HCPCS code V5274 – Assistive listening device, not otherwise specified

Key takeaways

HCPCS code V5274 bills an assistive listening device that no specific code from V5268 to V5273 or V5281 to V5290 describes.

It is a device code, not a hearing aid code, so wearable hearing aid styles and ear impressions never go on it.

Most payers price a not otherwise specified code from the device description and invoice sent with the claim.

Medicare lists V5274 as non-covered by statute, so payment depends on Medicaid, Medicare Advantage or commercial plan terms.

What HCPCS code V5274 covers

HCPCS code V5274 is the Level II code for an assistive listening device (ALD), not otherwise specified. CMS made it effective on January 1, 2002, and it remains active.

An ALD helps a person hear in one setting, such as a phone call, a classroom or the television. It can work alongside hearing aids or on its own. V5274 is the fallback for an ALD that none of the specific codes describe.

Because the code has no fixed fee, payers price it from your device description and invoice. Traditional Medicare excludes it, so the claim usually goes to Medicaid, a Medicare Advantage plan or a commercial payer.

The descriptor is silent on ear count, device style and fitting, and V5274 is not a hearing aid code. You can confirm the wording in the ASHA HCPCS code list for audiology.

Is V5274 the right code for this device?

V5274 fits only when no specific code describes the device. So treat it as the last stop, and rule out every specific option first.

• Telephone, alerting or TV device? Use V5268, V5269, V5270 or V5271 instead.
• TDD or cochlear implant accessory? Use V5272 or V5273.
• Personal FM/DM system or part? Use the matching code from V5281 to V5290.
• A supply or accessory, not a device? V5267 is the NOS code for hearing aid or ALD supplies and accessories.
• A hearing aid? Use the style code, or V5298 when no hearing aid code fits.

If the device still fits none of those, V5274 applies. Write down why the specific codes failed, because reviewers often ask for that reasoning. The flow below puts the whole rule-out order on one page.

How V5274 compares with its neighbor codes

The ALD codes sit together in the V5268 to V5290 range of the HCPCS Level II codes. The table puts V5274 beside its neighbors and the other catch-all codes that get confused with it.

The two catch-alls at the bottom of the table are the easiest to mix up with V5274. Supplies and accessories belong on V5267, while a hearing aid with no style code belongs on V5298.

Two other neighbors trip up older crosswalks. V5275 is an ear impression, each, and V5264 is an ear mold or insert. Neither one describes a hearing aid or an ALD.

Who pays for an ALD billed with V5274

CMS lists V5274 with coverage code S, which means non-covered by Medicare statute. The hearing aid exclusion sits in §1862(a)(7) of the Social Security Act, and the Medicare Benefit Policy Manual, Chapter 16, §100 sets it out. Traditional Medicare will not pay for the device.

Other payers decide for themselves, so coverage for ALD NOS varies by plan. Run an insurance eligibility verification before you order the device.

• Medicare Advantage: some plans offer hearing benefits as a supplemental benefit. Check whether that benefit names ALDs, not only hearing aids.
• Medicaid: each state sets its own hearing device list. Some cover ALDs for children only.
• Commercial plans: terms vary by policy. Ask whether the plan needs prior authorization for NOS codes.

A patient may want a Medicare denial to pass to a secondary payer. In that case, add modifier GY, which flags an item excluded by statute. An advance beneficiary notice is not required for excluded items, though you can issue one voluntarily.

How to describe and price the device on the claim

An NOS code has no fixed fee, so the payer cannot price it from the code alone. The claim has to tell them what the device is and what it cost.

• Description: name the manufacturer, model and what the device does. Put it in Item 19 of the CMS-1500, or the line note on an electronic 837P claim.
• Invoice: attach the manufacturer or supplier invoice. Many payers set the allowed amount from it.
• Units: bill one unit per device, unless the payer says otherwise.
• Modifiers: add the ones the payer asks for, such as NU for a new purchase.

Keep the description short and specific. A line that only reads “listening device” gives the reviewer no basis for a price, and it invites a request for records.

