Understanding Binaural Hearing Aid CPT Codes: A Comprehensive Guide
The following updates to Current Procedural Terminology (CPT ® American Medical Association) related to audiology services are effective January 1, 2026. Starting on January 1, 2026, a new set of 12 Current Procedural Terminology (CPT®) codes will be available to describe the professional services provided by audiologists for hearing device-related services. These new codes primarily describe the audiological services related to air conduction hearing devices.
While CPT codes identify procedures or services, HCPCS Level II codes identify supplies, equipment and devices, and procedures not found in the CPT system. The HCPCS codes (referred to as Hic-Picks) are administered by the Centers for Medicare and Medicaid Services (CMS) and begin with a single letter (A through V), followed by four numeric digits. They are grouped by the type of service or supply they represent and are updated annually by CMS with input from private insurance companies. Hearing services fall under some L-codes and V5008-V5336.
Note: Audiologists should always check with payers regarding coverage of new or revised billing codes. It is important to check directly with payers, including state Medicaid programs and third-party payers, before using the new codes. These codes currently have no assigned Relative Value Units (RVUs) and are subject to carrier pricing, which mirrors the legacy codes, which were also not statutorily covered under Medicare.
There are no changes to Healthcare Common Procedures Coding System (HCPCS) Level II codes related to audiology services in 2026. Hearing aids and related services are statutorily excluded from Medicare coverage and are not reimbursable through traditional Medicare Part B.
Overview of New CPT Codes for Hearing Devices
The following 12 new CPT codes are effective January 1, 2026, to report the professional services audiologists provide for hearing aids and other hearing devices. These codes include candidacy determination and hearing device selection.
CPT codes 92628-92632 are time-based. Timed code requirements follow the “half plus one” rule, meaning that for a 30-minute code, at least 16 minutes must be completed, and a 15- minute code must meet at least 8 minutes to report a unit. Each time-based code has a minimum duration threshold that must be met before it can be billed. Add-on codes apply once the full-time requirement for the base code has been exceeded. For example, a clinician must provide the entire 30-minutes for 92628 before they can bill the add-on code 92629. 92628-92632 are unilateral or bilateral. Do not use modifier -52 with timed codes. Candidacy (92628, 92629) and selection (92631, 92632) codes cannot be billed on the same date of service, as overlapping preparatory and counseling components exist.
CPT codes 92634-92637 are time-based. Timed code requirements follow the “half plus one” rule, meaning that for a 30-minute code, at least 16 minutes must be completed, and a 15- minute code must meet at least 8 minutes to report a unit. Each time-based code has a minimum duration threshold that must be met before it can be billed. Add-on codes apply once the full-time requirement for the base code has been exceeded. For example, a clinician must provide the entire 30-minutes for 92634 before they can bill the add-on code 92635. 92634-92637 are unilateral or bilateral. Do not use modifier 52 with timed codes.
These four codes describe additional assessments that require specialized equipment. The verification codes (92638-92641) were created to capture the specific types of verification that may be completed as part of the fitting and follow-up process (92634-92637). CPT codes 92638 and 92639 are untimed add-on codes to be reported in conjunction with fitting or follow-up codes. 92638 and 92639 may only be billed once the minimum requirements of the applicable base code have been met. 92639 is bilateral. 92641 can be billed alone or alongside services for other types of (e.g. 92641 is bilateral.
For simple routine services, such as cleanings or adjustments without orientation, the post-fitting follow-up codes (92636, 92637) may also apply only if the minimum times are met.
Billing Practices for Binaural Hearing Aids
Binaural hearing aid codes allow providers to save time by billing a single Current Procedural Terminology (CPT®) code for members requiring bilateral hearing aids. It is important to remember that these codes only need to be billed once to cover both ears and should never be billed twice for the same service.
As of January 2017, Blue Cross and Blue Shield of New Mexico (BCBSNM) has updated our billing system to not allow dual billing of binaural hearing aid codes. This edit applies to the following CPT codes:
- V5258 hearing aid, digital, binaural, BTE
- V5259 hearing aid, digital, binaural, CIC
- V5260 hearing aid, digital, binaural, ITC
- V5261 hearing aid, digital, binaural, ITE
When billing code V5261 in a bilateral situation, some insurance carriers require a 50 modifier, but this is a binaural code.
For more information, please refer to the American Medical Association guide for coding and billing for procedures and services with CPT and Healthcare Common Procedure Coding System codes.
Key Considerations:
- Always verify coverage with payers before using new codes.
- Understand time-based coding rules and minimum duration requirements.
- Ensure proper use of add-on codes in conjunction with base codes.
- Stay updated with annual changes from CMS regarding HCPCS codes.