CMS made significant revisions for contralateral routing hearing aid codes commonly known as CROS/BiCROS hearing devices (V5170 – V5240) effective January 1, 2019. The changes include the addition of 9 new codes and the revisions of 4 existing codes. The changes are an attempt to more accurately describe the current hearing aid technology used to treat patients with Single Sided Deafness and also patients with some degree of hearing loss in one ear and an unaidable hearing loss on the other side.
The original CROS/BiCROS codes were created in the 1980s to describe technology that is no longer available today. CROS and BiCROS hearing aids are no longer dedicated devices. Advancements in hearing aid technology allow for contralateral routing devices to be configured for a wide range of clinical applications.
The current codes create problems when working with insurance. The current CROS and BiCROS codes do not accurately describe to payers that the patient is receiving 2 devices (1 hearing aid and 1 contralateral routing device) regardless of degree of loss in the better ear. There also is currently no way to report when a single contralateral routing device is provided to a patient who wears an existing hearing aid on the opposite ear.
The original code change proposal application was submitted to CMS by the American Academy of Audiology (AAA), the American Speech-Language Hearing Association (ASHA), the Academy of Rehabilitative Audiology (ARA) and the Educational Audiology Association (EAA) and hearing aid industry manufacturer Phonak. CMS modified the original request, but we are hopeful that with aggressive payer and member education, the new and revised codes for 2019 will be beneficial.
The Academy’s Coding and Reimbursement Committee will be providing a series of member education and resources on this topic in the near future.
New Codes –
|V5171||Hearing aid, contralateral routing device, monaural, in the ear (ite)|
|V5172||Hearing aid, contralateral routing device, monaural, in the canal (itc)|
|V5181||Hearing aid, contralateral routing device, monaural, behind the ear (bte)|
|V5211||Hearing aid, contralateral routing system, binaural, ite/ite|
|V5212||Hearing aid, contralateral routing system, binaural, ite/itc|
|V5213||Hearing aid, contralateral routing system, binaural, ite/bte|
|V5214||Hearing aid, contralateral routing system, binaural, itc/itc|
|V5215||Hearing aid, contralateral routing system, binaural, itc/bte|
|V5221||Hearing aid, contralateral routing system, binaural, bte/bte|
These codes are intended to be used in reporting current contralateral routing technology.
Use the monaural codes when providing 1 contralateral routing device.
Use the binaural codes when providing 1 hearing aid and 1 contralateral routing device.
Revised Codes –
|V5190||Hearing aid, contralateral routing, monaural, glasses|
|V5200||Dispensing fee, contralateral, monaural|
|V5230||Hearing aid, contralateral routing system, binaural, glasses|
|V5240||Dispensing fee, contralateral routing system, binaural|
Use V5200 for dispensing 1 monaural contralateral routing device.
Use V5240 for dispensing 2 devices (e.g. binaural contralateral routing system, legacy CROS or BiCROS).
CMS recently updated the HCPCS file for CY2019. Codes V5170, V5180, V5210 and V5220 were deleted and should be discontinued for services on or after January 1, 2019. Reporting for all CROS and BiCROS services may be accomplished with the new HCPCS codes.
For inquires with regard to specific coding or individual coverage, please contact the payer directly for clarification. Information and a complete listing of all HCPCS codes for CY2019 may be accessed on the CMS website click here.
Disclaimer: While HCPCS codes are part of the standardized code set required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the use of HCPCS codes does not guarantee payment. You will need to check with your specific payors for their policy on these codes and devices.
Updated Guidance November 9, 2022 Late November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule on the 2023 Medicare Physician Fee Schedule (MPFS). The Academy has compiled a chart of 2023 reimbursement values for audiology codes, available here. This Final Rule contains significant provisions for the delivery of audiology services….
On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a pre-release notice of final rule-making for the CY 2023 Medicare Physician Fee Schedule Rule (MPFS). The notice will be final upon publication in the Federal Register. CMS also has provided a Fact Sheet that references significant changes for the provision of…
Late November 1, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on the 2023 Hospital Outpatient Prospective Payment System (OPPS). Under this rule, CMS finalizes a 3.8 percent increase in the OPPS payment rate for 2023, for those hospitals that meet quality reporting requirements. The OPPS provides technical component (TC) reimbursement…