Audiology billing and coding: a practice guide to CPT, V-codes, Medicare and TPAs

Audiology billing and coding starts with diagnostics: the tests your audiologists run in the booth and the sound lab.

Those tests bill under CPT codes, and CMS prices audiology's diagnostic codes on the Medicare Physician Fee Schedule.

Medicare covers audiology services as other diagnostic tests under section 1861(s)(3) of the Social Security Act, paid under the Physician Fee Schedule, and hospital-outpatient audiology as diagnostic services paid under the outpatient prospective payment system.

The diagnostic families a hearing practice bills from include audiometry, acoustic immittance, evoked potentials and OAEs, electrocochleography, auditory processing assessment, tinnitus assessment, cochlear implant programming, vestibular testing and cerumen removal.

Each code carries a status on the current fee schedule.

On the 2026 Physician Fee Schedule, status A marks an active code, while status N means the service is not covered by Medicare.

Screening pure-tone audiometry (92551) shows the second kind: CMS gives it status N and a medically unlikely edit (MUE) of 0 units, and it is not on CMS's audiology code list.

Knowing which codes sit on which status is the first thing your biller checks before the practice sets a fee or tells a patient what Medicare will cover.

The table below pulls a working set of the diagnostic codes CMS prices on the 2026 fee schedule, with their 2026 national amounts.

Descriptors are CMS's short descriptors, lightly paraphrased — CPT descriptors are AMA-copyrighted.

Figures are computed from each code's total relative value units (RVUs) times the $33.4009 non-QPP conversion factor, from CMS's RVU26D file released August 26, 2026.

These are national amounts before geographic adjustment.

Your Medicare Administrative Contractor's local fee schedule adjusts for geography, and clinicians participating in qualifying APM arrangements use the QPP file's conversion factor instead.

For 2026 the two conversion factors are $33.4009 (non-QPP file) and $33.5675 (QPP file, for qualifying APM participants).

Tests with no specific CPT code have their own route: the Medicare Claims Processing Manual (chapter 12, section 30.3) says unlisted audiology tests may be reported under 92700, the unlisted otorhinolaryngological service code.

The hearing aid service side of the CPT set changed on January 1, 2026.

CPT replaced the six hearing aid service codes 92590–92595 — in use since 1993 — with twelve new codes, 92628–92642, covering candidacy evaluation, hearing aid selection, fitting and follow-up, verification and assistive device services.

The deleted codes no longer appear in the 2026 Medicare RVU file or the October 2026 MUE table, and the new codes appear in their place.

Medicare's payment position on the new codes is stark: on the 2026 Physician Fee Schedule, 92628, 92629, 92631, 92632, 92634–92639, 92641 and 92642 all carry status N with zero RVUs — consistent with Medicare's statutory exclusion of hearing aids and hearing aid examinations, which the Medicare section below works through.

Other payers set their own positions, which is why ASHA advises checking with each payer before using 92628–92642: some payers may not replace the old codes right away, and some may keep using HCPCS V-codes for hearing aid services.

The new codes also work differently.

Codes 92628–92637 are time-based and laterality-neutral — their descriptors read unilateral or bilateral — and ASHA's guidance is that units follow the half-plus-one rule, with at least 16 minutes supporting a 30-minute code, and that modifier 52 is not used with the timed codes.

Two add-on codes cover verification: 92638 for behavioral verification and 92639 for verification with probe-microphone (real-ear) measurement, each reported only with the fitting or follow-up codes.

Code 92641, the electroacoustic hearing device verification, is untimed, standalone and bilateral, with modifier 52 marking unilateral testing.

Coding edits layer on top of the code set.

CMS's National Correct Coding Initiative bundles component codes into comprehensive ones: 92552, 92553, 92555 and 92556 cannot be billed with 92557 on the same day even with a modifier (modifier indicator 0), and in the immittance family the Q4 2026 edits bundle 92567, 92568 and 92550 into 92570, with 92567 and 92568 also bundling into 92550.

Hearing aids themselves and the professional services around them have a separate code family: HCPCS Level II V-codes, published in CMS's alphanumeric HCPCS file.

The device codes describe the aid by style and signal processing — V5257 is a digital monaural behind-the-ear hearing aid and V5261 is the binaural BTE equivalent.

The service V-codes cover the work around the device.

V5010 is for assessment for a hearing aid, V5011 for fitting, orientation and checking, and V5014 for repair or modification.

V5020 is the conformity evaluation code, V5241 the dispensing fee for a monaural hearing aid and V5160 the binaural dispensing fee.

Supply codes round out the claim: V5264 for a non-disposable ear mold or insert, V5265 for a disposable one, V5275 for an ear impression, V5266 for batteries, V5298 as the hearing aid not-otherwise-classified code and V5299 for miscellaneous hearing services.

Medicare's position on all of them is statutory.

