HCPCS Code V5264: Ear Mold/Insert, Not Disposable, Any Type

No. Code V5264 for ear molds is statutorily excluded from Medicare Part B coverage and is not reimbursed as a standalone service. Patients typically must pay out of pocket unless they have commercial insurance that provides partial coverage for hearing aids.

Bill V5264, when an itemized cost breakdown is required—for example, if an audiologist is currently making or replacing an ear mold separate from the hearing aid device and dispensing service. In certain states (e.g., Washington), replacement molds may be billed separately if the initial mold was bundled into the dispensing fee.

Reimbursement for V5264 ear mold inserts varies widely by payer. Since Medicare does not cover the cost, most payment comes from private insurers or self-pay. Some insurance carriers recognize it under their hearing aid benefits, but allowable amounts depend on contracts and HCPCS code policies. Always check the payer’s fee schedule for exact reimbursement rates.