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ILWUPMA WELFARE PLAN HEARING AID CLAIM FORM PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS BEFORE COMPLETING THIS FORM PART I. EMPLOYEE STATEMENT: 1. Employee (or Survivor) Local 2. Address (Street) Telephone.

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HCPCS code V5275 for Ear impression, each as maintained by CMS falls under Assistive Hearing Devices .

HCPCS code V5160 for Dispensing fee, binaural as maintained by CMS falls under Hearing Aids .

HCPCS code V5140 for Binaural, behind the ear as maintained by CMS falls under Hearing Aids .

Also, when using procedure code V5014 for minor repairs, providers must use modifier —52“ (Minor repairs). When billing V5014 for recasing or replating, providers must use modifier —22“ (Recasing or replating). For major repairs performed by the hearing instrument manufacturer, use V5014 without modifier —52“ or —22.

Most hearing aids are covered by warranties from the manufacturer for one-time loss and damage for at least the first year and sometimes longer. Your provider will easily be able to tell you if you are covered.

Hearing aid checks are reported using 92592 or 92593. Hearing aid verification and validation are reported using V5020. Hearing aid dispensing fees are reported using one of the following HCPCS codes: V5090, V5110, V5160, V5200, V5240, or V5241.

Hearing and Other Audiology Related Devices and Services CodeDescriptionV5261Hearing aid, digital, binaural, BTEV5262Hearing aid, disposable, any type, monauralV5263Hearing aid, disposable, any type, binauralV5264Ear mold/insert, not disposable, any type99 more rows

Hearing Aid Services CodesCodeDescriptionV5020Conformity EvaluationV5030Monaural, body worn, air conductionV5040Monaural, body worn, bone conduction59 more rows • Sep 21, 2020

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232