Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 323.00 - Rates for Hearing Services
Section 323.03 - General Rate Provisions, Requirements, and Rates
Current through Register 1531, September 27, 2024
(1) General Rate Provisions. Payment for the purchase of hearing aids and authorized related accessories and services for the care and maintenance of hearing aid instruments are the lowest of
(2) Reimbursement as Full Payment. The payment rates under 101 CMR 323.03 are full compensation for care rendered to publicly aided individuals and industrial accident patients, as well as for any related administrative or supervisory duties and costs in connection with the services provided. Each provider must, as a condition of acceptance of payment made by the governmental unit purchasing audiological services or purchaser under M.G.L. c. 152 (the Workers' Compensation Act), accept the rate as full payment and discharge of all obligations for the services rendered.
(3) General Requirements and Services Included.
(4) Two Audiologists. MassHealth pays for two audiologists working together to perform an evaluation of an individual member when the knowledge, skills, and experience of the primary audiologist have identified a need for a second audiologist to aid in completing the initial test battery, such as for the testing of very young children or those with other pertinent developmental, physical, cognitive, or maturational factors. Circumstances warranting the services of two audiologists must be fully documented in the member's medical record. To receive full payment, both audiologists must use the appropriate service code and modifier combination listed in Subchapter 6 of the MassHealth Audiologist Manual. MassHealth will pay 1/2 of the total allowable payment for two audiologists to each individual provider.
(5) Rates. 101 CMR 323.03(5) sets forth maximum fees for the items and services listed in 101 CMR 323.03(5).
Code |
Description |
Rate |
92541 |
Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording |
$52.21 |
92542 |
Positional nystagmus test, minimum of four positions, with recording |
$53.86 |
92544 |
Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording |
$43.19 |
92545 |
Oscillating tracking test, with recording |
$39.30 |
92546 |
Sinusoidal vertical axis rotational testing |
$81.48 |
92547 |
Use of vertical electrodes (List separately in addition to code for primary procedure) |
$24.52 |
Code |
Description |
Rate |
92551 |
Screening test, pure tone, air only |
$9.49 |
92552 |
Pure tone audiometry (threshold); air only |
$18.37 |
92553 |
Pure tone audiometry (threshold); air and bone |
$26.26 |
92555 |
Speech audiometry threshold |
$15.05 |
92556 |
Speech audiometry threshold; with speech recognition |
$22.20 |
92557 |
Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) |
$49.51 |
92562 |
Loudness balance test, alternate binaural or monaural |
$18.73 |
92563 |
Tone decay test |
$16.17 |
92565 |
Stenger test, pure tone |
$14.31 |
92567 |
Tympanometry (impedance testing) |
$20.36 |
92568 |
Acoustic reflex testing, threshold |
$14.26 |
92572 |
Staggered spondaic word test |
$8.39 |
92576 |
Synthetic sentence identification test |
$18.61 |
92577 |
Stenger test, speech |
$23.91 |
92579 |
Visual reinforcement audiometry (VRA) |
$29.59 |
92582 |
Conditioning play audiometry |
$31.82 |
92583 |
Select picture audiometry |
$33.04 |
92584 |
Electrocochleography |
$84.33 |
92587 |
Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report |
$56.57 |
92588 |
Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report |
$79.19 |
92590 |
Hearing aid examination and selection; monaural |
$24.23 |
92591 |
Hearing aid examination and selection; binaural |
$35.94 |
92592 |
Hearing aid check; monaural |
$15.19 |
92593 |
Hearing aid check; binaural |
$30.38 |
92594 |
Electroacoustic evaluation for hearing aid; monaural |
$41.64 |
92595 |
Electroacoustic evaluation for hearing aid; binaural |
$83.32 |
92596 |
Ear protector attenuation measurements |
