V5265 — Ear mold/insert, disposable, any type
V5265 is a HCPCS Level II code for ear mold/insert, disposable, any type. 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 V5265 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 V5265
- Long descriptor
- Ear mold/insert, disposable, any type
- Short descriptor
- Ear mold/insert, disp
- 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 V5265
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If V5265 is not quite right, the correct code is very often within a few positions of it.
- V5257Hearing aid, digital, monaural, bte
- V5258Hearing aid, digital, binaural, cic
- V5259Hearing aid, digital, binaural, itc
- V5260Hearing aid, digital, binaural, ite
- V5261Hearing aid, digital, binaural, bte
- V5262Hearing aid, disposable, any type, monaural
- V5263Hearing aid, disposable, any type, binaural
- V5264Ear mold/insert, not disposable, any type
- V5266Battery for use in hearing device
- V5267Hearing aid or assistive listening device/supplies/accessories, not otherwise specified
- V5268Assistive listening device, telephone amplifier, any type
- V5269Assistive listening device, alerting, any type
- V5270Assistive listening device, television amplifier, any type
- V5271Assistive listening device, television caption decoder
- V5272Assistive listening device, tdd
- V5273Assistive listening device, for use with cochlear implant
Questions about V5265
What is HCPCS code V5265?
V5265 is a HCPCS Level II code for ear mold/insert, disposable, any type. It sits in the Vision, Hearing and Speech-Language Pathology section.
Does Medicare cover V5265?
The CMS HCPCS file marks V5265 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 V5265 paid under the physician fee schedule?
V5265 carries PFS status code N. Non-covered service. Medicare does not cover it.