CROS HEARING AIDS
STANDARDS OF COVERAGE
CROS hearing aids are a benefit for beneficiaries of all ages when:
* There is demonstrated need for amplification.
* An audiogram indicates no residual hearing in the poorer ear (unaidable) and normal hearing in the better ear as demonstrated by thresholds less than 30 dB HL using the four frequency average of 500, 1000, 2000, and 4000 Hz.
The standards of coverage for CROS hearing aids are as follow:
Age Under 21 Years * The beneficiary must be receiving hearing impaired services through the school system.
* A maximum 90-day trial has been completed and indicates that amplification has been accepted and that auditory skills and learning capacity were enhanced, or there is a documented history of prior CROS hearing aid use.
Age 21 Years or Over * A Hearing Handicap Inventory for the Elderly, Hearing Handicap Inventory for Adults, Adult Performance Hearing Aid Benefit, or similar inventory indicates a need for amplification.
* Hearing aid is required for independent functioning (e.g., effects on employment, communication status).
DOCUMENTATION
Applicable documentation to be maintained in the beneficiary record for CROS hearing aids includes:
* A medical clearance signed and dated by the physician within six months prior to dispensing the hearing aid.
* An audiogram and recommendation of the make, model and type of hearing aid, signed and dated by the audiologist within six months prior to dispensing the hearing aid.
* For hearing aids not covered under the volume purchase contract, a copy of the manufacturer’s invoice showing the hearing aid model, serial number, invoice price, applicable discounts, and shipping and handling charges.
* Documentation of need for amplification addressing beneficiary’s communication needs. * A letter of medical necessity that identifies the specific medical reason or reasons why a non-contract hearing aid is required that cannot be met by a contracted hearing aid.
* CROS and BICROS continue to require prior authorization. In addition to the published documentation required, the letter of medical necessity must identify why a wired versus a non-wired hearing aid is needed.
* Additional applicable documentation includes:
Age Under 21 Years * Documentation from the educational system that the child is receiving hearing impaired services.
* Letters of support from the classroom teacher, the teacher consultant of the hearing impaired and/or the educational audiologist stating that amplification has been accepted and did enhance auditory skills and learning capacity following a
maximum 90-day trial, or documentation of a history of prior CROS hearing aid use.
Age 21 Years or Over * Results of the administration of the Hearing Handicap Inventory for the Elderly, Hearing Handicap Inventory for Adults, Adult Performance Hearing Aid Benefit, or similar inventory indicating need for amplification.
* Documentation of requirement for independent functioning (e.g., effects on employment, communication status).
PRIOR AUTHORIZATION REQUIREMENTS
PA is required for all CROS hearing aids. The following documentation must be submitted with all PA requests:
* MSA-1653-B.
* For hearing aids not covered under the volume purchase contract, documentation from the manufacturer showing invoice price, discounts, and shipping and handling charges.
* Medical clearance signed by a physician.
* Audiogram completed within the past six months, signed and dated by the audiologist, and including the recommended manufacturer, model and style. The audiogram must indicate no residual hearing in the poorer ear (unaidable) with normal hearing in the better ear as demonstrated by thresholds less than 30 dB HL using the four frequency average of 500, 1000, 2000, and 4000 Hz.
* Additional requirements include:
Age Under 21 Years * Documentation from the educational system that the child is receiving hearing impaired services.
* Letters of support from the classroom teacher, the teacher consultant of the hearing impaired and/or the educational audiologist stating that amplification has been accepted and did enhance auditory skills and learning capacity following a
maximum 90-day trial.
Age 21 Years or Over
* Results of the administration of the Hearing Handicap Inventory for the Elderly, Hearing Handicap Inventory for Adults, Adult Performance Hearing Aid Benefit, or similar inventory indicating need for amplification.
* Documentation of requirement for independent functioning (e.g., effects on employment, communication status).
PAYMENT RULES
Each of the HCPCS procedure codes for CROS systems covers both the transmitter and the receiver. No other hearing aid device procedure code may be billed in addition to the specific CROS code used.
Medicaid’s payment for a CROS hearing aid not covered under the volume purchase contract is the lesser of the acquisition cost or Medicaid’s maximum allowable amount. Acquisition cost consists of the manufacturer’s invoice price, minus any discounts, and includes actual shipping costs.
BICROS HEARING AIDS
STANDARDS OF COVERAGE
BICROS hearing aids are a benefit for beneficiaries of all ages when there is demonstrated need for amplification. The standards of coverage for BICROS hearing aids are as follows:
Age Under 21 Years An audiogram indicates no residual hearing in the poorer ear (unaidable) and indicates a hearing loss greater than 25 dB HL for the four frequency average of 500, 1000, 2000, and 4000 Hz in the better ear.
Age 21 Years or Over * An audiogram indicates no residual hearing in the poorer ear (unaidable) and indicates a hearing loss greater than 30 dB HL for the four frequency average of 500, 1000, 2000, and 4000 Hz in the better ear.
* Hearing aid is required for independent functioning (e.g., effects on employment, communication status).
DOCUMENTATION
Applicable documentation to be maintained in the beneficiary record for BICROS hearing aids includes:
* A medical clearance signed and dated by the physician within six months prior to dispensing the hearing aid.
* An audiogram and recommendation of the make, model and type of hearing aid, signed and dated by the audiologist within six months prior to dispensing the hearing aid.
* For hearing aids not covered under the volume purchase contract, a copy of the manufacturer’s invoice showing the hearing aid model, serial number, invoice price, applicable discounts and shipping and handling charges.
* Documentation of need for amplification addressing beneficiary’s communication needs.
* For beneficiaries age 21 years or over: Documentation of requirement for independent functioning (e.g., effects on employment, communication status).
* A letter of medical necessity that identifies the specific medical reason or reasons why a non-contract hearing aid is required that cannot be met by a contracted hearing aid.
* CROS and BICROS continue to require prior authorization. In addition to the published documentation required, the letter of medical necessity must identify why a wired versus a non-wired hearing aid is needed.
PRIOR AUTHORIZATION REQUIREMENTS
PA is required for all BICROS hearing aids. The following documentation must be submitted with all PA requests:
* MSA-1653-B.
* For hearing aids not covered under the volume purchase contract, documentation from the manufacturer showing invoice price, discounts, and shipping and handling charges.
* Medical clearance signed by a physician.
* Audiogram completed within the past six months, signed and dated by the audiologist, and including the recommended manufacturer, model and style.
* Additional requirements include:
Age Under 21 Years An audiogram indicates no residual hearing in the poorer ear (unaidable) and indicates a hearing loss greater than 25 dB HL for the four frequency average of 500, 1000, 2000, and 4000 Hz in the better ear.
Age 21 Years or Over * The audiogram must indicate no residual hearing in the poorer ear (unaidable) and a hearing loss greater than 30 dB HL for the four frequency average of 500, 1000, 2000, and 4000 Hz in the better ear.
* Documentation of requirement for independent functioning (e.g., effects on employment, communication status).
PAYMENT RULES
Each of the HCPCS procedure codes for BiCROS systems covers both the transmitter and the receiver/hearing aid. No other hearing aid device procedure code may be billed in addition to the specific BiCROS code used.
Medicaid’s payment for a BICROS hearing aid not covered under the volume purchase contract is the lesser of the acquisition cost or Medicaid’s maximum allowable amount.
Acquisition cost consists of the manufacturer’s invoice price, minus any discounts, and includes actual shipping costs.
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