Which ICD-10 codes support a V5274 claim?

Use the hearing-loss code the audiogram or clinical notes support, at the level of detail they record. The diagnosis has to show why the patient needs help hearing in a specific setting.

The device code does not dictate the diagnosis. Code the hearing loss the record shows, then let the device description explain the need.

Worked example: A personal amplifier for conversation

Say an audiologist recommends a personal hardwired amplifier for one-to-one conversation in noise. The patient’s audiogram shows bilateral sensorineural loss, and the patient has Medicaid coverage.

The device is not a telephone or TV amplifier, an alerting device or an FM/DM system. None of the specific codes describe it, so V5274 is the right choice.

The diagnosis is H90.3, which the audiogram supports. The claim line then carries V5274, one unit, the manufacturer, the model and a short purpose note. The invoice travels with it.

Before the order goes in, the front desk confirms that the state plan covers ALDs for adults, not only children. If it does not, the patient learns the cost before the device ships.

How a V5274 claim moves, step by step

A V5274 claim moves faster when the paperwork is ready before the device ships. Work through these steps in order.

1. Confirm no specific HCPCS code describes the device.
2. Check the patient’s plan covers ALD NOS, and get prior authorization where needed.
3. Record the diagnosis, the setting the device helps with, and any prescriber order.
4. Deliver the device, and keep a signed delivery record.
5. Build the claim with V5274, the description, the invoice and any payer modifiers.
6. Submit, then track the claim until it pays or comes back with a request.

Common mistakes that trip V5274 claims

Each of these errors can stall a V5274 claim. Fortunately, each one is easy to catch before submission.

• Billing a hearing aid as V5274. Hearing aids have their own style codes, and V5298 covers the rest.
• Skipping a specific ALD code. A TV amplifier billed as V5274 should have gone out as V5270.
• Sending no description or invoice. The payer cannot price the line and holds or denies it.
• Billing traditional Medicare for payment. The device is excluded, so collect from the patient or another payer.
• Mixing up V5267 and V5274. Accessories and supplies go on V5267, whole devices on V5274.

Check these items before you submit

Run through this list on every V5274 line. It takes a minute and can save you a resubmission.

• Specific ALD, FM/DM and hearing aid codes ruled out, with the reason noted.
• Payer coverage confirmed, and authorization number on the claim if one was needed.
• Device description with manufacturer, model and purpose.
• Invoice attached or ready to send.
• Diagnosis code that matches the record.
• GY added only when the payer is traditional Medicare.

How Pabau keeps V5274 claims complete

Device claims stall when the invoice sits in one system and the diagnosis sits in another. A payer query then sends someone hunting for both.

Pabau, our practice management and billing platform, keeps the device charge, invoice and diagnosis on one patient record. Its claims management software pre-fills the claim from that record. It also holds the claim back until required fields, such as authorization numbers, are complete.

For US practices, it checks eligibility in real time and tracks each claim’s status. As a result, your team spends less time chasing missing details after a payer queries a line.

Send device claims with every field filled

Keep the invoice, diagnosis and authorization for each device claim on one patient record. Required-field checks stop incomplete claims before they reach the payer.

Book a demo

Conclusion

V5274 earns payment when it is the only honest fit for the device. Get there by ruling out the specific codes, then let the description and invoice do the pricing work.

The bigger risk sits with the payer, not the code. Traditional Medicare will not pay, so settle coverage with the patient before you order. Book a demo to see how your team can send complete device claims the first time.

Continue your research

Need to cut repeat denials across your billing? Denial management in healthcare covers how to track, appeal and prevent denials across payer types.

Want to confirm coverage before you order a device? Insurance eligibility verification walks through the checks that confirm a payer will cover it.

Does the plan review NOS codes before payment? The prior authorization process explains how to request, track and document an approval.

Filing the device claim on paper? The CMS-1500 form template shows where the description and diagnosis codes go.

New to the billing side of the practice? What is medical billing explains how a claim moves from charge to payment.

Frequently asked questions