HCPCS Code V5267: Hearing Aid Supplies & Accessories, NOS

Key Takeaways

HCPCS code V5267 is the catch-all code for hearing aid or assistive listening device supplies and accessories not described by a more specific V-code.

Use V5267 only when no other code in the V5120-V5267 range accurately describes the item being billed.

Medicare does not routinely reimburse hearing aids for adults; coverage under V5267 may be limited and varies by payer and plan.

Medi-Cal requires a Treatment Authorisation Request (TAR) or CCS SAR before billing V5267 for supplies and accessories.

Applying LT, RT, and KX modifiers correctly is essential to prevent V5267 claim denials.

HCPCS code V5267 is one of the most misunderstood codes in audiology billing. Classified as “hearing aid or assistive listening device/supplies/accessories, not otherwise specified,” it sits at the end of the HCPCS Level II hearing aid range (V5120-V5267) as the designated catch-all option. Understanding when and how to use HCPCS code V5267 correctly can mean the difference between a paid claim and a preventable denial. This guide covers the official description, correct usage rules, coverage by payer, documentation requirements, applicable modifiers, and the most common billing errors audiology practices encounter with this code.

According to the American Speech-Language-Hearing Association (ASHA), HCPCS Level II codes are administered by the Centers for Medicare and Medicaid Services (CMS) and begin with a single letter (A through V) followed by four numeric digits. Unlike CPT codes, which identify procedures and services, HCPCS Level II codes identify supplies, equipment, devices, and items not captured within the CPT system. V5267 belongs to the Hearing Aids subset, which spans the range V5120 through V5267.

HCPCS Code V5267: Official Description and Correct Usage

The official CMS description for HCPCS code V5267 is: Hearing aid or assistive listening device/supplies/accessories, not otherwise specified. The short descriptor used in claims processing is “Hearing aid sup/access/dev.” This code is classified under the Hearing Aids subset (V5120-V5267) within HCPCS Level II, which covers the full range of hearing aid device types, bilateral and unilateral configurations, and associated accessories.

V5267 is an NOS (not otherwise specified) code. Under CMS coding conventions, NOS codes apply only when no more specific code in the applicable range accurately describes the item being billed. An audiology practice providing a patient with a behind-the-ear digital hearing aid, for example, would bill V5257 (hearing aid, digital, monaural, BTE) rather than V5267. The NOS code is reserved for items that genuinely fall outside the descriptions assigned to other V-codes in the V5120-V5267 range.

HCPCS Code V5267: When to Use vs. a More Specific Code

Selecting V5267 requires a two-step check. First, review every code in the V5120-V5267 range to confirm that none accurately describes the specific item. Second, document the reason a more specific code was not appropriate. Common situations where HCPCS code V5267 is legitimately applicable include custom or non-standard parts such as unique connectors, specialised ear mold inserts with no standard product description, or proprietary assistive listening device accessories that do not fit any existing hearing aid V-code definition.

Practices that routinely default to V5267 for convenience rather than clinical necessity face heightened audit risk. Payers examining claims patterns will flag providers who bill HCPCS code V5267 at high rates relative to more specific codes. Maintaining clear documentation of the code selection rationale protects the practice during retrospective review. The claims management workflow within a practice management system can help enforce code selection logic before claims are submitted.

HCPCS Code V5267 vs. Adjacent Hearing Aid Codes

Understanding where V5267 sits within the broader range clarifies when it is and is not appropriate. The table below covers the most commonly used codes near the end of the V5120-V5267 range to help audiology billers make faster, more accurate code selection decisions. When a patient receives a bilateral digital hearing aid fitting, for instance, V5261 (binaural BTE) or V5260 (binaural ITE) should be considered before HCPCS code V5267.

HCPCS Code V5267: Medicare and Medicaid Coverage Rules

Coverage for HCPCS code V5267 varies considerably across payers, and assumptions about reimbursement can lead to claim denials and unexpected patient balance billing. Understanding the coverage position of each major payer type is the foundation of an effective billing strategy for this code.

HCPCS Code V5267 and Medicare Coverage

Medicare does not routinely cover hearing aids for adults under Part B. This is a longstanding coverage exclusion: Original Medicare classifies hearing aids as non-covered items for most adult beneficiaries. Because HCPCS code V5267 describes hearing aid or assistive listening device supplies and accessories, reimbursement under Medicare is limited. The CMS HCPCS overview confirms this code falls within the hearing aid product category, which is subject to Medicare’s general exclusion for hearing aids.

Certain Medicare Advantage plans, however, include hearing aid benefits as an optional supplemental offering. When a patient carries a Medicare Advantage plan with a hearing benefit, check the plan’s formulary and covered item list before assuming V5267 will not be reimbursed. Local Coverage Determinations (LCDs) issued by Medicare Administrative Contractors (MACs) also govern coverage decisions in specific regions. Billing staff should verify the applicable LCD for the practice’s MAC jurisdiction before submitting claims. The documentation requirements for HIPAA-compliant billing intersect here: any coverage exception must be supported by contemporaneous medical records.

