Does V5243 require prior authorization?

No, V5243 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for V5243?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Binaural testing shows improved speech recognition using bilateral devices.
Binaural air conduction hearing aids are consideredmedically necessarywhenBOTHof the following criteria are met (A and B):
Both ears meet the criteria listed above in A and B;and
Air conduction hearing aid devices are consideredmedically necessaryfor the treatment of hearing loss whenALLof the following criteria are met (A and B):
The hearing loss is due to one of the following etiologies:Sensorineural hearing loss;orMixed hearing loss;orConductive hearing loss, which has been:unresponsive to medical interventions;andunresponsive to surgical interventions or not amenable to surgical correction;and
Sensorineural hearing loss;or