Otolaryngology Coding Alert
Use V5264 When You Break Down Dispensing
Question: Is there a code for making a hearing aid (HA) mold? How should we calculate the price for that? Can we report HA adjustment, such as 1-year post-placement? If so, how should I calculate for that price? Caution: Some payers may include subsequent adjustments in V5241's global surgical period. So check your top insurers- hearing service V code inclusions before coding any HA checks.
Delaware Subscriber
Answer: Yes. You can use HCPCS code V5264 (Ear mold/insert, not disposable, any type) for an ear mold. If you itemize an HA fitting, you may report V5264 for the ear mold, along with V5257 (Hearing aid, digital, monaural, BTE) for the HA, and V5241 (Dispensing fee, monaural hearing aid, any type) for the initial adjustment. You may also use V5264 when a patient receives replacement ear molds with no HA.
Don't overlook: Consider also reporting V5275 (Ear impression, each) when documentation shows an audiologist took an ear mold impression to:
- order a custom-fit hearing aid
- couple with a BTE hearing aid
- replace the patient's current mold with no hearing aid.
Tip: Few payers will reimburse for V5275, so you may want to include this in the cost of the HA, ear mold or swim plug.
To break down your costs, take your single-unit (if possible and allowed) invoice cost and add in all the other things that you typically bundle as part of HA dispensing (the HA, HA evaluation, ear mold impression, ear mold, batteries, orientation and verification), and the difference between your usual and customary fee for that aid and the total of those other costs becomes your dispensing fee.
For subsequent adjustments, consider two alternatives:
- Factor the long-term cost of rechecks into the bundled price.
- Report a hearing aid fitting or check with V5011 (Fitting/orientation/checking of hearing aid).
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