These documentation instructions are applicable only to HMSA members in small group and individual plans, Federal Plan 87 or HMSA Plan for Postal Service Employees.
| Code | Code Description | Documentation Required |
|---|---|---|
| V5267 | Hearing aid or assistive listening device/supplies/accessories, not otherwise specified | Clinical notes |
| V5268 | Assistive listening device, telephone amplifier, any type | Clinical notes |
| V5269 | Assistive listening device, alerting, any type | Clinical notes |
| V5270 | Assistive listening device, television amplifier, any type | Clinical notes |
| V5271 | Assistive listening device, television caption decoder | Clinical notes |
| V5272 | Assistive listening device, TDD | Clinical notes |
| V5273 | Assistive listening device, for use with cochlear implant | Clinical notes |
| V5281 | Assistive listening device, personal FM/DM system, monaural, (1 receiver, transmitter, microphone), any type | Clinical notes |
| V5282 | Assistive listening device, personal FM/DM system, binaural, (2 receivers, transmitter, microphone), any type | Clinical notes |
| V5283 | Assistive listening device, personal FM/DM neck, loop induction receiver | Clinical notes |
| V5284 | Assistive listening device, personal FM/DM, ear level receiver | Clinical notes |
| V5285 | Assistive listening device, personal FM/DM, direct audio input receiver | Clinical notes |
| V5286 | Assistive listening device, personal blue tooth FM/DM receiver | Clinical notes |
| V5287 | Assistive listening device, personal FM/DM receiver, not otherwise specified | Clinical notes |
| V5288 | Assistive listening device, personal FM/DM transmitter assistive listening device | Clinical notes |
| V5289 | Assistive listening device, personal FM/DM adapter/boot coupling device for receiver, any type | Clinical notes |
| V5290 | Assistive listening device, transmitter microphone, any type | Clinical notes |
In addition, HMSA may require submission of clinical records before or after payment of claims for the purpose of investigating potential fraudulent, abusive or other inappropriate billing practices, but only as long as there is a reasonable basis for believing such investigation is warranted.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform.
|