Does V5298 require prior authorization?

No, V5298 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for V5298?

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

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`V5298`, Hearing aid, not otherwise classified

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

For sigmoid sinus resurfacing: diagnostic documentation that pulsatile tinnitus is resulting from "sigmoid sinus dehiscence or diverticulum" (imaging/clinical findings supporting that etiology).
Documentation that "Medically correctable causes of tinnitus have been ruled out."

Documentation that the member "has tried and failed conservative tinnitus treatments, including counseling and reassurance, dietary modifications, and drug therapy."

For TENS as DME: record of prior conservative therapies tried and their outcomes, and documentation of severity and duration of tinnitus consistent with policy criteria.

Key Coverage Criteria

Transcutaneous electrical nerve stimulation (TENS) as durable medical equipment (DME) for members with severe tinnitus when all of the following criteria are met: "Medically correctable causes of tinnitus have been ruled out;" "Member has experienced severe tinnitus for more than 6 months," and "Member has tried and failed conservative tinnitus treatments, including counseling and reassurance, dietary modifications, and drug therapy."
Sigmoid sinus resurfacing for the treatment of pulsatile tinnitus resulting from sigmoid sinus dehiscence or diverticulum.
HCPCS codes covered if selection criteria are met: A4595 (Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)); E0720 (Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation); E0730 (Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation).
ICD-10 codes covered if selection criteria are met: H81.01 - H81.09 (Meniere's disease); H93.11 - H93.19 (Tinnitus); H93.A1 - H93.A9 (Pulsatile tinnitus).
No explicit "Covered Indications" section present in this document. The policy text does not state Medicare/Aetna coverage determinations. The document reviews clinical evidence for multiple interventions and the following clinical scenarios were evaluated in the literature:
ICD-10 codes covered if selection criteria are met: H93.A1 - H93.A9 (Pulsatile tinnitus).

2 Active Policies

ANTHEM-CG-SURG-82, Bone-Anchored and Bone Conduction Hearing Aids

AETNA-CPB-0406, Tinnitus Treatments

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V5298, Hearing aid, not otherwise classified