`V5281` Ald fm/dm system, monaural

Assistive listening device, personal fm/dm system, monaural, (1 receiver, transmitter, microphone), any type

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 V5281

Physician Fee Schedule (CY 2026, RVU26D)

Status N: non-covered service.

Payer policies and prior authorization for V5281

15 of 15 payer prior-auth lists that name V5281 require prior authorization or set conditions: UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
UnitedHealthcare Community Plan	Indiana Hoosier Care Connect	IN	prior auth under conditions	Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500.	Oct 1, 2026	Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth under conditions	Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500 Prosthetics are not DME — see orthotics and prosthetics.	Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Minnesota Metro Medicaid	MN	prior auth under conditions	Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – see orthotics and prosthetics	Oct 1, 2024	Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth under conditions	Prior authorization is required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500.	Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	MississippiCAN	MS	prior auth under conditions	site of care: outpatient	Apr 1, 2025	Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community Plan	Missouri Medicaid	MO	prior auth under conditions	Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME — see Orthotics and Prosthetics.	Jul 1, 2026	Prior authorization requirements for Missouri Medicaid Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth under conditions	Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – See orthotics and prosthetics	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth under conditions	Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – See orthotics and prosthetics	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	Rhode Island Medicaid	RI	prior auth under conditions	Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME – see Orthotics and prosthetics.	May 1, 2026	Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community Plan	TennCare	TN	prior auth under conditions	Prior authorization is required only for DME codes listed with a retail purchase or a cumulative rental cost of more than $500.	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Florida	FL	prior auth under conditions	Prior authorization required only for the codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME — see orthotics and prosthetics.	Oct 1, 2026	Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Hawaii (QUEST Integration)	HI	prior auth under conditions	Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500 Prosthetics are not DME — see Orthotics and prosthetics.	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth under conditions	Prior authorization is required only for the DME codes listed with a retail purchase or cumulative rental cost of more than $500.	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community Plan	Washington Apple Health	WA	prior auth under conditions	Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500.	Oct 1, 2026	Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023
UnitedHealthcare Community Plan	Wisconsin BadgerCare Plus and Medicaid SSI	WI	prior auth under conditions	Prior authorization required only for DME codes listed with a retail purchase or a cumulative rental cost of more than $500.	Sep 1, 2026	Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community

Payer coverage policies that name V5281

V5281 appears in 3 coverage policies from Aetna, 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
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

Recent prior-auth changes

Oct 1, 2026: PA removed, UnitedHealthcare Community Plan
Oct 1, 2026: PA removed, UnitedHealthcare Community Plan
Oct 1, 2026: PA removed, UnitedHealthcare Community Plan

Medicaid fee-for-service

Prior authorization required or conditional in IL, IN, NE, OH, VA.

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.

V5281 Ald fm/dm system, monaural