HCPCS Code V5267 Under State Medicaid Programs

Medicaid coverage for V5267 is determined at the state level, and requirements can differ substantially between programmes. California’s Medi-Cal programme provides one of the more detailed examples. Under the Medi-Cal hearing aid billing guide (CAMMIS), supplies and accessories with needs that do not match a standard product description must be billed using HCPCS code V5267. Critically, these items require a Treatment Authorisation Request (TAR) or CCS SAR before service delivery. The prior authorisation must include the manufacturer name and model number of the supply or accessory, along with supporting documentation from the treating provider.

Other state Medicaid programmes have their own coverage policies, which may include age limitations, quantity restrictions, or annual benefit caps. A practice billing V5267 in multiple states needs separate workflows for each state’s programme rather than a single blanket process. Automated billing workflows reduce the risk of submitting claims that do not meet a specific state’s prior authorisation conditions.

HCPCS Code V5267: Prior Authorisation and Documentation Requirements

Prior authorisation requirements for HCPCS code V5267 are payer-specific and should be confirmed for every plan before service delivery. Obtaining authorisation after the fact is rarely possible and often results in full claim denial.

Documentation Required to Bill HCPCS Code V5267

Regardless of payer, strong documentation is the primary defence against denial on claims submitted for HCPCS code V5267. Because this is an NOS code, the documentation burden is higher than for specific codes with established clinical criteria. A complete V5267 claim file should include all of the following elements.

• Order or prescription: A written order from the treating physician or qualified audiologist identifying the specific item being provided and the clinical rationale.
• Medical necessity statement: A clear explanation of why the item is medically necessary for this patient, referencing the patient’s diagnosis and hearing loss findings.
• Code selection rationale: Specific documentation of why no more specific HCPCS code in the V5120-V5267 range applies to the item being billed.
• Product identification: The manufacturer name and model number of the supply or accessory. This is mandatory for Medi-Cal TAR submissions and is best practice for all payers.
• Audiological assessment records: Recent audiogram results supporting the patient’s hearing loss severity and the clinical appropriateness of the device or accessory.

Practices that rely on comprehensive client records management within their practice system tend to produce more complete claim files, since all relevant documentation is linked directly to the patient’s record rather than stored in separate filing systems.

HCPCS Code V5267: National and Local Coverage Determinations

National Coverage Determinations (NCDs) published by CMS apply uniformly across all Medicare Administrative Contractor jurisdictions. Local Coverage Determinations (LCDs) are issued by individual MACs and may impose more restrictive criteria for a specific geographic area. When billing HCPCS code V5267 to Medicare Advantage or managed Medicaid plans, confirm whether an applicable NCD or LCD has been published that specifically addresses hearing aid accessories. Billing against the wrong coverage criteria is a leading cause of denials that could have been avoided with a pre-submission verification step.

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Modifiers Applicable to HCPCS Code V5267

Applying the correct HCPCS modifier to a V5267 claim is not optional. Missing or incorrect modifiers are among the most frequent technical reasons for claim denial, and they are straightforward to fix with the right coding protocols in place. The modifiers relevant to HCPCS code V5267 fall into two categories: laterality modifiers and coverage condition modifiers.

Laterality Modifiers for HCPCS Code V5267

When HCPCS code V5267 describes a supply or accessory associated with a hearing device for a specific ear, laterality modifiers must be applied. Submitting without a laterality modifier when billing a unilateral item will result in a payer edit or denial in most cases.

• Modifier LT: Left side. Apply when the accessory or supply relates to the left ear only.
• Modifier RT: Right side. Apply when the accessory or supply relates to the right ear only.
• No laterality modifier: Used only when the item is bilateral or is not ear-specific (for example, a cleaning kit or a generic carrying case that serves both devices).

Coverage Condition Modifier KX for HCPCS Code V5267

Modifier KX indicates that the requirements specified in the applicable LCD have been met and that the documentation supporting medical necessity is on file. For Medicare Advantage plans that cover hearing accessories under an applicable LCD, appending KX to HCPCS code V5267 signals to the payer’s claim processing system that the required documentation exists. Omitting KX when an LCD requires it will result in an automatic denial. Append KX only when the conditions genuinely are met; applying it inaccurately creates compliance risk. Compliance management workflows can flag modifier requirements at the point of coding based on the payer attached to the claim.

