`V5275` Ear impression

Ear impression, each

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

Medicare pricing for V5275

Physician Fee Schedule (CY 2026, RVU26D)

Status N: non-covered service.

Payer policies and prior authorization for V5275

1 of 1 payer prior-auth lists that name V5275 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue).

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)

Payer coverage policies that name V5275

V5275 appears in 6 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Premera Blue Cross, UnitedHealthcare.

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	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) Page \| 8 of 19 \| ∞	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Louisiana Only) (CS052LA.O) Fitting and Testing of Hearing Aids	listed, no stance	Aug 1, 2025	payer document

Recent prior-auth changes

Oct 1, 2026: PA removed, UnitedHealthcare Community Plan

Medicaid fee-for-service

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

CO: $43.30 (health_first_colorado), effective Jul 1, 2026
KY: $20.00 (audiology), effective Jul 1, 2014
NE: $23.71 (hearing_aid), effective Jul 1, 2024
OK: $23.40 (dme), effective Aug 1, 2020
TX: $24.18 (audiologist, Audiologist), effective Jul 1, 2018
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $19.48 (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.

V5275 Ear impression