HCPCS Code V5160: Dispensing Fee, Binaural

HCPCS Code V5160 covers the binaural hearing aid dispensing fee. Learn how to use this code for easy billing and documentation.

Use Code

## **What is HCPCS code V5160?** HCPCS code V5160 is a Level II HCPCS code with the code description “Dispensing fee, binaural.” It is used to report the professional service fee for dispensing binaural hearing aids rather than the cost of the devices themselves. This distinguishes it from codes for a monaural hearing aid (single ear) and from device codes that describe internal and external components such as a cochlear implant, external sound processor, or external attachment. V5160 applies to the dispensing of hearing aids that may be air conduction or body-worn, including digitally programmable analog devices that require fitting, programming, and verification before patient use. Documentation should specify if ear molds were included as part of the fitting, as these are sometimes billed under separate codes. This code is billed for the service of providing, programming, and counseling patients on their devices, along with other services related to the dispensing process, such as follow-up adjustments or maintenance counseling. It does not represent the physical hearing aid, its direct audio input receiver, or other hardware components — those are reported under their own HCPCS codes.

## **HCPCS code V5160 documentation requirements** HCPCS code V5160 describes the dispensing fee for binaural hearing aids. To ensure proper claim submission and compliance, documentation must clearly demonstrate medical necessity and the provision of two hearing aids. - Records must include the patient’s diagnosis (e.g., bilateral hearing loss) and a clear justification for binaural dispensing. The medical record should explain why two hearing aids are necessary to improve the patient’s communication ability or quality of life. - Include a signed and dated order or prescription from a licensed practitioner supporting the need for binaural hearing aids. - Maintain documentation that confirms two hearing aids were dispensed, including dates of service, device details (manufacturer, model, and serial numbers), and location or method of delivery. - If applicable, include documentation of related services such as hearing aid fitting, orientation, and follow-up care to demonstrate that the devices were properly programmed and the patient was counseled on their use.

## **HCPCS code V5160 billing requirements** Billing for HCPCS code V5160 captures the professional dispensing fee for binaural hearing aids (both ears) and must follow payer-specific guidelines to ensure proper reimbursement. - Bill one unit of V5160 for the dispensing fee when two hearing aids are provided to the patient. - Use V5160 only for binaural hearing aids; if only one hearing aid (monaural) is dispensed, bill the appropriate monaural dispensing code (e.g., V5090). - Submit through the appropriate payer channel (Medicare Part B or commercial insurance) and ensure dates of service match the dispensing encounter. - Do not use V5160 to bill for the hearing aid device, ear mold, direct audio input receiver, internal or external components, external sound processor, or external attachment. Those items have separate HCPCS codes. - Use appropriate modifiers (e.g., GA for ABN on file, GY for statutorily excluded services, or KX if medical necessity criteria are met) when required by the payer. RT and LT modifiers are typically not used with V5160 since it already specifies binaural service.

## **Other relevant codes** - **V5090**: Dispensing fee, unspecified hearing aid (for FM systems or vibrotactile devices) - **V5110**: Dispensing fee, bilateral - **V5130**: Binaural, in-the-ear (ITE) hearing aid - **V5140**: Binaural, behind-the-ear (BTE) hearing aid - **V5150**: Hearing aid in glasses, binaural - **V5200**: Dispensing fee, contralateral, monaural - **V5211**: Hearing aid, contralateral routing system, binaural, ITE/ITE - **V5240**: Dispensing fee, contralateral routing system, binaural - **V5266**: Battery for use in hearing device (standard batteries) - **V5267**: Hearing aid supplies and accessories, not otherwise specified

Frequently asked questions

HCPCS code V5160 is defined as the "Dispensing fee, binaural" hearing aids. It represents the professional fee associated with dispensing a pair of hearing aids (one for each ear). While V5160 applies explicitly to hearing aids, it does not cover the cost of the devices themselves or any separate assistive listening device, which would be billed under its own code.

Original Medicare (Part A and B) does not cover hearing aids or their dispensing fees, including HCPCS code V5160. Coverage for the binaural dispensing fee associated with hearing aids under V5160 is typically available only through Medicare Advantage plans, state Medicaid programs, or private insurers, not through Original Medicare. Providers should verify payer-specific coverage policies before billing this code.

HCPCS code V5160 is billed as one unit for the dispensing fee of binaural hearing aids, listing diagnosis codes for both ears. It includes up to one conformity evaluation and two follow-up visits during the trial period. Providers must submit proper documentation and bill on CMS-1500 or equivalent.