Other Modifiers to Consider with HCPCS Code V5267

Some payers require Modifier GA (waiver of liability statement on file) when a supply or accessory is expected to be denied as non-covered but the patient has been informed and has signed an Advance Beneficiary Notice (ABN). Modifier GY signals that the item is statutorily excluded from Medicare coverage, which allows the claim to generate a denial letter that the patient can use for secondary insurance purposes. Using GY with HCPCS code V5267 for standard Medicare Part B patients is often appropriate given the general hearing aid exclusion. Review the payer-specific modifier requirements listed in the relevant LCD or plan contract before submission. The CMS Physician Fee Schedule lookup tool provides payment information and applicable modifier indicators for HCPCS codes.

Common Billing Errors When Using HCPCS Code V5267

Audiology billing professionals encounter a consistent set of errors with HCPCS code V5267. Most are preventable with the right pre-submission checks. Identifying these patterns in your practice’s denial data is the first step toward reducing their frequency.

HCPCS Code V5267 Denial: Using NOS When a Specific Code Exists

The single most common error is billing HCPCS code V5267 when a more specific V-code accurately describes the item. Payers routinely conduct claims edits that flag NOS code usage where a defined code is available. A common scenario involves standard ear mold replacements: if the ear mold type matches an existing V-code description, billing V5267 instead will trigger a denial or a request for records. Train coding staff to treat V5267 as a last resort after exhausting the full V5120-V5267 range.

HCPCS Code V5267 Denial: Missing Prior Authorisation

Submitting a V5267 claim without a required TAR or pre-authorisation number is a clean claim failure. The denial reason code will typically cite “service not authorised” or “prior authorisation required.” Because the authorisation cannot be obtained retroactively for services already delivered, these denials often become write-offs. Building a payer-specific prior authorisation requirement checklist into the scheduling workflow prevents this outcome. Appointment management tools that flag payer requirements at the time of booking give front-desk staff the lead time needed to secure authorisation before the patient arrives.

HCPCS Code V5267 Denial: Incomplete Documentation on File

Payers may request records to support V5267 claims during post-payment audits even when the claim initially paid. If the documentation does not include a clear code selection rationale, a medical necessity statement, and current audiological findings, a recoupment demand may follow. Practices with centralised digital documentation workflows can attach supporting clinical records directly to the encounter before claim submission, making records retrieval for audit response faster and more complete.

HCPCS Code V5267 Denial: Modifier Errors and ABN Oversights

Submitting HCPCS code V5267 without a required laterality modifier, or omitting KX when an LCD requires it, creates an automatic edit fail in most claim processing systems. Separately, failing to obtain a signed ABN from a Medicare patient before providing a non-covered item removes the practice’s ability to bill the patient for the service. Both errors are process failures rather than clinical ones. The AAPC Codify HCPCS lookup is a useful reference for confirming modifier indicators and coverage notes for V5267 before submission.

Reviewed against current CMS HCPCS code set maintenance documentation and ASHA audiology billing guidance.

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Commonly Paired ICD-10 Diagnosis Codes for V5267

When billing HCPCS code V5267, pairing the claim with the correct ICD-10 diagnosis code strengthens medical necessity and reduces the likelihood of denial. The following ICD-10 codes are most frequently reported alongside V5267 for hearing aid supplies and accessories.

• H90.3 – Sensorineural hearing loss, bilateral. The most common diagnosis supporting bilateral hearing aid accessories.
• H90.5 – Unspecified sensorineural hearing loss. Used when the type of sensorineural loss has not been further specified in the clinical record.
• H90.0 – Conductive hearing loss, bilateral. Supports accessories for conductive-type hearing aids fitted to both ears.
• H90.6 – Mixed conductive and sensorineural hearing loss, bilateral. Applicable when the patient has both conductive and sensorineural components.
• H91.90 – Unspecified hearing loss, unspecified ear. A less specific option used only when the clinical documentation does not support a more precise code.
• Z96.29 – Presence of other otological and audiological implants. Relevant when V5267 accessories relate to an existing cochlear or auditory implant.

Selecting the most specific ICD-10 code supported by the patient’s audiological assessment strengthens the claim and demonstrates medical necessity. Avoid defaulting to unspecified codes when the audiogram findings support a laterality-specific or type-specific diagnosis.

Conclusion

HCPCS code V5267 is a legitimate and necessary billing code for audiology practices, but its catch-all nature requires disciplined usage. Applying it only when no more specific code in the V5120-V5267 range applies, documenting the selection rationale, understanding payer-specific coverage positions, securing prior authorisation before service delivery, and appending the correct modifiers are the five operational habits that keep V5267 claims clean.

Medicare’s longstanding exclusion of hearing aids for adults means that V5267 reimbursement under Original Medicare is limited for most patients. State Medicaid programmes, Medicare Advantage plans, and private insurers each have distinct coverage rules that require practice-specific verification workflows. Audiology billing teams that treat payer verification as a pre-service step rather than a post-denial recovery task consistently achieve higher clean claim rates with HCPCS code V5267. A practice management platform that integrates authorisation tracking, clinical documentation, and claims submission into a single workflow can significantly reduce the administrative burden this code often creates.

Frequently Asked Questions