471 NAC 8-005. BILLING AND PAYMENT FOR HEARING AIDS

005. BILLING AND PAYMENT FOR HEARING AIDS. 005.01 BILLING. 005.01(A) GENERAL BILLING REQUIREMENTS. Providers must comply with all applicable billing requirements codified in 471 NAC 3. In the event that individual billing requirements in 471 NAC 3 conflict with billing requirements outlined in this chapter, the individual billing requirements in this chapter will govern. 005.01(B) SPECIFIC BILLING REQUIREMENTS. Providers must submit claims to the Department on the appropriate claim form or electronic format. The provider or the provider's authorized agent must submit the provider's usual and customary charge for each procedure code listed on the claim. 005.01(B)(i) PROCEDURE CODES. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) procedure codes used by Medicaid are listed in the Nebraska Medicaid Practitioner Fee Schedule. 005.02 PAYMENT. 005.02(A) GENERAL PAYMENT REQUIREMENTS. Medicaid will reimburse the provider for services rendered in accordance with the applicable payment regulations codified in 471 NAC 3. In the event that individual payment regulations in 471 NAC 3 conflict with payment regulations outlined in this chapter, the individual payment regulations in this chapter will govern. 005.02(B) SPECIFIC PAYMENT REQUIREMENTS. Medicaid pays for covered hearing aid services at the lower of: (i) The provider's submitted charge; or (ii) The allowable amount for that procedure code in the Nebraska Medicaid Practitioner Fee Schedule for that date of service.