$26.62 |
92650 |
Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis |
$67.81 |
92651 |
Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report |
$67.81 |
92652 |
Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report |
$94.37 |
92653 |
Auditory evoked potentials; neurodiagnostic, with interpretation and report |
$94.37 |
V5020 |
Conformity evaluation |
$90.94 |
Code |
Description |
Rate |
92517 |
Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) |
I.C. |
92518 |
Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) |
I.C. |
92519 |
Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP) |
I.C. |
92601 |
Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming |
$143.78 |
92602 |
Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming (do not report 92602 in addition to 92601) |
$98.64 |
92603 |
Diagnostic analysis of cochlear implant, 7 years or older; with programming |
$90.51 |
92604 |
Diagnostic analysis of cochlear implant, 7 years or older; subsequent reprogramming (do not report 92604 in addition to 92603) |
$58.69 |
92620 |
Evaluation of central auditory function, with report; initial 60 minutes |
$59.45 |
92621 |
Evaluation of central auditory function, with report; each additional 15 minutes (List separately in addition to code for primary procedure) |
$14.87 |
92626 |
Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour |
$59.45 |
92627 |
Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (List separately in addition to code for primary procedure) |
$14.87 |
92700 |
Unlisted otorhinolaryngologic service or procedure |
I.C. |
Code |
Description |
Rate |
V5008 |
Hearing screening |
$30.83 |
V5010 |
Assessment for hearing |
$62.53 |
Code |
Description |
Rate |
V5090 |
Dispensing fee, unspecified hearing aid |
$331.26 |
V5110 |
Dispensing fee, bilateral |
$662.73 |
V5160 |
Dispensing fee, binaural |
$662.73 |
V5200 |
Dispensing fee, CROS contralateral, monaural |
$662.73 |
V5240 |
Dispensing fee, contralateral routing system, binaural |
$662.73 |
V5241 |
Dispensing fee, monaural hearing aid, any type |
$331.26 |
Code |
Description |
Rate |
V5030 |
Hearing aid, monaural, body worn, air conduction |
AAC |
V5040 |
Hearing aid, monaural, body worn, bone conduction |
AAC |
V5050 |
Hearing aid, monaural, in the ear |
AAC |
V5060 |
Hearing aid, monaural, behind the ear |
AAC |
V5070 |
Glasses, air conduction |
AAC |
V5080 |
Glasses, bone conduction |
AAC |
V5095 |
Semi-implantable middle ear hearing prosthesis |
AAC |
V5100 |
Hearing aid, bilateral, body worn |
AAC |
V5120 |
Binaural, body |
AAC |
V5130 |
Binaural, in the ear |
AAC |
V5140 |
Binaural, behind the ear |
AAC |
V5150 |
Binaural, glasses |
AAC |
V5171 |
Hearing aid, contralateral routing device, monaural, in the ear (ITE) |
I.C. |
V5172 |
Hearing aid, contralateral routing device, monaural, in the canal (ITC) |
I.C. |
V5181 |
Hearing aid, contralateral routing device, monaural, behind the ear (BTE) |
I.C. |
V5190 |
Hearing aid, contralateral routing, monaural, glasses |
AAC |
V5211 |
Hearing aid, contralateral routing device, monaural, behind the ear (BTE) |
I.C. |
V5212 |
Hearing aid, contralateral routing system, binaural, ITE/ITC |
I.C |
V5213 |
Hearing aid, contralateral routing system, binaural, ITE/BTE |
I.C. |
V5214 |
Hearing aid, contralateral routing system, binaural, ITC/ITC |
I.C. |
V5215 |
Hearing aid, contralateral routing system, binaural, ITC/BTE |
I.C. |
V5221 |
Hearing aid, contralateral routing system, binaural, BTE/BTE |
I.C. |
V5230 |
Hearing aid, contralateral routing system, binaural, glasses |
AAC |
V5242 |
Hearing aid, analog, monaural, CIC (completely in the ear canal) |
AAC |
V5243 |
Hearing aid, analog, monaural, ITC (in the canal) |
AAC |
V5244 |
Hearing aid, digitally programmable analog, monaural, CIC |
AAC |
V5245 |
Hearing aid, digitally programmable analog, monaural, ITC |
AAC |
V5246 |
Hearing aid, digitally programmable analog, monaural, ITE (in the ear) |
AAC |
V5247 |
Hearing aid, digitally programmable analog, monaural, BTE (behind the ear) |
