Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 323.00 - Rates for Hearing Services
Section 323.02 - Definitions
Current through Register 1531, September 27, 2024
As used in 101 CMR 323.00, terms have the meanings in 101 CMR 323.02.
Accessories. Those essential items or options on a hearing aid purchased by a hearing instrument specialist that are not intrinsic components of the basic hearing aid unit. Accessories do not include nonessential items such as carrying cases.
Adjusted Acquisition Cost (AAC). The actual unit price paid to a manufacturer by a hearing aid dispenser for a hearing aid or accessories, including costs for shipping and handling, and excluding postal insurance charges.
Assessment of Hearing Aid. A procedure that includes
(a) assessment of a patient's performance by appropriate tests with hearing aid devices;
(b) a recheck of the patient and hearing aid after the prescribed aid has been fitted and used for a trial period; and
(c) counseling related to the patient's adjustment to the use of the hearing aid.
Audiological Evaluation. A routine audiological evaluation that includes
(a) pure tone audiogram, by air and bone conduction testing; and
(b) speech reception and discrimination testing.
Aural Rehabilitation. Therapy provided by a qualified audiologist either in a group or individually including, but not limited to:
(a) Lip-reading. Training of the visual modality to improve the understanding of the speech or language of other speakers.
(b) Auditory Training. Training of the auditory modality to improve the understanding of the speech or language of other speakers.
Binaural. The type of fitting or aid necessitated by varying degrees of hearing loss in both ears that requires unparalleled amplification via the use of two microphones and/or receivers.
Binaural Fitting. The fitting of two hearing aids, one to each ear, by a provider; the fitting to the second ear taking place no later than six months after the fitting to the first ear.
Contralateral Routing Hearing Aid. A type of hearing aid configuration that routes sounds from the hearing-impaired ear to the hearing ear via the use of a microphone.
Electroacoustic Evaluation for Hearing Aid. A check of the patient's personal hearing aid (includes electroacoustical analysis of the aid).
EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.
Governmental Unit. The Commonwealth, any department, agency, board, division, or commission of the Commonwealth, and any political subdivision of the Commonwealth.
Hearing Aid. A small electronic device consisting of a microphone, an amplifier, and a receiver.
Hearing Aid Check. A check of the functioning of the patient's monaural or binaural hearing aid.
Hearing Services. Services including testing related to the determination of hearing loss, evaluation of hearing aids, the prescription of hearing aid devices, and aural rehabilitation.
Individual Consideration (I.C.). A designation indicating that there is no specified rate for a given service. Payment amounts for services designated "I.C." are determined by the governmental unit purchasing such services. The governmental unit determines the appropriate payment based on the provider's report of services provided and documentation as requested by the governmental unit. The report must include a pertinent history and diagnosis, a description of the service rendered, and the length of time spent with the patient. In making the determination of the appropriate payment amount, the governmental unit uses the following criteria:
(a) the policies, procedures, and practices of other third-party purchasers of care, both governmental and private;
(b) the severity and complexity of the patient's disorder or disability;
(c) prevailing provider ethics and accepted practice; and
(d) the time, degree of skill, and cost including equipment cost required to perform the procedure(s).
Industrial Accident Patient. A person who receives medical services for which persons, corporations, or other entities are in whole or part liable under M.G.L. c. 152 (the Workers' Compensation Act).
Major Repairs. Repairs to a hearing aid that must be made by a repair facility other than the provider's place of business.
Minor Repairs. Repairs performed at the provider's place of business such as, but not limited to, replacement and cleaning of tubing.
Monaural Fitting. The fitting of one hearing aid by a provider.
Non organic Test Battery. Tests done to determine functional hearing loss.
Out-of-office Rates. Providers must use the appropriate place of service (POS) code when billing for out-of-office services. Out-of-office rates are 115% of their respective in-office counterparts.
Out-of-office Services. Authorized services provided in a nursing home, school, patient's home, or any other setting where the provider travels from his or her usual place of business to provide the service. Out-of-office services include only the codes in the following sections.
101 CMR 323.03(5)(b)1.: Hearing Aid Dispensing Fees
101 CMR 323.03(5)(c): Maximum Fee for Earmolds
101 CMR 323.03(5)(d): Maximum Fee for Ear Impressions
101 CMR 323.03(5)(e): Maximum Fee for Batteries
101 CMR 323.03(5)(i): Maximum Fee for Minor Repairs
101 CMR 323.03(5)(j): Maximum Fee for Major Repairs
Place of Service (POS). Providers who file claims with MassHealth must use the following CMS POS codes.
03 - School
04 - Homeless shelter
11 - Office
12 - Home
22 - Outpatient hospital
26 - Military treatment facility
31 - Skilled nursing facility
32 - Nursing facility
99 - Other place of service
Provider. A provider acting within the scope of the provider's license, in accordance with all applicable state and federal laws, who meets such conditions of participation as have been adopted by governmental units purchasing audiological services or by purchasers under M.G.L. c. 152 (the Workers' Compensation Act), and who is one of the following:
(a) an audiologist who is currently licensed by the Massachusetts Board of Speech language Pathology and Audiology;
(b) any speech and hearing center (proprietorship, partnership, or corporation) that is not part of a hospital and provides authorized speech, hearing, or language services provided by a licensed, certified audiologist or a certified speech and language pathologist and does not bill separately from such facility for professional services;
(c) an audiology assistant who is currently licensed by the Massachusetts Board of Registration in Speech-language Pathology and Audiology; or
(d) a hearing instrument specialist who is currently licensed by the Massachusetts Board of Registration of Hearing Instrument Specialists.
Publicly aided Individual. A person who receives health care and other services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.
Used Hearing Aid. Any hearing aid that has been worn for any period of time by a user.
