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See a sample rate comparisonHCPCS V5261 Fee Schedule
Last Verified: September 2026
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.
Hearing aid, digital, binaural, BTE
| Key Fact | Detail |
|---|---|
| Service Type | Hearing Services Hearing Aids |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for V5261 |
National average reimbursement for HCPCS V5261 by major payers:
$2,823.70
$5,017.44
$2,589.53
$2,192.16
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HCPCS V5261
5 of 25 sample ratesHigher to lower in this preview
Piedmont Newton Hospital, Inc., Newton Medical Center
Piedmont Newton Hospital Inc
$6,316.06Published rateHospital Authority Of Mitchell County, Mitchell County Hospital
Hospital Authority Of Mitchell County
$5,000.00Published ratePiedmont Newton Ekg Billing LLC
Piedmont Newton Hospital Inc
$5,000.00Published rateMichael Koch
Chestatee Pathology Associates PC
$5,000.00Published rateProfessional Resources Management Of Rabun, LLC, Mountain Lakes Medical Center
$5,000.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS V5261 vs. Other Hearing Aids Codes
The HCPCS V5261 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 V5261 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 |
|---|---|---|
| V5260-HCPCS | High | Hearing aid, digital, binaural, ITE |
| V5261-HCPCS | High | Hearing aid, digital, binaural, BTE |
| V5262-HCPCS | Moderate | Hearing aid, disposable, any type, monaural |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS V5261. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the V5261 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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