`V5011` Hearing aid fitting/checking

Fitting/orientation/checking of hearing aid

Medicare coverage: Non-covered by statute
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for V5011

Physician Fee Schedule (CY 2026, RVU26D)

Status N: non-covered service.

Payer policies and prior authorization for V5011

6 of 6 payer prior-auth lists that name V5011 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	Federal Employee Program (FEP)	AZ	prior auth under conditions	FEP Standard and Basic only	Sep 1, 2026	Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
UnitedHealthcare Community Plan	AHCCCS Complete Care (ACC)	AZ	prior auth under conditions	Age under 21; For members younger than 21: Prior authorization is not required. For members 21 and older: Prior authorization is required.	Oct 1, 2026	Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Developmentally Disabled	AZ	prior auth under conditions	Age under 21; For members younger than 21: Prior authorization is not required. For members 21 and older: Prior authorization is required.	Oct 1, 2026	Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Long Term Care	AZ	prior auth under conditions	Age under 21; For members younger than 21: Prior authorization is not required. For members 21 and older: Prior authorization is required.	Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	New Mexico Turquoise Care	NM	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026

Payer coverage policies that name V5011

V5011 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Bone-Anchored Hearing Aids (0403)	listed, no stance (range V5008-V5299)	Jul 22, 2026	payer document
Aetna	Tinnitus Treatments (0406)	not covered (range V5010-V5267)	Jul 10, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Prosthetics (L.1.04.401)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Rhode Island	Hearing Aid Coverage	not covered	Jan 1, 2026	payer document
Premera Blue Cross	Hearing Aids (Excludes Implantable Devices)	listed, no stance	Sep 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, OH, WA.

CO: $64.94 (chp_plus, non-facility), effective Jul 1, 2026
KY: $42.26 (audiology), effective Jan 1, 2026
OK: $117.04 (dme), effective Aug 1, 2020
TX: $64.45 (audiologist, Audiologist), effective Mar 1, 2023
VA: $80.00 (medical), effective Jan 1, 2008
VT: $150.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $33.09 (hearing_aids), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

V5011 Hearing aid fitting/checking