HEARING AID SUPPLIES Replacement and Repair Billing

HEARING AID SUPPLIES AND ACCESSORIES REPLACEMENT

STANDARDS OF COVERAGE

Hearing aid supplies and accessories are considered a benefit, if necessary. A separate list of approved supplies, accessories, and maximums is available in addition to the MDHHS Hearing Aid Dealers Fee Schedule on the MDHHS website. (Refer to the Directory Appendix for website information.)


DOCUMENTATION

Applicable documentation to be maintained by the provider includes:

* A list of hearing aid supplies/accessories provided to the beneficiary within the past 365 days; and

* A copy of the manufacturer’s invoice showing the invoice price of the supplies/accessories, applicable discounts, and shipping charges.


PRIOR AUTHORIZATION REQUIREMENTS

PA is not required for hearing aid supplies and accessories if the sum of all payments for supplies/accessories billed within the past 365 days is equal to or less than the maximum fee as identified on the MDHHS Hearing Aid Dealers Fee Schedule.
PA is required for hearing aid supplies and accessories if:

* Any single item is billed with requested payment amounts over the maximum fee as identified on the MDHHS Hearing Aid Dealers Database.

* The sum of all payments for supplies/accessories billed within the past 365 days is over the maximum fee as identified on the MDHHS Hearing Aid Dealers Fee Schedule.

* An item exceeds the standards of coverage.

Hearing aid supplies/accessories that exceed either the maximum payment limit or the standards of coverage require PA. A list of supplies/accessories provided within the past 365 days must be submitted with the MSA-1653-B PA request.


PAYMENT RULES

Refer to the MDHHS Hearing Aid Dealers Fee Schedule on the MDHHS website for payment rules regarding hearing aid supply and accessory replacement.


REPLACEMENT OF DISPOSABLE HEARING AID BATTERIES

STANDARDS OF COVERAGE

Medicaid covers replacement of disposable hearing aid batteries, as appropriate, up to a quantity of 25 batteries per hearing aid per six months. All batteries must be dispensed in the original packaging and must be dispensed at least one year before the expiration date shown on the package. The establishment of a "battery club", where batteries are automatically mailed to a beneficiary regardless of need, is not allowed.

Hearing Aid Dealers may not bill for replacement of disposable batteries for cochlear implant devices.


PRIOR AUTHORIZATION REQUIREMENTS

PA is required for quantities exceeding the standards of coverage. Documentation must accompany the MSA-1653-B PA request to substantiate the need for additional batteries.


PAYMENT RULES

Medicaid’s payment for disposable hearing aid batteries is the lesser of Medicaid's maximum allowable amount or the acquisition cost plus 9.6 percent. Acquisition cost consists of the manufacturer’s invoice price, minus any discounts, and includes actual  shipping costs.


REPLACEMENT EARMOLDS

STANDARDS OF COVERAGE

13 years and over Beneficiaries who use hearing aids that require custom earmolds are eligible for replacement earmolds every 12 months without prior approval.

3 to 12 years Beneficiaries are eligible for replacement every six months without prior approval.

Under age 3 years Beneficiaries are eligible for replacement every three months without prior approval.



 PRIOR AUTHORIZATION REQUIREMENTS

PA is required for replacements exceeding the standards of coverage. Documentation must accompany the MSA-1653-B PA request to substantiate the need for additional earmold replacements.


PAYMENT RULES

Medicaid’s payment for replacement earmolds is the lesser of Medicaid's maximum allowable amount or the provider's usual or customary charges.


 HEARING AID REPAIRS AND MODIFICATIONS

 STANDARDS OF COVERAGE

Providers may bill for repairs and modifications only to the most recently dispensed outof- warranty hearing aid.

Repairs required after the hearing aid repair warranty has expired are reimbursed based on the contracted rate and will have a new warranty period specified per the contract.

Repairs are not covered for back-up aids or devices. Services under warranty may not be billed to Medicaid.

When a contract hearing aid that is covered under any warranty requires a repair, MDHHS will not reimburse the hearing aid dealer/audiologist for hearing aid fitting/checking services.

DOCUMENTATION

Applicable documentation to be maintained in the beneficiary's record includes an itemization of materials used to repair the hearing aid and related labor costs.

PRIOR AUTHORIZATION REQUIREMENTS

PA is not required for hearing aid repairs and/or modifications if:

* The hearing aid was purchased under the volume purchase contract. A processing fee of $19.20 may be added to the repair cost for hearing aids that are not covered under any warranty.

* The payments for the repair/modification are less than or equal to the maximum payment limit as published on the MDHHS Hearing Aid Dealers Fee Schedule (posted on the MDHHS website) for hearing aids that are not covered under any warranty.

* No more than two separate repairs/modifications are billed within 365 days for hearing aids that are not covered under any warranty.

PA is required for repairs and/or modifications to hearing aids that are not covered under any warranty if:

* The requested payment amount is over the maximum payment limit as published on the MDHHS Hearing Aid Dealers Fee Schedule (posted on the MDHHS website). (Refer to the Directory Appendix for website information.)

* Separate repairs/modifications are billed over two times within 365 days.

* Medicaid did not purchase the hearing aid.


Repairs that are expected to exceed either the maximum payment limit or two episodes within 365 days require PA. Documentation (manufacturer's actual invoice) must be submitted with the MSA-1653-B PA request. If the manufacturer’s actual invoice is not included, medical review staff will assign a penny screen to the code until the invoice is received.

The repair/modification of a hearing aid not purchased by Medicaid may be covered only when:

* The beneficiary’s hearing level, as supported by an audiogram, meets Medicaid coverage criteria; and

* The aid itself meets Medicaid coverage criteria.

A prior authorization request for this type of repair/modification must include both the date of purchase and the current audiogram.