V5242 — Hearing aid, analog, monaural, cic (completely in the ear canal)
V5242 is a HCPCS Level II code for hearing aid, analog, monaural, cic (completely in the ear canal). It belongs to the Vision, Hearing and Speech-Language Pathology section. Medicare does not pay it — see the coverage note below before you bill it.
Medicare coverage: Non-covered by statute
Excluded from coverage by the Social Security Act itself, not by a policy decision. No documentation and no appeal changes this one — an ABN is the relevant conversation.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusN
Non-covered service. Medicare does not cover it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of V5242 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for V5242
- Long descriptor
- Hearing aid, analog, monaural, cic (completely in the ear canal)
- Short descriptor
- Hearing aid, monaural, cic
- Added
- January 1, 2002
- BETOS
- O1F
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to V5242
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If V5242 is not quite right, the correct code is very often within a few positions of it.
- V5213Hearing aid, contralateral routing system, binaural, ite/bte
- V5214Hearing aid, contralateral routing system, binaural, itc/itc
- V5215Hearing aid, contralateral routing system, binaural, itc/bte
- V5220Hearing aid, bicros, behind the earterminated
- V5221Hearing aid, contralateral routing system, binaural, bte/bte
- V5230Hearing aid, contralateral routing system, binaural, glasses
- V5240Dispensing fee, contralateral routing system, binaural
- V5241Dispensing fee, monaural hearing aid, any type
- V5243Hearing aid, analog, monaural, itc (in the canal)
- V5244Hearing aid, digitally programmable analog, monaural, cic
- V5245Hearing aid, digitally programmable, analog, monaural, itc
- V5246Hearing aid, digitally programmable analog, monaural, ite (in the ear)
- V5247Hearing aid, digitally programmable analog, monaural, bte (behind the ear)
- V5248Hearing aid, analog, binaural, cic
- V5249Hearing aid, analog, binaural, itc
- V5250Hearing aid, digitally programmable analog, binaural, cic
Questions about V5242
What is HCPCS code V5242?
V5242 is a HCPCS Level II code for hearing aid, analog, monaural, cic (completely in the ear canal). It sits in the Vision, Hearing and Speech-Language Pathology section.
Does Medicare cover V5242?
The CMS HCPCS file marks V5242 as "Non-covered by statute". Excluded from coverage by the Social Security Act itself, not by a policy decision. No documentation and no appeal changes this one — an ABN is the relevant conversation.
How is V5242 paid under the physician fee schedule?
V5242 carries PFS status code N. Non-covered service. Medicare does not cover it.