Question
I have heard from many insurance companies that the typical code for
hearing aids-v5060 for monaural and v5140 for binaural are no longer
valid. However, they will not give me the new codes, and I cannot find
them anywhere. Do you know what they are? I would appreciate any help you have to offer.
Answer
The codes listed in question one (V5060 and V 5140) are still active and appropriate codes for monaural behind the ear hearing aid and binaural and behind the ear hearing aids. These codes are parts of a national coding system developed by the Center for Medicare and Medicaid Services (CMS) with input from the Veterans Administration and private insurance companies. The system is formally called Health Care Procedural Coding System (HCPCS). If the insurance companies are saying that these codes are no longer valid, then the appropriate question would be whether they are invalid due to lack of coverage. But these codes and that coding system are still very much alive and well. With the advent of HIPAA, the most common use for these codes across states is for the Medicaid system.
If a payor uses the CPT system, to your knowledge, are there any CPT codes consistent with selecting or fitting of hearing aids?
CPT code 92590 is described as "hearing aid examination and selection; monaural". Code 92591 is "hearing aid examination and selection; binaural".
I dispense hearing aids in an ENT office setting. We bill third parties when coverage is available according to their procedures. However, we are still frequently denied because either 1) We used the wrong CPT codes or 2) Per our contract, they can deduct a percentage of payment. At this point, we are billing the insurance company before ordering the hearing aids to determine coverage before the trial period is over. What are your suggestions?
For the first part of question 3, I would offer the suggestion of not only obtaining prior authorization for the verbal description of hearing aid procedures but also obtaining prior authorization for specific CPT or HCPCS codes. There is no CPT code for a hearing aid. If the CPT system is used, equipment and accessories are usually billed under 92700 (unlisted otorhinolaryngological service or procedure). That is why many insurance companies who do pay for hearing aids use the HCPCS system. That system allows for binaural or monaural behind the ear, in the ear, and other styles of hearing aids. For the second part of the question, I would offer the suggestion of presenting an Advanced Beneficiary Notice before the hearing aid evaluation begins to let the patient know that if the insurance company deducts a percentage of the payment, they will be liable for the difference. I offer this suggestion with the qualification of whether your contract with the insurer allows you to balance-bill the patient in instances of cost deduction.
Current CPT and HCPCS manuals may be purchased through the American Medical Association or medical bookstores and may also be ordered through many commercial bookstores. All CPT terminology and descriptors, including codes, are copyrighted by the American Medical Association.
Dr. Fifer is the Director of Audiology and Speech-Language Pathology at the University of Miami's Mailman Center for Child Development. He is also a member of ASHA's Health Care Economic Committee and ASHA's representative to the AMA's Relative Value Update Committee / Health Care Professions Advisory Committee.
