Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 145 - Medicaid Payment Rates
Article 4 - Payment Rates; Therapies and Related Services
7 AAC 145.340 - Hearing services payment rates

Universal Citation: 7 AK Admin Code 145.340

Current through November 28, 2024

(a) Subject to the limitations in 7 AAC 115.530, and this section, the department will pay an in-state audiologist for audiology services

(1) in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate determined under 7 AAC 145.050; and

(2) in accordance with the CPT Fee Schedule for Audiology Services table and HCPC Fee Schedule for Audiology Services table, adopted by reference in 7 AAC 160.900; for state fiscal year 2020, starting the later date of August 1, 2019, or after a 30 day notice to the providers, the payment rates for audiology services reimbursed under the Resource Based Relative Value Scale (RBRVS) methodology will be as described in 7 AAC 145.050 and the payment rates for audiology services not reimbursed under RBRVS will be 95 percent of the state fiscal year 2019 payment rates.

(b) Subject to the limitations in 7 AAC 115.530 and this section, the department will pay an in-state hearing aid dealer for hearing aid dealer services in accordance with the HCPC Fee Schedule for Hearing Aid Dealer Services table, adopted by reference in 7 AAC 160.900.

(c) Subject to the limitations in 7 AAC 115.530 and this section, the department will pay an out-of-state audiologist or hearing aid dealer in accordance with 7 AAC 145.025.

(d) The department will pay for the rental of hearing equipment and accessories at a rate not to exceed 10 percent of the purchase price per month for a maximum of 10 months. The department will not pay for a rental beyond the purchase price of the hearing equipment.

(e) Subject to the limitations in 7 AAC 115.530 and this section, the department will pay for monaural and binaural hearing aids billed at the following rates and using the following codes from the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900:

(1) code V5050 for any type of monaural hearing aid in the ear, $1,500;

(2) code V5060 for any type of monaural hearing aid behind the ear, $1,500;

(3) code V5130 for any type of binaural hearing aid in the ear, $3,000;

(4) code V5140 for any type of binaural hearing aid behind the ear, $3,000.

(f) If an item or service provided to a recipient is not included in a fee schedule described in (a)(2) or (b) of this section, the department will pay an audiologist or hearing aid dealer for that item or service at 80 percent of billed charges in this state for the first nine billings for the same item or service. Thereafter, the payment rate will be established based on the 50th percentile of the first 10 billings. The department will add a new payment rate to the fee schedule each time the department receives 10 billings for that item or service not already on the schedule. To be paid under this subsection, a billing must reflect a charge that complies with the applicable standards in 7 AAC 105.120.

(g) The department will not pay more than the following amounts for the following services:

(1) manufacturer's warranty deductible fee, $300 per hearing aid;

(2) postage or delivery costs from an audiologist or hearing aid dealer to a recipient, $30; payment under this paragraph includes payment for a return receipt postal fee when requested at the time of mailing, but does not include payment for postal insurance;

(3) postage or delivery costs from a manufacturer to an audiologist or hearing aid dealer following the manufacturer's repair of a hearing item, $30.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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