In the October 2026 HCPCS file the hearing aid V-codes carry coverage code S — non-covered by statute under section 1862(a)(7) of the Social Security Act — and every hearing aid V-code carries a Medicare MUE of 0 with the rationale CMS Policy.

The underlying exclusion, at 42 CFR 411.15(d), covers hearing aids and examinations for the purpose of prescribing, fitting or changing them.

Device and hearing-aid-service claims therefore belong with the payers that cover hearing benefits, not with Medicare.

One Medicaid floor is federal.

EPSDT — the Early and Periodic Screening, Diagnostic and Treatment benefit — requires coverage for children that includes diagnosis and treatment for defects in hearing, including hearing aids.

Our research did not establish adult Medicaid hearing aid coverage, so confirm your state Medicaid program's rules directly.

ASHA reports no changes to the HCPCS Level II V-codes for 2026: the CPT overhaul did not touch V-codes.

The payer-lag caution runs in both directions, though — some payers may keep using V-codes for hearing aid services even after adopting the new CPT codes, so confirm which set each of your payers wants before you submit.

Medicare is the rulebook audiology claims work starts from, and it offers two routes to a covered diagnostic test.

The traditional route is an order: outside the exception described next, Medicare generally requires a physician's or nonphysician practitioner's order for audiology services in all settings.

The second route is direct access — for dates of service on or after January 1, 2023, a patient can see an audiologist without an order once every 12 months for certain diagnostic tests the audiologist personally furnishes.

The direct-access exception is codified at 42 CFR 410.32(a)(4): once per patient per 12-month period, without an order, but not for services related to disequilibrium, hearing aids, or hearing aid exams, and not for tests of imbalance.

Non-acute hearing conditions only.

Direct-access claims carry modifier AB, which the modifiers section below works through.

What makes a test covered is the reason it was ordered or directly accessed, not the patient's diagnosis.

Tests ordered specifically to fit or modify a hearing aid are excluded.

The reverse also holds: when a physician refers a beneficiary for testing related to signs or symptoms of hearing loss, balance disorder, tinnitus, ear disease or injury, the diagnostic tests should be covered even if the only outcome is a hearing aid prescription.

One quirk trips up practices reading older CMS guidance.

The Medicare Benefit Policy Manual's audiology section (chapter 15, section 80.3) still carries 2010 text saying tests performed without a physician order are not covered.

That text predates the 2023 direct-access exception and is superseded for the qualifying tests the exception covers.

The structure around the benefit is unusual, and it shapes staffing.

Audiologists cannot bill audiology services incident to a physician, because they have their own benefit for services they personally furnish.

They cannot opt out of Medicare and operate on private contracts the way physicians can.

And the mandatory-claim rule cuts both ways: if an audiologist charges or attempts to charge a Medicare beneficiary for a covered service, the audiologist must submit the claim to Medicare.

Two coverage walls matter when you add service lines or delegate testing.

Medicare has no provision to pay audiologists for therapeutic services — vestibular treatment, auditory rehabilitation, auditory processing treatment and canalith repositioning are not billable by audiologists to Medicare.

And an audiologist may not bill the technical component when a technician performs the test, even under the audiologist's supervision; only a physician can bill technician-performed audiology work under direct physician supervision.

Medicaid claims follow each state program's own rules and code set, and adoption of the 2026 CPT change runs state by state.

Massachusetts Medicaid (MassHealth), for example, adopted the new hearing aid service codes for dates of service on or after January 1, 2026 through Administrative Bulletin 26-07, cross-walking the deleted codes to their replacements.

Confirm code choices with your state program or its payer.

Commercial payers and Medicare Advantage plans each set their own coverage rules.

The 2026 CPT change is the current flashpoint — ASHA's advice to check with each payer (state Medicaid, commercial and MA plans) before using 92628–92642 exists because some payers may not switch at once.

Build your fee grid payer by payer rather than assuming one schedule carries across.

Third-party administrators are the fourth channel.

TPA hearing networks administer hearing aid benefit programs: the practice joins the network, sees the network's members under its program rules, and works under the network's own reimbursement model.

In ASHA's 2023 private-practice report, 57% of private-practice audiologists worked with third-party administrators for hearing aid dispensing and related services.

The reimbursement amounts were not published on the provider pages our research read, so ask each network directly.

The models differ in ways that reach your books.

Amplifon Hearing Health Care describes itself as an independent, manufacturer-neutral third-party administrator, and its provider FAQ describes payments for hearing aids and accessories processed through Amplifon, with patient payment required when the aids are ordered and diagnostic testing fees collected by the clinic.

TruHearing describes device orders placed through its Echo provider portal and shipped to the provider's office, and says its model eliminates the cost of goods for providers.

Both are the companies' own descriptions; joining or declining a network is the practice's business decision.

Modifiers tell the payer what was different about the service, and audiology billing turns on two of them.

