CPT Codes for Binaural Hearing Aids: A Comprehensive Guide
This article provides a detailed overview of Current Procedural Terminology (CPT) codes related to audiology services, focusing on binaural hearing aids. It covers updates effective January 1, 2026, and essential billing guidelines for audiologists and related healthcare providers.
Example of Binaural Hearing Aids
Updates to CPT Codes for Audiology Services (Effective January 1, 2026)
The following updates to Current Procedural Terminology (CPT ® American Medical Association) related to audiology services are effective January 1, 2026. There are no changes to Healthcare Common Procedures Coding System (HCPCS) Level II codes related to audiology services in 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.
Important 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.
New CPT Codes Effective January 1, 2026
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.
- 92628-92632: Time-based codes for candidacy determination and hearing device selection.
- 92634-92637: Time-based codes for fitting and follow-up services.
- 92638-92641: Untimed add-on codes for verification.
Time-Based Coding Rules
CPT codes 92628-92632 and 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 92628 before they can bill the add-on code 92629.
92628-92632 and 92634-92637 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.
Verification 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.
Billing 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 their 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
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.
When billing these codes in a bilateral situation, some insurance carriers require a 50 modifier, but this is a binaural code.
Hearing aids and related services are statutorily excluded from Medicare coverage and are not reimbursable through traditional Medicare Part B.
Understanding HCPCS Code V5261
HCPCS code V5261 refers to a digital, binaural, in-the-ear (ITE) hearing aid. Here's a breakdown:
- Code: V5261
- Description: Hearing Aid, Digital, Binaural, In-The-Ear (ITE)
Digital binaural in-the-ear (ITE) hearing aids are small electronic devices worn in both ears that amplify sound for individuals with hearing loss. The devices capture sound with a microphone, process it digitally, and transmit the amplified sound to the inner ear, helping to improve hearing ability.
The Process of Fitting and Using Binaural Hearing Aids
- Hearing Assessment: The patient undergoes a hearing assessment.
- Custom Ear Molds: Custom ear molds may be made for better fitting.
- Programming: The audiologist programs the digital BTE hearing aids with the patient's hearing profile.
- Fitting and Education: The devices are fitted, and the patient is taught how to use, adjust, and care for them.
The initial fitting and programming session typically takes about 1-2 hours.
During Procedure: Minimal discomfort during fitting and ear mold creation, adjusting to having devices behind the ears.
Post-Procedure: May experience a period of adjustment to wearing and effectively using the hearing aids.
Types of Hearing Aids
Various types of hearing aids cater to different needs and preferences:
- Behind-The-Ear (BTE): Provide more amplification and are suitable for a wider range of hearing loss.
- In-The-Ear (ITE)
- In-The-Canal (ITC)
- Completely-In-Canal (CIC): ITE and CIC may be less noticeable but have shorter battery life and might not be suitable for severe hearing loss.
- Bone-Anchored Systems and Cochlear Implants: More invasive and suitable for specific types of hearing loss.
| Hearing Aid Type | Description | Pros | Cons |
|---|---|---|---|
| Behind-The-Ear (BTE) | Worn behind the ear with a tube connecting to an earmold inside the ear canal. | More amplification, suitable for a wider range of hearing loss. | More visible. |
| In-The-Ear (ITE) | Custom-made to fit within the outer ear. | More discreet than BTE. | Shorter battery life, may not be suitable for severe hearing loss. |
| In-The-Canal (ITC) | Custom-made to fit within the ear canal. | More discreet than BTE. | Shorter battery life, may not be suitable for severe hearing loss. |
| Completely-In-Canal (CIC) | Fits entirely within the ear canal. | Most discreet option. | Shortest battery life, limited features. |