Current through Register Vol. 63, No. 9, September 1, 2024
(1) The provider
shall bill the Division for hearing aids at the provider's acquisition cost and
shall be reimbursed at that rate. For purposes of this rule, acquisition cost
is defined as the actual dollar amount paid by the provider to purchase the
item directly from the manufacturer or supplier plus any shipping or
postage.
(2) The provider shall
submit history of hearing aid use and an audiogram when requesting Prior
Authorization (PA) for hearing aids.
(3) Procedure codes are the following:
(a) 92594 - Electroacoustic evaluation for
hearing aid, monaural;
(b) 92595 -
Electroacoustic evaluation for hearing aid, binaural;
(c) 92596 - Ear protector eval, measurement
of adequacy of hearing protection device;
(d) V5014 - Repair/modification of hearing
aid, requires PA;
(e) V5266 -
Hearing aid batteries, limited to 60 individual batteries per calendar
year;
(f) V5264 - Ear mold/insert,
not disposable, any type, requires PA;
(g) V5274 - Assistive listening device, not
otherwise specified, requires PA;
(h) V5030 - Hearing aid, monaural, body worn,
air conduction, requires PA;
(i)
V5040 - Hearing aid, monaural, body worn, bone conduction, requires
PA;
(j) V5050 - Hearing aid,
monaural, in the ear, requires PA;
(k) V5060 - Hearing aid, monaural, behind the
ear, requires PA;
(l) V5130 -
Hearing aid, binaural, in the ear, requires PA;
(m) V5140 - Hearing aid, binaural, behind the
ear, requires PA;
(n) V5171 -
Hearing aid, contralateral routing device, monaural, ITE, requires
PA;
(o) V5180 - Hearing aid,
contralateral routing device, monaural, BTE, requires PA;
(p) V5211 - Hearing aid, contralateral
routing system, binaural, ITE- requires PA;
(q) V5221 - Hearing aid, contralateral
routing system, binaural, BTE- requires PA;
(r) V5246 - Hearing aid, digitally
programmable analog, monaural, ITE, requires PA;
(s) V5247 - Hearing aid, digitally
programmable analog, monaural, (BTE) requires PA;
(t) V5252 - Hearing aid, digital
programmable, binaural, ITE, requires PA;
(u) V5253 - Hearing aid, digital
programmable, binaural, BTE, requires PA;
(v) V5256 - Hearing aid, digital, monaural,
ITE, requires PA;
(w) V5257 -
Hearing aid, digital, monaural, BTE, requires PA.
Tables referenced are available from the
agency.
