HCPCS V5211 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Hearing Services • Hearing Aids |
| Complexity Level | High |
National average reimbursement for HCPCS V5211 by major payers:
$1,720.47
$1,206.05
$4,369.51
$3,823.33
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS V5211 | ||||||
United | V5211 | $2348.97 | 1760498588 - PIEDMONT NEWTON HOSPITAL, INC., NEWTON MEDICAL CENTER | 814475074 - (GA) PIEDMONT NEWTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | V5211 | $2376.63 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | V5211 | $1895.76 | 1063741163 - AZTEC URGENT CARE, LLC | 271495988 - (NM) AZTEC URGENT CARE LLC | NM | Urgent Care Clinic/Center (261QU0200X) |
United | V5211 | $2489.81 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | V5211 | $2659.57 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | V5211 | $2489.81 | 1073502985 - CHU CHEN | 42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | V5211 | $2001.38 | 1225281603 - EMORY CRAWFORD LONG HOSPITAL | 581537752 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | V5211 | $2368.31 | 1710992433 - HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE, JEFFERSON HOSPITAL | 581309961 - (GA) HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE | GA | General Acute Care Hospital (282N00000X) |
United | V5211 | $3063.13 | 1922178789 - SCOTTISH RITE CHILDRENS MEDICAL CTR, CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE | 580572465 - CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | V5211 | $1741.81 | 1306890942 - BROOKS COUNTY HOSPITAL | 586002830 | GA | Critical Access Hospital (282NC0060X) |
United | V5211 | $1165.72 | 1922178789 - SCOTTISH RITE CHILDRENS MEDICAL CTR, CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE | 580572465 - CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | V5211 | $1396.25 | 1770684284 - THE HOSPITAL AUTHORITY OF MONROE COUNTY, GEORGIA, MONROE COUNTY HOSPITAL | 586010602 - (GA) THE HOSPITAL AUTHORITY OF MONROE COUNTY GEORGIA | GA | Critical Access Hospital (282NC0060X) |
United | V5211 | $1264.56 | 1356552350 - REDMOND PARK HOSPITAL LLC, REDMOND HOSPITAL BASED SERVICES LLC | 201017054 - (GA) REDMOND PARK HOSPITAL LLC | GA | General Acute Care Hospital (282N00000X) |
United | V5211 | $2489.81 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | V5211 | $1469.93 | 1821017831 - BACON COUNTY HEALTH SERVICES, INC, BACON COUNTY RURAL HEALTH CLINIC | 582224545 - (GA) BACON COUNTY HEALTH SERVICES INC | GA | Rural Acute Care Hospital (282NR1301X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS V5211 vs. Other Hearing Aids Codes
The HCPCS V5211 code is part of the Hearing Services services used for Hearing Aids. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS V5211 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| V5200-HCPCS | Moderate | Dispensing fee, contralateral, monaural |
| V5211-HCPCS | High | Hearing aid, contralateral routing system, binaural, ite/ite |
| V5212-HCPCS | High | Hearing aid, contralateral routing system, binaural, ite/itc |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS V5211. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the V5211 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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