Does V5261 require prior authorization?

No, V5261 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for V5261?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Binaural testing shows improved speech recognition using bilateral devices.
Binaural air conduction hearing aids are consideredmedically necessarywhenBOTHof the following criteria are met (A and B):
Both ears meet the criteria listed above in A and B;and
Air conduction hearing aid devices are consideredmedically necessaryfor the treatment of hearing loss whenALLof the following criteria are met (A and B):
The hearing loss is due to one of the following etiologies:Sensorineural hearing loss;orMixed hearing loss;orConductive hearing loss, which has been:unresponsive to medical interventions;andunresponsive to surgical interventions or not amenable to surgical correction;and
Sensorineural hearing loss;or

ANTHEM-CG-DME-37 — CG-DME-37 Air Conduction Hearing Aids

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