AAC |
V5248 |
Hearing aid, analog, binaural, CIC |
AAC |
V5249 |
Hearing aid, analog, binaural, ITC |
AAC |
V5250 |
Hearing aid, digitally programmable analog, binaural, CIC |
AAC |
V5251 |
Hearing aid, digitally programmable analog, binaural, ITC |
AAC |
V5252 |
Hearing aid, digitally programmable, binaural, ITE |
AAC |
V5253 |
Hearing aid, digitally programmable, binaural, BTE |
AAC |
V5254 |
Hearing aid, digital, monaural, CIC |
AAC |
V5255 |
Hearing aid, digital, monaural, ITC |
AAC |
V5256 |
Hearing aid, digital, monaural, ITE |
AAC |
V5257 |
Hearing aid, digital, monaural, BTE |
AAC |
V5258 |
Hearing aid, digital, binaural, CIC |
AAC |
V5259 |
Hearing aid, digital, binaural, ITC |
AAC |
V5260 |
Hearing aid, digital, binaural, ITE |
AAC |
V5261 |
Hearing aid, digital, binaural, BTE |
AAC |
V5262 |
Hearing aid, disposable, any type, monaural |
AAC |
V5263 |
Hearing aid, disposable, any type, binaural |
AAC |
V5298 |
Hearing aid, not otherwise classified |
AAC |
Code |
Description |
Rate |
V5264 |
Ear mold/insert, not disposable, any type |
AAC+ $15.74 |
V5265 |
Ear mold/insert, disposable, any type |
AAC+ $15.74 |
Code |
Description |
Rate |
V5275 |
Ear impression, each |
$15.74 |
Code |
Description |
Rate |
V5266 |
Battery for use in hearing device |
$1.67 |
L8621 |
Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each |
AAC |
L8622 |
Alkaline battery for use with cochlear implant device, any size, replacement, each |
AAC |
L8623 |
Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each |
AAC |
L8624 |
Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
AAC |
Code |
Description |
Rate |
L8691 |
Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each |
$1,931.37 |
L8692 |
Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment |
I.C. |
L8693 |
Auditory osseointegrated device abutment, any length, replacement only |
$1,700.57 |
L8694 |
Auditory osseointegrated device, transducer/actuator, replacement only, each |
$1,059.11 |
Code |
Description |
Rate |
V5267 |
Hearing aid or assistive listening device/supplies/accessories, not otherwise specified |
AAC+ 45% |
V5274 |
Assistive listening device, not otherwise specified |
AAC+ 45% |
Code |
Description |
Rate |
V5011 |
Fitting/orientation/checking of hearing aid |
$37.35 |
Code |
Description |
Rate |
99499 |
Unlisted evaluation and management service |
$5.38 |
Code |
Description |
Rate |
V5014 |
Repair/modification of a hearing aid |
AAC+ 45% |
Code |
Description |
Rate |
L7510MS |
Repair of prosthetic device, repair or replace minor parts (six-month maintenance and servicing fee for reasonable and necessary parts and labor that are not covered under any manufacturer or supplier warranty) (I.C.) (for use only for the purchase of a cochlear implant service contract in accordance with 130 CMR 426.416: Reimbursable Services.) |
I.C. |
L8615 |
Headset/headpiece for use with cochlear implant device, replacement |
$337.44 |
L8616 |
Microphone for use with cochlear implant device, replacement |
$78.60 |
L8617 |
Transmitting coil for use with cochlear implant device, replacement |
$68.65 |
L8618 |
Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement |
$19.62 |
L8619 |
Cochlear implant, external speech processor and controller, integrated system, replacement |
$7,259.54 |
L8627 |
Cochlear implant, external speech processor, component, replacement |
$6,518.03 |
L8628 |
Cochlear implant, external controller component, replacement |
$1,130.05 |
L8629 |
Transmitting coil and cable, integrated, for use with cochlear implant device, replacement |
$163.56 |
L9900 |
Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code |
I.C. |
Code |
Description |
Rate |
V5299 |
Hearing service, miscellaneous |
I.C. |
(6) Medical Services. The payment rates for medical services are set forth in 101 CMR 317.00: Rates for Medicine Services.
(7) Therapeutic Services. The payment rates for therapeutic services are set forth in 101 CMR 339.00: Rates for Restorative Services.