Current through Register Vol. 56, No. 18, September 16, 2024
(a)
Reimbursement for a new hearing aid shall be the lower of the following
charges:
1. The provider's usual and
customary charges; or
2. A charge
consisting of the following:
i. Wholesale
cost of the instrument; plus
ii.
Wholesale cost of the earmold, as per laboratory invoice or laboratory price
list; plus
iii. Insurance,
shipping, and handling costs included as a component of the manufacturer's
cost; plus
iv. Wholesale cost of
the batteries; plus
v. A dispensing
fee of $ 175.00 for a monaural fitting or $ 280.00 for a binaural
fitting.
(b)
Reimbursement for a returned hearing aid shall be as follows:
1. Should it be determined at the follow-up
examination that the prescribed hearing aid properly supplied has failed to
provide the beneficiary with the anticipated communication benefit, and that a
different aid will not be prescribed (that is, there will be no exchange), the
provider shall be reimbursed for services and materials upon return of the
hearing aid, at the lower of the following:
i. The provider's usual and customary charge;
or
ii. A charge consisting of the
following:
(1) Wholesale cost of the earmold,
as per laboratory invoice or laboratory price list; plus
(2) Wholesale cost of the batteries, cord and
garment bag, as per laboratory invoice or laboratory price list; plus
(3) The manufacturer's restocking fee, if
any; plus
(4) A service fee of $
30.00.
(c) Replacement of an aid within one year
from date of original dispensing, if not covered by the manufacturer's
warranty, shall be reimbursed at the lower of the following:
1. The provider's usual and customary charge;
or
2. A charge consisting of the
following:
i. Wholesale cost of the
instrument; plus
ii. Wholesale cost
of the earmold, as per laboratory invoice or laboratory price list;
plus
iii. Insurance, shipping, and
handling costs included as a component of the manufacturer's cost;
plus
iv. A dispensing fee of $
50.00.
(d)
Reimbursement for repair of a hearing aid, if not covered by the manufacturer's
warranty, shall be the lower of the following:
1. The provider's usual and customary charge;
or
2. A charge consisting of the
following:
i. Manufacturer's cost of repair;
plus
ii. A 50 percent service
fee.
(e)
Reimbursement for replacement parts, if not covered by the manufacturer's
warranty, shall be the lower of the following:
1. The provider's usual and customary charge;
or
2. A charge consisting of the
following, depending upon the part or parts to be replaced:
i. Earmolds: Wholesale cost, as per
laboratory invoice or laboratory price list, plus $ 10.00;
ii. Batteries, which shall be provided as a
three month's supply: Manufacturer's list price less 20 percent;
iii. Cords: Manufacturer's list price less 20
percent;
iv. Receivers:
Manufacturer's list price less 20 percent;
v. Garment bags: Manufacturer's list price
less 20 percent.
(f) In addition to other remedies provided
under State and Federal laws, rules and regulations, the Department of Medical
Assistance and Health Services may deny payments and/or recoup payments from a
provider if:
1. The recipient of a hearing
aid did not meet the hearing aid candidacy requirements at
10:64-2.1(b);
2. Documentation submitted by the provider
does not justify dispensing a hearing aid; or
3. The provider did not comply with the
procedures for dispensing a hearing aid in accordance with N.J.A.C. 10:49 and
this chapter.
