The American Academy of Audiology (the Academy) and others recently requested revisions for codes and code descriptors in the CROS/BiCROS family and Centers for Medicare and Medicaid Services approved many of the proposed changes. The groups requested the changes to reflect changes in CROS/BiCROS technology. 

CROS—contralateral routing of signal—systems are traditionally fit when a patient has unaidable hearing loss in the poorer ear and normal hearing in the better ear, whereas BiCROS—bilateral microphones with contralateral routing of signal—hearing aids are fit when a patient has unaidable hearing loss in the poorer ear and aidable hearing loss in the better ear. Both types of systems aid the listener by transmitting signals coming from the side with poorer hearing to the side with better hearing to overcome the head shadow effect. 

The experienced clinician may recall that traditional wireless CROS and BiCROS technology were dedicated device pairs where the signal was wirelessly transmitted from an offside microphone (i.e., transmitter) to either a receiver or a hearing aid/receiver worn on the better ear. If the patient had normal hearing in one ear and unaidable loss in the other ear, a CROS system was ordered that did not provide amplification to the good ear and the system only served to transmit signals from the unaidable side to the ear with normal hearing. If the patient had aidable hearing loss in the better ear and unaidable loss in the poorer ear, then a BiCROS system was ordered where a transmitter was placed on the poorer ear and a hearing aid/receiver (that could be adjusted to fit the configuration of hearing loss in the better ear, while also receiving a signal from the transmitter) was fit on the better ear. 

Current contralateral routing technology can be programmed in a CROS or BiCROS configuration where the hardware is the same, but the programming determines the functionality (i.e., routing) of the signal between the two devices. In addition, current hearing aid technology allows the clinician to dispense a contralateral routing device to an existing CROS-compatible hearing aid when clinically applicable. These changes in technology necessitated new codes in the Healthcare Common Procedure Coding System (HCPCS) system to clarify that the programming is what differs, whereas, the actual hearing devices can be the same.  

The following codes and descriptions will increase coding specificity and became effective on January 1, 2019. The new code set also creates a mechanism to bill the unique scenario when a patient loses hearing in one ear, which only requires the addition of a contralateral routing device (i.e., transmitter) on the poorer ear, to be programmed to an existing CROS-compatible device already worn on the better ear.  

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

Updated Code Descriptions

V5200 Dispensing fee, contralateral, monaural

V5240 Dispensing fee, contralateral routing system, binaural

V5190 Hearing aid, contralateral routing, monaural, glasses

V5230 Hearing aid, contralateral routing system, binaural, glasses

Deleted Codes

V5170 Hearing aid, CROS, ITE

V5180 Hearing aid, CROS, BTE

V5210 Hearing aid, BiCROS, ITE

V5220 Hearing aid, BiCROS, BTE

V5171, V5172, V5181, V5190 may be used when dispensing a contralateral routing device to a patient who already wears a CROS-compatible hearing aid in the better ear. The clinician should choose the code that corresponds to the appropriate model being fit on the poorer ear. The corresponding dispensing fee would be V5200, Dispensing fee, contralateral, monaural to indicate a contralateral microphone was dispensed.

V5211, V5212, V5213, V5214, V5215, V5221, V5230 may be used when the fitting system is comprised of a hearing aid for the better ear with a contralateral routing device on the poorer ear, traditionally referred to as a BiCROS system. The corresponding dispensing fee would be V5240 Dispensing fee, contralateral routing system, binaural. 

The following scenarios are meant to further demonstrate appropriate use of the codes.


Scenario 1

Patient presents for fitting with single-sided deafness in the right ear with normal hearing in the left ear and is fit with a bilateral contralateral routing system with receiver-in-the-ear (RITE) style on both ears. 

Audiologist reports: 

HCPCS codes:

V5240 Dispensing fee, contralateral routing system, binaural

V5221 Hearing aid, contralateral routing system, binaural, BTE/BTE

ICD10 codes: 

H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side

Z46.1 Encounter for fitting and adjustment of hearing aid


Scenario 2

Patient who currently has bilateral BTE hearing aids presents for a hearing aid consultation following sudden onset of decreased hearing in the right ear. Patient now has a profound hearing loss in the right ear with no measurable word recognition and stable mild-to-severe sensorineural hearing loss in the left ear. The existing hearing aids are compatible with a contralateral routing system, and you fit a contralateral routing RITE device for the right ear to communicate with the patient’s left hearing aid. 

Audiologist reports: 

HCPCS codes:

V5200 Dispensing fee, contralateral, monaural

V5181 Hearing aid, contralateral routing device, monaural, BTE

ICD10 codes:

H90.3 Sensorineural hearing loss, bilateral

Z46.1 Encounter for fitting and adjustment of hearing aid


Scenario 3

Patient presents for hearing aid consultation with a five-year-old ITC in the right ear for mild-conductive hearing loss and has not worn a hearing aid in the left ear due to profound sensorineural hearing loss. Patient is now in a work scenario that requires the ability to understand speech from the left side, and you recommend a bilateral contralateral routing system. Patient prefers the ITC style in the right ear and a contralateral routing RITE style for the left ear.

Audiologist reports:

HCPCS codes:

V5240 Dispensing fee, contralateral routing system, binaural

V5215 Hearing aid, contralateral routing system, binaural, ITC/BTE

ICD10 codes:

H90.A11 Conductive hearing loss, unilateral, right ear, with restricted hearing on the contralateral side

H90.A22 Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side

Z46.1 Encounter for fitting and adjustment of hearing aid

With the new code sets, audiologists will need to carefully review coding options and choose the most appropriate code for contralateral routing fittings. Documentation should support the choice in coding, and the devices should be clearly described within clinical notes. 

As payers update fee schedules, providers may receive denials as billing systems may not have been updated to recognize the new codes and descriptions. Providers are advised to follow up with payers to educate them on the new code sets. 

Members may inform the Academy of any problems encountered with the new codes through reimbursement@audiology.org. If patterns are identified, the Academy will draft communications to assist in payer education regarding the new code options or contact the payer directly.