Reimbursable Services

(A) Audiological Evaluation/Testing Services. Payment for an audiological evaluation will be made only if the evaluation is recommended by a physician. (B) Hearing Aid Purchase. Payment for a hearing-aid purchase includes the following: (1) the hearing aid and standard accessories and options required for the proper operation of the hearing aid; (2) the proper fitting and instruction in the use, care, and maintenance of the hearing aid; (3) maintenance, minor repair, and servicing of the hearing aid that is furnished free of charge to non-MassHealth members; (4) the initial manufacturer's warranty against loss or damage; and (5) the loan of a hearing aid to the member by the hearing instrument specialist, when necessary. (C) Earmold. The provider may not claim payment for an earmold until the earmold has actually been delivered to the member. The date of service for the earmold is the date on which the earmold was delivered to the member. An earmold is not reimbursable if it is included in the manufacturer's price of the hearing aid or if the member already has an appropriate earmold. Payment for an earmold includes the following: (1) the ear impression; (2) the proper fitting of the earmold; and (3) any adjustments that may be needed during the operational life of the earmold. (D) Ear Impression. (1) Ear Impression for an ITE/ITC Hearing Aid. Payment for an ear impression for a hearing aid includes one properly formed ear impression for each in-the-ear (ITE) or in-the-canal (ITC) hearing aid purchased. The provider may not claim payment for an ear impression for a hearing aid until the hearing aid has actually been delivered to the member. (2) Ear Impression for an Earmold for a BTE Hearing Aid. Payment for an ear impression for a hearing aid includes one properly formed ear impression for each behind-the-ear (BTE) hearing aid. (E) Batteries. Batteries must be new at the time of purchase. (F) Accessories. Payment for accessories and hearing-aid options includes proper fitting and adjustment of the accessory as needed. Accessories must be billed separately from the basic hearing-aid unit. (G) Major Repairs. The provider of a repair service is responsible for the quality of the workmanship and parts, and for ensuring that the repaired hearing aid is in proper working condition. The hearing instrument specialist is responsible for ensuring that the repaired hearing aid is in proper working condition upon returning the aid to the member. Payment for a major repair to a hearing aid is limited to the following conditions. (1) All warranties and insurance must have expired. (2) The hearing aid must be sent directly to the repair facility or manufacturer that will perform the repair. (The handling charges of an intermediary are not reimbursable.) (3) The repair service must include a written warranty against all defects for a minimum of six months. (4) A copy of the invoice from the repair facility or manufacturer for the cost of the repair must be kept in the member’s medical record. (H) Office Visits for Evaluation and Management Services. The MassHealth agency pays for an office visit for evaluation and management services only when one or more of the following services is required and is provided as part of the visit: (1) minor adjustments to the hearing aid to assure a proper fitting, such as an earmold adjustment, when the provider is not the provider who initially fit the hearing aid, and the provider who initially fit the hearing aid is no longer a MassHealth provider; (2) minor office repairs for which the provider customarily charges non-MassHealth members; (3) cleaning of the hearing aid; or (4) replacement of parts such as, but not limited to, tubing, hooks, battery doors, and recasing. (I) Refitting Services and Other Professional Services. The MassHealth agency pays for additional fitting or refitting services only where the hearing aid was dispensed more than one year prior to the date of service of the refitting services. These professional services include refitting of the aid, orientation, counseling with the member or member’s family, contact with interpreters, fitting of a loaner aid, and similar services. Payment for these services must include a face-to-face encounter with the member.