Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 8 - HEARING AID SERVICES
Section 355.8141 - Reimbursement for Hearing Aid Services
Universal Citation: 1 TX Admin Code ยง 355.8141
Current through Reg. 49, No. 38; September 20, 2024
(a) The Texas Department of Health or its designee shall make direct vendor payments to providers of hearing aid services participating in the Texas Medical Assistance (Medicaid) Program. Participating providers are reimbursed within the limits defined by the maximum allowable fee schedule for hearing aid services established by the Texas Board of Health.
(b) Reimbursement for a hearing aid shall be based on the lowest of the invoice cost of the hearing aid, the acquisition cost of the hearing aid, or the department's maximum allowable fee.
(1) Providers must include on the claim form
the model number, serial number, and warranty date of the hearing
aid.
(2) The department may
authorize reimbursement for a hearing aid that exceeds the maximum allowable
fee under the following conditions:
(A) the
recipient shall certify in writing a preference for a specific hearing aid;
and
(B) the recipient shall
acknowledge in the certification the responsibility to pay the difference
between the acquisition cost of the preferred instrument and the department's
maximum allowable fee.
(3) The department or its designee shall
establish a fee schedule to set the upper limits of reimbursement for
authorized hearing aid services. The fee schedule shall include costs for
hearing aids, earmolds, evaluation, fitting and dispensing, and follow-up
visits.
(A) The maximum allowable fee
schedule is subject to periodic review by the department or its designee to
determine if adjustment to the fee schedule is necessary. The fee schedule is
compared to the aggregate of providers' billed charges and invoice or
acquisition costs to determine the necessity for and extent of adjustment. Any
adjustment to the fee schedule is subject to the availability of legislatively
appropriated funds. The department or its designee informs participating
providers of changes to the fee schedule through the Texas Medicaid Bulletin
which is distributed to all providers enrolled in the Texas Medicaid
Program.
(B) Reimbursement for a
physician's examination to determine the need for a hearing aid shall not be
subject to the fee schedule. The department shall consider the examination a
physician service and shall reimburse physicians according to the methodology
described in § 29.1104 of this title (relating to Texas Medicaid
Reimbursement Methodology (TMRM)).
(4) The department or its designee does not
reimburse institutions or hospitals for hearing aid services and supplies as
separate items of service if these supplies and services are included in their
reimbursement formula.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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