89 Ill. Adm. Code 140.497
Hearing Aids
Section 140
Section 140.497 Hearing Aids
a) Hearing aids are
reimbursed in accordance with Section 140.481(d).
b) In
order to be eligible for reimbursement from the Department for monaural and
binaural hearing aids, the following criteria must be met:
1) When
testing is performed in an acoustically treated sound suite:
A) The
hearing loss must be 20 decibels or greater at any two of the following
frequencies: 500, 1000, 2000, 4000, 8000 Hertz; or
B) The
hearing loss must be 25 decibels or greater at any one of 500, 1000, 2000
Hertz.
2) When
testing is performed in other than an acoustically treated sound suite:
A) The
hearing loss must be 30 decibels or greater at any two of the following
frequencies: 500, 1000, 2000, 4000, 8000 Hertz; or
B) The
hearing loss must be 35 decibels or greater at any one of 500, 1000, 2000
Hertz.
3) A
written statement, dated and signed by a licensed physician, that the patient's
hearing loss has been medically evaluated and the patient is considered a
candidate for a hearing instrument. The statement must include the date when
the medical evaluation took place and the sale of the hearing instrument cannot
be more than 6 months immediately following the date of the evaluation.
c) The following items are
to be kept in the patient's file:
1) The written statement
required by subsection (b)(3).
2) Audiogram.
3) Hearing Aid Evaluation
Results.
4) Case history and
identifying information.
5) Copy
of Manufacturer's invoice with patient's name and hearing aid serial number.
6) Copy of Manufacturer's
invoice for ear mold, if applicable.
d) Payment
for all hearing aids is contingent upon providers fitting and dispensing
hearing aids in accordance with the requirements set forth in the Hearing
Instrument Consumer Protection Act [225 ILCS 50] and implementing Public Health
regulations, except that no payment will be made when there has been a medical
evaluation waiver signed by the prospective user.