Question
What is the correct way to bill for binaural hearing aids? Our claims have been processed as 1 unit when we use a binaural code such as V5261, even when we bill as 2 units. Can we bill a V5257 with a LT/RT modifier? We usually receive the maximum amount the insurance will pay, however the wording on the Explanation of Benefits is confusing regarding how much the patient owes.
Answer
V5261, or "Hearing aid, digital, binaural, BTE," is very appropriate when billing for two binaural, digital behind the ear hearing aids as that is what the HCPCS code description specifies. It should be billed as one unit (which is two hearing aids.) Some third party payers may prefer V5257RT and 5257LT and I would contact them for guidance of their preference in utilizing these choices in order to expedite your claim.
I would also suggest billing the dispensing fee for binaural hearing aids, V5160. If earmolds were a part of this patient's amplification system, that may be billed as V5264, two units since that descriptor, unlike the previous two mentioned above, requires specification of one or two units.
You may want to contact the insurance company to clarify for them that these are for binaural hearing aids. They may need some gentle education as to the fact that these codes are binaural and they may have other requirements for completion as part of this billing process, which then may be addressed at that time.
Debbie Abel, Au.D., is the former chair of the Coding and Practice Management Committee for the American Academy of Audiology and a former member of the AAA Ethical Practices Board. She currently is serving her second year of her term on the American Academy of Audiology and is the board liaison to the Coding and Reimbursement Committee. She's now the audiology manager for Hearing Resource Center in Poway, CA after having a private practice for 13 years in Alliance, OH.