V5263 Hearing aid, disp, binaural

Hearing aid, disposable, any type, binaural

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for V5263

Physician Fee Schedule (CY 2026, RVU26D)

Status N: non-covered service.

Payer policies and prior authorization for V5263

10 of 10 payer prior-auth lists that name V5263 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Rocky Mountain Health Plans, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)State of Arizona employee group (SYD, S3Z)AZprior auth requiredSep 1, 2026State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Rocky Mountain Health PlansRocky Mountain Health Plans CHP+COprior auth requiredOct 1, 2026Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
UnitedHealthcare Community PlanAHCCCS Complete Care (ACC)AZprior auth under conditionsAge under 21; For members younger than 21: Prior authorization is not required. For members 21 and older: Prior authorization is required.Oct 1, 2026Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community PlanALTCS Developmentally DisabledAZprior auth under conditionsAge under 21; For members younger than 21: Prior authorization is not required. For members 21 and older: Prior authorization is required.Oct 1, 2026Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community PlanALTCS Long Term CareAZprior auth under conditionsAge under 21; For members younger than 21: Prior authorization is not required. For members 21 and older: Prior authorization is required.Oct 1, 2026Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community PlanMassachusetts OneCareMAprior auth under conditionsPrior authorization is required for replacements when billed with modifier radionavigation aids.Nov 1, 2025Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025
UnitedHealthcare Community PlanMassachusetts Senior Care Options (SCO)MAprior auth under conditionsPrior authorization is required for replacements when billed with modifier radionavigation aids.Nov 1, 2025CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025
UnitedHealthcare Community PlanMassachusetts Senior Care Options (SCO) and OneCareMAprior auth requiredOct 1, 2026Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026
UnitedHealthcare Community PlanMississippi CHIPMSprior auth requiredApr 1, 2025Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community PlanNew Mexico Turquoise CareNMprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026

Payer coverage policies that name V5263

V5263 appears in 15 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaBone-Anchored Hearing Aids (0403)listed, no stance (range V5008-V5299)Jul 22, 2026payer document
AetnaTinnitus Treatments (0406)not covered (range V5010-V5267)Jul 10, 2026payer document
AnthemAir Conduction Hearing Aids (CG-DME-37)covered if criteria are metNov 6, 2025payer document
Blue Cross & Blue Shield of MississippiProsthetics (L.1.04.401)covered if criteria are metpayer document
Blue Cross & Blue Shield of Rhode IslandHearing Aid Coverage
Commercial Products		listed, no stanceJan 1, 2026payer document
Premera Blue CrossHearing Aids (Excludes Implantable Devices)
Page | 8 of 19 | ∞		listed, no stanceSep 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone- Anchored, and Semi-Implantable (for Kansas Only) (CS052KS.04)
Wearable Hearing Aids		listed, no stanceSep 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone- Anchored, and Semi-Implantable (for Nebraska Only) (CS052NE.V)
Wearable Hearing Aids		listed, no stanceJun 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone- Anchored, and Semi-Implantable (for Tennessee Only) (CS052TN.T)
Wearable Hearing Aids		listed, no stanceJun 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (CS052.V)
Wearable Hearing Aids		listed, no stanceJun 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (2026T0396II)
Wearable Hearing Aids		listed, no stanceMar 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for New Mexico Only) (CS052NM.D)
Wearable Hearing Aids		listed, no stanceJun 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Ohio Only) (CS052OH.F)
Wearable Hearing Aids		listed, no stanceSep 1, 2026payer document
UnitedHealthcareHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Pennsylvania Only) (CS052PA.S)
Wearable Hearing Aids		listed, no stanceJun 1, 2026payer document
UnitedHealthcareHearing Instruments and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Kentucky Only) (CS052KY.13)
Wearable Hearing Aids		listed, no stanceAug 1, 2026payer document

Medicaid fee-for-service

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

  • VT: $0.00 (outpatient_hospital_opps), effective Feb 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.