405 IAC 5-19-13 Hearing aids; purchase

Sec. 13. Medicaid reimbursement is available for the purchase, repair, or replacement of hearing aids under the following conditions: (1) Prior authorization is required for the purchase of hearing aids. (2) When a member is to be fitted with a hearing amplification device by either a licensed audiologist or a registered hearing aid specialist, a medical clearance and audiometric test form must be completed and submitted with the prior authorization request form. Professional services associated with the dispensing of a hearing aid must be performed in accordance with the appropriate provisions of 405 IAC 5-22. (3) Hearing aids purchased by Medicaid become the property of the office. (4) Hearing aids are not covered for members with a unilateral pure tone average (500, 1,000, 2,000, or 3,000 hertz) equal to or less than thirty (30) decibels. (5) Binaural aids and CROS-type aids will be authorized only when significant, objective benefit to the member can be documented. (6) Medicaid does not reimburse for canal hearing aids. (7) Medicaid reimbursement of hearing aids is based on the most recently published fee schedule in effect. If this amount is not available, then use clause (A) as follows: (A) The average acquisition cost of the item adjusted by a multiplier of one and two-tenths (1.2), if available. If this amount is not available, then use clause (B). (B) The manufacturer's suggested retail price adjusted by a multiplier of seventy-five hundredths (0.75). (8) Reimbursement of a hearing aid dispensing fee is also available subject to the following requirements: (A) Is a one-time dispensing fee. (B) May be billed only in conjunction with a hearing aid procedure code that has an established fee schedule amount. (C) Includes all services related to the initial fitting and adjustment of the hearing aid, orientation of the patient, and instructions on the hearing aid. (9) Reimbursement for binaural hearing aids will be twice the monaural rate.