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

Learn about HCPCS code V5264 for custom ear mold inserts, coverage rules, billing, and documentation requirements.

## **Overview of V5264 for ear mold inserts** HCPCS code V5264 refers to an ear mold insert, not disposable, any type. An ear mold insert fits inside the ear and directs amplified sound from the device into the ear canal. These molds provide comfort, retention, and improved acoustic performance for patients using hearing devices, such as monaural hearing aids or other unspecified types of hearing aids. Unlike disposable plugs, the V5264 for ear mold represents a reusable and durable option that can be customized to meet individual patient needs. The code falls under HCPCS codes for hearing aids, maintained by CMS, and is used by providers when billing for ear mold inserts or ordering custom earplugs for patients. Audiologists may fit, shape, or modify the mold to ensure a proper seal and optimal performance. This HCPCS code for ear mold is essential when reporting hearing aid HA mold adjustments, documenting ear mold inserts supplied to patients, or when billing for molds and ordering custom inserts. Because it applies to non-disposable ear molds of any type, it is often used in cases where long-term durability is needed for daily use, comfort, and stability of the hearing device.

## **Documentation requirements** When billing for HCPCS code V5264, records must clearly justify and support the service. Documentation should include: - A physician order or audiologist's prescription that specifies the need for a non-disposable ear mold insert, not a disposable mold or generic insert. - Identification of the hearing aid model, ear mold insert type, and whether it is monaural or binaural. Include serial number or mold/canal shape drawing if required. - Clinical notes indicating the patient's hearing device use, complaints, or feedback regarding comfort, fit, or sound quality, showing why a durable, custom (or semi-custom) mold is required. - Proof of fitting, including description of the mold, was trimmed, modified, or shaped to fit the patient's ear canal or ear anatomy. Records should show that the mold was delivered and adjusted. - For billing and audit purposes, include cost information (if available) or manufacturer's documentation for the mold insert, especially if non-standard materials or custom features are used.

## **Billing requirements** When billing HCPCS code V5264, providers should report one unit for each ear mold insert and use the RT (right ear) or LT (left ear) modifier to specify the side being billed. The documentation must clearly show that the ear mold insert is medically necessary for use with a hearing aid device, rather than being a disposable or generic insert. Because V5264 falls under standardized hearing device codes, it is essential to confirm each payer’s policy regarding coverage frequency, allowable features, and costs. Medicare Part B does not cover standalone ear molds, and any claim submitted under this program will be denied. To support reimbursement, the claim should also include a valid ICD-10 diagnosis code that demonstrates medical necessity for hearing loss. Providers must pay close attention to individual payer requirements, since coverage criteria, allowable amounts, and bundling rules vary significantly among private insurers.

## **Other relevant codes** #### **HCPCS codes** - **V5265** - Ear mold/insert, disposable, any type - **V5262** - Hearing aid, disposable, any type, monaural - **V5275** - Ear impression, each - **V5241** - Dispensing fee, monaural hearing aid, any type - **V5050** - Hearing aid, monaural, in the ear - **V5267** - Hearing aid or assistive listening device/supplies/accessories, not otherwise specified - **V5060** - Hearing aid, monaural, behind the ear - **V5298** - Hearing aid, not otherwise classified #### **ICD-10-CM codes** - **H90.3** - Sensorineural hearing loss, bilateral - **H90.5** - Unspecified sensorineural hearing loss - **H90.0** - Conductive hearing loss, bilateral - **H90.2** - Unspecified conductive hearing loss - **H90.6** - Mixed conductive and sensorineural hearing loss, bilateral - **H91.90** - Unspecified hearing loss, unspecified ear - **H91.20** - Sudden idiopathic hearing loss, unspecified ear

Frequently asked questions

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.