payment.

Book a demo

Conclusion

V5250 is a narrow code: one pair of digitally programmable analog CIC aids, billed once. Most errors on it come from treating it as a one-ear or fully digital code.

Because Medicare excludes it, your payer mix decides whether a V5250 pair gets paid at all. Confirm the technology, bill the pair as 1 unit and attach a bilateral diagnosis.

To see how Pabau keeps hearing aid records and claims together, book a demo.

Continue your research

Dispensing a fully digital CIC pair instead? HCPCS code V5258 covers the digital binaural CIC code and its payer rules.

Fitting a single fully digital CIC aid? HCPCS code V5254 explains the monaural digital CIC code.

Billing an analog CIC pair? HCPCS code V5248 covers the analog binaural CIC code.

Billing the dispensing fee for a pair? HCPCS code V5160 covers the binaural dispensing fee.

Want hearing aid claims to pass on first submission? What makes a clean claim lists the checks payers run before processing.

Frequently asked questions