Hearing aid devices

1 per ear every 5 years (monaural codes = bill quantity of 1) (binaural codes = bill quantity of 1)

Hearing aid assessment

Procedure code V5010 may be reimbursed as medically necessary.

Hearing aid accessories

Prior authorization is required for procedure code V5267. Hearing aid accessories reimbursed separately for clients who are birth through 20 years of age include, but are not limited to, chin straps, clips, boots, and headbands.

Fitting and dispensing visit

1 per hearing aid procedure code

Ear mold and ear impression

1 each per hearing aid device may be reimbursed with procedure codes V5264, V5265, and V5275 (monaural codes = bill quantity of 1) (binaural codes = bill quantity of 2)

Revisit (as necessary)

2 per calendar year when billed by any provider. Procedure code 92592 may be reimbursed for the first and second revisits for a monaural fitting. Procedure code 92593 may be reimbursed for the first and second revisits for a binaural fitting.

Batteries (replacement only)

Procedure code V5266 may be reimbursed as medically necessary when a hearing aid device has been previously reimbursed.

Note: If a hearing aid has not been reimbursed by the CSHCN Services program in the last 5 years, the replacement batteries may be reimbursed upon appeal with a statement documenting medical necessity.

Replacement or additional hearing aids within a 5-year period

Prior authorization is required for the appropriate hearing aid procedure code.

Hearing aid repair or modification

1 per year after the 1-year warranty period has lapsed may be reimbursed with procedure code V5014.