The first is AB, CMS's modifier for direct-access claims.

When a Medicare patient is seen under the once-per-12-months exception, CMS says to use the AB modifier, and CMS publishes an audiology code list marking which codes allow it.

The list — the version effective January 1, 2024 — marks the vestibular codes 92517 through 92549 as NO for modifier AB, and marks audiometry, immittance, electrocochleography, OAE, cochlear implant programming, 92620–92627, 92640 and the auditory evoked potential codes 92651–92653 as YES.

Comprehensive hearing test 92557 is on the list.

The vestibular line matches the direct-access rule itself: disequilibrium and imbalance tests stay order-based.

The second is modifier 52.

Under NCCI policy, audiologic function tests 92550 through 92588 include testing of both ears: only one unit may be reported for both ears, and modifier 52 is used if only one ear is tested.

The 2026 hearing aid service codes follow their own logic — the untimed electroacoustic verification code 92641 takes modifier 52 for unilateral testing, while the timed codes 92628–92637 must not be used with modifier 52 at all.

These edits update on their own calendars — the current Medicare practitioner MUE table is the October 1, 2026 version — so confirm the current edits with your Medicare Administrative Contractor before relying on a modifier decision for a specific claim.

Documentation is where billing meets clinical operations, and Medicare's rules explain why.

Coverage turns on the reason the test was ordered or directly accessed, not the diagnosis, so the claim's basis is the first thing documentation carries: the ordering provider when the claim is order-based, and the direct-access basis when it is not.

The once-per-12-months clock matters here too, because the exception covers one no-order visit per patient per 12-month period.

Who performed the test is the second thread.

Medicare gives audiologists their own benefit for audiology services they personally furnish, and the technical-component rule keeps audiologists from billing tests a technician performed.

Where assistants or technicians sit in your testing workflow, the performer question is one to work through with your MAC before the workflow goes live.

Equipment records belong in the same file.

NCCI policy says the code ranges 92552–92557, 92562–92588, 92597 and 92650–92653 may be reported only if calibrated electronic equipment is used, so calibration logs are the practice-side evidence that the condition was met.

The mandatory-claim rule closes the loop: if an audiologist charges or attempts to charge a Medicare beneficiary for a service covered by Medicare, the audiologist must submit the claim to Medicare.

For everything more specific — what your MAC expects in a note, or what a payer's audit guide requires — confirm with the MAC and the payer.

This page describes how the rules read; it does not tell you how to code a claim.

A denial review starts by mapping the reason code to a rule, and the rules on this page generate the predictable categories:

• Status N codes billed to Medicare. Screening 92551 carries status N with an MUE of 0, and the new hearing aid service codes (92628, 92629, 92631, 92632, 92634–92639, 92641 and 92642) carry status N with zero RVUs. On the 2026 fee schedule, status N means the service is not covered by Medicare.
• The hearing aid exclusion. Claims for hearing aids and for examinations to prescribe, fit or change them are excluded by statute.
• NCCI bundling. Component audiometry codes bundled into 92557 with a modifier indicator of 0 cannot be paid alongside it on the same day even with a modifier; 92567, 92568 and 92550 bundle into 92570 with the same modifier indicator of 0, and 92567 and 92568 also bundle into 92550.
• MUE limits. The practitioner MUE table effective October 1, 2026 sets 1 unit per day for most audiometry codes (92550–92588, 92620, 92625, 92626 and 92650–92653 among them), with add-on 92627 at 6 units and 92621 at 2.
• Unit rules on bilateral tests. Audiologic function tests 92550–92588 include both ears, with one unit covering both, so a second unit for the other ear is an edit hit.
• Payer transition lag. Some payers may not have replaced 92590–92595 in their systems after the January 1, 2026 deletion, or may expect V-codes instead of the new CPT codes.
• V-code MUEs. Every hearing aid V-code carries a Medicare MUE of 0 with the rationale CMS Policy, so device and hearing-aid-service claims route to the payers that cover the benefit, not to Medicare.

Accounts receivable is the same loop on a calendar: work denials by reason code, match each to the rule that generated it, correct and resubmit where the rule allows, and route device claims to the payer that actually covers the benefit.

Track aging from your own remittance data — our research for this guide found no published denial-rate or days-in-AR benchmark for audiology practices — and trend your numbers against themselves month over month.

Who owns this work is a staffing decision: billing can sit with the front desk, a practice manager or a dedicated biller, and candidates for the dedicated seat see it under audiology billing specialist jobs.

Billing is one thread of the wider operation covered by our hiring for your hearing practice hub.

Employer information, not licensing, legal, medical, clinical, billing or coding advice. Code sets, fee schedules and payer rules change; confirm current requirements with CMS, your Medicare Administrative Contractor and each payer, and with a health-care attorney for contract and compliance questions.