Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-11 - DMEPOS: hearing aids

(1) Testing of air-conducted stimuli at thresholds of five hundred hertz (Hz), one thousand Hz, two thousand Hz, and four thousand Hz;

(2) Assessment of air-conducted speech awareness or speech reception threshold;

(3) Establishment of most comfortable and most uncomfortable listening levels;

(4) Pure-tone bone conduction audiometry (unless the individual's age or capability precludes such testing); and

(5) For an individual younger than twenty-one years of age, the following components:

(1) The default certificate of medical necessity (CMN) form is the ODM 01915, "Certificate of Medical Necessity: Hearing Aids" (rev. 7/2018).

(2) A completed CMN, signed and dated not more than ninety days before the requested dispensing date, is accompanied by a hearing evaluation report, compiled not more than six months before the requested dispensing date, made up of the following components:

(3) Separate payment may be made for the hearing test itself,administered by authorized individuals working within their scope of practice and conducted in an appropriate sound environment in accordance with nationally accepted standards. Hearing tests should be performed on both ears; a detailed explanation is needed if bilateral testing cannot be done.

(4) The need for a hearing aid is demonstrated when the results of a basic hearing test performed on one ear indicate the following minimum best pure-tone average hearing loss:

(5) A claim for payment should be submitted only after the acceptability of the hearing aid has been confirmed, usually during a follow-up visit scheduled within thirty days after delivery. The individual may instead confirm acceptability by waiving the follow-up visit. In either case, the provider maintains relevant documentation. If the hearing aid is deemed unacceptable by either the provider or the individual, then payment is limited to the cost of the earmold insert and batteries. If payment has already been made for the hearing aid, then the claim is to be adjusted.

(6) The following warranty periods apply:

(7) A warranty comprehensively covers the following services:

(8) A programmable hearing aid, such as a hearing aid employing contralateral routing of signal (CROS) or binaural contralateral routing of signal (BiCROS), may be indicated if an individual has a documented need for such technology in noisy or otherwise adverse hearing environments.

(9) Separate payment may be made for the taking of an impression for an earmold insert (other than an insert dispensed with a hearing aid). Such payment is limited neither by the place of service nor by the individual's living arrangement.

(10) Regardless of how a hearing aid was purchased, payment may be made for necessary repair only if the following conditions are satisfied:

(1) The department may at any time ask a provider to produce a copy of the manufacturer's original cost estimate, a copy of the manufacturer's final invoice detailing discounts and shipping costs, and (if applicable) an explanation of any differences between the figures.

(2) No payment will be made for the following hearing aids:

(3) No payment (including payment of a deductible amount) will be made for replacement if either of the following conditions is satisfied:

(4) Concurrent requests or claims for two separate hearing aids will be treated as a single request or claim for a binaural hearing aid.

(5) Payment for a hearing aid includes the following items:

(6) Payment for hearing aid dispensing includes the following services:

(1) Payment for a hearing aid is the least of three figures:

(2) Payment for repair of a hearing aid is the submitted charge, which represents one of the following amounts: