“Listen, Linda!” We’ve all seen, laughed at and maybe even quoted the viral video of the little boy trying to debate his side of a disagreement with his mother. And while that clip is a source of Internet amusement, the need to listen, or rather, the need to hear is anything but funny. Hearing aids are essential technology for those who need them. However, the high cost of hearing aids can make these services prime targets for improper billing.
What to Look For
The New Year promises new hearing aid Current Procedural Terminology (CPT) codes that become effective 01/01/2026. The codes are unilateral/bilateral codes related to hearing aid candidacy, selection services, fitting services, post fitting follow-up services and supplemental technology fitting services. According to the CPT definitions, many of these codes are bundled with each other and should not be reported separately.
92628 – Evaluation for hearing aid candidacy
92631 – Hearing aid selection services
92634 – Hearing aid fitting services
92636 – Hearing aid post-fitting follow-up services
92642 – hearing assistive device, supplemental technology fitting services.
Improper billing in the hearing aid industry can be deliberate attempts to overcharge or can be accidental errors in coding. Upcoding for more expensive or complex equipment or services than actually received is often done to inflate claim totals. Additionally, when services are billed that either aren’t performed or are not medically necessary, this can lead to overpayments. The cumulative effect of improper billing may have healthcare payers yelling “Listen, Linda! What are we doing with our money?!”
HCFS Has You Covered
Combating improper billing in hearing aid codes requires a multi-pronged approach. Payers need to leverage advanced data analytics to identify suspicious billing patterns and inappropriate number of services. Payers also play a vital role in preventing improper billing by staying informed, actively scrutinizing medical billing and updating internal edits. If you’re using the HCFSPlatform™, we’ve got you covered. Our Artificial Intelligence (AI) models can identify spikes and other anomalous billing patterns. We can also help identify new provider billing patterns to potentially catch any inappropriate billing quickly. Some examples of our alerts we already have in place for these 2026 hearing aid codes include:
- [2847-01] – UNBUNDLING, HEARING AID CANDIDACY
- [2848-01] – UNBUNDLING, HEARING AID SELECTION SERVICES
- [2849-01] – UNBUNDLING, HEARING AID FITTING SERVICES
- [2850-01] – UNBUNDLING, HEARING AID POST-FITTING FOLLOW-UP SERVICES
[1] https://oig.hhs.gov/documents/evaluation/10939/OEI-BL-24-00420.pdf
If you’re not using the HCFSPlatform™ and you’re interested in knowing more, email us at [email protected].
If you have questions or comments, you may email us at [email protected].
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