Current through Register Vol. 56, No. 18, September 16, 2024
(a) An
otologic examination and a hearing aid examination shall be performed prior to
prescribing a hearing aid. The physician or advanced practice nurse performing
the medical examination of the Medicaid/NJ FamilyCare eligible beneficiary
shall determine if an audiological examination is medically necessary for
beneficiaries 21 years of age or older. If the physician or advanced practice
nurse determines that an audiological examination is medically necessary for
beneficiaries 21 years of age or older, the audiological examination shall be
completed prior to prescribing a hearing aid. All Medicaid/NJ FamilyCare
eligible beneficiaries under 21 years of age shall have an audiological
examination completed prior to the prescribing of a hearing aid. If the
beneficiary is a patient of a long-term care facility, a nursing facility
hearing aid screening shall also be performed, as indicated at (a)3 below. (See
Fiscal Agent Billing Supplement, FD-36.)
1.
Otologic examinations shall consist of a history and physical examination of
the ear, nose and throat with a relevant diagnosis supporting the need for
audiologic and hearing aid examination, with such examination signed and dated
by the otologist and forwarded to the individual providing the audiological and
hearing aid examinations.
2.
Audiological examinations performed by an audiologist or otologist shall
include the following (data other than that in this section are acceptable for
infants and non-verbal children):
i. Pure
tone air and bone conduction thresholds;
ii. Speech reception thresholds;
iii. Speech discrimination scores;
iv. Masking when indicated;
v. Most comfortable listening levels
(MCL);
vi. Uncomfortable loudness
levels or thresholds of discomfort; and
vii. Middle ear measurements and reflex
thresholds when indicated.
3. A hearing aid examination performed by an
audiologist, otologist or hearing aid dispenser shall include initial hearing
aid testing as described in this section, and follow-up as described in
10:64-2.6;
i. Initial testing shall be as follows:
(1) Either in the sound field both with and
without amplification (aided and unaided) to indicate benefit and effectiveness
of the prescribed amplification; or
(2) With a master hearing aid.
(b) Hearing
aid candidacy requirements shall be as follows:
1. Monaural hearing aid candidates shall meet
the following conditions related to treatment of a hearing loss:
i. 45dB or worse hearing loss at 2000 Hz in
the better ear; or
ii. 40dB or
worse average hearing loss at 500, 1000, 2000 and 3000 Hz in the better ear;
or
iii. Asymmetrical hearing loss
in which there is:
(1) Either 40dB or worse
hearing loss at 2000 Hz in the better ear, or a 35dB or worse average hearing
loss at 500, 1000, 2000 and 3000 Hz in the better ear; and
(2) 60dB or worse average hearing loss at
500, 1000, 2000 and 3000 Hz in the poorer ear;
2. A CROS/BICROS hearing aid candidate shall
have one ear which is too poor to be aided by a hearing aid device;
or
3. Binaural hearing aid
candidates and candidates with unilateral hearing loss who request coverage of
a hearing aid device for their poor ear shall have hearing loss which meets the
following conditions:
i. 35dB or worse hearing
loss at 2000 Hz in the ear to be aided; or
ii. 30dB or worse average hearing loss at
500, 1000, 2000 and 3000 Hz in the ear to be aided.
