Question 1

What is HCPCS code V5242?

Accepted Answer

HCPCS code V5242 is "Hearing aid, monaural, cic". Hearing aid, analog, monaural, cic (completely in the ear canal)

Question 2

What category is V5242 in?

Accepted Answer

V5242 belongs to HCPCS Category V (Vision and Hearing Services).

Question 3

When should I use HCPCS code V5242?

Accepted Answer

Use V5242 when billing for hearing aid, monaural, cic. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is V5242 covered by Medicare?

Accepted Answer

Coverage for V5242 (Hearing aid, monaural, cic) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for V5242?

Accepted Answer

Documentation for V5242 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).